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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by M on March 24, 2000, at 21:42:48
...a little self-indulgent venting
Well, another day has gone by and, again, here I sit --house is a wreck, laundry's not done, very little food in the frig, week-old calls that haven't been returned, and empty prescription bottles that haven't been refilled. Haven't showered or dressed in...how many days now? The Wellbutrin I ran out of last week is still waiting to be retrieved from the doc's office, as is the prescription for Klonopin he added for sleep at my request (sound, restful sleep evades me.) I just can't seem to pull myself together enough to drive over there and pick it up. I guess I'm not really convinced it works that well anyway. (About the only choice it seems...bad reaction to SSRIs, medical condition prohibits tricyclics and MAO inhibitors, and the Trazadone that worked wonderfully for about a year, pooped out.)
Every night I tell myself that tomorrow will be different. I'll make a to-do list. Shower and dress. Do all the things I've been feeling so damned guilty about not having done for so long. I'll get my meds and begin taking them again, religiously. I'll go back to the gym and work out every day (exercise has always made me feel so much better.) I won't just send out resumes, I'll get out there and pound the pavement and BEG if I have to but, dammit, I'll find a job!
But it doesn't happen. 9:00 pm, another day has gone by and, again, here I sit. Right where I was yesterday...and the day before...and the day before that. I think I'm just too tired.
Does it ever end?
Posted by Noa on March 24, 2000, at 22:19:45
In reply to Wallowing, or...., posted by M on March 24, 2000, at 21:42:48
I may sound like a one track record (gee, now isn't that kind of an outmoded expression), but your immobility, which sounds so much like my day to day experience of life these days, makes me wonder whether you have had your thyroid function evaluated.
I have just started reading a book called, Living Well with Hypothyroidism by Mary Shomon, and am beginning to believe that anyone who is depressed should be screened for hypothyroidism. You might want to check out the author's web page at the following address: http://www.thyroid-info.com/
Posted by M on March 24, 2000, at 23:25:18
In reply to Re: Wallowing, or...., posted by Noa on March 24, 2000, at 22:19:45
> I may sound like a one track record (gee, now isn't that kind of an outmoded expression), but your immobility, which sounds so much like my day to day experience of life these days, makes me wonder whether you have had your thyroid function evaluated.
>
> I have just started reading a book called, Living Well with Hypothyroidism by Mary Shomon, and am beginning to believe that anyone who is depressed should be screened for hypothyroidism. You might want to check out the author's web page at the following address: http://www.thyroid-info.com/You know, it's interesting that you mention thyroid. I've been wondering for the last three years or so whether I could possibly be hypothyroid. Aside from the unrelenting depressive symptoms that seem to be resistent to drug therapy (except for Trazadone, the very first AD I was ever prescribed...was great for a a little under a year and then pooped out. Nothing else since has worked nearly as well. The beginning of hypothyroidism, perhaps?), I have:
. gained weight that I haven't been able to shed (up until that time I was always very thin and, in fact, had trouble gaining weight)
. had problems with hot flashes, night sweats, and chills. One extreme or the other, it seems. It's as though my internal thermostat is out of whack. Gyne blamed it on menopause, but the symptoms began quite suddenly and hormone replacement has not relieved them.
. began losing my hair in clumps after about six months of taking Trazadone. Doc and I blamed it on the drug, but the hair never fully grew back even after I stopped taking it.
. very, very dry skin.
. difficulty going to sleep and staying asleep; feel as if I never reach a deep sleep.
. complete lack of energy and motivation
. virtually no sex drive
Now, having said all that, about a year ago my gynecologist DID run a thyroid test because even with erratic periods and hot flashes he didn't believe I was menopausal. The results were normal.
I have an appointment with the pdoc in April. Think it might be well worthwhile to have a discussion with him about this. In the meantime, I'll take a look at the website you noted.
Thanks for the info.
Posted by bob on March 24, 2000, at 23:55:40
In reply to Re: Wallowing, or...., posted by M on March 24, 2000, at 23:25:18
> > I may sound like a one track record (gee, now isn't that kind of an outmoded expression), but your immobility, which sounds so much like my day to day experience of life these days, makes me wonder whether you have had your thyroid function evaluated.
... Noa, you promote the thyroid, I'll do the ritalin.
