![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 71. This is the beginning of the thread.
Posted by bulldog2 on September 27, 2008, at 19:11:43
The following is an excerpt from an eminent neuropsychitrist Dr. Marianco:
--------------------------------------------------------------------------------
Marianco--Do SSRI's increase T4 to T3 conversion (outside of their ability to through stated purpose of reducing stress for the patient)?I corrected my note - removing that reference. Mea culpa - I shouldn't write when I'm tired.
Thyroid function and serotonin activity are highly linked. Both need to be addressed to optimize function.
T3 (the active thyroid hormone created from T4 in the liver by the 2D6 enzyme) desensitizes presynaptic serotonin autoreceptors - thus leading to an increase in serotonin production. Giving T3 induces serotonin production. Similarly, in hypothyroidism, serotonin production is reduced. T3 augments the effects of serotonin-increasing medications (such as the SSRIs) by the additive effect both have on desensitizing presynaptic serotonin autoreceptors.
Serotonin stimulates hypothalamic TRH production, leading to an increase in TSH production from the pituitary. Adequate serotonin production is necessary to maintain thyroid hormone levels. Increasing serotonin levels with an SSRI may thus help improve thyroid hormone production.
A caveat: Theoretically, an excess serotonin may lead to the opposite reaction. For example, excess serotonin leads to reduction in dopamine production, which then leads to increased norepinephrine production, leading to an increased stress response and cortisol production.
High levels of cortisol (which can also be caused by high stress levels, low testosterone, etc.) can directly lead to suppression of pituitary TSH secretion, and impair conversion of T4 to T3, and can impair serotonin function (by reducing serotonin receptor density, increasing serotonin uptake via increase in serotonin transporter production, and by increasing tryptophane oxygenase production in the liver - thus reducing tryptophan, the precursor to serotonin).
It may be thus important to have an idea of serotonin levels (unless one has a good clinical feel as to a patient's clinical response to assess serotonin levels - as a psychiatrist may have) by measuring urine serotonin levels. This, somewhat, correlates with brain serotonin levels, though I am still assessing this for clinical utility.
__________________
Any statement I make on this site is for educational purposes only and will change as medical knowledge progresses. It does not constitute medical advice, does not substitute for proper medical evaluation from physician, does not create a doctor/patient relationship or liability. If you would like medical advice, please ask your doctor. Thank you.
Posted by Phillipa on September 27, 2008, at 21:24:19
In reply to Thyroid levels and Serotonin, posted by bulldog2 on September 27, 2008, at 19:11:43
Bulldog2 got enough serotonin and T3 has been tried. Thanks for the info I'm sure a lot others will be highly interested. Love Phillipa
Posted by bulldog2 on September 28, 2008, at 7:35:27
In reply to Re: Thyroid levels and Serotonin » bulldog2, posted by Phillipa on September 27, 2008, at 21:24:19
> Bulldog2 got enough serotonin and T3 has been tried. Thanks for the info I'm sure a lot others will be highly interested. Love Phillipa
Obviously you did not read the article in it's entirety so I will show you the excerpt you seem to have missed. There is a possibility your thyroid levels may be causing you problems. So please read the following. Excess serotonin can be caused by excess thyroid.
A caveat: Theoretically, an excess serotonin may lead to the opposite reaction. For example, excess serotonin leads to reduction in dopamine production, which then leads to increased norepinephrine production, leading to an increased stress response and cortisol
Posted by bulldog2 on September 28, 2008, at 7:39:41
In reply to Re: Thyroid levels and Serotonin » bulldog2, posted by Phillipa on September 27, 2008, at 21:24:19
> Bulldog2 got enough serotonin and T3 has been tried. Thanks for the info I'm sure a lot others will be highly interested. Love Phillipa
I also suggest you read the artcle carefully and it's entirety. Your statement "got enough serotonin and tried t3" really bothers me. You always ask people for info and than don't have the time to read carefully what has been gathered.
Posted by Phillipa on September 28, 2008, at 10:51:11
In reply to Re: Thyroid levels and Serotonin, posted by bulldog2 on September 28, 2008, at 7:39:41
Oh was the info for me? I thought it was for the board in general. My mistake. Phillipa
Posted by bulldog2 on September 28, 2008, at 11:38:24
In reply to Re: Thyroid levels and Serotonin » bulldog2, posted by Phillipa on September 28, 2008, at 10:51:11
> Oh was the info for me? I thought it was for the board in general. My mistake. Phillipa
No it was for the board in general but if you make a comment on the info please have the courtesy to read the entire comment or why bother and make a comment.
Posted by Phillipa on September 28, 2008, at 12:06:05
In reply to Re: Thyroid levels and Serotonin, posted by bulldog2 on September 28, 2008, at 11:38:24
I did sorry must have misunderstood it. I'm not that bright in interrpreting data. My apologies again. Let the others who understand comment then. Phillipa
Posted by bleauberry on September 28, 2008, at 15:16:55
In reply to Thyroid levels and Serotonin, posted by bulldog2 on September 27, 2008, at 19:11:43
Very interesting stuff. Thanks for sharing. I have always thought that hormones have a huge, usually underestimated or not even considered, influence on mood. Due to their control of neurotransmitters, receptor sensitivities, and feedback loops. The information you shared helps to see a snip of that in action.
