![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by gloria on May 26, 2000, at 12:04:57
In reply to Re: Atypical Depression, posted by harry b. on May 26, 2000, at 11:42:06
> Gloria- Also read the description of 'retarded atypical
> depression. Very similar. I was convinced I was a
> match for the profile. I asked my pdoc about it
> but she dismissed it, saying the symtoms are of
> depression, period. The only concession she made
> was to give me Ritalin.
>
> Maybe there are different treatment modalities, I
> don't know. Hopefully someone here with more knowledge
> will post.>So do you still take the Ritalin? If so does it help? I self medicated myself with amphentamines for years. Only way I had some sort of normal life! I have thought about trying a stimulant, but how in the world would I be able to handle it with panic attacks. Stimulants really are the only thing that gets me up and going and that in turn helps lift the depression! But I have tried Wellbutrin and Prozac and was to much stimulation. So is Ritalin or Adderall different? Hey I am just trying to help myself here as I can't afford my pdoc anymore and I have a pretty good doctor that is willing to help me. Thanks Gloria
Posted by Noa on May 26, 2000, at 13:05:12
In reply to Re: harry b., posted by gloria on May 26, 2000, at 12:04:57
GLoria, how about your thyroid, have you had some tests done?
Posted by Noa on May 26, 2000, at 13:11:58
In reply to Re: harry b., posted by Noa on May 26, 2000, at 13:05:12
> GLoria, how about your thyroid, have you had some tests done?
Atypical depression and low-grade hypothyroidism share a lot of characteristics. Someone who suffers from depression and also has an undiagnosed and untreated low grade hypothyroid condition will have a very hard time responding to any psychiatric meds.
This book really gave me a lot of info I needed (review from Amazon):
book review: the thyroid solution
The Thyroid Solution : A Mind-Body Program for Beating Depression and Regaining Your Emotional and Physical Health
by Ridha AremPeople with thyroid disease face several critical challenges:
1. Recognizing their own various and seemingly unrelated symptoms as a potential thyroid problem, and getting their doctor to recognize the symptoms as well
2. Having the thyroid tests interpreted liberally enough to catch many low-level cases of thyroid problems.
3. Getting the right dosage of the right medicine.
4. Convincing the doctor to even recognize the symptoms, and test for a thyroid problem.
5. Once diagnosed, treated, at optimal thyroid hormone blood levels, and on the right mix of thyroid drugs...figuring out what to do you do if you STILL don't feel well?
Ridha Arem's book does an excellent, fairly groundbreaking job on points 1 and 2. Unlike the other currently available patient-directed books on thyroid disease, Dr. Arem's book talks honestly and openly about symptoms such as brain fog, depression, loss of libido, weight gain, anxiety, and many others. These are symptoms that all too frequently, doctors either deny, ignore, don't recognize, or attribute to causes other than the thyroid. Arem has also researched and analyzed the relationship of thyroid disease to brain chemistry, and resulting depression, anxiety disorders, mood disorders and other mental and emotional effects -- in great depth. This is a subject simply not covered in any of the current thyroid-related books available to patients. It is to Dr. Arem's credit that he has greatly added to the scientific understanding of the mind-thyroid relationship.
Dr. Arem also provides a good scientific grounding in why patients with low-level thyroid problems should be treated, with enough information that patients can show the relevant pages and references to their doctor and perhaps convince the doctor to treat them.
Where the book seems to be less pioneering is in its approach to the many millions of thyroid patients who get diagnosed, treated, are at optimal thyroid hormone blood levels, and on the right mix of thyroid drugs...who STILL don't feel well.
