Posted by Noa on March 9, 2000, at 18:30:25
Finally saw my pdoc. We went around and around, disagreeing on a few points, but both agreeing the thyroid thing had to be looked at more closely.
I have been taking cytomel and synthroid for a few years, to augment my ADs. Originally, my tests showed me to be borderline hypothyroid, with a TSH of something like 4.9. Within a week of starting thyroid meds, I did feel much better. But eventually, my depression just kept getting worse, leading to me adding Ritalin, increasing the effexor, adding serzone, and adding lithium. I probably left out a few steps, but who cares.
Last night, my pdoc told me the target for my TSH should less than 1 ("normal" is between .5 and 5). My last test showed it to be 3.8. We both figure the lithium has made me hypothyroid, which undermined the initial effectiveness the lithium was having (the first 6 weeks). Still, I don't know what my TSH readings were prior to the lithium--I need to call my internist and find out.
After my appointment, it occured to me that my pdoc should have told me about needing to get my TSH down to 1 a long time ago. Maybe increasing the thyroid meds would have been the right intervention before some of the other steps.
I happened to have seen a friend last night who has Hashimoto's disease, which is an autoimmune disorder that causes hypothyroidism. She confirmed the need to keep the TSH down to 1. She said she feels best (physically and emotionally) when it is that low. Only problem for her is convincing her internist of this and the need to adjust her meds accordingly. She got much better results from seeing an endocrinologist who specializes in Hashimoto's, but of course to see a specialist, you have to go through your primary care doctor, who is receiving disincentives for referrals. In any event, my friend also recommends checking thyroid levels at least every three months because of how sensitive it is to changes, stress, illness, etc.
It makes sense to me that it's the thyroid because of how physical this episode has been. There has been the mood plunge and lack of motivation, but also the fatique, and general slowness, and the feeling of leadenness. Every thing has been hard--a big effort. And every thing has tired me out.
So, now my quest is to get my TSH down to 1 and hopefully I will feel better. I have already increased the cytomel (in addition to the increase in the synthroid made two weeks ago).
After that, I don 't know what aspect of my cocktail I am going to go after. My pdoc strongly believes I need the mood stabilizer. He says that my favorable initial response to lithium confirms the diagnosis of bipolar depression. I am ambivalent. The thing is, I don't care for the lithium's side effects, especially having to go to the bathroom every 30 minutes. If I know the lithium is working, maybe I cantolerate it better. These past few weeks, tho, because it felt like the lithium had stopped working, I really began to resent this annoyance.
As for wellbutrin, he agreed it could be a good choice, but brought up old notes on his laptop that said I had developed tinnitus after adding wellbutrin to the effexor. Whether I would get tinnitus on wellbutrin alone, who knows? Also, does anyone know if tinnitus is as likely with Wellbutrin SR as it is with IR?
Thanks.
poster:Noa
thread:26511
URL: http://www.dr-bob.org/babble/20000302/msgs/26511.html