![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by AnneL on November 3, 2001, at 18:04:59
Hi,
I am on Effexor XR 225 mg. along with Klonipin 1 mg at bedtime. This was initially prescribed for a major depressive bout which was I felt to be of a situational nature. I am noticing a pattern with my moods that is really starting to bother me. Every weekend becomes a "chore", I go out walking both Saturday and Sunday morning and come home distinctly different feeling, i.e., I become depressed, very slightly anxious (because I feel the depression coming on), and take long naps. I felt distinctly energized during my week at work, however, to the point that my husband noticed. Energized, "happy", worked late at work, etc. I'am really starting to wonder about my moods. Anyone with similar experiences, any thoughts on how to manage the ups and downs? Thanks, Anne
Posted by Mitch on November 4, 2001, at 10:54:28
In reply to Weekenders Syndrome Mood changes, etc., posted by AnneL on November 3, 2001, at 18:04:59
> Hi,
> I am on Effexor XR 225 mg. along with Klonipin 1 mg at bedtime. This was initially prescribed for a major depressive bout which was I felt to be of a situational nature. I am noticing a pattern with my moods that is really starting to bother me. Every weekend becomes a "chore", I go out walking both Saturday and Sunday morning and come home distinctly different feeling, i.e., I become depressed, very slightly anxious (because I feel the depression coming on), and take long naps. I felt distinctly energized during my week at work, however, to the point that my husband noticed. Energized, "happy", worked late at work, etc. I'am really starting to wonder about my moods. Anyone with similar experiences, any thoughts on how to manage the ups and downs? Thanks, AnneHi Anne,
It sounds to me that work has become relatively more interesting to you lately. Have you had a recent promotion into an interesting/exciting job? I am bipolar and I have rapid cycling moods (every 20 days), and I can get really drawn into (hyperfocused) on work at times. I don't think you are necessarily having bipolar symptoms, though. You might just be getting a little "obsessive" with your work and you are crashing a little when you are away from it. I have found out one thing about some antidepressants-they have this tendency to make work a lot more *tolerable* or rather the intellectual challenges are facilitated by the meds in some cases making work "fun" where it might have been viewed as a *chore* previously (despite being depressed or not)!
Mitch
Posted by AnneL on November 4, 2001, at 22:42:35
In reply to Re: Weekenders Syndrome Mood changes, etc. » AnneL, posted by Mitch on November 4, 2001, at 10:54:28
>Hi Mitch,
You make an interesting point. But I do notice that I am definitely hyperfocused at work and am noticing that although I am moving extremely fast (mind, my movements), instead of accomplishing more, I find that I am going off on tangents (fun tangents, very creative time). My former Pdoc has suggested that I get my meds evaluated for the addition of a possible mood stabilizer. My new Pdoc wanted me to consult with my endocrinologist about my TSH levels during the last 2 years to make sure that I was not "over-treated" and in a hyperthyroid state which would have accounted for my 1 1/2 year obssession with weight loss (43 pounds), exercise, running 6 days out of the week and at the gym 4 to 5 nights a week, and my hyperfocused attention to the Weight Watchers program (I took it to a new level and then some!) I alienated my family and children, could not sit down and watch tv for more than 5 minutes and slept (and slept well! for about 4 to 5 hours at night to begin a brand new day of running, taking care of family (more like taking care of myself),going to the gym and monitoring my food). My guess is, and I will talk with him this week is that he wants to rule out a Bipolar II (?) diagnosis before adding a mood stabilizer vs. a thyroid-medication induced episode.
Consulted with my endocrinologist and I am properly treated at proper levels (no incredibly low TSH levels and the only time I had difficulty with my Synthroid was when one wacko primary care upped my dose from 150 mcg of Synthroid to 200 mcg of Synthroid for a very slightly elevated TSH which could have been due to either calcium intake or iron supplementation. I did have palpitations and insomnia during the 3 week period which quickly went away when I backed down to my original dose of Synthroid. No mania, just anxiety and palpitations.