I hear from 500 thyroid patients a week at my thyroid disease website, and of the 10,000 patients who receive my thyroid-disease newsletter, many write to me regularly, so I hear from people in the trenches with thyroid disease every day. I know that despite the best advice of the rare doctors like Arem who understand thyroid problems, most doctors simply don't have much of an understanding of the issue. For the majority of patients, even finding a doctor who will agree to thyroid testing, much less treatment, can be Job One. It is my fervent wish that these doctors will read Arem's book, and at least open their minds to Dr. Arem's interpretations of what is a "normal" thyroid test result, or what constitutes low-level hypothyroidism and warrants treatment. Where the book leaves patients -- including me, as I have Hashimoto's thyroid disease with resulting hypothyroidism -- hanging is that there are many people who have found that much more is needed than even just the things Dr. Arem recommends as the crux of his program -- T4/T3 drugs, therapy, mind-body exercise and complex carbohydrate diet.
Dr. Arem's book acknowledges that hypothyroidism can cause infertility or miscarriage, but doesn't address how thyroid patients themselves can help to increase the likelihood of a successful and healthy pregnancy. He also skims fairly quickly over the issues of relationships between thyroid disease and women's hormonal medicine.
Given its somewhat scientific style, Dr. Arem's book should be required reading for all doctors, who could benefit from the breadth of understanding Dr. Arem has about the symptoms of thyroid disease. Given the respectable, conventional endocrinology credentials of the author -- the book could be valuable ammunition for patients who need to fight for proper diagnosis and treatment with less enlightened doctors. Being able to point to the fact that a conventional endocrinologist has written positively about these previously shunned forms of diagnosis, treatment, and hormone replacement takes them out of the realm of "alternative" or "quackery," a development that is only good for all thyroid patients in our search for the best possible lives and health.
Posted by Ant-Rock on May 26, 2000, at 13:29:14
In reply to Atypical Depression, posted by gloria on May 26, 2000, at 11:13:26
> When I found this description on atypical depression it hit me like a ton of bricks!
>
> --mood reactivity (unlike "typical" depressives, can be cheered up temporaily)
> --overeating or increased appetite (rather than reverse)
> --oversleeping (rather than insomnia)
> --high rejection sensitivity
> --so-called "leaden paralysis" (i.e., patient complains of feeling "heavy", inacapable of movement or action, etc.)
>
> Well if this is fairly accurate then that describes me to a T! Especially the heavy laden feeling of motor skills. That one really stood out!
>
> I really would like to hear more descriptions from people diagnosed with this. Maybe that is why I am having such a hard time finding the right medicine. I haven't been properly diagnosed. This really, really, sounds like me!
>
> How does panic disorder fit into all of this? For me it feels like I have been covering up my depression, tough it out and my body just won't fight anymore and wants to fly instead. You know the fight,flight thing with panic! God this is going to be bad isn't it! Sounds like one of the harder things to get help for.
>
> Thanks GloriaGloria,
The maoi med called Parnate is often helful for this type of depression. It has stimulating properties similar to stimulants and seems to work well for many people who have posted in the past. You must follow a special diet w/maoi's but it's not as difficult to follow as one would first think. Check out the "Tips" section of this site, their is some good info on this med.Good Luck,
Anthony
Posted by Kim on May 26, 2000, at 14:06:04
In reply to Re: Atypical Depression, posted by Ant-Rock on May 26, 2000, at 13:29:14
Dear Gloria,
I also would try Parnate for atypical depression. I know some people on this board are afraid of MAOIs, but I have taken them for years with no problems and with fewer side effects than other ADs.The current diet restrictions are not nearly as restrictive as the old ones--a lot of things they used to tell you to avoid they finally decided were just not a problem. (And not that I would recommend it to anyone else, but I admit to not being too strict in following the diet.)
Good luck
Kim
Posted by Carol on May 26, 2000, at 22:54:24
In reply to Re: Atypical Depression, posted by Kim on May 26, 2000, at 14:06:04
This is my first time to write. I was so happy to
read about atypical depression as I was diagnosed
with that almost 2 years ago. I was using Manerix
(maybe only available in Canada) and dexedrine.
When that stopped being effective I tried
Wellbutrin and Zoloft but began gaining weight
same as I did with Prozac.