Phillipa claimed to have enough serotonin. We don't know that. A urine test might help see a more objective picture, but even that may or may not be totally reflective of what is going on intracellularly within the nervous system. Just because a low dose of Luvox is on board doesn't mean there is plenty of serotonin. Also claimed was trying T3. That's not the whole truth. A particular dose was tried that felt like coffee stimulation, and then abandoned. That is not a good trial of T3. Should have been a much lower dose.
The info you shared also highlights why it is important to judge doses by how they feel by each individual patient, and not limit treatment to mere lab numbers on paper, which are very wide general guidelines that fit a large segment of the population, but certainly not all-inclusive and certainly not a Bible.
Posted by bulldog2 on September 28, 2008, at 15:46:58
In reply to Re: Thyroid levels and Serotonin » bulldog2, posted by bleauberry on September 28, 2008, at 15:16:55
> Very interesting stuff. Thanks for sharing. I have always thought that hormones have a huge, usually underestimated or not even considered, influence on mood. Due to their control of neurotransmitters, receptor sensitivities, and feedback loops. The information you shared helps to see a snip of that in action.
>
> Phillipa claimed to have enough serotonin. We don't know that. A urine test might help see a more objective picture, but even that may or may not be totally reflective of what is going on intracellularly within the nervous system. Just because a low dose of Luvox is on board doesn't mean there is plenty of serotonin. Also claimed was trying T3. That's not the whole truth. A particular dose was tried that felt like coffee stimulation, and then abandoned. That is not a good trial of T3. Should have been a much lower dose.
>
> The info you shared also highlights why it is important to judge doses by how they feel by each individual patient, and not limit treatment to mere lab numbers on paper, which are very wide general guidelines that fit a large segment of the population, but certainly not all-inclusive and certainly not a Bible.The way we currently test hormones also is not very reliable. The ranges are very wide and include data from all age ranges. Most docs pronounce you normal if you fall somewhere in that vast range which may not be normal at all.
P-docs should do hormonal testing before they prescribe ads. Once ads are started they should do followup tests to see if the meds are disturbing any of the hormonal levels and adjust the meds accordingly.
P-docs typically start with ssris because their the safest and easiest to prescribe. Why not due neurotransmitters tests to see if there's a shortage of one particular one.
It seems like p-docs continue to use a trial and error method that does not incorporate a scientific method. To much wasted time with this method which causes to many patients to abandone treatment.
Posted by Phillipa on September 28, 2008, at 19:51:38
In reply to Re: Thyroid levels and Serotonin, posted by bulldog2 on September 28, 2008, at 15:46:58
Well I definitely agree with that!!!! Phillipa
Posted by Phillipa on September 29, 2008, at 0:35:07
In reply to Re: Thyroid levels and Serotonin, posted by bulldog2 on September 28, 2008, at 15:46:58
Well my neice the thyroid expert e-mailed and said finally my numbers are normal so that is at less positive. Phillipa
Posted by fleeting flutterby on September 29, 2008, at 12:08:31
In reply to Thyroid levels and Serotonin, posted by bulldog2 on September 27, 2008, at 19:11:43
> The following is an excerpt from an eminent neuropsychitrist Dr. Marianco:
>
>
>
> --------------------------------------------------------------------------------
>
>
> Marianco--Do SSRI's increase T4 to T3 conversion (outside of their ability to through stated purpose of reducing stress for the patient)?
>
> I corrected my note - removing that reference. Mea culpa - I shouldn't write when I'm tired.
>
> Thyroid function and serotonin activity are highly linked. Both need to be addressed to optimize function.
>
> T3 (the active thyroid hormone created from T4 in the liver by the 2D6 enzyme) desensitizes presynaptic serotonin autoreceptors - thus leading to an increase in serotonin production. Giving T3 induces serotonin production. Similarly, in hypothyroidism, serotonin production is reduced. T3 augments the effects of serotonin-increasing medications (such as the SSRIs) by the additive effect both have on desensitizing presynaptic serotonin autoreceptors.
>
> Serotonin stimulates hypothalamic TRH production, leading to an increase in TSH production from the pituitary. Adequate serotonin production is necessary to maintain thyroid hormone levels. Increasing serotonin levels with an SSRI may thus help improve thyroid hormone production.
>
> A caveat: Theoretically, an excess serotonin may lead to the opposite reaction. For example, excess serotonin leads to reduction in dopamine production, which then leads to increased norepinephrine production, leading to an increased stress response and cortisol production.
>
> High levels of cortisol (which can also be caused by high stress levels, low testosterone, etc.) can directly lead to suppression of pituitary TSH secretion, and impair conversion of T4 to T3, and can impair serotonin function (by reducing serotonin receptor density, increasing serotonin uptake via increase in serotonin transporter production, and by increasing tryptophane oxygenase production in the liver - thus reducing tryptophan, the precursor to serotonin).
>
> It may be thus important to have an idea of serotonin levels (unless one has a good clinical feel as to a patient's clinical response to assess serotonin levels - as a psychiatrist may have) by measuring urine serotonin levels. This, somewhat, correlates with brain serotonin levels, though I am still assessing this for clinical utility.
> __________________
> Any statement I make on this site is for educational purposes only and will change as medical knowledge progresses. It does not constitute medical advice, does not substitute for proper medical evaluation from physician, does not create a doctor/patient relationship or liability. If you would like medical advice, please ask your doctor. Thank you.
