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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Ilene on May 4, 2004, at 22:06:02
My psychiatric diagnoses are depression (probably unipolar) and GAD. I've been treatment resistant for 8 or 9 years. The only 2 ADs that did anything for me were desipramine and prozac, and they both pooped out.
I've been taking a thyroid hormone (Cytomel, or T3) to augment my current drug mix for about ten days, and I'm feeling significantly, but not totally, better. This is the *only* med that has made a difference in years. My other meds are Marplan, Risperdal, Neurontin (at night), Klonopin (as needed), and Florinef (for low blood pressure).
Since all of these drugs have side effects, would it make sense to stop the Marplan, Risperdal, and Neurontin and take only the Cytomel, or does the Cytomel need another drug for AD effects?
Thank you.
Posted by SLS on May 5, 2004, at 6:50:33
In reply to Thyroid hormone vs. ADs, posted by Ilene on May 4, 2004, at 22:06:02
Hi Ilene.
Did you take blood tests to evaluate your thyroid function before starting Cytomel?
If your tests came back normal, then I would say that the Cytomel is working in concert with one or more of the drugs you were already taking. Adding Cytomel as an augmentor is a very old strategy that came into use before the age of Prozac. Generally, it was added to tricyclics. I guess it makes sense to let the drugs do their magic before attempting to discontinue any of them. I would certainly leave the Marplan in place for now.
Keep feeling better and better and better!
BTW, have you ever tried lithium to augment antidepressants?
- Scott> My psychiatric diagnoses are depression (probably unipolar) and GAD. I've been treatment resistant for 8 or 9 years. The only 2 ADs that did anything for me were desipramine and prozac, and they both pooped out.
>
> I've been taking a thyroid hormone (Cytomel, or T3) to augment my current drug mix for about ten days, and I'm feeling significantly, but not totally, better. This is the *only* med that has made a difference in years. My other meds are Marplan, Risperdal, Neurontin (at night), Klonopin (as needed), and Florinef (for low blood pressure).
>
> Since all of these drugs have side effects, would it make sense to stop the Marplan, Risperdal, and Neurontin and take only the Cytomel, or does the Cytomel need another drug for AD effects?
>
> Thank you.
Posted by Ilene on May 5, 2004, at 19:49:09
In reply to Re: Thyroid hormone vs. ADs, posted by SLS on May 5, 2004, at 6:50:33
> Hi Ilene.
>
> Did you take blood tests to evaluate your thyroid function before starting Cytomel?
>Yes. One of three tests was abnormal but did not show the pattern typical of hypothyroidism. My internist says it's "euthyroid sick syndrome", which means it's behaving oddly due to my having been sick for a long time. The usual treatment is no treatment; the thyroid is supposed to recover when the patient recovers. I have chronic fatigue syndrome; since it's by definition "chronic" there's no telling if I will recover.
> If your tests came back normal, then I would say that the Cytomel is working in concert with one or more of the drugs you were already taking. Adding Cytomel as an augmentor is a very old strategy that came into use before the age of Prozac. Generally, it was added to tricyclics. I guess it makes sense to let the drugs do their magic before attempting to discontinue any of them. I would certainly leave the Marplan in place for now.
>I'm going to ease off the Risperdal and Neurontin and keep the Marplan. It's the one with the most side effects, however.
> Keep feeling better and better and better!Thanks. I'm working on it!
>
> BTW, have you ever tried lithium to augment antidepressants?
>
>
Lithium was awful. Within a few days I got edema in my ankles, gained weight, felt cold and tired, and just didn't like it.
I.
Posted by Bill LL on May 6, 2004, at 9:20:27
In reply to Thyroid hormone vs. ADs, posted by Ilene on May 4, 2004, at 22:06:02
Thyroid hormones can generally only alleviate depression by itself for someone who is hypothyroid (TSH above 4 or 5 I believe). And even in that case, T3 is not given alone. The person is treated with either T4 alone, or with both T3 and T4. The other choice is armor thyroid which has T3 and T4 along with other stuff.
