Immune activation and deficit in neurotransmitters synthesis in treatment resistant depression: about a case of Hashimoto encephalopathy
Matthieu Gasnier 1*, Pierre Ellul 2, Vincent Trebossen 2, Raphaël Gaillard 3, 4
1Assistance Publique, Hopitaux de Paris (AP-HP), Hotel-Dieu, Unité de Psychiatrie, Paris, France, 2Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Robert Debré Hospital, Department of Child and Adolescent Psychiatry, Paris, France., 3Université Paris Descartes, INSERM UMR S894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Paris, France., 4Centre Hospitalier Sainte - Anne, Faculty of Medicine Paris Descartes, Service Hospitalo-Universitaire, Paris, France
Received: March 15, 2019; Revised: June 5, 2019; Accepted: June 10, 2019; Published online: June 10, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
We report a case of Hashimoto encephalopathy initially presented as a drug-resistant depression with predominant apathy and asthenia, successfully treated with cyclophosphamide. We suspected that the psychiatric symptoms were due to a deficit in neurotransmitter synthesis related to immune activation. We hypothesized that the immunomodulatory treatment helped to restore the neurotransmitter synthesis and thus decreased the patient’s depressive symptoms. In this case report we propose an innovative model in which immunity might disturbs neurotransmitters synthesis leading to depressive symptoms.
Keywords: psychiatry, depression, immunity, neurotransmitter


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