> Now, having said all that, about a year ago my gynecologist DID run a thyroid test because even with erratic periods and hot flashes he didn't believe I was menopausal. The results were normal.Normal may not be good enough for someone with depression.
That said, Noa can say a helluva lot more than me about when normal isn't normal.
As for the getting stuck ... well, if you're anything like me, the enormity of the tasks make me balk and do things like signing on to Babbleland for hours and hours.
Pick one thing. Forget the rest. Get that one thing done, then give yourself a short break or a reward.
my one cent
bob
Posted by M on March 25, 2000, at 0:49:55
In reply to Beating Noa to the punch ..., posted by bob on March 24, 2000, at 23:55:40
> > > I may sound like a one track record (gee, now isn't that kind of an outmoded expression), but your immobility, which sounds so much like my day to day experience of life these days, makes me wonder whether you have had your thyroid function evaluated.
>
> ... Noa, you promote the thyroid, I'll do the ritalin.
>
>
> > Now, having said all that, about a year ago my gynecologist DID run a thyroid test because even with erratic periods and hot flashes he didn't believe I was menopausal. The results were normal.
>
> Normal may not be good enough for someone with depression.
>
> That said, Noa can say a helluva lot more than me about when normal isn't normal.
>
> As for the getting stuck ... well, if you're anything like me, the enormity of the tasks make me balk and do things like signing on to Babbleland for hours and hours.
>
> Pick one thing. Forget the rest. Get that one thing done, then give yourself a short break or a reward.
>
> my one cent
> bobThanks, Bob. The "pick one thing, get that one thing done" trick has, in fact, worked pretty well for me on some days. Over the last couple of weeks, however, it just doesn't seem that anything is working very well. Even the smallest task seems not only difficult but impossible...even sorta pointless.
Must be in a rut, eh?
Posted by d on March 25, 2000, at 11:06:09
In reply to Re: Wallowing, or...., posted by M on March 24, 2000, at 23:25:18
Definitely ask to see results of thyroid screen. If within normal range but on high side, you would be wise to try treating it. It is true - what's normal for some isn't for others. That's the reason for ranges, ain't it?
Posted by M on March 25, 2000, at 12:40:01
In reply to Re: Wallowing, or...., posted by d on March 25, 2000, at 11:06:09
> Definitely ask to see results of thyroid screen. If within normal range but on high side, you would be wise to try treating it. It is true - what's normal for some isn't for others. That's the reason for ranges, ain't it?
Makes sense to me. Unfortunately, the docs don't necessarily agree. To some of them, "normal" at any range=no meds.
A couple of years ago when I was having difficulty finding an effective AD, the pdoc suggested augmenting Wellbutrin with Synthroid, Ritalin, or Dexedrine; however, he would not prescribe a stimulant without first getting a clearance from my cardiologist. The cardiologist's response? "My god, that's SPEED! I can't agree with that! Besides, you don't look depressed to ME." Obviously, the pdoc couldn't risk the liability of prescribing a drug the cardiologist didn't condone(btw, the cardic condition has been stable for many years.)
I recently read that hypothyroidism in middle-aged women can, among other things, contribute to heart disease. What a catch 22. Can't take thyroid meds because of cardiac condition and, yet, hypothyroidism could exacerbate disease. Doesn't make any sense to me. I guess I'll wait and see what the pdoc says in April.
Btw, anyone know if hypothyroidism can also cause varying neuritis or neuropathic symptoms?
Posted by ash on March 26, 2000, at 12:22:32
In reply to Re: Wallowing, or...., posted by M on March 25, 2000, at 12:40:01
M,
My thyroid results were also normal according to my primary doc. I still insisted on seeing an endocronolgist. He did a complete thyroid screen including antibodies, free T3 and free T4 in addition to the usual TSH, total T3 and T4. I had extremely high antibodies even though my TSH was still within the upper limit of about 5. He said I had a form of subclinical hypothyroidism called autoimmune thyroidisis (Hashimoto's disease) and put me on T4 and T3 supplements.
I might add that even the thyroid medication didn't make a dent in my depression though it did help some for the total lethargy I was wallowing in.
Good luck.
Ash
Posted by Noa on March 26, 2000, at 14:12:30
In reply to Re: Wallowing, or...., posted by M on March 25, 2000, at 12:40:01
Absolutely on the issue of what is "normal"--many doctors seem to rely too heavily on a statistical norm and leave their thinking minds at the door. If "normal" for TSH levels is said to be between .5 and around 5, what does this mean? Does it mean that "most" (a statistical majority of) people are completely asymptomatic at these levels? What about the minority?
