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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by nmk on April 13, 2003, at 19:08:27
Mitch and all other babblers, I'm sorry to bother you again with some questions but I really need your help and appreciate the support you have offered in the past.
Here is my situation. One year ago, I was diagnosed with PPD. Since I had experienced PPD with my twins 7 years ago, I was put on 50 mg of zoloft after delivery of my third. The PPD came with severe this time around and increasing the zoloft to 150mg did nothing. I then tried Effexor (did nothing but make me dizzy and anxoius) and Lexapro (worked ok but nausea was too intense, even combined with a prescription anti-nausea drug).
Had my thryroid tested 3 months after the PPD diagnosis and it came back low so I was put on .025mg synthroid. Felt a little better after a week but still couldn't kick the depression/anxiety/agitation.
Then Strattera came out. I was put on 18 mg and my life changed completely....for three weeks. Then all hell broke loose and the anxiety/depression returned.
Two months ago, my doc said that if the AD's were not going to work, he was going to try Trileptal. He started me at 600 mg x2 per day but the nausea and dizziness were too much for me to take. Here is my current combo: 300 mg Trileptal x2 per day, 50 mg zoloft, 18 mg of Strattera and at night 25 mg of seroquel and 15 mg of remeron.
One other thing....when he started me on the trileptal, he also switched my thryoid med to .025 cytomel because he stated that cytomel was a more effective for the depression. Well, the cytomel sent my anxiety through the roof within days and I went off. The strange thing is, that when I went of the thyroid meds 3 weeks ago, I felt wonderful and therefore, attributed this last year of med hell to the thyroid meds. Well, the depression and anxiety returned a few days ago so I don't know what is going on. I feel over-medicated, frustrated, and wonder if I need to be on the Trileptal at all (or any meds for that matter). I continue to ask my pdoc for a diagnosis but he seems to feel that it is more important to "treat the symptoms". I have never had a classic manic episode in my life, but since the PPD started, I go from depression, to anxiety/agitation, to feeling "normal" for a few weeks.
I apologize for the lengthy post but I wanted to give you the complete history so I know what to ask for/discuss with my doctor this Friday. I did set up an appt. with an endo to have a full thyroid profile completed since my pdoc has not been monitoring my levels. I know that many times with PPD, the thyroid problems eventually correct on their own.
I am hoping you can offer me any insight, advice, support that you can. Thanks for your help.!
Nicole
Posted by McPac on April 13, 2003, at 21:24:15
In reply to Mitch and others, I really need some advice..., posted by nmk on April 13, 2003, at 19:08:27
I don't really know if this link is what you need but see what you think!
Posted by Ritch on April 14, 2003, at 10:40:48
In reply to Mitch and others, I really need some advice..., posted by nmk on April 13, 2003, at 19:08:27
> Mitch and all other babblers, I'm sorry to bother you again with some questions but I really need your help and appreciate the support you have offered in the past.
>
> Here is my situation. One year ago, I was diagnosed with PPD. Since I had experienced PPD with my twins 7 years ago, I was put on 50 mg of zoloft after delivery of my third. The PPD came with severe this time around and increasing the zoloft to 150mg did nothing. I then tried Effexor (did nothing but make me dizzy and anxoius) and Lexapro (worked ok but nausea was too intense, even combined with a prescription anti-nausea drug).
>
> Had my thryroid tested 3 months after the PPD diagnosis and it came back low so I was put on .025mg synthroid. Felt a little better after a week but still couldn't kick the depression/anxiety/agitation.
>
> Then Strattera came out. I was put on 18 mg and my life changed completely....for three weeks. Then all hell broke loose and the anxiety/depression returned.
>
> Two months ago, my doc said that if the AD's were not going to work, he was going to try Trileptal. He started me at 600 mg x2 per day but the nausea and dizziness were too much for me to take. Here is my current combo: 300 mg Trileptal x2 per day, 50 mg zoloft, 18 mg of Strattera and at night 25 mg of seroquel and 15 mg of remeron.
>
> One other thing....when he started me on the trileptal, he also switched my thryoid med to .025 cytomel because he stated that cytomel was a more effective for the depression. Well, the cytomel sent my anxiety through the roof within days and I went off. The strange thing is, that when I went of the thyroid meds 3 weeks ago, I felt wonderful and therefore, attributed this last year of med hell to the thyroid meds. Well, the depression and anxiety returned a few days ago so I don't know what is going on. I feel over-medicated, frustrated, and wonder if I need to be on the Trileptal at all (or any meds for that matter). I continue to ask my pdoc for a diagnosis but he seems to feel that it is more important to "treat the symptoms". I have never had a classic manic episode in my life, but since the PPD started, I go from depression, to anxiety/agitation, to feeling "normal" for a few weeks.