Since I am only on an AD and Klonopin, wouldn't one expect me to get "worse" without the addition of a mood stabilizer if in fact I had some type of Bipolar diagnosis? I have not lapsed into any vigorous exercise or diet program since my descent into depression when my whole world came tumbling down (that was a good thing). To the contrary, I cannot get motivated to stay with any exercise program or diet at all since I started Effexor. I just don't have that motivation anymore (in all honesty, I miss that former part of my life, I was really *happy*, completed 2 half marathons, etc.) So why add a mood stabilizer if I have not had any more episodes of going off the deep end by over-dieting and exercising? I don't overspend, behave in risky behaviors, etc, but did have quite a time as a teenager and in my twenties by doing stupid things. I do have periods of time of intense happiness. But then again, maybe it just feels intense, because feeling low sucks. One other thing that may be complicating this whole thing is for the last 3 months I have been on a very small dose of progestin for the control of very heavy menstrual periods (menorrhagia) which is working like a charm, but could be causing some of my low moods, but cannot explain the energetic
moments and creative periods of time.I am giving serious thought to tapering off both Effexor and Klonopin to find out where I'am at. I am of the belief that I experienced a mid-life crisis and reacted to turning 40 by trying to get slim and in shape, but ended up over doing it for what I will admit was a fairly long time (1 1/2 years). I also believe that my intense reactions to some serious problems my children were having also led to my depressive episode. These issues are resolving.
How do others feel about discontinuing meds (if I can even get my Pdoc to "buy" into this line of thinking)? I don't mean just stopping them, but discontinuing them under a doctor's care and seeing where I am at? I want my life back, whatever that means. Thanks for listening and thanks for any responses. :) Anne
Posted by Mitch on November 5, 2001, at 10:02:00
In reply to Consensus on withdrawing from meds under Dr's care » Mitch, posted by AnneL on November 4, 2001, at 22:42:35
> >Hi Mitch,
>
> You make an interesting point. But I do notice that I am definitely hyperfocused at work and am noticing that although I am moving extremely fast (mind, my movements), instead of accomplishing more, I find that I am going off on tangents (fun tangents, very creative time). My former Pdoc has suggested that I get my meds evaluated for the addition of a possible mood stabilizer. My new Pdoc wanted me to consult with my endocrinologist about my TSH levels during the last 2 years to make sure that I was not "over-treated" and in a hyperthyroid state which would have accounted for my 1 1/2 year obssession with weight loss (43 pounds), exercise, running 6 days out of the week and at the gym 4 to 5 nights a week, and my hyperfocused attention to the Weight Watchers program (I took it to a new level and then some!) I alienated my family and children, could not sit down and watch tv for more than 5 minutes and slept (and slept well! for about 4 to 5 hours at night to begin a brand new day of running, taking care of family (more like taking care of myself),going to the gym and monitoring my food). My guess is, and I will talk with him this week is that he wants to rule out a Bipolar II (?) diagnosis before adding a mood stabilizer vs. a thyroid-medication induced episode.I didn't realize that you were on thyroid meds! I just got a letter back from my endo. and my TSH was 1.4. I was convinced I was hyperthyroid over the last few weeks, but I have just been a little hypomanic I guess.
Yep, it sounds like your energy level is getting a little "pegged"! FWIW, Effexor has been known to trigger hypomania fairly frequently in susceptible people. You mentioned going "off in fun tangents", well that is fairly tell-tale for hypomania. I would suggest backing off the Effexor somewhat and see if that takes a little wind out of your sails before you start adding more meds and inadvertently complicate things.
>
> Consulted with my endocrinologist and I am properly treated at proper levels (no incredibly low TSH levels and the only time I had difficulty with my Synthroid was when one wacko primary care upped my dose from 150 mcg of Synthroid to 200 mcg of Synthroid for a very slightly elevated TSH which could have been due to either calcium intake or iron supplementation. I did have palpitations and insomnia during the 3 week period which quickly went away when I backed down to my original dose of Synthroid. No mania, just anxiety and palpitations.
