Association between thyroid dysfunction, metabolic disturbances, and clinical symptoms in first-episode, untreated Chinese patients with major depressive disorder: Undirected and Bayesian network analyses

Pu Peng; Qianjin Wang; Xiao E Lang; Tieqiao Liu; Xiang-Yang Zhang

doi:10.3389/fendo.2023.1138233

Association between thyroid dysfunction, metabolic disturbances, and clinical symptoms in first-episode, untreated Chinese patients with major depressive disorder: Undirected and Bayesian network analyses

Front Endocrinol (Lausanne). 2023 Feb 28:14:1138233. doi: 10.3389/fendo.2023.1138233. eCollection 2023.

Authors

Pu Peng¹, Qianjin Wang¹, Xiao E Lang², Tieqiao Liu¹, Xiang-Yang Zhang^{3

4}

Affiliations

¹ Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
² Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.
³ CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
⁴ Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.

Abstract

Aims: Thyroid dysfunction and metabolic disturbances are common in major depressive disorder (MDD) patients. We aimed to assess the relationship between thyroid dysfunction, metabolic disturbances, and clinical symptoms in Chinese first-episode, drug-naïve (FEDN) MDD patients using undirected and Bayesian network methods.

Methods: 1718 FEDN MDD patients were recruited. Serum levels of free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), anti-thyroglobulin (TgAb), thyroid peroxidases antibody (TPOAb), total cholesterol (TC), total triglycerides (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), and glucose were assessed. Blood pressure and body mass index were measured. Hamilton Rating Scale for Depression (HAMD), Hamilton Rating Scale for Anxiety, and positive subscale of Positive And Negative Syndrome Scales were used to detect clinical symptoms. An undirected network with EBICglasso default and a directed acyclic graph (DAG) using the Bayesian network approach was conducted.

Results: The prevalence rates of clinical symptoms, thyroid dysfunction, and metabolic dysfunction were as follows: anxiety (n=894, 52%), psychotic symptoms (171, 10%), subclinical hypothyroidism (SCH, n=1041, 61%), abnormal TgAb (n=297, 17%), abnormal TPOAb (n=438, 25%), hyperthyroidism (n=5, 0.3%), hypothyroidism (n=3, 0.2%), hyperglycemia (n=241, 14%), hypertriglyceridemia (n=668, 39%), low HDL-C (n=429, 25%), hypercholesterolemia (421, 25%), abnormal TC (357, 21%), abnormal LDL-C (185, 11%). overweight or obesity (n=1026, 60%), and hypertension (n=92, 5.4%). Both networks demonstrated serum TSH and TC levels and the severity of depression played an important role in the pathophysiology of MDD.

Conclusions: MDD patients may have thyroid and metabolic dysfunction in the early stage. Targeting hypercholesterolemia, depressive symptoms, and SCH in MDD patients may hold promise in reducing clinical symptoms, metabolic disturbances, and thyroid dysfunction.

Keywords: anxiety; major depressive disorder; metabolic disturbances; network analysis; psychotic symptoms; thyroid dysfunction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bayes Theorem
Cholesterol, LDL
Depressive Disorder, Major* / complications
Depressive Disorder, Major* / epidemiology
East Asian People
Humans
Hypercholesterolemia*
Hypothyroidism*
Thyroid Diseases* / complications
Thyroid Diseases* / epidemiology
Thyrotropin

Substances

Cholesterol, LDL
Thyrotropin

Grants and funding

This study was supported by the Provincial Natural Science Foundation of Hunan (Grant No. 2020JJ4795 to Tieqiao Liu). These sources had no further role in this study design, in the data collection and analysis, in the writing of the report, and in the decision to submit the paper for publication.