>Hey, I think your sharing is very kind of you and I imagine it will be of help to some. I'm sorry though-- I'm lost. I'm very much a commoner and just don't grasp what this is saying. I've had Hashimotos Disease since I was 27.... hypothyroid. Started on synthroid at .50mcg, 7 years later was upped to .75mcg then 5 years later to .88mcg now I've been increased to 100mcg.
Iv'e always been regarded as "the one with no energy"..... "the one will little emotion"..... yet I dont' have a weight problem(I'm on the thin side).....
I have no medical education, I don't have any college degree at all.(i dont' even know what "caveat" is-- that you use) This talk of T4 and T3 is like trying to learn another language. I do know my overall level -last tested at 2.3 but that's all I know. My doc said if it's between 0-5 then it's OK. I'm on Lexapro also now(for almost 5 months) and feel even MORE lethargic, with no desire to have goals. yuk. I hate all this. It's all so confusing to me.I like the idea of not paying so much attention to numbers but listening to how the patient is FEELING--- that should be a no brainer but it just isn't.
I wish I could better understand what you are saying-- I do appreciate your kindness and efforts to inform-- and wanted you to know that.
best to you,
flutterby-mandy
Posted by Phillipa on September 29, 2008, at 12:22:53
In reply to Re: Thyroid levels and Serotonin » bulldog2, posted by fleeting flutterby on September 29, 2008, at 12:08:31
Mandy I get confused also. In the past a high TSH made me very anxious but was thin too. Now it's low and thin again don't get it either. And SSRI's do nothing now for me in the past they reved me up it was horrible even with benzos now nothing. So no winning. Love Phillipa
Posted by fleeting flutterby on September 29, 2008, at 12:31:18
In reply to Re: Thyroid levels and Serotonin » fleeting flutterby, posted by Phillipa on September 29, 2008, at 12:22:53
> Mandy I get confused also. In the past a high TSH made me very anxious but was thin too. Now it's low and thin again don't get it either. And SSRI's do nothing now for me in the past they reved me up it was horrible even with benzos now nothing. So no winning. Love Phillipa<<
Hi Phillipa,
Well, sorry you're confused too but at least I'm not alone. thanks for the camaraderie. **hearts** to you. :o)
flutterby-mandy
Posted by Phillipa on September 29, 2008, at 12:46:55
In reply to Re: Thyroid levels and Serotonin » fleeting flutterby, posted by Phillipa on September 29, 2008, at 12:22:53
Here's another study. Boy it gets complicated to me. Phillipa
Peripheral thyroid hormones and response to selective serotonin reuptake inhibitors
Michael Gitlin, Lori L. Altshuler, Mark A. Frye, Rita Suri, Emily L. Huynh, Lynn Fairbanks, Michael Bauer, and Stanley Korenman
Gitlin, Altshuler, Frye, Suri, Fairbanks, Bauer Department of Psychiatry; Korenman Department of Endocrinology, UCLA School of Medicine, Los Angeles, Calif.
Top
Abstract
Introduction
Methods
Results
Discussion
References Abstract
Objective
To examine the relation between baseline measurements of thyroid function and response to selective serotonin reuptake inhibitors (SSRIs) and to consider the effect of these antidepressants on thyroid hormone levels.
Methods
Nineteen subjects with major depression, but without a history of thyroid treatment or lithium treatment, were treated openly with either sertraline or fluoxetine in a university- affiliated tertiary care hospital. Hamilton Depression Rating Scale (Ham-D) scores were measured before and after treatment. Clinical Global Impressions (CGI) scores were measured at study end. Thyroid data, consisting of values for thyroid-stimulating hormone (TSH), triiodothyronine (T3, measured by radioimmunoassay [RIA]), thyroxine (T4, measured by RIA) and free T4, were collected before and after treatment. Complete thyroid data were available for 17 subjects. Data were collected during 19971999.
Results
Baseline TSH correlated strongly with response to treatment as measured by change in Ham-D scores (r = 0.64, p = 0.003). Low TSH values correlated with greater improvement in depressive symptoms. Thyroid hormone levels decreased with treatment, but these decreases did not correlate with clinical improvement.
Conclusion
Baseline thyroid function, as measured by serum TSH, may predict a patient's response to antidepressant treatment with SSRIs. Optimal thyroid function, beyond simply being within the normal laboratory values, may be necessary for an optimal response to antidepressants.Medical subject headings: depression, serotonin uptake inhibitors, thyroid hormones, thyrotropin, thyroxine, triiodothyronine.
Top
Abstract
Introduction
Methods
Results
Discussion
References IntroductionThere has long been an interest in the relation between thyroid function and the course of a depressive episode. As part of that interest, many studies have evaluated both the predictive value of baseline thyroid indices and subsequent response to antidepressant treatment, as well as the change in these indices with treatment.1,2,3,4,5 Up to 10% of individuals with depression may present with elevated levels of thyroid-stimulating hormone (TSH) and normal thyroxine (T4) and triiodothyronine (T3) levels (subclinical hypothyroidism).6,7 The clinical impact of an elevated TSH level is still unclear, but preliminary evidence suggests that it may predict a poor response to antidepressants.7With antidepressant treatment, the most common change in thyroid hormones is a decrease in T4 and free T4 without a significant reduction in TSH.2,5 Of note, these changes are generally within the euthyroid range of values. Some studies have shown that responders to antidepressants show a greater decrease in T4 levels compared with nonresponders.8,9
In this study, we explored these 2 areas by examining, first, the relation between baseline thyroid hormones and the clinical antidepressant response to selective serotonin reuptake inhibitors (SSRIs) and, second, the change in thyroid hormone levels with SSRI treatment.