>
> Since I am only on an AD and Klonopin, wouldn't one expect me to get "worse" without the addition of a mood stabilizer if in fact I had some type of Bipolar diagnosis? I have not lapsed into any vigorous exercise or diet program since my descent into depression when my whole world came tumbling down (that was a good thing). To the contrary, I cannot get motivated to stay with any exercise program or diet at all since I started Effexor. I just don't have that motivation anymore (in all honesty, I miss that former part of my life, I was really *happy*, completed 2 half marathons, etc.) So why add a mood stabilizer if I have not had any more episodes of going off the deep end by over-dieting and exercising? I don't overspend, behave in risky behaviors, etc, but did have quite a time as a teenager and in my twenties by doing stupid things. I do have periods of time of intense happiness. But then again, maybe it just feels intense, because feeling low sucks. One other thing that may be complicating this whole thing is for the last 3 months I have been on a very small dose of progestin for the control of very heavy menstrual periods (menorrhagia) which is working like a charm, but could be causing some of my low moods, but cannot explain the energetic
> moments and creative periods of time.
>
> I am giving serious thought to tapering off both Effexor and Klonopin to find out where I'am at. I am of the belief that I experienced a mid-life crisis and reacted to turning 40 by trying to get slim and in shape, but ended up over doing it for what I will admit was a fairly long time (1 1/2 years). I also believe that my intense reactions to some serious problems my children were having also led to my depressive episode. These issues are resolving.I would alter one factor at a time if it's possible to do so. IMO, The Effexor is just wiring you for sound. Ask your doc about dropping the dose from 225mg to say 150mg for a couple of weeks and see if all this settles down some. You may just need a lowered dose. If it is keeping you out of major depression you may need to take some maintenance dose of an AD indefnitely. From reading your response I don't detect any euphoria, you just sound "fast" not "high".
Hope this helps.
Mitch>
> How do others feel about discontinuing meds (if I can even get my Pdoc to "buy" into this line of thinking)? I don't mean just stopping them, but discontinuing them under a doctor's care and seeing where I am at? I want my life back, whatever that means. Thanks for listening and thanks for any responses. :) Anne
Posted by Noa on November 5, 2001, at 15:17:17
In reply to Re: Consensus on withdrawing from meds under Dr's care » AnneL, posted by Mitch on November 5, 2001, at 10:02:00
Weekenders Syndrome--sounds like me a lot of the time. At the moment, I am finding work pretty stimulating and rewarding. This follows a period of time when I was having difficulty performing to expectations, so I started investing more of myself into making it work better at work, and the results have been good. I'm not overdoing it at all, though. But weekends are hard in terms of motivation. There are a million chores to do, which casts a cloud over the whole weekend, so I end up some weekends avoiding the chores but not having any fun either! I am working on this in therapy, because for me, it goes beyond a biochemical issue. It has to do with caring enough about myself vs. being able to feel motivated at work because it affects other people, etc. This weekend, my friend got me out of the house on Saturday afternoon and that made a huge difference for me.
I would advocate caution if you are thinking about going off Effexor. I think I agree that you might start with a less drastic change first. I have tweaked my Effexor dosage several times before finding the right level, including several times when it was lowered and then the serzone was raised, until a good ratio was found. For you, maybe it is about tweaking the dose (under doctor's care, of course) or trying a mood stabilizer to augment the effexor. It sounds like your pdoc wants you to consider this, no?
Posted by Mitch on November 5, 2001, at 23:05:35
In reply to Re: Consensus on withdrawing from meds under Dr's care, posted by Noa on November 5, 2001, at 15:17:17
> Weekenders Syndrome--sounds like me a lot of the time. At the moment, I am finding work pretty stimulating and rewarding. This follows a period of time when I was having difficulty performing to expectations, so I started investing more of myself into making it work better at work, and the results have been good. I'm not overdoing it at all, though. But weekends are hard in terms of motivation. There are a million chores to do, which casts a cloud over the whole weekend, so I end up some weekends avoiding the chores but not having any fun either! I am working on this in therapy, because for me, it goes beyond a biochemical issue. It has to do with caring enough about myself vs. being able to feel motivated at work because it affects other people, etc. This weekend, my friend got me out of the house on Saturday afternoon and that made a huge difference for me.
