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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by bookgurl99 on May 16, 2003, at 1:24:35
Hey,
I am thinking of quitting psych meds. I believe that my symptoms of severe anxiety may be controllable through other means, though I will have to be quite disciplined as I ride out the non-med period and change my lifestyle for the better.
With getting off Zoloft, and seeing a positive change there, and then feeling dopey again on Serzone (my old favorite), and Straterra,I'm starting to feel that it may be healthier for me to find other ways.
Admittedly, I have a chance that changing my thyroid treatment to a t4/t3 treatment (not just t4) will help my anxiety. So I may have more 'options,' just not technically psych related.
My intuition has been nagging me on this for awhile. I think that there may be another way out there for me.
Does anyone have suggestions for me? Did you ever quit meds and find another way? How do you get through those first couple of months when your brain's looking for the med?
Right now I envision lots of anxiety, counterbalanced with yoga, daily exercise, journaling prayers, and therapy. Plus keeping on top of my eating right.
Any hope for an anxious/ocd type off meds?
Posted by Snoozy on May 16, 2003, at 1:51:46
In reply to Thinking of quitting meds, posted by bookgurl99 on May 16, 2003, at 1:24:35
Hi books -
I'm also an anxious OCD type, and I've been off Xanax for 2 months now. I'm still taking Wellbutrin, which if it does anything, probably actually induces anxiety:) I was on benzos for about 10 years for anxiety.
I tapered off really slowly, and it wasn't bad. There's no night-and-day difference in my anxiety levels - maybe they're a bit higher now, but not a big difference. It seems like with a lot of meds, not just psych meds, you get into this cycle of taking one drug, and then having to take another drug to counteract side effects from the first drug, so on and so on, until all the pharmacists know you by your first name.
Your ideas sound really good - what about meditation and relaxation techniques? I have a really nice relaxation tape that I find quite helpful. I also learned some relaxation techniques I can use anywhere.
I'd be curious to hear if changing thyroid meds does anything for you. I've been on just Synthroid forever.
Good luck - I hope this works for you!
> Hey,
>
> I am thinking of quitting psych meds. I believe that my symptoms of severe anxiety may be controllable through other means, though I will have to be quite disciplined as I ride out the non-med period and change my lifestyle for the better.
>
> With getting off Zoloft, and seeing a positive change there, and then feeling dopey again on Serzone (my old favorite), and Straterra,I'm starting to feel that it may be healthier for me to find other ways.
>
> Admittedly, I have a chance that changing my thyroid treatment to a t4/t3 treatment (not just t4) will help my anxiety. So I may have more 'options,' just not technically psych related.
>
> My intuition has been nagging me on this for awhile. I think that there may be another way out there for me.
>
> Does anyone have suggestions for me? Did you ever quit meds and find another way? How do you get through those first couple of months when your brain's looking for the med?
>
> Right now I envision lots of anxiety, counterbalanced with yoga, daily exercise, journaling prayers, and therapy. Plus keeping on top of my eating right.
>
> Any hope for an anxious/ocd type off meds?
>
>
Posted by bookgurl99 on May 16, 2003, at 2:48:38
In reply to Re: Thinking of quitting meds » bookgurl99, posted by Snoozy on May 16, 2003, at 1:51:46
> I'd be curious to hear if changing thyroid meds does anything for you. I've been on just Synthroid forever.
>Snoozy, I'm on levoxothyrine generic synthroid, but most of the symptoms that bother me at this point may be thyroid related. (Mostly, trouble concentrating, memory troubles, brain foggy stuff.)
Thyroid Info prints an abstract of a New England Journal Of Medicine Article here: http://www.thyroid-info.com/articles/t3drugsnejm.htm; which shows that many people experience better cognition and mood on T3(cytomel or in armour) in addition to T4 (synthroid). So hopefully my dr. will be open-minded about it; he may help as he's fearful that I'll become diabetic, and t3 _may_ help one lose weight.
Thx for the support. Yeah, I'll try prescriptions again if I must, but I want to see if I can get everything else in shape too.
p.s. I read a medical study on women with ocd a few years ago; the test concluded that female ocd _may_ be related to low or low normal thyroid (hypothyroidism). Interesting, hmm?
Posted by medlib on May 16, 2003, at 7:09:51
In reply to Thinking of quitting meds, posted by bookgurl99 on May 16, 2003, at 1:24:35
Hi books--
I'm going in for thyroid tests soon to see if I should add T3 to my Synthroid; I *would* like to see what effects Cytomel might have.
