Depression and Hypothyroidism

To the Editor.— In a recent article, Sternbach et al (1983;249:1618) reported that six of 44 consecutive outpatients (13.5%) referred to a psychiatric hospital for evaluation of "depression and anergy" had augmented thyrotropin (TSH) responses to thyrotropin-releasing hormone (TRH), indicating some degree of hypothyroidism. The authors suggest that the majority of depressed outpatients have abnormalities in the TRH test result. Although this may be the case, we believe that selecting a population of depressed patients who have anergy seems to allow inappropriate conclusions about the incidence of augmented TSH responses in depression. Affective presentation of grade 3 hypothyroidism is more likely to be accompanied by anergy rather than agitation and anxiety. 2 Gold et al (1981;245:1919) reported an 8% incidence of some degree of hypothyroidism in series of 250 consecutive patients referred for treatment of depression and anergy using thyroxine, triiodothyronine, TSH, and TRH tests. Whereas this may be the