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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by juniper on January 1, 2000, at 17:45:34
a little history:
i have been off and on several ADs, benzos, ritalin for the past 10 years (i am 23). i first dove into mental disorders when i was 11--i had an odd form of what i'd say was OCD, which focused on my skin, more specifically the total annihilation of any form of blemish or precurser thereof. i attracted the attention of my parents and therefor therapists and pdocs when i became anorexic/depressed at age 13. many drugs, hospitalizations, and therapy later i am working on depression and binge eating (does it ever get any easier?) i am now taking 150mg of effexor XR--though this is not supervised by any doctor--it is an old prescription i dug up and filled. i think the medication is having only a slight effect, which is the way all medication has been for me (unless there is no effect).
six years ago i was diagnosed with hypothyroidism and i take 1.0mg of synthroid daily. i have my TSH levels checked every 6 months or so and usually i swing around normal (though i do not understand precisely what this means). i wonder though if considering my depression and energy level it would benefit me to be on the high end of normal (i do understand that the semantics here are a bit tricky, as high levels of TSH
are indicative of low levels of other thyroid hormones). does anyone know if staying on the high end of the normal spectrum may help depression?
Posted by Scott L. Schofield on January 1, 2000, at 21:22:24
In reply to influence of thyroid on depression, posted by juniper on January 1, 2000, at 17:45:34
> six years ago i was diagnosed with hypothyroidism and i take 1.0mg of synthroid daily. i have my TSH levels checked every 6 months or so and usually i swing around normal (though i do not understand precisely what this means). i wonder though if considering my depression and energy level it would benefit me to be on the high end of normal (i do understand that the semantics here are a bit tricky, as high levels of TSH are indicative of low levels of other thyroid hormones). does anyone know if staying on the high end of the normal spectrum may help depression?
I just responded to another person’s post that may be of some help here. Not to be pretentious…
> Thyroid analysis is a tricky thing that I don’t trust the average run-in-the mill endocrinologist to perform.
The tests themselves may be simple enough, but interpreting them can be a real challenge. TRH, TSH, T4, T3, T4/T3 ratio… Now try to interpret them in the context of severe neurophysiological depression and the changes in thyroid function that may result from it. Now try to interpret them in the context of severe neurophysiological depression and the plethora of drugs the subject may be taking as treatment. Now consider all of the aforementioned as being totally irrelevant because, regardless of thyroid function, thyroid medications will be used as an allotropic adjunct to augment the current treatment being employed on the subject.I think that there are some clinicians who would agree with your surmises regarding thyroid levels. Low thyroid levels in and of themselves are capable of producing depression. It is not an uncommon practice to add thyroid hormones to a treatment regime, regardless of test results. It seems to me that it would be a lot simpler to just consider trying thyroid medications and see what happens. Both T3 (Cytomel) and T4 (Synthroid) should be considered as neither are universally effective. Cytomel actually made me feel significantly worse, while Synthroid was somewhat helpful. For others, it is Cytomel that does the trick. Psychiatrists may tend to choose Cytomel, as much of the past literature has focused on it. I think that this tendency may thus be self-perpetuating, leading to the unwarranted neglect of Synthroid.
Good Luck… Let us know what happens.
Sincerely,
Scott
Posted by S. Suggs on January 2, 2000, at 5:06:47
In reply to influence of thyroid on depression, posted by juniper on January 1, 2000, at 17:45:34
"normal" is only a text book range to group us all into one category. I would suggest you find a good Endocrinologist and have him check you over from "head to toe", you may find a solution to your problem. Who knows? Best y2k wishes and blessings,
S. Suggs
Posted by saint james on January 3, 2000, at 2:05:18
In reply to Re: influence of thyroid on depression, posted by S. Suggs on January 2, 2000, at 5:06:47
> "normal" is only a text book range to group us all into one category. I would suggest you find a good Endocrinologist and have him check you over from "head to toe", you may find a solution to your problem. Who knows? Best y2k wishes and blessings,
>
> S. Suggs
james here....Here, here. Endocrinology is even more complex than neurology ! A consult and work up is a good idea. In general I have read you want to keep levels in the upper 1/4 of norm.....but you really need a good Endocrinologist to interp all the tests.
j
Posted by Zeke on January 4, 2000, at 17:21:09
In reply to Re: influence of thyroid on depression, posted by S. Suggs on January 2, 2000, at 5:06:47
> I would suggest you find a good Endocrinologist and have him check you over from "head to toe", you may find a solution to your problem.
