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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 yellowbird01 on April 6, 2009, at 7:09:23
Is it possible for cytomel to actually make depression worse? That doesnt make logical sense to me, but I have to ask. I havent had any useful response to meds in the past so my dr started me on cytomel based on the idea of subclinical hypothyroidism... my blood count wasnt abnormal. I took 10mcg for about 3-4 weeks and recently switched up to 25mcg. The last few weeks, but especially this weekend, I've felt worse than I've felt in a long time. My depression tends to be cyclical so it could easily be just that, but is it possible for cytomel to be having the opposite effect? I also take adderall in the AM but otherwise no other meds at this time. Thanks!
Posted by SLS on April 6, 2009, at 7:25:17
In reply to cytomel - worsening depression?, posted by yellowbird01 on April 6, 2009, at 7:09:23
> Is it possible for cytomel to actually make depression worse?
Yes. It does mine. My system likes T4 (thyroxine) better. Be careful when trying to "out-think" the brain using our best of logic because our understanding of it is so limited. To your brain, it makes perfect sense that T3 (triiodothyronine / Cytomel) would make your depression worse. It is what it is. In the meantime, we must respond to such observations with an inductive logic that will allow us to conclude that T3 is probably exacerbating your depression.
What is the condition that you are treating?
- Scott
Posted by yellowbird01 on April 6, 2009, at 7:58:11
In reply to Re: cytomel - worsening depression? » yellowbird01, posted by SLS on April 6, 2009, at 7:25:17
Thanks Scott for such a quick response!
What is the condition that I am treating? Well, my only medical problem at this point is depression. My depression has been very severe in the past but is more moderate now. My thyroid numbers have always been normal but my pdoc was suggesting that subclinical hypothyroidism might be playing a role since I havent responded to other anti-depressants, mood stabalizers, etc. The adderall is also being used for depression. It seems to be the only thing that gives me a lift (or any positive benefit really).
I'll probably give my pdoc a call today. He is very good about calling back. Thanks for your help.
Posted by yellowbird01 on April 6, 2009, at 8:03:45
In reply to Re: cytomel - worsening depression? » yellowbird01, posted by SLS on April 6, 2009, at 7:25:17
I tried to call my pdoc and it turns out he is out of the office this week and wont be checking messages again until next Monday. Oh well.. looks like I'll be dealing with it this week and if need be, I'll give him a call next week.
Posted by SLS on April 6, 2009, at 9:57:36
In reply to Re: cytomel - worsening depression? » SLS, posted by yellowbird01 on April 6, 2009, at 8:03:45
For me, what was done to demonstrate cause and effect was to discontinue the Cytomel for a few days, and then restart it to see if it was indeed responsible for making my depression worse. It was.
I am curious to know if there is any bipolarity in you or your family.
- Scott
Posted by Phillipa on April 6, 2009, at 12:20:24
In reply to Re: cytomel - worsening depression? » yellowbird01, posted by SLS on April 6, 2009, at 9:57:36
Scott last year the eno added a mere 5 of cytomel to my synthroid but it made me more anxious yes I do have thyroid disease. But how does cytomel make depression worse as thought it boosted synthroid? Love Phillipa
Posted by yellowbird01 on April 6, 2009, at 12:36:34
In reply to Re: cytomel - worsening depression? » yellowbird01, posted by SLS on April 6, 2009, at 9:57:36
I'm going to give the new dosage a few days to allow my system to get used to it and see what happens... then next Monday, if no improvement, I'll definitely contact my pdoc or try a few days off as a test. Good idea.
As I wrote my last response and referred to my depression as cyclical, I thought it might set off the bipolar bells. I know very little about my family's health history due to the "family rules" which prohibit discussing such things. Nonetheless, I really dont think bipolar is what is going on for me. I tend to have a low level of depression most all the time... my therapist has suggested dysthymia. From time to time, the more moderate-severe depression steps in that effects my functioning, brings suicidal thoughts, etc. I've had two major depressive episodes that have lasted 1-2 years each, the second ending about two years ago. Since then, the same heavy darkness that says "major depression" tends to reappear from time to time for anywhere from a week to several weeks. After a little bit of time, I get back into a place where I'm functioning well again. Not terribly happy, but functioning.
I often wonder how much of my depression is biological and how much is something else. I do think a portion is biological, but I also have issues with self esteem, identity, etc that no doubt contribute. I am beginning to think spending all this money on a psychaitrist and medications is really just a waste of my time and money.
