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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Phil on December 4, 2000, at 13:10:25
Fellow Babblers,
Long time, no see. Wish I could say things have been good but I'm to the point with depression that working is becoming almost impossible. My computer's not much better so I'm having to write this in notepad and paste it here.
My current meds are Klonopin(3mg-day), Ritalin(varies10-40mg day),
Remeron(52.5mg day and pushing to 60), and, as of 4 days ago, pdoc added Cytomel(25mg day).
Questions. How long, generally, do thyroid meds take to work or can that be answered here? Are results generally quick or more like 2-4 weeks. I've been trying to research this stuff but my computer only allows for short bursts of online time, aarrrgghh.
I believe, feel, or whatever that I'm going to go back to Amitriptyline..it worked well for me in the 80's and early 90's. The SE's weren't much fun but at least I was functioning. I'm allergic to Effexor unfortunately. My other option for severe recurrent depression and anhedonia suggested recently was Nardil. MAO's scare me a little but aside from diet restrictions, may be more tolerable than Amitrip. Thing is, I know Amitrip. works and Nardil is an unknown for me and time's a wasting.
I don't like the idea of staying on Klonopin much longer but I'm pretty much stressed to the max with it onboard so tapering right now is probably not too bright.
I'm back in high stress retail, dealing w/ significant brain fog, and am desperately hoping for a miracle. I'm also back in talk therapy and intending to start group in January but won't start in this state of mind.
Thanks friends...Phil
Posted by shar on December 4, 2000, at 13:39:30
In reply to Cytomel, input needed, long. Suggestions?, posted by Phil on December 4, 2000, at 13:10:25
> Fellow Babblers,
> Long time, no see. Wish I could say things have been good but I'm to the point with depression that working is becoming almost impossible. My computer's not much better so I'm having to write this in notepad and paste it here.
> My current meds are Klonopin(3mg-day), Ritalin(varies10-40mg day),
> Remeron(52.5mg day and pushing to 60), and, as of 4 days ago, pdoc added Cytomel(25mg day).
> Questions. How long, generally, do thyroid meds take to work or can that be answered here? Are results generally quick or more like 2-4 weeks. I've been trying to research this stuff but my computer only allows for short bursts of online time, aarrrgghh.
> I believe, feel, or whatever that I'm going to go back to Amitriptyline..it worked well for me in the 80's and early 90's. The SE's weren't much fun but at least I was functioning. I'm allergic to Effexor unfortunately. My other option for severe recurrent depression and anhedonia suggested recently was Nardil. MAO's scare me a little but aside from diet restrictions, may be more tolerable than Amitrip. Thing is, I know Amitrip. works and Nardil is an unknown for me and time's a wasting.
> I don't like the idea of staying on Klonopin much longer but I'm pretty much stressed to the max with it onboard so tapering right now is probably not too bright.
> I'm back in high stress retail, dealing w/ significant brain fog, and am desperately hoping for a miracle. I'm also back in talk therapy and intending to start group in January but won't start in this state of mind.
> Thanks friends...Phil
Posted by Gracie on December 4, 2000, at 14:24:43
In reply to Cytomel, input needed, long. Suggestions?, posted by Phil on December 4, 2000, at 13:10:25
I was on Elavil for years and it worked "ok". I switched to Nardil and, at the time, it was a lifesaver for me. However, after a couple of years it "pooped out" on me. If you don't mind the diet restrictions, and they really aren't that bad, give it a try.
> Fellow Babblers,
> Long time, no see. Wish I could say things have been good but I'm to the point with depression that working is becoming almost impossible. My computer's not much better so I'm having to write this in notepad and paste it here.
> My current meds are Klonopin(3mg-day), Ritalin(varies10-40mg day),
> Remeron(52.5mg day and pushing to 60), and, as of 4 days ago, pdoc added Cytomel(25mg day).
> Questions. How long, generally, do thyroid meds take to work or can that be answered here? Are results generally quick or more like 2-4 weeks. I've been trying to research this stuff but my computer only allows for short bursts of online time, aarrrgghh.
> I believe, feel, or whatever that I'm going to go back to Amitriptyline..it worked well for me in the 80's and early 90's. The SE's weren't much fun but at least I was functioning. I'm allergic to Effexor unfortunately. My other option for severe recurrent depression and anhedonia suggested recently was Nardil. MAO's scare me a little but aside from diet restrictions, may be more tolerable than Amitrip. Thing is, I know Amitrip. works and Nardil is an unknown for me and time's a wasting.
> I don't like the idea of staying on Klonopin much longer but I'm pretty much stressed to the max with it onboard so tapering right now is probably not too bright.