>
> I apologize for the lengthy post but I wanted to give you the complete history so I know what to ask for/discuss with my doctor this Friday. I did set up an appt. with an endo to have a full thyroid profile completed since my pdoc has not been monitoring my levels. I know that many times with PPD, the thyroid problems eventually correct on their own.
>
> I am hoping you can offer me any insight, advice, support that you can. Thanks for your help.!
>
> Nicole
I would pursue the thyroid situation until it has been completely unraveled and thoroughly investigated. Getting an endocrinologist is vital here. It does sound like bipolar mood cycling, BUT until you get all of the possible neuro-endocrine issues addressed or eliminated, you are not going to be able to tell for sure. It would be a hassle to take too many or the wrong meds due to an undiagnosed general medical condition.
Posted by nmk on April 14, 2003, at 14:41:48
In reply to Re: Mitch and others, I really need some advice... » nmk, posted by Ritch on April 14, 2003, at 10:40:48
Thank you both for the replies, you have been so helpful and I really appreciate your input. A few more questions for you....I see the endocrinologist on Wednesday and other than a complete thryoid profile, what other tests should I request?
Also, could the trileptal be the source of the anxiety/agitation? This is where my confusion comes in. Sounds like a silly question but if one is given a mood stabilizer but is not bipolar, what are the effects? If I do in fact have BPII, what is your take on my pdoc prescribing 50 mg of zoloft and 18 mg of Strattera. Couldn't it be that all of these AD's are the source of the anxiety (especially the Strattera)?
Thanks,
Nicole
>
>
> I would pursue the thyroid situation until it has been completely unraveled and thoroughly investigated. Getting an endocrinologist is vital here. It does sound like bipolar mood cycling, BUT until you get all of the possible neuro-endocrine issues addressed or eliminated, you are not going to be able to tell for sure. It would be a hassle to take too many or the wrong meds due to an undiagnosed general medical condition.
Posted by Snoozy on April 15, 2003, at 1:05:22
In reply to Mitch and others, I really need some advice..., posted by nmk on April 13, 2003, at 19:08:27
Hi - I'm new here, and I just wanted to throw my 2 cents in on hypothyroidism. I've been hypothyroid for many years.
I would suggest that if you're not familiar with the thyroid and the treatments, that you do some research before you see the endocrinologist. When you first get into this, and you don't know what any of the terms mean, it can be confusing.
Synthroid is a T4 replacement, and Cytomel is T3. Learning about the two is helpful (also TSH).
I have found it useful over the years to have copies of my thyroid test results, just to see where things have been/are going.
I apologize if I'm butting in, or telling you things you already know. I have found over the years that having some knowledge of an illness or treatment has been an immense help in getting the right treatment. (Or feeling better about whatever the doc comes up with ;)> Mitch and all other babblers, I'm sorry to bother you again with some questions but I really need your help and appreciate the support you have offered in the past.
>
> Here is my situation. One year ago, I was diagnosed with PPD. Since I had experienced PPD with my twins 7 years ago, I was put on 50 mg of zoloft after delivery of my third. The PPD came with severe this time around and increasing the zoloft to 150mg did nothing. I then tried Effexor (did nothing but make me dizzy and anxoius) and Lexapro (worked ok but nausea was too intense, even combined with a prescription anti-nausea drug).
>
> Had my thryroid tested 3 months after the PPD diagnosis and it came back low so I was put on .025mg synthroid. Felt a little better after a week but still couldn't kick the depression/anxiety/agitation.
>
> Then Strattera came out. I was put on 18 mg and my life changed completely....for three weeks. Then all hell broke loose and the anxiety/depression returned.
>
> Two months ago, my doc said that if the AD's were not going to work, he was going to try Trileptal. He started me at 600 mg x2 per day but the nausea and dizziness were too much for me to take. Here is my current combo: 300 mg Trileptal x2 per day, 50 mg zoloft, 18 mg of Strattera and at night 25 mg of seroquel and 15 mg of remeron.
>
> One other thing....when he started me on the trileptal, he also switched my thryoid med to .025 cytomel because he stated that cytomel was a more effective for the depression. Well, the cytomel sent my anxiety through the roof within days and I went off. The strange thing is, that when I went of the thyroid meds 3 weeks ago, I felt wonderful and therefore, attributed this last year of med hell to the thyroid meds. Well, the depression and anxiety returned a few days ago so I don't know what is going on. I feel over-medicated, frustrated, and wonder if I need to be on the Trileptal at all (or any meds for that matter). I continue to ask my pdoc for a diagnosis but he seems to feel that it is more important to "treat the symptoms". I have never had a classic manic episode in my life, but since the PPD started, I go from depression, to anxiety/agitation, to feeling "normal" for a few weeks.