I agree except I suggest a neuroendocrinologist. Most 'simple' endocrinologists tend to focus more on diabetes etc. and aren't well versed on neuropsychiatric-endocrine connections in a clinical sense.
You have a much better shot at finding a neuroendocrinologist if you live near a major city or medical school -- most neuroendocrinologists are in academia...
One interesting thing about thyroid hormones is their similarity to catecholamines (dopamine, norepinephrine) and the fact that they are similarly metabolized from tyrosine.
Another tidbit, is the research about kids with ADD also being resistant to thyroid hormone.
Lastly, is what is referred to as the HPA axis -- hypothalamic-ptuatary-adrenal axis -- (and HPT axis -- T = thyroid) which plays a role in both cause and effect in psychiatric disorders.
Take a look at these URLs...
Affective disorders, thyroid autoimmunity and the HPA and HPT axis
http://www.mentalhealth-net.com/research/projects/0167/The Neurobiology of Depression
(the section "Hormonal Abnormalities" in particular)
http://medicine.psu.ac.th/psychiatry/0698neme.htm
Posted by S. Suggs on January 5, 2000, at 5:38:54
In reply to Re: influence of thyroid on depression, posted by Zeke on January 4, 2000, at 17:21:09
Zeke, my friend, you just taught me a new one. I had no idea that a Neuroendocrinologist even exist. Thanks for the info on thyroid issues, you seem to have it down well. Blessings,
S. Suggs
Posted by juniper on January 5, 2000, at 13:58:32
In reply to Re: influence of thyroid on depression-to Zeke, posted by S. Suggs on January 5, 2000, at 5:38:54
i want to thank everyone for the information they added to this post...i also had no idea that neuroendocrinogist was even a legitamate word.
thanks to all!juniper
Posted by Seamus on January 9, 2000, at 10:48:21
In reply to Re: influence of thyroid on depression-to Zeke, posted by S. Suggs on January 5, 2000, at 5:38:54
Suggs,
Me again. Tests, tests and more tests -- Bah! I have no idea what a full thyroid workup, incl HPA would run, but I can imagine it's not cheap.
I opted for the empirical method, and fortunately my doctor agreed. A cursory CYA (cover your ass) of TSH, T3 and T4, then added the thyroid. Another TSH, T3 and T4 every six months.
Focus on the solution, not the problem.
Seamus
Posted by Scott L. Schofield on January 9, 2000, at 15:08:05
In reply to Re: influence of thyroid on depression-to Zeke, posted by Seamus on January 9, 2000, at 10:48:21
> Suggs,
>
> Me again. Tests, tests and more tests -- Bah! I have no idea what a full thyroid workup, incl HPA would run, but I can imagine it's not cheap.What's an HPA test?
- Scott
Posted by S. Suggs on January 9, 2000, at 19:38:55
In reply to Re: influence of thyroid on depression-to Zeke, posted by Seamus on January 9, 2000, at 10:48:21
Several months ago we did a series of about 6 thyroid test. My doc is more on the conservative side and less aggressive when it comes to meds - even though he let me try parnate at my request and take it to the PDR max 60 mg (even though others go much higher). Thanks for the post, and blessings,
S. Suggs
Posted by Seamus on January 10, 2000, at 19:49:49
In reply to Re: influence of thyroid on depression-to Zeke, posted by S. Suggs on January 9, 2000, at 19:38:55
> Several months ago we did a series of about 6 thyroid test. My doc is more on the conservative side and less aggressive when it comes to meds - even though he let me try parnate at my request and take it to the PDR max 60 mg (even though others go much higher). Thanks for the post, and blessings,
Ask the dork what possible harm could come from the addition of 1 gr.thyroid? Could the benefit outweigh the predictable side effects, if any?
There's conservatism, and there's ossification. Which camp is your doctor in?
Seamus
Posted by S. Suggs on January 11, 2000, at 5:17:54
In reply to Re: influence of thyroid on depression-to Zeke, posted by Seamus on January 10, 2000, at 19:49:49
I'd love to ad the thyroid. I do plan on talking to him to run it by as a suggestion. I'll have to do my homework (get hardcopy info) for him. Any suggestions, thanks and blessings,
S. Suggs
This is the end of the thread.
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