Apparently, there is some new research showing that a TSH of 2 or higher is highly predictive of future hypothyroid symptoms.
Many docs are afraid to prescribe thyroid hormones because of the possible increase in risk for osteoporosis. However, now there are some researchers saying that the risk for osteoporosis is increased with actual hyperthyroid illness, and not necessarily from thyroid hormone replacement.
And, M, you are right, hypothyroid is associated with increased risk of heart disease.
I urge you to check out the website mentioned above. It is an excellent resource--even has doctor recommendations.
BTW, the book, Living Well with Hypothyroidism, has been extremely helpful to me, and how fortunate that is has hit the shelves just as I begin to address my questions about how my hypothyroidism affects my depression and my response to medications. The author explains the different diagnostic tests and how to make sense of the results, including some of the history and controversy about diagnosing hypothyroidism. She discusses treatment options, drug quality, why treatment sometimes does not work, and what to about it. Finally, she provides lists of resources, including Dr. Bob's Psychopharmocology Tips, from which she cites discussions about the use of T3 and T4 to treat hypothyroidism associated with depression, giving credit to pdocs for being ahead of their non-psychiatric peers in thinking more flexibly about thyroid treatment.
Posted by M on March 26, 2000, at 17:14:14
In reply to Re: Wallowing, or...., posted by ash on March 26, 2000, at 12:22:32
> M,
>
> My thyroid results were also normal according to my primary doc. I still insisted on seeing an endocronolgist. He did a complete thyroid screen including antibodies, free T3 and free T4 in addition to the usual TSH, total T3 and T4. I had extremely high antibodies even though my TSH was still within the upper limit of about 5. He said I had a form of subclinical hypothyroidism called autoimmune thyroidisis (Hashimoto's disease) and put me on T4 and T3 supplements.
>
> I might add that even the thyroid medication didn't make a dent in my depression though it did help some for the total lethargy I was wallowing in.
>
> Good luck.
>
> Ash
An appointment with an endrocrinologist is next on my list after seeing the pdoc in April.It's a bit disappointing to hear that thyroid meds did nothing to decrease your depression. I guess there's no magic pill out there that cures everything, eh?
Posted by M on March 26, 2000, at 17:27:20
In reply to Re: Wallowing, or...., posted by Noa on March 26, 2000, at 14:12:30
> Absolutely on the issue of what is "normal"--many doctors seem to rely too heavily on a statistical norm and leave their thinking minds at the door. If "normal" for TSH levels is said to be between .5 and around 5, what does this mean? Does it mean that "most" (a statistical majority of) people are completely asymptomatic at these levels? What about the minority?
>
> Apparently, there is some new research showing that a TSH of 2 or higher is highly predictive of future hypothyroid symptoms.
>
> Many docs are afraid to prescribe thyroid hormones because of the possible increase in risk for osteoporosis. However, now there are some researchers saying that the risk for osteoporosis is increased with actual hyperthyroid illness, and not necessarily from thyroid hormone replacement.
>
> And, M, you are right, hypothyroid is associated with increased risk of heart disease.
>
> I urge you to check out the website mentioned above. It is an excellent resource--even has doctor recommendations.
>
> BTW, the book, Living Well with Hypothyroidism, has been extremely helpful to me, and how fortunate that is has hit the shelves just as I begin to address my questions about how my hypothyroidism affects my depression and my response to medications. The author explains the different diagnostic tests and how to make sense of the results, including some of the history and controversy about diagnosing hypothyroidism. She discusses treatment options, drug quality, why treatment sometimes does not work, and what to about it. Finally, she provides lists of resources, including Dr. Bob's Psychopharmocology Tips, from which she cites discussions about the use of T3 and T4 to treat hypothyroidism associated with depression, giving credit to pdocs for being ahead of their non-psychiatric peers in thinking more flexibly about thyroid treatment.
Hmmm, thought I posted this message but it didn't seem to make it here. Oh well, here it is again:Thanks, Noa. I visited the website you suggested and found lots of good info. I'm heading to the library tomorrow to pick up a copy of Living Well with Hypothyroidism so I'll be well prepared for the doc next month!
This is the end of the thread.
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