Top
Abstract
Introduction
Methods
Results
Discussion
References MethodsAll subjects in the current study were recruited from a larger study of the dosing and efficacy of fluoxetine versus sertraline in the treatment of major depression.10 Subjects who agreed to have their peripheral thyroid hormones assayed before and after treatment with the SSRI gave written informed consent and were included in the current study. Nineteen subjects form the sample described in this report. Inclusion criteria were a current diagnosis of major depressive episode, as defined in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition,11 and age between 18 and 60 years. The diagnosis was made by a structured interview with trained raters. Exclusion criteria were as follows: 1) a history of substance abuse within the last 30 days; 2) current or recent treatment with an antidepressant; 3) history of previous manias or hypomanias; 4) previous failure of treatment with fluoxetine or sertraline; and 5) a history of thyroid disease or current treatment with thyroid hormones. No patient was treated with lithium before study entry.At study entry, baseline clinical assessments included the 21-item Hamilton Depression Rating Scale (Ham-D)12 and the Clinical Global Impressions (CGI) Severity of Illness and Global Improvement scales.13 Subjects were then treated with sertraline, 50 mg daily (n = 8), sertraline, 100 mg daily (n = 4), or fluoxetine, 20 mg daily (n = 7), with medication and dose assigned alternately, that is, patient 1 received sertraline, 50 mg, patient 2, sertraline, 100 mg, and patient 3, fluoxetine, but openly. At 6 weeks, subjects with a Ham-D score above 7 and a CGI Global Improvement score above 1 (less than marked improvement) had their daily doses increased to sertraline, 100 mg daily, sertraline, 200 mg daily, or fluoxetine, 40 mg daily, respectively. Total treatment time was 10 weeks. Although subjects were assessed every 2 weeks for 10 weeks, in this report, only the final CGI scores (both severity and improvement subscales) and Ham-D will be considered. Ham-D scores were assessed by research assistants and physicians who all had previous rating training.
At baseline, thyroid indices were measured using standard venipuncture techniques: TSH was assessed using solid-phase immunoradiometric assay, T4 by radioimmunoassay (RIA), T3 by RIA and free T4 by rabbit anti-T4 antibody (Diagnostic Products Kit). For all assays, the intra-assay and interassay variation were less than 10%. Thyroid tests were batch run. At the end of the study, the same thyroid indices were measured again. Two subjects did not complete the post- treatment thyroid measurements. Our sample, therefore, includes 19 subjects at baseline (12 on sertraline and 7 on fluoxetine) and post-treatment clinical evaluation, of whom 17 underwent thyroid evaluations both before and after treatment.
Hormone levels were screened for distributional properties and determined to be appropriate for parametric analysis. Paired t tests were used to evaluate changes in levels of TSH, T4, T3 and free T4 before and after treatment for the 17 patients with values from both time points. Response to treatment was measured by the change in Ham-D scores from before and after treatment, with positive values reflecting improvement in Ham-D symptoms. A stepwise regression analysis was used to predict improvement in Ham-D scores, with baseline values for TSH, T4, T3 and free T4 as the independent variables (n = 19).
Top
Abstract
Introduction
Methods
Results
Discussion
References ResultsThe 19 subjects were 10 women and 9 men, with a mean age of 37.6 (standard deviation [SD] 9, range 2758) years. Four subjects had a high school education or less, 10 were college graduates and 5 had graduate school experience. The mean Ham-D score was 20.7 (SD 1, range 1431). After treatment, the mean Ham-D score was 7.8 (SD 1.4, range 018). Thyroid values at baseline and after treatment for the 17 subjects with complete data are shown in Table 1. There was a slight increase in TSH and a decrease in T4, T3 and free T4 after treatment. These differences were statistically significant for T4 and T3, but not for free T4 or TSH. Changes in Ham-D scores did not correlate significantly with changes in thyroid hormone values.Table 1
The patients' condition improved by an average of 12.9 points on the Ham-D scale (range 1 to 31) after treatment. The degree of improvement was related significantly to baseline TSH levels (r = 0.64, p = 0.003), with low baseline TSH predicting a greater decline in Ham-D scores (Fig. 1). This relation held even after controlling for initial Ham-D scores. However, this relation was not seen when dividing the sample into subjects with remitting depression (Ham-D score < 8) versus subjects with nonremitting depression (Ham-D score > 8) (t17 = 1.06, p = 0.31). None of the other baseline thyroid indices added significantly to the prediction of response to treatment when correlations and t tests for subjects with remitting depression versus those with nonremitting depression were examined.
Fig. 1: Correlation of improvement in Hamilton Depression Rating Scale (Ham-D) scores with low baseline thyroid-stimulating hormone (TSH) values.
Top
Abstract
Introduction
Methods
Results
Discussion
References DiscussionThe results of this study suggest that a more active hypothalamicpituitarythyroid system, as measured by a lower serum TSH value, is associated with a better response to SSRI antidepressants. The relation was not seen, however, when the sample was split into subjects with remitting depression versus subjects with nonremitting depression.The small number of subjects studied is a major limitation of the study and suggests the need for caution in the interpretation of our results. Insufficient statistical power because of the small number of subjects might explain some of the negative results seen. Another limitation of the study is the use of 2 SSRIs that, although similar, may have had different effects on and relations to thyroid measures. A third study limitation is the lack of placebo controls, which may have contributed to inflated response rates.