I am now trying a combination of Wellbutrin,
Manerix, and dexedrine. Because of the Wellbutrin
causing anxiety I take klonazepam and immovane at
bedtime. Also I take ativan sometimes for the
anxiety.
Would like to hear more from others. I also have
to deal with SAD.
Thanks
Carol
Posted by harry b. on May 27, 2000, at 1:40:09
In reply to Re: harry b., posted by gloria on May 26, 2000, at 12:04:57
>
> >So do you still take the Ritalin? If so does it help? I self medicated myself with amphentamines for years. Only way I had some sort of normal life! I have thought about trying a stimulant, but how in the world would I be able to handle it with panic attacks. Stimulants really are the only thing that gets me up and going and that in turn helps lift the depression! But I have tried Wellbutrin and Prozac and was to much stimulation. So is Ritalin or Adderall different? Hey I am just trying to help myself here as I can't afford my pdoc anymore and I have a pretty good doctor that is willing to help me. Thanks GloriaGloria- Yes, I am taking Ritalin, have been for
about a month. I'm sorry that I can't really tell
you if/how much it helps because the Celexa I'm
taking has lost some of it's effectiveness. Sometimes
it's difficult to realize which med is doing what.
I think it is helping a bit, though I find it to be
very subtle and I do not get a 'wired' effect from
it.I can't answer your concern about stimulants affecting
your panic attacks. Do you take meds for the
panic attacks?My best to you
Posted by BrendaF on May 27, 2000, at 8:40:05
In reply to Atypical Depression, posted by gloria on May 26, 2000, at 11:13:26
Gloria,
I suffer from atypical depression, too, with major episodes every so often (usually triggered by life events). I could never figure out how I could enjoy laughing so much, seem so normal to people who didn't know me, and acually felt like I enjoyed some peoples' company----however, once I was alone, I was like a zombie. I felt dead inside. Boy, did I sleep! And what better escape...second only to consuming an entire cake by yourself. Aaahhh, the leaden feeling---I know it well. I wasn't sure if I was a complete fake around other people at work or if I was just hopelessly lazy when I was alone. I do better around people, but unfortunately, the depression makes you not want to socialize, so the weekends I didn't have my little girl I would stay at home--not talking to another soul until I got back to work. Then I would feel so ashamed.....for not getting things done, for not having a life outside of work. I would tell people I didn't do anything over the weekend, knowing they wouldn't actually think I was being literal (which I was).
I took Ritalin in conjuntion with Prozac and later Effexor. It helped a little....kinda. I was more talkative and alert at work, but once I got home I could crawl right back in bed no matter if I just took my Ritalin or not. This may not be the case for everyone, though. I think the biggest problem is that it helps your energy, but without the motivation, it's not worth much. I'm now taking 300mg of Wellbutrin. I've only been on it a little over 2 weeks, but I've heard it can be good for motivation since it's a stimulating AD. Either it's the placebo effect or I've actually noticed a slight change for the better. Will let you know how it goes.
Hope you find something that helps you. Take care!
Posted by Noa on May 27, 2000, at 10:41:03
In reply to Re: Atypical Depression, posted by BrendaF on May 27, 2000, at 8:40:05
Brenda and Gloria,
Have you had your thyroid checked?
Posted by BrendaF on May 27, 2000, at 11:41:20
In reply to Re: Atypical Depression, posted by Noa on May 27, 2000, at 10:41:03
> Brenda and Gloria,
>
> Have you had your thyroid checked?
Afraid so, Noa. Alas, it was normal. (sigh!) And I had such high hopes..................:-)
Posted by Noa on May 27, 2000, at 11:59:48
In reply to Re: Atypical Depression, posted by BrendaF on May 27, 2000, at 11:41:20
Mind my asking what tests were done and what the numbers were?
Posted by BrendaF on May 27, 2000, at 12:36:41
In reply to Re: Atypical Depression, posted by Noa on May 27, 2000, at 11:59:48
> Mind my asking what tests were done and what the numbers were?