As you go off rx meds, you might consider adding niacinamide (a natural supplement) for anxiety. Even if it doesn't completely control your anxiety, it may make tapering off of meds less of an ordeal. From the threads above, it sounds like a number of babblers have found it helpful. I plan to try Enada (NADH), TMG, fish oil and magnesium supplements after the T3 issue is settled; I hope some or all may enable me to d/c, or at least lower the dosage of, the Effexor and/or Wellbutrin I currently take. So, I think that your plan definitely sounds worth trying.
I hope that "less is more" for both of us. Good luck!---medlib
Posted by bookgurl99 on May 16, 2003, at 8:56:23
In reply to Re: Thinking of quitting meds » bookgurl99, posted by medlib on May 16, 2003, at 7:09:51
Medlib,
Hey thanks for your support and suggestions. I never knew that niacinamide can help. :D
Isn't it surprising how many hypos there are of us on psych meds? Maybe it's time for medicine to reconsider the T3 issue for _real_, not treat it as a fringe practice.
books
Posted by daizy on May 16, 2003, at 9:06:55
In reply to Thinking of quitting meds, posted by bookgurl99 on May 16, 2003, at 1:24:35
Hi! Im also thinking of coming off my meds soon, as the anhedonia is really starting to get unbearable. It is a big step, but you sound prepared for it, like you have a list of things that will help you, certainly keeping fit and eating a balanced diet is very important, it also gives you something to focus on. Routine is also important, if you get into a routine be, it with exercise or keeping a diary of you feelings and therapy, it all gives you structure.
Im thinking of keeping a benzo with me, Im hoping it will stop me from having a panic attack, knowing that its there if I need when I feel very anxious, that might be an Idea?
Good luck I really hope its successeful!Hey,
>
> I am thinking of quitting psych meds. I believe that my symptoms of severe anxiety may be controllable through other means, though I will have to be quite disciplined as I ride out the non-med period and change my lifestyle for the better.
>
> With getting off Zoloft, and seeing a positive change there, and then feeling dopey again on Serzone (my old favorite), and Straterra,I'm starting to feel that it may be healthier for me to find other ways.
>
> Admittedly, I have a chance that changing my thyroid treatment to a t4/t3 treatment (not just t4) will help my anxiety. So I may have more 'options,' just not technically psych related.
>
> My intuition has been nagging me on this for awhile. I think that there may be another way out there for me.
>
> Does anyone have suggestions for me? Did you ever quit meds and find another way? How do you get through those first couple of months when your brain's looking for the med?
>
> Right now I envision lots of anxiety, counterbalanced with yoga, daily exercise, journaling prayers, and therapy. Plus keeping on top of my eating right.
>
> Any hope for an anxious/ocd type off meds?
>
>
Posted by Tabitha on May 16, 2003, at 9:48:30
In reply to Thinking of quitting meds, posted by bookgurl99 on May 16, 2003, at 1:24:35
trust your instinct, and just see how it goes. I've quit my mood stabiliser and reduced my AD and so far doing fine. I found the benefit I was getting from the extra meds was smaller than I thought, and not really worth the side effects. I've tried quitting before and failed, but this time it's better.
Good luck!
Posted by judy1 on May 16, 2003, at 13:07:20
In reply to Thinking of quitting meds, posted by bookgurl99 on May 16, 2003, at 1:24:35
I relied a great deal on my pdoc (actually very supportive of my decision) and therapist. Since my pdoc is an MD he would tell me a lot of my symptoms were withdrawal and he had numerous patients having the same symptoms. it really helped knowing I had support and knowing other people were experiencing the same feelings. I did go the supplement route- Truehope- but got tired of taking 16 pills a day. I think you'll find your positive attitude the key to success here, the brain is pretty powerful. best of luck-judy
Posted by Pfinstegg on May 16, 2003, at 13:49:45
In reply to Re: Thinking of quitting meds » bookgurl99, posted by judy1 on May 16, 2003, at 13:07:20
From what you say, anxiety rather than depression is your most prominent symptom; with that situation, I think it's really worthwhile to aim for either lower or no meds. Probably going gradually lower while you add the other things you mentioned would be the smoothest and easiest.