The association between a lower baseline TSH and greater improvement in depressive symptoms is compatible with a small, but consistent, literature that suggests a relation between thyroid indices and clinical response. In the most recent study, Cole et al14 found that a lower baseline free T4 index and a higher TSH value were significantly associated with a poorer response to treatment of bipolar depression. No other variables, whether demographic, clinical or treatment with lithium, explained this association. Similarly, Sane et al15 found a higher free T4 index was associated with a shorter length of stay in hospital (as a measure of response to antidepressant treatment) in men who had been admitted to hospital with major depression.
Furthermore, in this study, changes in peripheral thyroid hormone levels decreased with antidepressant treatment. The reduction in peripheral thyroid indices after antidepressant treatment is also consistent with most, but not all, previous studies.1,5 As noted here, the lack of statistical significance for the changes in free T4 may reflect the small sample in our study.
Few studies have evaluated the association between SSRI treatment for depression and changes in thyroid indices. Shelton et al16 found no significant changes in TSH or total T4 with fluoxetine treatment but found an association between the decline in T3 levels and response to fluoxetine. König et al17 found an 11% decrease in thyroxine levels with paroxetine treatment. As in other studies, we found that changes in TSH values after antidepressant treatment were less consistent than those of T3 and T4.
In summary, the results of our study suggest that more active thyroid function, even within the normal range as measured by TSH values, may predict the response to therapy with SSRIs.
Acknowledgments
This study was supported in part by a grant from Eli Lilly and Company.
Posted by bulldog2 on September 29, 2008, at 18:39:04
In reply to Re: Thyroid levels and Serotonin » bulldog2, posted by fleeting flutterby on September 29, 2008, at 12:08:31
> > The following is an excerpt from an eminent neuropsychitrist Dr. Marianco:
> >
> >
> >
> > --------------------------------------------------------------------------------
> >
> >
> > Marianco--Do SSRI's increase T4 to T3 conversion (outside of their ability to through stated purpose of reducing stress for the patient)?
> >
> > I corrected my note - removing that reference. Mea culpa - I shouldn't write when I'm tired.
> >
> > Thyroid function and serotonin activity are highly linked. Both need to be addressed to optimize function.
> >
> > T3 (the active thyroid hormone created from T4 in the liver by the 2D6 enzyme) desensitizes presynaptic serotonin autoreceptors - thus leading to an increase in serotonin production. Giving T3 induces serotonin production. Similarly, in hypothyroidism, serotonin production is reduced. T3 augments the effects of serotonin-increasing medications (such as the SSRIs) by the additive effect both have on desensitizing presynaptic serotonin autoreceptors.
> >
> > Serotonin stimulates hypothalamic TRH production, leading to an increase in TSH production from the pituitary. Adequate serotonin production is necessary to maintain thyroid hormone levels. Increasing serotonin levels with an SSRI may thus help improve thyroid hormone production.
> >
> > A caveat: Theoretically, an excess serotonin may lead to the opposite reaction. For example, excess serotonin leads to reduction in dopamine production, which then leads to increased norepinephrine production, leading to an increased stress response and cortisol production.
> >
> > High levels of cortisol (which can also be caused by high stress levels, low testosterone, etc.) can directly lead to suppression of pituitary TSH secretion, and impair conversion of T4 to T3, and can impair serotonin function (by reducing serotonin receptor density, increasing serotonin uptake via increase in serotonin transporter production, and by increasing tryptophane oxygenase production in the liver - thus reducing tryptophan, the precursor to serotonin).
> >
> > It may be thus important to have an idea of serotonin levels (unless one has a good clinical feel as to a patient's clinical response to assess serotonin levels - as a psychiatrist may have) by measuring urine serotonin levels. This, somewhat, correlates with brain serotonin levels, though I am still assessing this for clinical utility.
> > __________________
> > Any statement I make on this site is for educational purposes only and will change as medical knowledge progresses. It does not constitute medical advice, does not substitute for proper medical evaluation from physician, does not create a doctor/patient relationship or liability. If you would like medical advice, please ask your doctor. Thank you.
> >
>
> Hey, I think your sharing is very kind of you and I imagine it will be of help to some. I'm sorry though-- I'm lost. I'm very much a commoner and just don't grasp what this is saying. I've had Hashimotos Disease since I was 27.... hypothyroid. Started on synthroid at .50mcg, 7 years later was upped to .75mcg then 5 years later to .88mcg now I've been increased to 100mcg.
> Iv'e always been regarded as "the one with no energy"..... "the one will little emotion"..... yet I dont' have a weight problem(I'm on the thin side).....
> I have no medical education, I don't have any college degree at all.(i dont' even know what "caveat" is-- that you use) This talk of T4 and T3 is like trying to learn another language. I do know my overall level -last tested at 2.3 but that's all I know. My doc said if it's between 0-5 then it's OK. I'm on Lexapro also now(for almost 5 months) and feel even MORE lethargic, with no desire to have goals. yuk. I hate all this. It's all so confusing to me.
