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Low Levels of Transthyretin in the CSF of Depressed Patients
CITATION:  Sullivan, G.M., Hatterer, J.A., et al.  (1999). Low Levels of Transthyretin in the CSF of Depressed Patients.  Am J Psychiatry, 156:710-715.


Objective: Transthyretin plays an important role in the transport and distribution of thy-,oid hormone in the central nervous system (CNS). This study replicated and extended to )atients with nonrefractory depressive illness a pilot study indicating that patients with reractory major depression have significantly lower levels of CSF transthyretin than do iealthy comparison subjects. 

Method: Lumbar punctures were performed in drug-free subjects with DSM-III-R major depression (N=18), DSM-III-R bipolar disorder, depressed Dhase (N=1), and healthy comparison subjects (N=24). CSF concentrations of transthyretin, determined by a quantitative dot-immunobinding assay, of the depressed patients and :ompanson subjects were compared by analysis of covariance (ANCOVA). The relation-ship between CSF transthyretin levels and Hamilton Depression Rating Scale scores was ietermined in a subset of the depressed patients. 

Results: CSF concentrations of transthyretin were significantly lower in the depressed patients than in the comparison subjects Dy ANCOVA. Within the depressed group there was no significant overall correlation between CSF transthyretin levels and Hamilton depression scale scores, but there was a sig-,iificant inverse correlation in male depressed patients (N=8) between CSF transthyretin -oncentrations and Hamilton depression scores. 

Conclusions: Lower CSF transthyretin -oncentrations in depressed patients may reflect either a stable trait in this population or a state change secondary to depression or other factors. Lower CSF transthyretin concentrations may result in altered CNS thyroid hormone homeostasis. Such alteration could acount for certain mood and neurovegetative symptoms of depression and might contribute to failure of standard antidepressant treatment.


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