I no longer take any AD's, but really count on the Cytomel, synthroid, fish oil, magnesium and a ton of vitamins - all the B's especially. Also, I do try to exercise and meditate every day, although I'm not as disciplined as i wish!
It really is fascinating how many people posting here need to take thyroid supplements. The NE Journal of Medicine article you mentioned made me ask for the addition of Cytomel, and I noticed an immediate change for the better- in depressive symptoms, not so much with anxiety, although it didn't make it worse either.
I have begun thinking that just as cortisol regulation is abnormal in anxiety and depression, thyroid metabolism probably is too. The stressors must come first, followed by the development of abnormalities in the brain metabolism of thyroid and cortisol, and then, last, the symptoms of depression and/or anxiety. I'd be so curious to know how many people here have thyroid abnormalities. Guess I'll ask in a later post!
Pfinstegg
Posted by stjames on May 16, 2003, at 13:57:48
In reply to Thinking of quitting meds, posted by bookgurl99 on May 16, 2003, at 1:24:35
> Does anyone have suggestions for me?
Yes, I think you are setting yourself up to fail
if you quit meds before you have started your
"other methods" and worked with these methods for a while.
Posted by bookgurl99 on May 16, 2003, at 15:12:13
In reply to Re: Thinking of quitting meds, posted by Pfinstegg on May 16, 2003, at 13:49:45
>The NE Journal of Medicine article you mentioned made me ask for the addition of Cytomel, and I noticed an immediate change for the better- in depressive symptoms, not so much with anxiety, although it didn't make it worse either.
I'm so excited that it helped! How did you convince your dr. to try it? I find more docs worried about my skeleton (ie., possible osteoporosis after long-term t3 use) than my overall quality of life(i.e., negative brain effects from long-term ssri use).
Posted by Jack Smith on May 16, 2003, at 16:58:37
In reply to Re: Thinking of quitting meds, posted by Pfinstegg on May 16, 2003, at 13:49:45
> It really is fascinating how many people posting here need to take thyroid supplements. The NE Journal of Medicine article you mentioned made me ask for the addition of Cytomel, and I noticed an immediate change for the better- in depressive symptoms, not so much with anxiety, although it didn't make it worse either.
Pfinstegg,
I am curious. Did your doc add in cytomel without doing tests on your thyroid? How did it help re depressive symptoms?
JACK
Posted by Pfinstegg on May 16, 2003, at 18:40:33
In reply to cytomel » Pfinstegg, posted by bookgurl99 on May 16, 2003, at 15:12:13
You're right about having to pressure the doctors a bit. My internist didn't want to do it because of the osteoporosis danger, just as you said. I asked for a referral to an endocrinologist, and he was very comfortable adding it. He gets a lot of referrals just for help with depressive symptoms, apparently. He cut the dosage of the synthroid I was taking in half, and then added Cytomel, so the total amount of thyroid supplement I'm taking is the same.
He does want me to take 1500 mg of calcium every day, and to have a bone density test every two years. He indicated that if osteoporosis began developing, he would treat me with one of the medications for that. He also has me come in every three months for a TSH, T4 and T3. He wants the T4 and T3 to stay within normal range, and doesn't want the TSH to go below 0.3 (it was 3.8 as of last week). Just having a doctor work so thoughtfully and carefully with me like this is a potent AD all by itself!
Pfinstegg
Posted by Pfinstegg on May 16, 2003, at 19:07:18
In reply to Cytomel Augmenting » Pfinstegg, posted by Jack Smith on May 16, 2003, at 16:58:37
Oh no, he's a big tester! As I mentioned to Bookgurl, above, he is constantly checking the TSH, T3 and T4. He did baselines before starting, and has me repeat them every three months. If I don't go in for the tests, I can't get the meds refilled!
It's always hard to say just how one thing helps, as like most of us, I was trying to do a bunch of things at once when the depression was very severe- including fish oil, magnesium, a ton of vitamins, especially the B's and a 3-week course of TMS, which I had in January. However, I was following the severity of the depression for several months prior to having the TMS with the Beck 2 Depression Inventory, and after starting Cytomel, I went within about two days from the "severe" to the "moderate" category. This was a real change, as I had been in the "severe" for about two years, despite many extended AD trials, and after adding Cytomel, I pretty much stayed in the "moderate" category from October until the following January. When I had the TMS, I actually got to "normal", and have been pretty much that way in the four months since then. I should add that I began seeing a psychoanalyst twice a week in February who's specialty is dealing with childhood neglect and abuse issues, which I have. I hope that that will help me get solid enough not to relapse.