>
> I like the idea of not paying so much attention to numbers but listening to how the patient is FEELING--- that should be a no brainer but it just isn't.
>
> I wish I could better understand what you are saying-- I do appreciate your kindness and efforts to inform-- and wanted you to know that.
>
> best to you,
> flutterby-mandy
>I think I will try to make this simple since I'm not sure I totally understand all of this. The higher the tsh means the harder your thyroid is working to convert t4 into t3. The hypothesis seems to be this than disrupts the production of other hormones. By supplementing the body with synthroid you supplement the body with needed t4 or some supplement with t4 and t3 and this takes the load off the thyroid gland. As the tsh goes down the gland is now not working as hard and this may improve other hormonal functions.
I think the doctor had a hypothesis that ssris by boosting serotonin help the thyroid function better and bring the tsh down.
Or in some cases thyroid meds plus an ssri bring about even a better response.
Posted by Phillipa on September 29, 2008, at 19:20:47
In reply to Re: Thyroid levels and Serotonin, posted by bulldog2 on September 29, 2008, at 18:39:04
In my case only when TSH was high the addition of a small dose of synthroid 25mcg at the time after l0 days of increased anxiety and the need to take extra benzos still working and at the hospital like magic like your ears popping after a head cold I instantly felt so much better it was like a miracle and had at that point never taken an SSRSI. So I lowered the benzo dose way down and for over two years things were wonderful worked and felt great. Haven't had that happen with any synthroid changes when bloodwork said TSH was high very high and dose escalation of synthroid resulted in higher anxiety so then SSRI added which simply made anxiety worse. That's my story. Phillipa
Posted by fleeting flutterby on September 29, 2008, at 20:07:07
In reply to Re: Thyroid levels and Serotonin, posted by bulldog2 on September 29, 2008, at 18:39:04
> >
>
> I think I will try to make this simple since I'm not sure I totally understand all of this. The higher the tsh means the harder your thyroid is working to convert t4 into t3.<<------Yes, that's how I've had it explained to me. and when my levels were "through the roof"(as the doc said)-- I was very hypothroid-- was told my thyroid was working way way too hard.
>>The hypothesis seems to be this than disrupts the production of other hormones. By supplementing the body with synthroid you supplement the body with needed t4 or some supplement with t4 and t3 and this takes the load off the thyroid gland. As the tsh goes down the gland is now not working as hard and this may improve other hormonal functions.<<
----hmmmm yea, that makes sense.
> I think the doctor had a hypothesis that ssris by boosting serotonin help the thyroid function better and bring the tsh down.<<---- Oh! so those that don't have an actual thyroid disease might still have low thyroid levels and thus SSRIs may jump the thyroid levels to more normal functioning? Is that what this is saying? if that's the case then SSRIs can be quite beneficial for those that need a little thyroid "push".
> Or in some cases thyroid meds plus an ssri bring about even a better response.<<-----Oh, I see. that's interesting. Well I don't think Lexapro is working that way for me. maybe I should switch to something else...... I have to think about this.....
thank you bulldog for simplifying it.
flutterby- mandy
Posted by Larry Hoover on October 4, 2008, at 17:50:25
In reply to Thyroid levels and Serotonin, posted by bulldog2 on September 27, 2008, at 19:11:43
> T3 (the active thyroid hormone created from T4 in the liver by the 2D6 enzyme) desensitizes presynaptic serotonin autoreceptors
???
I believe that this source is wrong. T4 is a substrate for cytochrome 3A4, not 2D6. And that's a good thing, because some people have no 2D6 function whatsoever.
3A4 function/rate is influenced by many drugs, and by diet (e.g. the grapefruit effect). Makes you wonder what happens to T3 levels.
Lar
Posted by Maisey on February 8, 2012, at 4:21:00
In reply to Thyroid levels and Serotonin, posted by bulldog2 on September 27, 2008, at 19:11:43
So, if I'm on Synthroid but still have symptoms of depression, should I try T3 supplementation or an anti-depressant? I keep reading about T3 helping with depression in people with hypothyroidism. My hypothyroidism is very mild, but my depression is pretty bad. I also have PCOS. I'm so confused as to how it all fits together. I was on Lexapro for 5 years, and mysteriously end up hypothyroid. I went off Lexapro and on Synthroid. Lexapro actually was never a great deal of help, but I'm doing badly - I may try it again. I also take progesterone cream to regulate my menstrual cycles. I thought my ups and downs may have something to do with PCOS, but now I don't think so.
Posted by Maisey on February 8, 2012, at 4:26:20
In reply to Thyroid levels and Serotonin, posted by bulldog2 on September 27, 2008, at 19:11:43
So, if I'm on Synthroid but still have symptoms of depression, should I try T3 supplementation or an anti-depressant? I keep reading about T3 helping with depression in people with hypothyroidism. My hypothyroidism is very mild, but my depression is pretty bad. I also have PCOS. I'm so confused as to how it all fits together. I was on Lexapro for 5 years, and mysteriously end up hypothyroid. I went off Lexapro and on Synthroid. Lexapro actually was never a great deal of help, but I'm doing badly - I may try it again. I also take progesterone cream to regulate my menstrual cycles. I thought my ups and downs may have something to do with PCOS, but now I don't think so.