I'm sure I wadded up the letter and threw it in the trash before I sat down and had a good cry, so I'm gonna try to answer from memory (scary) I believe the test results they sent me told me my TSH level was normal. I even looked up on the internet what normal levels would be to see if maybe I was even close to abnormal, but I was pretty much in the middle. I believe it was 2.6 or 2.8.....somewhere around there. That's when I decided to accept the brain chemistry explanation once and for all, and get back on meds. Wellbutrin seems to be doing ok so far. Of course, it's only been about 2 weeks, so we'll see. I've got my fingers crossed.
Posted by CarolAnn on May 27, 2000, at 13:01:19
In reply to Atypical Depression, posted by gloria on May 26, 2000, at 11:13:26
Gloria,
Every single one of these descriptions is sooo me; they could call it "CarolAnn" depression instead of "atypical depression"! What I don't understand, is why we don't hear about this type of depression more. Alot of these symptoms aren't even listed in the general "criteria" for having depression, and yet, it seems that this type is more frequent then the other. I wish they would put more effort into finding specific drugs for us!
Anyway, Gloria, I tried Ritalin and found it very addictive. Even though I had no prior use of stimulants, I just wanted more and more. Now, I am on Adderall, and I think there is a risk of addictive behaviour, but it depends on the individual. As far as panic attacks, yes the stimulant *may* have a detrimental effect, but it might not. My doctor gives me Xanax to use "as needed" when I start to feel panicky. Good luck! CarolAnn
> --mood reactivity (unlike "typical" depressives, can be cheered up temporaily)
> --overeating or increased appetite (rather than reverse)
> --oversleeping (rather than insomnia)
> --high rejection sensitivity
> --so-called "leaden paralysis" (i.e., patient complains of feeling "heavy", inacapable of movement or action, etc.)
>
> Well if this is fairly accurate then that describes me to a T! Especially the heavy laden feeling of motor skills. That one really stood out!
>
> I really would like to hear more descriptions from people diagnosed with this. Maybe that is why I am having such a hard time finding the right medicine. I haven't been properly diagnosed. This really, really, sounds like me!
>
> How does panic disorder fit into all of this? For me it feels like I have been covering up my depression, tough it out and my body just won't fight anymore and wants to fly instead. You know the fight,flight thing with panic! God this is going to be bad isn't it! Sounds like one of the harder things to get help for.
>
> Thanks Gloria
Posted by Noa on May 27, 2000, at 15:33:28
In reply to Re: Atypical Depression, posted by CarolAnn on May 27, 2000, at 13:01:19
Brenda, 2.8 or so is sort of on the low end of "normal" range, although one article I read said that anything over 2 is highly predictive of developing overt hypothyroid. The psychiatric symptoms usually come first. Still, your TSH numbers don't scream hypothyroid. I would keep in mind, though that for psychiatric purposes, a small dose of thyroid hormone, usually T3, but also sometimes both T3 and T4, can often help people respond better to meds, the strategy keeping the TSH in the hyper range. This, of course, is something that psychopharmocologists do all the time but that your average family doctor is unfamiliar with. So, if you get partial results from the wellbutrin, but not enough, ask your pdoc about adjunctive thyroid hormone treatment. Someone else mentioned stimulants as an adjunct, and I have found that helpful. Especially if you continue to have fatigue, etc. But first, see how the WB does.
"Brain Chemistry"---If it were your thyroid, that would not get you "off the hook" as far as brain chemistry. Thyroid hormone is indeed a brain chemical in the sense that it is required for brain cells to function normally, and it interacts closely with serotonin and norepinephrine.
Posted by Sherry on May 27, 2000, at 20:40:30
In reply to Re: Atypical Depression, posted by Noa on May 27, 2000, at 15:33:28
Okay I'm sure you guys do not want to hear this, but here goes anyways. I have been on a trip to hell for the last 6 years, and AD's provided no relief for me. I have tried just about every AD on the market, and I either could not tolerate the side effects or they were useless.
