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Randomised trial of thyroxine to prevent postnatal depression in thyroid-antibody-positive women

Bronllys Hospital, Brecon

ROSSANA ORETTI, MRCPsych

Princess of Wales Hospital, Bridgend

JOHN LAZARUS, FRCP

Division of Endocrinology, Llandough Hospital, Cardiff

ARTHUR PARKES, PhD and REES JOHN, FRCPath

University Hospital of Wales, Cardiff

COLIN RICHARDS, FRCOG

Caerphilly and District Miner's Hospital, Caerphilly

ROBERT NEWCOMBE, PhD

University of Wales College of Medicine, Cardiff

REGINALD HALL, FRCP (deceased)

Correspondence: Dr Brian Harris, Consultant Psychiatrist, Department of Psychological Medicine, Bronllys Hospital, Brecon LD3 OLU, UK. Tel: +44 (0) 1874711255; e-mail: brianharris{at}totalise.co.uk

Declaration of interest None. Financial support is detailed in the Acknowledgements.

Background Women who are positive for thyroid antibodies in early gestation are prone to post-partum depression, apparently independent of thyroid dysfunction, as measured by serum levels of free thyroxine, free triodothyroxine and thyroid-stimulating hormone. This finding may be due to infrequent monitoring of thyroid function, because hyperthyroidism, hypothyroidism and combinations of both may occur post-partum.

Aims To test the hypothesis that stabilising thyroid function post-partum by administering daily thyroxine reduces the rate of occurrence and severity of associated depression.

Method In a randomised double-blind placebo-controlled trial, 100 µg of thyroxine or placebo was given daily to 446 thyroid-antibody-positive women (342 of whom were compliant) from 6 weeks to 6 months post-partum, assessing their psychiatric and thyroid status at 4-weekly intervals.

Results There was no evidence that thyroxine had any effect on the occurrence of depression. The 6-month period prevalence of depression was similar to that reported previously.

Conclusions The excess of depression in thyroid-antibody-positive women in the post-partum period is not corrected by daily administration of thyroxine.

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