Posted by ed_uk2010 on February 8, 2012, at 7:55:06
In reply to Re: Thyroid levels and Serotonin, posted by Maisey on February 8, 2012, at 4:26:20
>So, if I'm on Synthroid but still have symptoms of depression, should I try T3 supplementation or an anti-depressant? I keep reading about T3 helping with depression in people with hypothyroidism. My hypothyroidism is very mild, but my depression is pretty bad.
On Synthroid (at your current dose), do you have any persistent physical signs of hypothyroidism? Also, do you recent blood results suggest that your thyroid function is still abnormal? If you are no longer hypothyroid on Synthroid, adding T3 may be detrimental rather than beneficial. If your GP is unsure, an endocrinologist should be able to advise. An endocrinologist might also order more detailed blood tests.
If your thyroid function is still low, symptoms may include...
Feeling cold when other people don't
Constipation
Dry skin
Slow heart rate
Muscle/joint achesOther symptoms such as weight gain are also associated with PCOS and could therefore lead to confusion. The same applies to fatigue, which is almost universal in depression.
>....mysteriously end up hypothyroid.
Hypothyroidism is a very common condition. Many patients are diagnosed out of the blue. It is not likely to be related to the Lexapro. PCOS and hypothyroidism often occur together, and hypothyroidism can aggravate depression.
>Lexapro actually was never a great deal of help, but I'm doing badly - I may try it again.
If it wasn't very effective, it might be better to try a different type of antidepressant, or a psychological treatment (if available).
>I also take progesterone cream to regulate my menstrual cycles.
Is it working? Some women with PCOS use contraceptives such as 'Yaz' to regulate menstruation and relieve symptoms such as acne.
Posted by Maisey on February 8, 2012, at 10:29:55
In reply to Re: Thyroid levels and Serotonin » Maisey, posted by ed_uk2010 on February 8, 2012, at 7:55:06
> >So, if I'm on Synthroid but still have symptoms of depression, should I try T3 supplementation or an anti-depressant? I keep reading about T3 helping with depression in people with hypothyroidism. My hypothyroidism is very mild, but my depression is pretty bad.
>
> On Synthroid (at your current dose), do you have any persistent physical signs of hypothyroidism? Also, do you recent blood results suggest that your thyroid function is still abnormal? If you are no longer hypothyroid on Synthroid, adding T3 may be detrimental rather than beneficial. If your GP is unsure, an endocrinologist should be able to advise. An endocrinologist might also order more detailed blood tests.
>
> If your thyroid function is still low, symptoms may include...
>
> Feeling cold when other people don't
> Constipation
> Dry skin
> Slow heart rate
> Muscle/joint aches
>
> Other symptoms such as weight gain are also associated with PCOS and could therefore lead to confusion. The same applies to fatigue, which is almost universal in depression.
>
> >....mysteriously end up hypothyroid.
>
> Hypothyroidism is a very common condition. Many patients are diagnosed out of the blue. It is not likely to be related to the Lexapro. PCOS and hypothyroidism often occur together, and hypothyroidism can aggravate depression.
>
> >Lexapro actually was never a great deal of help, but I'm doing badly - I may try it again.
>
> If it wasn't very effective, it might be better to try a different type of antidepressant, or a psychological treatment (if available).
>
> >I also take progesterone cream to regulate my menstrual cycles.
>
> Is it working? Some women with PCOS use contraceptives such as 'Yaz' to regulate menstruation and relieve symptoms such as acne.
>Ed, hi. Bear with me here - I didn't get any sleep last night b/c of a nasty cold. I hope I don't leave anything out. My TSH was tested in Dec. and August and came out normal. I also had a Hashimoto's test done (thyroid anti-bodies) because I HAD been experiencing some symptoms similar to those that I had before being dxed hypothyroid. It was also normal, and the symptoms disappeared.
I wish I had the money for a physchiatrist or endo. I'm lucky to have a doctor where I live! Really, my grandma's moved and she has been with a nurse practitioner only for 2 years. I actually wanted to make an appt to see the physchiatrist I saw when I stayed in the hospital (I admitted myself to the hospital when I was feeling suicidal, 5 years ago.). His office said that since I'd chosen to have my follow-up care w/my family doctor after that stay, that I'd need a referral AND it would be at least 2 mons wait time so I would be better off letting my family doc handle it. (Her words.) It is just as well b/c I don't want to risk my health ins rates going up. It barely pays for anything as it is, and at $150 a month, it's difficult. I have to get a gum graft done which isn't covered at all so it's $100 here $1000 there... My family is helping me out financially is the only way I can afford my current expenses. And my dad will have to retire soon b/c his health isn't that great... I can only work very-part-time hours because of my moodswings.
I think my doctor feels I'm bipolar but does not want to say for some reason. There is a family history. I'm glad b/c something like that could get me thrown off my ins. I don't have the ability to go beyond the basics in healthcare.
My doctor I think prefers Lexapro as an anti-depressant in general, but he moved away from it for me b/c of the cost. There isn't a generic, I have no prescription drug coverage, so it was running me $88 a month. Also, I didn't think it did much, but I was at the point for awhile that I was holding down at least a part-time steady job. It was when I went off Lexapro and I got dxed with PCOS and hypothyroidism that I went downhill. I started bc pills which I never should've tried. When I was 21 and was on the pill, I had a nervous breakdown and quit a job when I stopped taking them mid-pack. When my gyno gave them to me this last time, the summer before last, I had a bad spell the first week of taking them. I told my co-worker she should "kill herself and get it over with." Now, this is a unique situation b/c she has bipolar and, being the boss' daughter, had to work there so she could have a job. Nobody else would probably employ her. I still don't know what I was thinking or where it came from. BC pills are the debbil, IMO. They made me walk away from the one job that I loved, and they came close to making me lose my last one, though, strangely enough boss' daughter was understanding b/c I think she knows how she is. I've had irregular cycles since I was about 18, but straightening them out w/bc pills is when I began to have the problems I have now. IDK whether it triggered illness in me or it was a worsened hormone imbalance, but I seriously don't think I've been the same since that first incident.
