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Mirtazapine use may increase the risk of hypothyroxinemia in patients affected by major depressive disorder
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  • Ying Zhao,
  • Na Wang,
  • Shi Wu Wen,
  • Mingcan Li,
  • Yuan Yuan,
  • Ravi Retnakaran,
  • Ruiling Zhang,
  • Desheng Zhai
Ying Zhao
Xinxiang Medical University
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Na Wang
Xinxiang Medical University
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Shi Wu Wen
University of Ottawa Faculty of Medicine
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Mingcan Li
Xinxiang Medical University
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Yuan Yuan
Xinxiang Medical University
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Ravi Retnakaran
University of Toronto
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Ruiling Zhang
Xinxiang Medical University
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Desheng Zhai
Xinxiang Medical University
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Abstract

Background Hypothyroxinemia, i.e. Low free T4 with normal TSH level, which overlaps, to a great extent, with the laboratory criteria of central hypothyroidism, could be easily neglected, if attention is paid only to patients with elevated TSH. We aimed to assess the association between mirtazapine use and hypothyroxinemia in patients affected by major depressive disorder. Methods We conducted a retrospective cohort study in the Second Affiliated Hospital of Xinxiang Medical University between January 2016 and December 2018. Patients affected by major depression disorder and admitted to the hospital for treatment during the study period and had thyroid tests at admission and after treatment were included. Patients with abnormal thyroid function at baseline or received mood stabilizers or quetiapine during hospitalization were excluded. Mirtazapine use was the exposure measure, and hypothyroxinemia was as the primary outcome of this study. Log-binomial model was used to estimate the association between mirtazapine use and hypothyroxinemia, after adjusting for potential confounding factors. Results A total of 220 eligible patients were included in the final analysis. Of them, 88 used mirtazapine. The incidence of hypothyroxinemia in patients who used mirtazapine was higher (37.5%) than those patients who did not use (19.7%). The relative risk of developing hypothyroxinemia was 1.64 (95% confidence interval: 1.31-1.78) for mirtazapine use, after adjusting for confounding factors. Conclusion Mirtazapine use was associated with the risk of developing hypothyroxinemia. Clinicians should be aware that hypothyroxinemia may be neglected in patients treated by mirtazapine due to attention paid only to those with elevated TSH.

Peer review status:ACCEPTED

15 Dec 2020Submitted to British Journal of Clinical Pharmacology
16 Dec 2020Submission Checks Completed
16 Dec 2020Assigned to Editor
26 Jan 2021Reviewer(s) Assigned
14 Feb 2021Review(s) Completed, Editorial Evaluation Pending
24 Feb 2021Editorial Decision: Revise Major
17 Apr 20211st Revision Received
04 May 2021Assigned to Editor
04 May 2021Submission Checks Completed
04 May 2021Review(s) Completed, Editorial Evaluation Pending
10 May 2021Reviewer(s) Assigned
26 May 2021Editorial Decision: Revise Minor
29 May 20212nd Revision Received
31 May 2021Assigned to Editor
31 May 2021Submission Checks Completed
31 May 2021Review(s) Completed, Editorial Evaluation Pending
09 Jun 2021Editorial Decision: Accept