>Hi Noa,
I can identify with that. It seems that whatever I do for a consistent period of time seems to get "burned in" and "reverberates" and I have trouble "switching out" of a mode of sorts. I worked seven days a week for about three years straight with little interruption! My pdoc thinks this is more like OCPD or "workaholism". That, combined with social anxiety doesn't help matters much. I really think if I can change my "work enviroment" to be "health-provoking!" would be the better way to go. I am just tired of trying to change myself to fit my work environment. I would rather change my work envrionment to be nurturing of the positive aspects of my personality instead.
Mitch
Posted by AnneL on November 5, 2001, at 23:42:23
In reply to Re: Consensus on withdrawing from meds under Dr's care » AnneL, posted by Mitch on November 5, 2001, at 10:02:00
Hi Mitch,
Thanks for your reply, I really appreciate your thoughts on this subject. I think I finally admitted to myself this morning that my new "Mirena" levonorgestrel releasing IUD just had to be removed Today! My mood has changed since its insertion and my husband has been gently trying to get this point across. Very up and down moods, it would be impossible to ever
know what treatment plan is right without getting back to at least my "pre-IUD" baseline.So the IUD is gone as of today. It's amazing how one can get an appointment when the hysteria is just below the surface (I'am so embarrassed). But, I'll put that behind me and move on.
I also reduced my dose of Effexor from 225 to 150 starting this AM. I am in the medical profession and it continues to amaze me how little some docs know about these meds. Saw my GP today and I do respect him immensely and trust him. He liked the idea of getting rid of the IUD and reducing my dose of Effexor, but gently suggested that instead of dropping it by 75 mg. per week that I take it easy and drop it by 37.5 mg. per week and
assess how I am doing.I feel extremely empowered by finally making a decision. Sitting on a fence and feeling paralyzed is terrible. I have every confidence that my mood will return to my pre-IUD state in a very short period of time. And that mood is generally pretty reliable with the exception of getting PMS, but, hey I've come to terms with it.
Thanks again for everything! Anne :)
Posted by AnneL on November 5, 2001, at 23:55:14
In reply to Re: Consensus on withdrawing from meds under Dr's care, posted by Noa on November 5, 2001, at 15:17:17
Hi Noa,
As you can see from my response to Mitch I have accompished quite a bit today in terms of making some decisions about my health care, i.e., getting rid of a hormonal agent which is well-known to cause depression and what the literature terms "mood changes" and reducing my dose of Effexor from 225 to 150 mg. This was kind of done with my GP's approval, well kind of after the fact, but we'll see what happens. And I just might take his recommendation to taper more slowly
with respect to the Effexor. This will depend on how well I do over the next few days.I will see my new Pdoc for the second time this week. First time was all history taking, etc. Hopefully, he will be the type of professional who knows how to work well with the well-informed consumer and a healthcare professional. Medicine has had to change drastically as patients have become "consumers" and very knowledgable ones at that. I'll keep you posted as to what I learn along the way. After all, this is just one big experiment, in one way or another. :) Anne
Posted by Mitch on November 6, 2001, at 9:07:20
In reply to Re: Consensus on withdrawing from meds under Dr's care » Mitch, posted by AnneL on November 5, 2001, at 23:42:23
> I also reduced my dose of Effexor from 225 to 150 starting this AM. I am in the medical profession and it continues to amaze me how little some docs know about these meds. Saw my GP today and I do respect him immensely and trust him. He liked the idea of getting rid of the IUD and reducing my dose of Effexor, but gently suggested that instead of dropping it by 75 mg. per week that I take it easy and drop it by 37.5 mg. per week and
> assess how I am doing.
>That might not be a bad idea actually (your GP's "slow-go" suggestion). There are a lot of people that have an awful time withdrawing from Effexor. Maybe the first big drop from 225mg > 150mg might pass relatively event-free (except reduction of undesired stuff from it). You might want to take it down below 150mg in the 37.5mg steps that he mentioned, however (I would). Also, be aware that you might find a comfortable maintenance dose of Effexor that works for you for a more extended period of time(a few months) without causing you much trouble(who knows-37.5 or 75mg/day?).