For the last 2 weeks, I have been on the Atkins Diet, and I am here to tell you that I am improving every day. I have not felt this good since the beast nearly crippled me in 1994. I urge all of you to buy a copy of the book ,and give it a whirl. This is the only diet I have ever been on that I am not hungry or have uncontrollable cravings. I am exercising for the first time in 3 years, and I am much more mentally alert. The first week, however, was rough. I was fatigued quite a bit, but I made it through the adjustment. I feel so much better. The improvement is dramatic, and I know that I am going to continue seeing improvement. You have nothing to lose by trying it, and I'm sure you will see a huge difference as I have. This is probably only good for those of you who have a weight problem in addition to your depression. I did not start the diet, however, to try and lose weight. I began it to see if it would help me mentally. It has, and if I lose some unwanted weight in the process, GREAT! Please give it a try.
Sherry
Posted by Kim on May 28, 2000, at 0:59:53
In reply to Re: Atypical Depression, posted by Noa on May 27, 2000, at 15:33:28
Noa,
Can the thyroid hormone be given as an adjunct to MAOI's? I've had partial response to Parnate & messed with several things to try and make it better--Pdoc finally took me off it altogether--got a new Pdoc and he's put me back on it. I did have my thyroid checked and was told it was "normal" (Dr. didn't give me the numbers so I can't tell you exactly what they were). Would the thyroid hormone cause problems taking it if my thyroid really is normal?
Thanks--Kim
Posted by Joanna on May 28, 2000, at 12:39:05
In reply to Atypical Depression, posted by gloria on May 26, 2000, at 11:13:26
Gloria, I am diagnosed as atypical depression. I've been on Prozac and valium for more years than I can tell you. I've had my thyroid checked over and over again. One pdoc years ago suggested a hypoglycemic diet similar to the Atkins diet and it helped with the weight but not the over sleeping or anxiety. I've tried immipramine which was horrible. I couldn't put a thought together. Zoloft made me irritable. Even the Prozac had to be titrated up from 5mg over many years to the 60mg I'm on now. I had to be started out on liquid Prozac. We stopped that when I got my teaspoons and tablespoons mixed up:)Out of desperation the other day I tried one of my son's lithium and that worked nicely. His depakote worked well but left me sleepy the next day. Maybe because I took it with valium. The valium isn't working anymore when I get very anxious. I took 5 the other night and sat outside on the stoop for an hour and I still couldn't get to sleep and when I did it was fragmented. I have a pdoc appt on Tues to change my meds. It is so very frustrating. I know what you're going thru.
Joanna
Posted by Noa on May 30, 2000, at 12:44:52
In reply to Re: Atypical Depression/Thyroid, posted by Kim on May 28, 2000, at 0:59:53
Kim, I am not sure about MAOIs and thyroid meds.
About "normal". Normal for TSH is a range between about .5 and 5. Most docs just look to see if your TSH is within that range. Problem is, normal for one person might be 2 while normal for another might be 4, and even slight elevation in your optimal level could make a huge difference in how you feel. Psychiatric symptoms of hypothyroid show up well before more overt physical signs. Pdocs like to have the TSH on the low end for purposes of boosting AD effect.
If your TSH is really low, and your T4 and T3 are high, yes, taking thyroid hormone would possibly be a problem.
Posted by Ant-Rock on May 31, 2000, at 7:55:00
In reply to Re: Atypical Depression/Thyroid, posted by Noa on May 30, 2000, at 12:44:52
Noa,
I was hoping you could give me your opinion on my thyroid test results. I have to wait a while to get a follow up so any info would be much appreciated. Results as follows:
3rd Gn TSH...1.873
Free T4...1.31
My Cortisol and testosterone were both "out of range", Low.Thank you for your time,
Anthony
Posted by Noa on May 31, 2000, at 12:23:04
In reply to Re: Atypical Depression/Thyroid (For Noa), posted by Ant-Rock on May 31, 2000, at 7:55:00
Anthony,
Check out this web page, for more on interpreting your thyroid test results:
http://thyroid.about.com/health/thyroid/library/howto/htthyroid-test.htm?terms=normal+test+results
According to this page, free T4 is considered normal betwen about .7 to 2.0
TSH of 1.873 sounds low, meaning it is unlikely that you have hypothyroid.