If you are euthyroid, T3 alone, without your other meds, will probably not help you.
> My psychiatric diagnoses are depression (probably unipolar) and GAD. I've been treatment resistant for 8 or 9 years. The only 2 ADs that did anything for me were desipramine and prozac, and they both pooped out.
>
> I've been taking a thyroid hormone (Cytomel, or T3) to augment my current drug mix for about ten days, and I'm feeling significantly, but not totally, better. This is the *only* med that has made a difference in years. My other meds are Marplan, Risperdal, Neurontin (at night), Klonopin (as needed), and Florinef (for low blood pressure).
>
> Since all of these drugs have side effects, would it make sense to stop the Marplan, Risperdal, and Neurontin and take only the Cytomel, or does the Cytomel need another drug for AD effects?
>
> Thank you.
Posted by BarbaraCat on May 7, 2004, at 13:53:22
In reply to Thyroid hormone vs. ADs, posted by Ilene on May 4, 2004, at 22:06:02
Let's consider a dysfunctional HPA-axis. No matter what else is going on, or what meds you're taking, if the hypothalamus is dysfunctional you will continue to have problems downline in all the systems it affects. The hypothalamus in the brain's limbic system controls the thyroid and most of the other hormonal systems through an informational feedback loop, so if this signalling system is out of whack the entire hormonal system begins to malfunction and will affect every aspect of mental and physical health.
The thyroid is one of the most obvious when things go wrong, as it's so involved in all metabolic processes. Blood tests, even sensitive TSH tests don't always show the full picture, as they don't show the actual cellular uptake of thyroid hormones. A 'sick eythyroid condition' is an astute observation by your doc. Treating the symptoms is more important than test numbers, and since you responded so well to T3/T4, that's the key.
Treating the symptomatic conditions (thyroid and other hormonal therapy, and mood disorder medication) is important, but the most effective therapy is to go upline and work on healing and restoring healthy hypothalamus function. The hypothalamus can get damaged many ways, unrelieved stress and unrefreshing sleep being the main cause and effect - a vicous cycle that needs to be interrupted and reset. The answer is rest, good diet, and stress management in its myriad forms -- doing whatever it takes to get control over these lifestyle habits.
You can help reset the hypothalamic cortisol switch by getting to sleep before 11 and getting 8-9 hours of good refreshing sleep, and then being physically active during the daylight hours. Basically, attuning to our natural sleep/wake cycles. Difficult for most of us in this nutty world we live in, but since HPA-axis dyfunction is showing up as a big contributor to mood disorders, we need to help Mother Nature along.
Getting alot of deep restful sleep in the initial healing phase is crucial. Whatever it takes to get to sleep and reach the restorative Stage IV phase. Melatonin can help with this, as can an herbal sleep formula and an effective sleep med. Unfortunately, many prescription sleep meds and benzos disrupt Stage IV sleep. I take Ambien along with the herbals and melatonin because I need the extra knockout power and Ambien is OK for Stage IV. My HPA axis has been ailing a long time and will take a bit to heal, but as I allow this natural process, more and more my physical and emotional pain is clearing out and healing. Drinking lots of water is very important also. We need so much healthy physical support to heal the deeper emotional issues -- and vice versa.
You might also look into taking l-tyrosine and extra B vitamins, especially B6. These are the building blocks for thyroxine and will help your thyroid meds' effectiveness. Also, 100mg daily of Coenzyme Q helps ignite a hotter cellular metabolic rate. These things have helped my hypothyroid condition, which when untreated or lagging makes me feel crummy in every way.