Mitch
Posted by Noa on November 6, 2001, at 12:58:20
In reply to Re: Consensus on withdrawing from meds under Dr's care » Noa, posted by AnneL on November 5, 2001, at 23:55:14
Wow. Good detective work. sounds like good decisions. I would err on the side of caution with taking it slow with lowering the effexor dose. It is worth the added cost of some extra 37.5 mg pills to not have the potential discomfort from a quick drop off. Good luck.
Posted by Noa on November 6, 2001, at 12:59:53
In reply to Re: Consensus on withdrawing from meds under Dr's care » Noa, posted by Mitch on November 5, 2001, at 23:05:35
I don't switch gears so easily myself. I don't get outwardly rigid like some people do--it is more internalized-- I get really unfocused and have difficulty knowing how to start the "next" thing.
Posted by SLS on November 6, 2001, at 14:29:16
In reply to Weekenders Syndrome Mood changes, etc., posted by AnneL on November 3, 2001, at 18:04:59
> Hi,
> I am on Effexor XR 225 mg. along with Klonipin 1 mg at bedtime. This was initially prescribed for a major depressive bout which was I felt to be of a situational nature. I am noticing a pattern with my moods that is really starting to bother me. Every weekend becomes a "chore", I go out walking both Saturday and Sunday morning and come home distinctly different feeling, i.e., I become depressed, very slightly anxious (because I feel the depression coming on), and take long naps. I felt distinctly energized during my week at work, however, to the point that my husband noticed. Energized, "happy", worked late at work, etc. I'am really starting to wonder about my moods. Anyone with similar experiences, any thoughts on how to manage the ups and downs? Thanks, Anne
Hi Anne.Do you wake up at the same time on weekends as you do during the week? If you wake up later on weekends, that might contribute to a worsening of the vegetative symptoms of depression. With affective disorders, it is important to maintain the circadian rhythm by keeping regular sleep/wake cycles. A good example would be going to bed at 11:00pm and waking at 7:00am. The rhythm is synchronized in large part by the environmental cue of waking up and probably being exposed to light. One way of getting extra sleep on weekends is to wake up at 7:00am (or regular weekday time), regardless of what time you went to bed the night before - even if it was 3:00am. It is best to get out of bed, put on a light, become fully awake, and then go back to bed. It really works.
- Scott
Posted by Noa on November 6, 2001, at 17:46:14
In reply to Re: Weekenders Syndrome Mood changes, etc. » AnneL, posted by SLS on November 6, 2001, at 14:29:16
Good point! Over the past number of months, I have started keeping a fairly regular cycle, and I agree that it helps. The past few weekends, tho, I started the bad habit of going back to sleep late morning. You are probably right, Scott, that it causes me to have more depressed mood, lack of motivation, etc.
Posted by wendy b. on November 7, 2001, at 1:30:37
In reply to Weekenders Syndrome Mood changes, etc., posted by AnneL on November 3, 2001, at 18:04:59
This conversation has been interesting. Thanks for starting it, Ann.
On the cognitive and energetic level, yes, I have experienced the weekender's syndrome, only it happens every night. I am BP II and sleep very little (3 1/2 to 4 hrs sleep per evening). By 7:00 at night, I have no energy or inclination for household chores, so a lot goes undone. Weekends I sleep in.
I understand Mitch's point about being ready, willing and able to go all out and work like a dog for *other people* or organizations, but for myself? I can't motivate myself as much as I wish I could. I too would like to find a work situation that nurtured me as much as I do *it*.
As for the diagnosis question, I would bet that you are BP II as well, your description of the symptoms sounds classic for hypomania. I would 'suggest' this to the pdoc. Read up on bipolar mood disorders on some of the links on psychobabble's pages. Effexor was nasty for me, didn't do anything to energize me at all. I like Wellbutrin much better, and it doesn't induce hypomania like other ADs. Titrate down SLOWLY on the Effexor, 37.5 per week sounds just right. Each time I went down I experienced some bad nausea for about a day or so. When I went off it all the way, I would open the capsule and pour some out, take half of the 37.5 cap for a week, then half of the half, etc. It made a very big difference.