Pfinstegg
Posted by Pfinstegg on May 16, 2003, at 19:38:57
In reply to Re: cytomel » bookgurl99, posted by Pfinstegg on May 16, 2003, at 18:40:33
Sorry, I made a mistake about my TSH. It's 0.38 at present, not 3.8. In case anyone is looking into it for themselves and wants some idea of what they should be aiming for, my endocrinologist thinks that this very low level is what patients with depression need to have in order for the synthroid and Cytomel to make a difference. I think the NEJM article mentioned aiming for a TSH of 0.5 or slightly lower, also.
This is a special way of thinking about TSH levels when depression is an issue, as the normal range for TSH is about 0.3 to 4.5. It's more usual for general practitioners and internists to not want to give any treatment as long as one's TSH falls somewhere within that range.
Pfinstegg
Posted by bookgurl99 on May 16, 2003, at 21:49:30
In reply to Re: cytomel- Bookgurl99, posted by Pfinstegg on May 16, 2003, at 19:38:57
> Sorry, I made a mistake about my TSH. It's 0.38 at present, not 3.8.
Thx for clarifying.
Yes, the dr. I was seeing is very conservative. She was happy with me at 1.25, which is better than the 4.0 some people are forced to live with.
Even slightly above 1.0, I can feel the difference. Below 1.0, all the good stuff I do -- exercise, eating well, etc., actually starts making a difference.
Maybe I can see if my dr. if open to this, and try an endo if nothing else. :D
books
Posted by Pfinstegg on May 16, 2003, at 23:01:28
In reply to Re: cytomel- Bookgurl99 » Pfinstegg, posted by bookgurl99 on May 16, 2003, at 21:49:30
That's so interesting! You can actually tell the difference when your TSH is 1.0 or lower? It might be really worthwhile to get it down to 0.5 or thereabouts and see how you feel at that level. I'm assuming that it would help more with depression than anxiety, and I'm not sure from what you've said how much depression is an issue for you. But if you are interested in cutting down on your meds, why not try it? From the NEJM article, I recall the rationale behind adding Cytomel is that it is the form our brains use, and some people are not good at converting T4 (synthroid) to T3. If you decide to try it, please let us know how it works- maybe under the INFORMAL PB THYROID STUDY thread?
Pfinstegg
Posted by noa on May 17, 2003, at 9:27:27
In reply to Re: cytomel- Bookgurl99, posted by Pfinstegg on May 16, 2003, at 19:38:57
> my endocrinologist thinks that this very low level is what patients with depression need to have
My endo, too.
My pdoc had my TSH tested and had me add cytomel, and later, synthroid, both of which helped. But later on, when I was on lithium, which was working for about 6 weeks and then my depression got worse, I checked my TSH again and it had gone way up again. It was then that I realized that the thyroid aspect of it was key (as opposed to treating my depression as a bipolar spectrum problem). I did a lot of reading and then saw an endo, who diagnosed primary hypothyroidism, and had me increase my synthroid dose until improvement in symptoms leveled off. He kept my cytomel dose the same, only he told me to split it into two because cytomel is shorter acting.
He also told me that patients like me with hypothyroidism and depression often don't get relief from the depression until the thyroid is treated down to a TSH below 1. I leveled the syntrhoid off at a TSH of .3, if I'm remembering correctly (it's been a few years).
Posted by bookgurl99 on May 17, 2003, at 10:00:43
In reply to Re: cytomel- Bookgurl99, posted by Pfinstegg on May 16, 2003, at 23:01:28
> That's so interesting! You can actually tell the difference when your TSH is 1.0 or lower? It might be really worthwhile to get it down to 0.5 or thereabouts and see how you feel at that level.
Yeah, I can really tell, and I am genuinely more "cheerful" at this level.
I think it does help anxiety, just because your brain levels of neurotransmitters can become more healthily balanced if your whole body has that extra oomph. Plus, the extra energy allows me to take care of things that procrastinating on would cause a negative effect on my life!
I've recently switched gp's, as my old one would smile when I told her about my low thyroid symptoms (muscle pain while walking, etc.), and I think she just overall did not respect my perceptions. I have a good impression of the new guy; I'll try him out.
books
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