Lithium, on the other hand, almost undid all the other good things I was doing for my thyroid and it's taking a while to undo the damage since quitting. Lithium competes with thyroxine at receptor sites and is BAD for the thyroid, no matter what any doc might say otherwise. It confuses things terribly and it's not uncommon for TSH values to fluctuate wildly on lithium, sometimes hypo and sometimes hyper. Interesting, when you consider the effect this hypo-hyper fluctuation might have on bipolar disorder!
Posted by noa on May 7, 2004, at 20:38:57
In reply to Re: Thyroid hormone vs. ADs, posted by Bill LL on May 6, 2004, at 9:20:27
Ilene, FWIW...
Although thyroid hormones (both synthroid and cytomel), have made a huge difference for me, I would have to say that even though I have primary hypothyroidism, the thyroid hormones alone would not adequately treat my depression. When I've reduced my AD dosages, the depression has worsened. BUT, the ADs did not really work at all until the thyroid meds were at current dosage--ie, until hypothyroidism was adequately treated.
Posted by florence on May 9, 2004, at 20:46:38
In reply to Thyroid hormone vs. ADs, posted by Ilene on May 4, 2004, at 22:06:02
> Dear Ilene, I have unipolar depression and chronic fatigue induced by Lupron shots I took for menstrual migraines. I am convinced that the Lupron (which acts on the pituitary,altered my HPA axis. I have been ruled out for CFIDS according to the guidelines, but the fatigue I suffer is right on the nose as that described by CFIDS patients. I have been bedridden with fatigue everyday since January of this year.I have been in bed with my laptop searching for help. I have done extensive research on thyroid. I too, found info that Cytomel has been used for "decades" to augment antidepressants.(Dr. James Schaller M.D.) Dr. Elizabeth Vliet's book Screaming to be Heard: Hormone Connections Women Suspect and Drs Ignore, states that high levels of T3, Cytomel can cause heart attacks. Dr. Russell Joffe (Thyroid Hormones Levels and Recurrence of Major Depression) believes T3 (cytomel) levels are related to depression but not to T4 (Synthroid) levels. Dr. Phelps has seen folks feel better in terms of energy as their TSH level comes down from 3-4 to 1-2. Dr Alan Cohen (neurologist and psychiatrist says most patients with fatigue, anergia, and depression need TSH levels in the lower zone <1.0Dr. Peter Whybrow UCLA- uses T4 only as a mood stabilizer. His research involves bipolars disorder. I would be very CAREFUL about stopping other meds because the Cytomel is short-acting and can increase heart rate. I am NOT SURE but it may worsen anxiety. PLEASE BE CAREFUL!. I am not entirely familiar with all your other meds. I am debating whether to ask for Klonopin to help with the chronic fatigue: just read an article on Immune Support by a dr (name?) who uses Klonopin as one of his first line treatments for Chronic Fatigue. I now take Provigil (a non-amphetamine stimulant which isn't working very well AND I have to take Xanax to offset the restless, crying, that I experience when it begins to wind down. I hope you post again- I can really relate! I have read some people have their anxiety reduced when their thyroid is functioning properly. I have started Armour thyroid (T3 and T4) but so far I have not noticed many improvements. I am PRAYING that I will notice SOMETHING when I get on an optimum dose. Sending you some cyber hugs becuz I really know how you feel... I have tried SO many ADs that did next to nothing.......................My psychiatric diagnoses are depression (probably unipolar) and GAD. I've been treatment resistant for 8 or 9 years. The only 2 ADs that did anything for me were desipramine and prozac, and they both pooped out.
>
> I've been taking a thyroid hormone (Cytomel, or T3) to augment my current drug mix for about ten days, and I'm feeling significantly, but not totally, better. This is the *only* med that has made a difference in years. My other meds are Marplan, Risperdal, Neurontin (at night), Klonopin (as needed), and Florinef (for low blood pressure).
>
> Since all of these drugs have side effects, would it make sense to stop the Marplan, Risperdal, and Neurontin and take only the Cytomel, or does the Cytomel need another drug for AD effects?
>
> Thank you.
This is the end of the thread.
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