I too have the bleeding problem, and am on a very low-dose oral contraceptive (Mircette), which has both estrogens and progesterone. It has been very helpful. I was on this before my mood swings became really bad, and so I know it's not causing what I'm experiencing now. Even if it were, I'm not going to go back to the amount of bleeding I was having every month... I'm on the lowest dose possible of the hormones, so i just have to live with that. I think if you can get along without the IUD, fine, but rethink it later, IF the bleeding becomes bad again. You have to weigh the risks/benefits. My gynecologist warned me that blood loss like I was having could cause anemia, and tested me for it before I went on the pill (I was ok)...
As for going off the meds entirely, I would not. You do not want to risk the effects of a huge manic episode, or a lower-than-low depression. I would actually increase the meds, and try a relatively low-side effect mood stabilizer like neurontin. I'm on that. While I feel it helped me for a while on its own (10 months), I probably need to add something, like Depakote or lithium. Mitch was very helpful talking to me about this. Seems like one of these could help you too.
Let us know, and take care,
Wendy
Posted by AnneL on November 10, 2001, at 0:48:29
In reply to Re: Weekenders Syndrome Mood changes, etc. » AnneL, posted by wendy b. on November 7, 2001, at 1:30:37
Hi all,
Well, after I rid myself of my IUD, dropped my dose of Effexor XR from 225 to 75 mg. over 4 days
and cut my Klonopin (taken at bedime for sleep) by one-half to 0.5 mg, I decided that maybe I was doing a lot rather hastily (duh!) This is a typical behavior, rush into something before thinking it through. Luckily, no serious withdrawal symptoms except a feeling during the day that I had too much caffeine, pretty uncomfortable and some crying spells (which do coinside with the start of PMS).Saw my new Pdoc, this is our second meeting and I thought Noa might have a thought or two concerning my Pdoc's advice. Although my TSH is within normal range (3rd generation range 0.35-5.55) at 1.57, my Pdoc wants me to decrease my dose of Synthroid from 150 mcg to 125 mcg. This puzzled me. Why I asked? He said he noticed a "lid lag" which he states is seen sometimes in those who have two much thyroid hormone. He said when I glance at the floor while talking with him he can see the upper white of my eye, meaning the lid is "lagging". Noa have you ever heard of such a thing?
So his plan was Synthroid down to 125 mcg from 150 mcg (the source of my thyroid disorder is autoimmune, Hashimoto's disease to be exact) and go back up to 150 mg. of Effexor, stay at 1 mg. of Klonopin for now. OK, I agree with not dropping the Effexor too rapidly, but after thinking about it, I called my endocrinologist today and she said that "lid lag" is only seen in patient's with Grave's disease (hyperthyroidism) that my TSH is within range, etc. She dosen't buy his theory at all, but said I could drop it and see how I feel and get my TSH redrawn in one month or less if I start having symptoms, such as fatigue and depression (oh great!).
I have never met a doctor PDoc or otherwise who has been so "hung-up" on lowering a thyroid dosage. Any ideas or suggestions? By the way, I feel so much better without the hormone IUD. That thing was really making me moody.
I think he is trying to rule out a thyroid-induced hyper state when I was dieting and exercising for about 1 1/2 years. Ever since I had the onset of my depression in Jan. Feb. of this year, I haven't engaged in any of those behaviors. My eating is normal (well, probably too much) and I'am not obsessed with exercise, to the contrary, I feel quite unmotivated. I don't know anymore. I guess I should be greatful that someone is checking all avenues instead of pushing another pill. I feel pretty resistant about lowering my Synthroid and I think this stems from my fear that my metabolism will decrease and I will gain more weight. I have already gained back approximately 10 to 15 pounds since I stopped dieting and exercising. One more interesting thing, that progestin-releasing IUD along with the Effexor is a bad combo in that I really craved carbohydrates. That seems to be easing up a little. Anyway, thanks for listening and any suggestions. :) Anne
Posted by Mitch on November 10, 2001, at 1:06:51
In reply to Noa, Mitch and Wendy - Interesting twist, posted by AnneL on November 10, 2001, at 0:48:29
> Hi all,
>
> Well, after I rid myself of my IUD, dropped my dose of Effexor XR from 225 to 75 mg. over 4 days
> and cut my Klonopin (taken at bedime for sleep) by one-half to 0.5 mg, I decided that maybe I was doing a lot rather hastily (duh!) This is a typical behavior, rush into something before thinking it through. Luckily, no serious withdrawal symptoms except a feeling during the day that I had too much caffeine, pretty uncomfortable and some crying spells (which do coinside with the start of PMS).
