Association between panic disorder, major depressive disorder and celiac disease: A possible role of thyroid autoimmunity
Introduction
Patients with celiac disease often show depressive and anxiety symptoms [1], [2], [3]; however, the frequency of the cooccurrence of affective and anxiety disorders in celiac disease is still unknown, and the role of potential risk factors needs to be further elucidated.
Wheat gluten has been considered as a potential pathogenic factor for psychiatric disorders [4], [5], although, to date, no univocal evidence has been provided that gluten withdrawal may interrupt the course of depressive symptoms [2].
The increased prevalence of affective disorders in celiac patients might also be related to other conditions known to be associated to celiac disease. Interestingly, the prevalence of thyroid diseases (particularly autoimmune thyroid disorders) appears to be increased in celiac patients [6], [7]. Several previous investigations have suggested that subclinical autoimmune hypothyroidism may represent a risk factor for the development of affective disorders [8], [9]. Moreover, recent evidence seems to indicate high levels of thyroid antibodies in depressive disorders [10] and an increased risk of major depressive disorder (MDD) and panic disorder (PD) in patients with thyroid disease [11], [12].
The purpose of the present investigation therefore was to evaluate the relationship between celiac disease and psychiatric disorders, using international standardized psychiatric diagnostic criteria and standardized psychiatric assessment tools, and to measure the relevance of associated thyroid disease in the development of psychiatric illnesses in celiac patients.
Section snippets
Methods
A case–control rectrospective design was used in this study. Cases were 36 adult celiac outpatients attending the Internal Medicine Department of the University of Cagliari, 27 females and 9 males, age 18–64 years (mean±S.D.=41.1±15.3), on a 6-month gluten-free diet, and duration of celiac disease symptoms range from 6 months to 52 years (mean±S.D.=14.0±8.3). Controls were 144 subjects (36 males, 108 females) aged 18–64 years (mean±S.D.=41.3±14.9) who were obtained by matching each “celiac
Lifetime prevalence of mental disorders
When compared to controls, a higher lifetime prevalence of DSM-IV MDD, dysthymic disorder (DD), adjustment disorder (AD) and PD was observed in celiac patients; no differences were found for generalized anxiety disorder, specific phobia and social phobia (Table 1).
Onset of depressive symptoms in 3 (20%) of the 15 cases affected by MDD had occurred subsequent to commencing gluten-free diet. Five (33.3%) of the 15 MDD cases had presented a particularly severe depressive episode after starting
Discussion
The first evidence of a relationship between adult celiac disease and psychiatric disorders was reported in 1982, when Hallert and Derefeldt [1], using the MMPI, first described an increased prevalence of depressive symptoms in celiac patients. These authors also suggested a potential linkage between psychopathology and generalized malabsorption. Subsequent studies have also shown a significant association between adult celiac disease and anxiety or depressive symptoms [2], [3], [4]. Depressive
References (35)
- et al.
Thyroid and celiac disease: clinical serological and echographic study
Am J Gastroenterol
(1998) - et al.
Thyroid disease and mental illness: a study of thyroid disease in psychiatric admissions
J Psychosom Res
(1988) - et al.
Prevalence of major depression and dysthymia in Sardinia
Eur Neuropsychopharmacol
(1995) - et al.
A study of the association between Crohn's disease and psychiatric illness
Gastroenterology
(1984) - et al.
Depression in adult untreated celiac subjects: diagnosis by the pediatrician
Am J Gastroenterol
(1999) - et al.
Symptomless autoimmune thyroiditis in depression
Psychiatry Res
(1982) - et al.
Psychic disturbances in adult celiac disease
Scand J Gastroenterol
(1982) - et al.
Depressive symptoms in adult coeliac disease
Scand J Gastroenterol
(1998) - et al.
Celiac subjects and inpatients affected by inflammatory bowel disease: a personality trait or a reactive illness?
Hepatogastroenterology
(1996) - et al.
Is schizophrenia rare if grain is rare?
Biol Psychiatry
(1984)
Plasma precursor amino acids of central nervous system monoamines in children with coeliac disease
Gut
Coeliac disease and autoimmune thyroid disease
Gut
Subclinical hypothyroidism: a review of neuropsychiatric aspects
Int J Psychiatry Med
The prevalence of affective disorder and in particular of a rapid cycling of bipolar disorder in patients with abnormal thyroid function tests
Clin Endocrinol
Thyroid autoantibodies in depressive disorders
Acta Med Austriaca
Prevalence of psychiatric disorders in thyroid disease patients
Neuropsychobiology
Independent expression of serological markers of thyroid autoimmunity and epatitic C infection in general population
J Endocrinol Invest
Cited by (113)
The bidirectional relationship of depression and disturbances in B cell homeostasis: Double trouble
2024, Progress in Neuro-Psychopharmacology and Biological PsychiatryCeliac disease and mental health—A concealed association
2023, American Journal of the Medical SciencesPersisting symptoms in patients with Hashimoto's disease despite normal thyroid hormone levels: Does thyroid autoimmunity play a role? A systematic review
2021, Journal of Translational AutoimmunityCitation Excerpt :In these studies, the following tests and questionnaires were used to evaluate symptoms: CIDI, Clinical Characteristics FM, EPDS, HADS-D, HADS-A, HRDS, MADS, MINI, POMS-D, POMS-A, Prevalence of FM/CWP. A significant relation between symptoms and thyroid autoimmunity was described in the three studies of individuals from a primary care facility, two studies in postpartum women, in both studies of pregnant women, in the study of perimenopausal women, and in both studies of patients with another autoimmune disease [45–54]. Overall, 16 of the 23 population-based studies reported a statistically significant association between symptoms and thyroid autoimmunity.
Neuropsychiatric manifestations in celiac disease
2019, Epilepsy and BehaviorRelationship between motivation, adherence to diet, anxiety symptoms, depression symptoms and quality of life in individuals with celiac disease
2019, Journal of Psychosomatic ResearchCitation Excerpt :In particular, Hallert et al. [18] highlighted that individuals with celiac disease have a lower quality of life compared to the general population. The research shows the need for preventative action to avoid mood and anxiety-related symptoms in such individuals [8] in order to also improve their quality of life. Since research shows that people's quality of life improves after starting the diet [33], it would be useful to investigate the processes that facilitate the motivation to adhere to a gluten-free diet.
Cytokine alterations in panic disorder: A systematic review
2018, Journal of Affective DisordersCitation Excerpt :According to DSM-5 (APA, 2013), PD is a unitary diagnostic category, although there are diverse clinical presentations for the disorder. High rates of PD in clinical samples of people with autoimmune diseases (Carta et al., 2002) could lead us to postulate that the dysfunction produced in the GABA system could facilitate the onset of a panic disorder in some types of PD patients, which could explain the strong variability of the results. Additionaly, inflammatory markers can be associated with the severity of anxiety symptoms, and differences in symptom severity may account for some of the data heterogeneity between studies.