> I'm back in high stress retail, dealing w/ significant brain fog, and am desperately hoping for a miracle. I'm also back in talk therapy and intending to start group in January but won't start in this state of mind.
> Thanks friends...Phil
Posted by Noa on December 4, 2000, at 14:38:08
In reply to Cytomel, input needed, long. Suggestions?, posted by Phil on December 4, 2000, at 13:10:25
I'll have to look it up, but for me, cytomel made a noticeable difference within about a week. I don't know if acts at the same speed for people with and without hypothyroid, though. I'll see what info I can find.
Posted by Noa on December 4, 2000, at 17:38:17
In reply to Cytomel, input needed, long. Suggestions?, posted by Phil on December 4, 2000, at 13:10:25
I somehow can't cut and paste this, but at Dr. Bob's Tips, there is a post from a doctor who cites an article about comparing Cytomel and Synthroid, and it says that cytomel (T3) showed results within 3 to 4 weeks.
I think I felt a difference much quicker than that.
Do a search at Dr. Bob's PsyPharm Tips--by checking off thyroid hormone in the checklist of medications. The thread is called "Thyroid Augmentation Strategies"
Posted by Noa on December 5, 2000, at 5:50:30
In reply to Cytomel, input needed, long. Suggestions?, posted by Phil on December 4, 2000, at 13:10:25
Hi, Phil.
I have been looking around for info on how long it takes for T3 to start making a difference in augmenting antidepressants, but haven't found anything great.
However, in rereading some of the material from the "Thyroid and Depression" folder at PBtips, I was reminded of a couple of dosing tips that I want to pass on to you, that not all pdocs tell their patients (mine didn't):
-take on an empty stomach--about two hours after eating and and hour before eating (my endo says an hour is best, but at least 30 minutes before eating). Food interferes with absorption.
-Cytomel is short acting, so split the dose in two (my pdoc didn't know this--my endo told me).
-don't miss doses--because it is short acting, missing a dose can cause your blood levels to drop. It is more effective if the levels stay consistent. (*drastic* ups and downs in blood levels can make you more vulnerable to heart palpitations).
-don't take the cytomel at the same time as any iron or calcium supplements. If you take multivitamins, it is better to not take the cytomel at the same time.
Posted by Lycaste on December 5, 2000, at 22:54:55
In reply to Cytomel, input needed, long. Suggestions?, posted by Phil on December 4, 2000, at 13:10:25
Hi Phil,
Here's what Ridha Arem, author of "The Thyroid Solution" and endrocinologist, has to say:
"T3's effectiveness in boosting the efficacy of antidepressants in controlling depression is similar to that of lithium. The patient's symptoms often respond to the addition of T3 within a few days. Therefore, if no beneficial effect has been noted within three to four weeks, T3 treatments should be stopped."
He also stresses the importance of breaking up the dose: he often suggests 3 times a day, 5 hours apart.
Hope this helps.
Lycaste
> Fellow Babblers,
> Long time, no see. Wish I could say things have been good but I'm to the point with depression that working is becoming almost impossible. My computer's not much better so I'm having to write this in notepad and paste it here.
> My current meds are Klonopin(3mg-day), Ritalin(varies10-40mg day),
> Remeron(52.5mg day and pushing to 60), and, as of 4 days ago, pdoc added Cytomel(25mg day).
> Questions. How long, generally, do thyroid meds take to work or can that be answered here? Are results generally quick or more like 2-4 weeks. I've been trying to research this stuff but my computer only allows for short bursts of online time, aarrrgghh.
> I believe, feel, or whatever that I'm going to go back to Amitriptyline..it worked well for me in the 80's and early 90's. The SE's weren't much fun but at least I was functioning. I'm allergic to Effexor unfortunately. My other option for severe recurrent depression and anhedonia suggested recently was Nardil. MAO's scare me a little but aside from diet restrictions, may be more tolerable than Amitrip. Thing is, I know Amitrip. works and Nardil is an unknown for me and time's a wasting.
> I don't like the idea of staying on Klonopin much longer but I'm pretty much stressed to the max with it onboard so tapering right now is probably not too bright.
> I'm back in high stress retail, dealing w/ significant brain fog, and am desperately hoping for a miracle. I'm also back in talk therapy and intending to start group in January but won't start in this state of mind.
> Thanks friends...Phil
Posted by Phil on December 6, 2000, at 7:21:05
In reply to Re: Cytomel, input needed, long. Suggestions? » Phil , posted by Lycaste on December 5, 2000, at 22:54:55
> Hi Phil,
>
> Here's what Ridha Arem, author of "The Thyroid Solution" and endrocinologist, has to say:
>
> "T3's effectiveness in boosting the efficacy of antidepressants in controlling depression is similar to that of lithium. The patient's symptoms often respond to the addition of T3 within a few days. Therefore, if no beneficial effect has been noted within three to four weeks, T3 treatments should be stopped."