>
> Saw my new Pdoc, this is our second meeting and I thought Noa might have a thought or two concerning my Pdoc's advice. Although my TSH is within normal range (3rd generation range 0.35-5.55) at 1.57, my Pdoc wants me to decrease my dose of Synthroid from 150 mcg to 125 mcg. This puzzled me. Why I asked? He said he noticed a "lid lag" which he states is seen sometimes in those who have two much thyroid hormone. He said when I glance at the floor while talking with him he can see the upper white of my eye, meaning the lid is "lagging". Noa have you ever heard of such a thing?
>
> So his plan was Synthroid down to 125 mcg from 150 mcg (the source of my thyroid disorder is autoimmune, Hashimoto's disease to be exact) and go back up to 150 mg. of Effexor, stay at 1 mg. of Klonopin for now. OK, I agree with not dropping the Effexor too rapidly, but after thinking about it, I called my endocrinologist today and she said that "lid lag" is only seen in patient's with Grave's disease (hyperthyroidism) that my TSH is within range, etc. She dosen't buy his theory at all, but said I could drop it and see how I feel and get my TSH redrawn in one month or less if I start having symptoms, such as fatigue and depression (oh great!).
>
> I have never met a doctor PDoc or otherwise who has been so "hung-up" on lowering a thyroid dosage. Any ideas or suggestions? By the way, I feel so much better without the hormone IUD. That thing was really making me moody.
>
> I think he is trying to rule out a thyroid-induced hyper state when I was dieting and exercising for about 1 1/2 years. Ever since I had the onset of my depression in Jan. Feb. of this year, I haven't engaged in any of those behaviors. My eating is normal (well, probably too much) and I'am not obsessed with exercise, to the contrary, I feel quite unmotivated. I don't know anymore. I guess I should be greatful that someone is checking all avenues instead of pushing another pill. I feel pretty resistant about lowering my Synthroid and I think this stems from my fear that my metabolism will decrease and I will gain more weight. I have already gained back approximately 10 to 15 pounds since I stopped dieting and exercising. One more interesting thing, that progestin-releasing IUD along with the Effexor is a bad combo in that I really craved carbohydrates. That seems to be easing up a little. Anyway, thanks for listening and any suggestions. :) Anne
Hi Anne,FWIW, your writing seems a lot more pointed and less *racy* since your reduction of Effexor dosage. You sound a lot better. Your pdoc is probably concerned about Effexor withdrawal symptoms.
Mitch
Posted by Noa on November 13, 2001, at 16:43:05
In reply to Re: Noa, Mitch and Wendy - Interesting twist » AnneL, posted by Mitch on November 10, 2001, at 1:06:51
I have heard about the eyelids pulling back in hyperthyroidism/Graves disease. There are some photos on the internet of thyroid eye problems showing eyes that look "bug-eyed", ie, retracted lids. But I had never heard of "lid-lag" perse.
Has your endo checked your eyes?
I would have the pdoc and endo talk to each other. IMHO, it is the endo that is the thyroid expert, not the pdoc, and if the pdoc is concerned about you possibly having too much thryoid hormone, some reassurance from your endo should help.