I am not that well informed about the other types of tests, but it seems you might find more info through the thyroid-info site. Good luck.
BTW, if your cortisol is high, what did the doc say about that? Is it a function of being depressed, or is there possibly an adrenal problem causing the high cortisol and/or the depression?
Posted by Ant-Rock on May 31, 2000, at 13:48:16
In reply to Re: Atypical Depression/Thyroid (For Noa), posted by Noa on May 31, 2000, at 12:23:04
Thank you for your input, Noa. Actually my Cortisol level is low. Whether this has to do with adrenal problems or not, I just don't know. problem is, the doctors don't seem to know either. Maybe my follow up visit will prove more fruitful.
Again, thank you for responding.
Anthony
Posted by Noa on May 31, 2000, at 15:02:44
In reply to Re: Atypical Depression/Thyroid (For Noa), posted by Ant-Rock on May 31, 2000, at 13:48:16
There are adrenal conditions that cause low cortisol, too, as I understand. Is this an endocrinologist you are seeing?
Posted by Ant-Rock on May 31, 2000, at 19:46:14
In reply to Re: Atypical Depression/Thyroid (For Noa), posted by Noa on May 31, 2000, at 15:02:44
> There are adrenal conditions that cause low cortisol, too, as I understand. Is this an endocrinologist you are seeing?
Yes, my second endo in the last 8 months. The first Dr. diagnosed the low cortisol, but told me he didn't think it contributed to my constant fatigue. Sometimes once a Dr. hears you're being treated for depression, they attribute all your physical problems to it. I've read that low cortisol levels can cause fatigue, but this Dr. wasn't convinced and said he couldn't do anything for me. So this new Dr. at my first visit did some blood tests,(the ones in my first post), and again came back low cortisol, AND low testosterone. Anyway, hopefully at my next visit I can get a better explanation of these results.
Thank you for your concern Noa, it means a lot.
Anthony
Posted by AndrewB on June 2, 2000, at 0:52:03
In reply to Re: Atypical Depression/Thyroid (For Noa), posted by Ant-Rock on May 31, 2000, at 19:46:14
Anthony,
I was reading some interesting info. related to strategies to deal with adrenal insufficiency; testosterone patches, DHEA supplements and the like. To take a look at this info., go to www.cfidsfoundation.org/conferences/seetranscript.htm.
Your endo. doesn't seem too helpful. You might consider a CFIDS specialist. Many of them seem to be quite resourceful and take fatigue seriously, even when it is mixed with depression.
AndrewB
Posted by Ant-Rock on June 2, 2000, at 17:07:22
In reply to Re: Atypical Depression/Thyroid (For Noa), posted by AndrewB on June 2, 2000, at 0:52:03
> Anthony,
>
> I was reading some interesting info. related to strategies to deal with adrenal insufficiency; testosterone patches, DHEA supplements and the like. To take a look at this info., go to www.cfidsfoundation.org/conferences/seetranscript.htm.
>
> Your endo. doesn't seem too helpful. You might consider a CFIDS specialist. Many of them seem to be quite resourceful and take fatigue seriously, even when it is mixed with depression.
>
> AndrewBThank you for the cfids web site Andrew, I will try to check it out this weekend. I have a new endo-doc, so hopefully when I go back for my follow-up in 2 weeks I can get some answers.
Hows the COMT(?) trial working out? I hope things are well for you.
I've never heard of any cfids docs here in RI, but I guess it's possible.
Again, thank you for taking the time to help, it is very much appreciated.Anthony
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.