It has been hypothesized that depression leads to inhibition of the D2 enzyme responsible for conversion of T4 into T3 due to the increase...
Both tricyclic antidepressants [77] and SSRIs [78] appear to enhance the activity of D2 resulting in an increased conversion of T4 into active T3 in the brain. T3 was suggested to enhance neurotransmission in the central noradrenergic pathways [79] and deficiency in catecholamines has been raised as a possible mechanism in depression [80]. Additionally, it has been shown that anti-depressants with variable mechanisms of action have different effects on thyroid indices [81]. Further studies are therefore required to better elucidate this complex interaction between the HPT axis and the neurotransmitter system.