>
> He also stresses the importance of breaking up the dose: he often suggests 3 times a day, 5 hours apart.
>
> Hope this helps.
>
> Lycaste
>
>
> > Fellow Babblers,
> > Long time, no see. Wish I could say things have been good but I'm to the point with depression that working is becoming almost impossible. My computer's not much better so I'm having to write this in notepad and paste it here.
> > My current meds are Klonopin(3mg-day), Ritalin(varies10-40mg day),
> > Remeron(52.5mg day and pushing to 60), and, as of 4 days ago, pdoc added Cytomel(25mg day).
> > Questions. How long, generally, do thyroid meds take to work or can that be answered here? Are results generally quick or more like 2-4 weeks. I've been trying to research this stuff but my computer only allows for short bursts of online time, aarrrgghh.
> > I believe, feel, or whatever that I'm going to go back to Amitriptyline..it worked well for me in the 80's and early 90's. The SE's weren't much fun but at least I was functioning. I'm allergic to Effexor unfortunately. My other option for severe recurrent depression and anhedonia suggested recently was Nardil. MAO's scare me a little but aside from diet restrictions, may be more tolerable than Amitrip. Thing is, I know Amitrip. works and Nardil is an unknown for me and time's a wasting.
> > I don't like the idea of staying on Klonopin much longer but I'm pretty much stressed to the max with it onboard so tapering right now is probably not too bright.
> > I'm back in high stress retail, dealing w/ significant brain fog, and am desperately hoping for a miracle. I'm also back in talk therapy and intending to start group in January but won't start in this state of mind.
> > Thanks friends...Phil
Posted by Noa on December 6, 2000, at 19:01:49
In reply to Re: Cytomel, input needed, long. Suggestions? » Phil , posted by Lycaste on December 5, 2000, at 22:54:55
Thanks, Lycaste. That is such an important book. I forgot about checking there for more info. That book really helped me hone in on my thyroid problems and a treatment plan.
Posted by Noa on December 6, 2000, at 19:02:43
In reply to Thanks for the input..np, posted by Phil on December 6, 2000, at 7:21:05
Phil, how are you feeling, are you noticing any benefit from the T3?
Posted by Lycaste on December 7, 2000, at 16:07:06
In reply to Re: Cytomel, input needed---Dr. Arem's book, posted by Noa on December 6, 2000, at 19:01:49
Hi Noa,
I just bought the book so it was fresh in my mind.
While I have you here, so to speak, I was hoping you'd be willing to answer a couple of questions for me.
I, of course, have thyroid disease. In my case, I been treated to both hyper- and hypo- episodes over the years. So far, I've been treated only with Synthroid (T4.)
I am toying with the idea of adding T3 to see if helps with my long-standing dysthymia. Suppressing my TSH entirely doesn't appear to be an option for me. In my last test 2 months ago, I was down to .30, and I am now showing clear signs hyperthyroidism.
But playing with T3 still would be an option, which my endocrinologist is willing to do once we get me stabilized again on T4. (My dose needs adjusting because I've lost 25 lbs over the last 6 months or so.)
My main symptom--or the one that seems to most negatively affect my life and self-confidence--is what I'll call lack of mental energy or motivation. I really want to make a distinction here between mental and physical energy, because I honestly don't think I have a problem with physical energy. I can take long hikes, work out intensively at the gym, etc. without feeling undue fatigue. And many of the things I have trouble motivating myself to do take little or no physical energy at all--in fact, I may even expend more physical energy in the long run in avoiding the task.
What I seem to have is a puzzling and chronic inability to translate thought into action. From little things to big things, from chores to pleasant activities, it doesn't matter: I'll think, and think, and think again about doing them and that's often as far as it goes. It takes a forcing of will for me to do things most people do without any effort. This is true even when my mood is good.
Oddly enough, once a month I get a taste of what normal motivation looks like. More often than not, the day before my period my motivational clutch stops slipping and I am rather effortlessly able to get into gear. (I often joke that I seem to have reverse PMS.) However, to have normal motivation once a month hardly leaves me with much a life. In fact, I think my low mood is as much a symptom as a cause of my lack of motivation: it is hard to feel upbeat when you are chronically understimulated (I think the technical description is "bored outta your gourd") 'cause you can't seem to get off your duff.