>
> I apologize for the lengthy post but I wanted to give you the complete history so I know what to ask for/discuss with my doctor this Friday. I did set up an appt. with an endo to have a full thyroid profile completed since my pdoc has not been monitoring my levels. I know that many times with PPD, the thyroid problems eventually correct on their own.
>
> I am hoping you can offer me any insight, advice, support that you can. Thanks for your help.!
>
> Nicole
Posted by Snoozy on April 15, 2003, at 1:13:22
In reply to Re: Mitch and others, I really need some advice..., posted by Snoozy on April 15, 2003, at 1:05:22
> Hi - I'm new here, and I just wanted to throw my 2 cents in on hypothyroidism. I've been hypothyroid for many years.
>
> I would suggest that if you're not familiar with the thyroid and the treatments, that you do some research before you see the endocrinologist. When you first get into this, and you don't know what any of the terms mean, it can be confusing.
>
> Synthroid is a T4 replacement, and Cytomel is T3. Learning about the two is helpful (also TSH).
>
> I have found it useful over the years to have copies of my thyroid test results, just to see where things have been/are going.
>
>
> I apologize if I'm butting in, or telling you things you already know. I have found over the years that having some knowledge of an illness or treatment has been an immense help in getting the right treatment. (Or feeling better about whatever the doc comes up with ;)
>
I found an info. pdf from the American Thyroid Association that you may find helpful:http://www.thyroid.org/resources/patients/brochures/Hypothyroidism%20Booklet%20for%20web.pdf
> > Mitch and all other babblers, I'm sorry to bother you again with some questions but I really need your help and appreciate the support you have offered in the past.
> >
> > Here is my situation. One year ago, I was diagnosed with PPD. Since I had experienced PPD with my twins 7 years ago, I was put on 50 mg of zoloft after delivery of my third. The PPD came with severe this time around and increasing the zoloft to 150mg did nothing. I then tried Effexor (did nothing but make me dizzy and anxoius) and Lexapro (worked ok but nausea was too intense, even combined with a prescription anti-nausea drug).
> >
> > Had my thryroid tested 3 months after the PPD diagnosis and it came back low so I was put on .025mg synthroid. Felt a little better after a week but still couldn't kick the depression/anxiety/agitation.
> >
> > Then Strattera came out. I was put on 18 mg and my life changed completely....for three weeks. Then all hell broke loose and the anxiety/depression returned.
> >
> > Two months ago, my doc said that if the AD's were not going to work, he was going to try Trileptal. He started me at 600 mg x2 per day but the nausea and dizziness were too much for me to take. Here is my current combo: 300 mg Trileptal x2 per day, 50 mg zoloft, 18 mg of Strattera and at night 25 mg of seroquel and 15 mg of remeron.
> >
> > One other thing....when he started me on the trileptal, he also switched my thryoid med to .025 cytomel because he stated that cytomel was a more effective for the depression. Well, the cytomel sent my anxiety through the roof within days and I went off. The strange thing is, that when I went of the thyroid meds 3 weeks ago, I felt wonderful and therefore, attributed this last year of med hell to the thyroid meds. Well, the depression and anxiety returned a few days ago so I don't know what is going on. I feel over-medicated, frustrated, and wonder if I need to be on the Trileptal at all (or any meds for that matter). I continue to ask my pdoc for a diagnosis but he seems to feel that it is more important to "treat the symptoms". I have never had a classic manic episode in my life, but since the PPD started, I go from depression, to anxiety/agitation, to feeling "normal" for a few weeks.
> >
> > I apologize for the lengthy post but I wanted to give you the complete history so I know what to ask for/discuss with my doctor this Friday. I did set up an appt. with an endo to have a full thyroid profile completed since my pdoc has not been monitoring my levels. I know that many times with PPD, the thyroid problems eventually correct on their own.
> >
> > I am hoping you can offer me any insight, advice, support that you can. Thanks for your help.!
> >
> > Nicole
>
>
Posted by Ritch on April 15, 2003, at 10:26:13
In reply to Re: Just a few more questions for you » Ritch, posted by nmk on April 14, 2003, at 14:41:48
The only tests that I have ever been through with an endo were the basic thyroid ones. Trileptal could be causing the agitation, but so could all of your meds. I would pressure your pdoc for a diagnosis (the BP-thing). IF he will not volunteer one-see if you can force him to speculate about it at the least. Just my opinion here, but I think it is ludicrous to treat people with all sorts of meds based on suspicions without committing to a diagnosis and discussing ?why? they are being prescribed.
> Thank you both for the replies, you have been so helpful and I really appreciate your input. A few more questions for you....I see the endocrinologist on Wednesday and other than a complete thryoid profile, what other tests should I request?
>
> Also, could the trileptal be the source of the anxiety/agitation? This is where my confusion comes in. Sounds like a silly question but if one is given a mood stabilizer but is not bipolar, what are the effects? If I do in fact have BPII, what is your take on my pdoc prescribing 50 mg of zoloft and 18 mg of Strattera. Couldn't it be that all of these AD's are the source of the anxiety (especially the Strattera)?