Progesterone cream makes me have a cycle each month when normally, I would be skipping every other month or so. I used to think PCOS was the cause of the moodswings, but now I don't think so b/c they appear at various times during the cycle. I don't have a pattern with it. Really, I just don't handle adversity well - I never have. I'm hesitant to take an SSRI because I take so many other things. Like last night, I have to look at 2 possible drug interactions when taking simple cough medicine. I ended up getting no sleep b/c the cough med must've superseded my elavil - I was wide awake the entire night. I can't imagine having to balance 3. But, I sent a letter to my doctor telling him how I was feeling, and that I'd like to try cytomel if he thinks it something that might help or Lexapro. I'll just have to find a way to pay for it if he goes with Lexapro. I'm sure he's at his wit's end with me since he's been pushing me toward Paxil during the last 2 visits - I'm not good at listening to him. Paxil just seems like it would be so bad with the side effects. I know I should consider my mental health first, but there is evidence now these drugs affect metabolism, thyroid function. Plus, generally, I am pretty stable - I've improved some over the past several months. No huge blowups. I just go through these spells where I'm ultra-sensitive. It's hard to explain but I just don't feel right and I see the bad in everything. I can't make myself do things I don't want to do. Then, I come out of it like nothing happened. It's almost like a high, though I don't go on mad shopping sprees or anything. It could be hormones. When my periods were normal, I'd always get 1 seriously low PMS day. Now, I have many days throughout the month like that. That's why my gyno wanted the pill for me b/c the pill shuts down the process so I'm not struggling to ovulate and I get a steady stream of hormones. Prog cream doesn't affect ovulation - it just makes sure I build and shed the lining. My gyno says I probably am ovulating - just not regularly. I actually find I do slightly better on months I do no prog. cream. I will bloat and break out and have that 1 bad PMS day, but I don't seem to have as many bad days. I'm going to cease it this month to see how it goes.
I actually don't have many PCOS symptoms. I'm underweight, I don't break out unless it's a month I skip a cycle, I have normal blood sugar, no insulin resistance. I do have borderline high cholesterol and hypothyroidism, common among women w/PCOS.
Posted by ed_uk2010 on February 8, 2012, at 13:35:55
In reply to Re: Thyroid levels and Serotonin, posted by Maisey on February 8, 2012, at 10:29:55
>My TSH was tested in Dec. and August and came out normal. I also had a Hashimoto's test done (thyroid anti-bodies) because I HAD been experiencing some symptoms similar to those that I had before being dxed hypothyroid. It was also normal, and the symptoms disappeared.
It sounds like your Synthroid dose is correct and you are not experiencing obvious symptoms of hypothyroidism. I doubt that T3 treatment would be beneficial for your mental health because Synthroid alone seems to have stabilised your thyroid function and your mental health problems (probably) pre-date the hypothyroidism.
>I think my doctor feels I'm bipolar but does not want to say for some reason. There is a family history.It does sound like you have some form of mood disorder, bipolar or otherwise. Depression, anger, irritability and feeling sensitive can be a problem in most types of mood disorder. There are a lot of people on here with bipolar so you can get a great deal of information. It would certainly be better if you could afford to see a psychiatrist though.
>My doctor I think prefers Lexapro as an anti-depressant in general, but he moved away from it for me b/c of the cost. There isn't a generic, I have no prescription drug coverage, so it was running me $88 a month.
By far the closest product to escitalopram (Lexapro) is citalopram. Citalopram is available as a generic. Citalopram is much more similar to Lexapro than Paxil. Paxil can be an effective antidepressant, but it does seem to cause somewhat more adverse effects than citalopram and Lexapro. Paxil also tends to be more difficult to stop because the withdrawal symptoms are more intense. Sertraline (Zoloft) is currently a popular SSRI. We have generics of sertraline in the UK, I assume you do too.
>Also, I didn't think it did much, but I was at the point for awhile that I was holding down at least a part-time steady job.
If you do have bipolar disorder, antidepressants can be problematic. They sometimes destabilise mood. On the other hand, I doubt that your primary care doctor would want to make a bipolar diagnosis or prescribe mood stabilisers.
>my Elavil - I was wide awake the entire night.
Ah, so you take amitriptyline? Amitriptyline is an antidepressant but some people just take very low doses for sleep.
>I actually find I do slightly better on months I do no prog. cream. I will bloat and break out and have that 1 bad PMS day, but I don't seem to have as many bad days. I'm going to cease it this month to see how it goes.
I'm not that familiar with the cream, but progesterone tablets sometimes cause mood changes so it's something to be aware of.
Posted by Maisey on February 8, 2012, at 19:34:46
In reply to Re: Thyroid levels and Serotonin » Maisey, posted by ed_uk2010 on February 8, 2012, at 13:35:55
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