As for hypomania due to too much thyroid hormone--this is just a layperson's humble opinion, but, it still doesn't make that much sense to me because from what I've read (see references in the thyroid and depression folder), when people have hyperthyroidism, they don't FEEL energetic. Their hearts may race, they may sweat a lot and lose weight, etc. but the descriptions I've read (and from seeing my mother when she had hyperthyroidism) are of feeling *fatigued and exhausted*, despite the hyperarousal (can be like anxiety symptoms I think) and that hyperthyroidism doesn't allow for a prolonged steady state of being hyperthyroid--you get sick pretty fast, as opposed to hypothyroid, where you can have low or moderate levels of it for a long period of time without much change.
Perhaps the hypomania hypothesis is correct for you, but the idea that it is from the thyroid hormone doesn't sound likely to me (again, just mho). Maybe it was triggered by the effexor--people here have reported that if they have a tendency toward hypomania, some antidepressants can trigger the hypomanic "switch".
This is just my understanding--based on what I've read (please read for yourself). Talk more to your endo, read some of the resources in the folder. Also, there is a new book on thyroid just out. Haven't read it, can't remember the name, etc. I'll try to find out......
Posted by AnneL on November 14, 2001, at 0:02:53
In reply to Re: Noa, Mitch and Wendy - Interesting twist, posted by Noa on November 13, 2001, at 16:43:05
Hi Noa,
Thanks for your thoughtful response. I researched
a website at www.thyroidmanager.org This is an excellent site which includes an entire textbook
on thyroid disease and management."Lid lag" is seen in Grave's disease and I would surmise that this is caused by the inflammatory process of the ocular muscles which result in the actual "eyeball" being pushed out which in early stages can cause "lid lag". Although I have Hashimoto's disease which can cause an initial hyperthyroid state as the thyroid is being attacked by the body's own antibodies, it ultimately ends up with the thyroid gland being replaced by lymphocytes and other diseased tissue
which causes gland failure. I have been hypothyroid for 17 years now and have been followed closely either by a GP or most recently
(last 3 years) by a competent endocrinologist.She (my endo) laughed at the lid-lag diagnosis and said that can occur with Grave's disease patients and also can be a normal finding in persons who are euthyroid. So essentially his observation of "lid-lag" is pretty meaningless and
reducing my dose of Synthroid would not be something she suggests.As I mentioned my TSH is within range at 1.57 From some of the web sites that you suggested, I have read that many hypothyroid or sub-clinical hypothyroid patient's "feel better" when the TSH
does not exceed 2. As a matter of fact your suggestions to do some research on thyroid disease
also led me to a New England Journal of Medicine abstract which indicates that many hypothyroid patients actually do better on a combination of T3 (Cytomel) and T4 (Synthroid, Unithroid, levothyroxine). I gave my endo the article and she agreed to drop my Synthroid to 0.125 mg and add 12.5 mcg of Cytomel to try out the combination approach.All I can say is that within 2 days of getting rid of the hormone levonorgestrel, a potent synthetic hormone with high androgenic properties
from my system, I feel great! I am not moody whatsoever and did not have any "weekender's syndrome" at all last weekend. Progesterone is just to depresogenic for me.I have reduced my dose of Effexor from 225 to 150(with Pdocs blessings) and I am hypothesizing that since I am not under the depressive effects of the progestin, I am starting to feel a little wound up, or hyper. I started an exercise program again and I do notice that I am getting "gung ho" again. This bears careful watching or I fear I will start overdoing it again.
I did not have the hyper feeling when I was first taking Effexor when I became acutely depressed last February. If in fact, I am prone to mood lability such as Bipolar II (I have no idea what the difference between I and II is) wouldn't Effexor have caused me to shift rapidly to a hypomanic phase due to not being on a concurrent mood stabilizer?
Ever since the first Pdoc mentioned that he wanted me to see a psychopharmacologist because he felt that maybe I was "not on the right meds"
and maybe needed the addition of a mood stabilizer, I have been overly concerned, call it
obsessed if you will. And now with the new Pdoc
calling my thyroid meds into question, I just feel really insecure about the whole thing. Maybe
someone can help break this into bite size pieces for me. Thanks for listening, I know I am obsessing over this. :) Anne
This is the end of the thread.
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