Does any of this seem similar to your experiences before you got your thyroid adequately treated? In particular, did you feel a distinction between physical and mental energy (motivation) and did the adding of T3 help?
Thanks for any sharing of your experiences that you are willing to do.
Lycaste
> Thanks, Lycaste. That is such an important book. I forgot about checking there for more info. That book really helped me hone in on my thyroid problems and a treatment plan.
Posted by Noa on December 7, 2000, at 18:12:38
In reply to Re: Cytomel, input needed---Dr. Arem's book, posted by Lycaste on December 7, 2000, at 16:07:06
Hi, Lycaste.
No, for me, the mental and physical fatigue seemed to go hand in hand.
There is an article in the Thyroid and Depression folder--actually an interview and an article, I think---by a doctor who treats anergic depression, associated with hypothyroidism, with dexedrine.
I take adderall and it does help me be more focused and calm. I don't have ADD, but have similar symptoms due to depression and hypothyroid. At this point the severe focus and cognitive problems from the hypothyroid are resolved, because I am no longer hypothyroid. But the ADD-like symptoms from the depression are still there, so the adderall helps, along with its role in boosting the AD effect of the Effexor.
I would be curious to ask your endo if it is possible to figure out the hormonal patterns that are giving you that one good day a month, and whether adjustments in thyroid meds could affect hormone leves, etc. OR, if there is another hormonal approach that could do this. I am not so good at remembering the ups and downs of estrogen and progesteron, etc. during the cycle, but I seem to remember my gyno tell me that a lot of estrogen has built up right before menstration starts, and I wonder if that has a role in your clear day.
I think there is a review of the book "Screaming to be heard" on the "read!" page at www.dr-bob.org (link at top of PB page). I think (haven't read it) this book deals with how women's hormones affect mood, etc.
Posted by Lycaste on December 10, 2000, at 2:13:13
In reply to Re: Cytomel, input needed---Dr. Arem's book, posted by Noa on December 7, 2000, at 18:12:38
Hi Noa,
Thanks for your response.
The article by Alan Cohen that you refer to is interesting. I've thought about going the stimulant route. Right now, I've begun trialing adrafinil because it seemed to be less likely to have side-effects. It is early days yet, but it does seem to be helping, at least with the small stuff. I don't think my kitchen has been kept so clean for so many days running in years.
I have to say that Arem's book is one of the best I've ever seen on the subject of thyroid disease and its affect on mood/mental functioning. It was a revelation to me each organ does its own conversion of T4 to T3--so it is possible that I'm not getting adequate T3 in the brain even when I have no overt physical symptoms of hypothyroidism. So I think I'll still pursue adding some T3 to see what that does for me. (That's IF my thyroid appears to settle down. I seem to be blessed with having Hashimoto's AND Grave's at the same time, which means the damn thing sputters a lot.)
The other thing I found interesting is Arem's experience that even after people's blood levels return to normal, it can take a long time to shake the effects of having been hypothyroid.
I don't know how long ago you were diagnosed or how long you were hypothyroid before that, but perhaps some of your lingering symptoms will simply resolve over time.By the way, I think that both progesterone and estrogen fall percipitously right before menstruation. I've always assumed that, for whatever reason, I actually feel better when my levels of hormones are low. Maybe I'll be one of those women who gets to feel some post-menopausal zest. 'Twould be only fair after having had pre-menopausal drag.
Thanks again,
Lycaste
> Hi, Lycaste.
>
> No, for me, the mental and physical fatigue seemed to go hand in hand.
>
> There is an article in the Thyroid and Depression folder--actually an interview and an article, I think---by a doctor who treats anergic depression, associated with hypothyroidism, with dexedrine.
>
> I take adderall and it does help me be more focused and calm. I don't have ADD, but have similar symptoms due to depression and hypothyroid. At this point the severe focus and cognitive problems from the hypothyroid are resolved, because I am no longer hypothyroid. But the ADD-like symptoms from the depression are still there, so the adderall helps, along with its role in boosting the AD effect of the Effexor.
>
> I would be curious to ask your endo if it is possible to figure out the hormonal patterns that are giving you that one good day a month, and whether adjustments in thyroid meds could affect hormone leves, etc. OR, if there is another hormonal approach that could do this. I am not so good at remembering the ups and downs of estrogen and progesteron, etc. during the cycle, but I seem to remember my gyno tell me that a lot of estrogen has built up right before menstration starts, and I wonder if that has a role in your clear day.
>
> I think there is a review of the book "Screaming to be heard" on the "read!" page at www.dr-bob.org (link at top of PB page). I think (haven't read it) this book deals with how women's hormones affect mood, etc.
This is the end of the thread.
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