>
> Thanks,
>
> Nicole
>
> >
> >
> > I would pursue the thyroid situation until it has been completely unraveled and thoroughly investigated. Getting an endocrinologist is vital here. It does sound like bipolar mood cycling, BUT until you get all of the possible neuro-endocrine issues addressed or eliminated, you are not going to be able to tell for sure. It would be a hassle to take too many or the wrong meds due to an undiagnosed general medical condition.
>
>
Posted by nmk on April 15, 2003, at 12:20:20
In reply to Re: Just a few more questions for you » nmk, posted by Ritch on April 15, 2003, at 10:26:13
Thank you both for taking the time too reply. I really appreciate your insight Mitch and I will press a little harder for a dx.
Snoozy, thanks for the article...i have printed it off and will read before my appt. tomorrow.
Nicole
Posted by nmk on April 17, 2003, at 11:58:28
In reply to Mitch and others, I really need some advice..., posted by nmk on April 13, 2003, at 19:08:27
Went to the endocrinologist yesterday and he concurred with your advice Mitch. He suggested we rule out anything medical and go from there. He said my thryoid was enlarged and ordered the standard blood tests so now i will wait and see. He also said that the dose of synthroid my pdoc had me on was not at a therapeutic level. I should have gone to med school. Thanks again Mitch, you are a gem.
Posted by noa on April 17, 2003, at 13:06:48
In reply to Re: Endo update, posted by nmk on April 17, 2003, at 11:58:28
GOod luck. I'm glad you went to an endo. If your thyroid is enlarged--it sounds like there is definitely a problem to treat.
I was on low doses of thyroid meds from pdoc but it was only when the endo diagnosed the hypothyroidism and we raised the synthroid did I start getting proper AD effect form my AD meds.
Keep us posted.
Posted by Ritch on April 17, 2003, at 21:23:38
In reply to Re: Endo update, posted by nmk on April 17, 2003, at 11:17:03
> Went to the endocrinologist yesterday and he concurred with your advice Mitch. He suggested we rule out anything medical and go from there. He said my thryoid was enlarged and ordered the standard blood tests so now i will wait and see. He also said that the dose of synthroid my pdoc had me on was not at a therapeutic level. I should have gone to med school. Thanks again Mitch, you are a gem.
Thanks, Let us know what the results are of your tests! Geez, I hope that you have nothing more to do than to take an appropriate dosage of thyroid hormone supplementation to shrink your thyroid and get your TSH back into a decent range. Uggh-I wouldn't want to have to go through surgery again.... Even an overnight observational stay in the hospital sucks. I think you may be on a good track and simply an adjustment of medication is all you need!
Posted by nmk on April 21, 2003, at 11:28:03
In reply to Re: Endo update » nmk, posted by Ritch on April 17, 2003, at 21:23:38
>
Let's hope so. A few days after the endo appt. I saw my pdoc and he feels that the primary source of my depression/anxiety is not due to my thyroid. He increased the Trileptal from 600 mg per day to 750 mg and wants me to titrate up every 4 days by 150 mg to reach a max dose of 1200 mg. Am not on any thryoid meds yet since the test results are not back.This is all so confusing....I do feel better since I increased the Trileptal; the depression is gone and I feel energized. I don't know if it is due to the meds or if I am cycling. Also, I don't know if I should continue to titrate up if I am doing well at 750 mg. For a control freak like myself, this is so difficult to deal with.
Posted by noa on April 21, 2003, at 12:18:15
In reply to Re: Endo update, posted by nmk on April 21, 2003, at 11:28:03
Even if thyroid isn't the primary reason for the depression, if you are hypothyroid, it could be getting in the way of full response from the meds.
But it is good to hear that you are feeling better on your increased dose. Hope it continues to improve.
Posted by Ritch on April 21, 2003, at 23:39:26
In reply to Re: Endo update, posted by nmk on April 21, 2003, at 11:28:03
> >
> Let's hope so. A few days after the endo appt. I saw my pdoc and he feels that the primary source of my depression/anxiety is not due to my thyroid. He increased the Trileptal from 600 mg per day to 750 mg and wants me to titrate up every 4 days by 150 mg to reach a max dose of 1200 mg. Am not on any thryoid meds yet since the test results are not back.
>
> This is all so confusing....I do feel better since I increased the Trileptal; the depression is gone and I feel energized. I don't know if it is due to the meds or if I am cycling. Also, I don't know if I should continue to titrate up if I am doing well at 750 mg. For a control freak like myself, this is so difficult to deal with.
>
>The next step is to get your thyroid lab work back in and proceed from there. Then you will know whether your pdoc's hunches are correct or not.
This is the end of the thread.
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