Posted by Phillipa on April 6, 2009, at 13:56:49
In reply to Re: cytomel - worsening depression? » SLS, posted by yellowbird01 on April 6, 2009, at 12:36:34
This is what i found so your thyroid is normal and given T3 does that mean that if thyroid is normal T3 can cause depression confused? Love Phillipa
USE OF T3 THYROID HORMONE TO TREAT DEPRESSION
Gabe Mirkin, M.D.
If you are tired much of the time, your doctor will order blood tests for the two thyroid hormones called T3 and T4 and for the brain hormones called TSH and prolactin. If your TSH is high and your prolactin is normal, you are probably hypothyroid and need to take thyroid hormone to give you more energy and prevent heart and blood vessel damage.Doctors treat people with low thyroid function with thyroid pills called T4 (Levothroid, one brand name is Synthroid). Many doctors think that a person needs only T4 because the thyroid gland makes T4 and then it is converted to T3 in other tissues. However, some people become depressed when they take just T4 and their depression can be cured when they take both thyroid hormones, T3 and T4.
When a depressed patient comes to me and is taking thyroid hormone, T4, I immediately order a blood test called TSH to check if he or she is getting the correct dose. If the TSH is normal, I reduce the dose of T4 by 50% and add a very low dose of T3 (brand name, Cytomel) because it safer to prescribe too low a dose, rather than too high a dose. Overdoses cause shakiness, irritability, irregular heart beats, clots, and osteoporosis. The patient returns in one month for a blood test, TSH, to see if the total thyroid dose is correct. If the TSH is too high, the thyroid dose is too low and I raise the T3 (Cytomel) dose by 5 to 10 m5 each month until the TSH is normal. Then once a year I check TSH blood levels to make sure that the person's requirements for thyroid hormone are being met.
For example, the usual replacement dose for low thyroid function is 100 micrograms per day. If a depressed patient has a normal TSH, I reduce the T4 dose to 50 mcg/day and add 5 mcg of T3 per day. One month later, if the TSH blood is still too high I raise the T3 dose to 10 or 20 mcg and continue to increase the T3 level each month until the TSH is normal.
Exciting research shows that the thyroid hormone called T3 can help treat depression (1,2,3). Psychotherapy often fails to control depression. Sigmund Freud, the father of psychotherapy, proposed theories about depression, that many psychiatrists do not accept because his writings were his opinions and not presented as scientific data supported by controlled experiments. The dominant theory today is that depression is caused by low brain levels of the neurotransmitters, serotonin and norepinephrine. The drugs such as Paxil, Prozac and Zoloft that treat depression are supposed to raise brain levels of these neurotransmitters. Doctors can also raise brain levels of serotonin by prescribing pills containing T3, a hormone produced by peripheral tissue from T4, which is produced by the thyroid gland. (1) They also prescribe T3 by itself or together with antidepressants. Depression is common among people who have too much or too little thyroid hormone. Doctors usually treat low thyroid function with T4 also known as Levothroid and many people become even more depressed. They treat this depression by prescribing T3 as well as T4.
An article in the Journal of Clinical Psychiatry shows that T3 can be used to treat post traumatic stress disorder, commonly seen in soldiers and people who have been through other causes of terrible emotional trauma (13).
Try to balance T3 and T4 so you will not be taking too much thyroid and harm yourself. 1)If you now take 100 mcg of Levothroid (T4): 2) Lower T4 (Levothroid) to 50 mcg and add Cytomel (T3) 5 mcg each day. 3) One month later, have your doctor draw blood for TSH. 4) If it is normal, you are on the correct dose and should get blood tests TSH once a year. 5) If TSH is too high, increase Cytomel to 10 mcg and hold Levothroid at 50. 6) Draw monthly TSH until it is normal. Keep on raising Cytomel by 5 mcg until TSH is normal.
1) M Weissel.Treatment of psychiatric diseases with thyroid hormones.Acta Medica Austriaca, 1999, Vol 26, Iss 4, pp 129-131.
2) H Heuer, MKH Schafer, K Bauer.Thyrotropin-Releasing Hormone (TRH), a signal peptide of the central nervous system.Acta Medica Austriaca, 1999, Vol 26, Iss 4, pp 119-122.
3) F Konig, C vonHippel, T Petersdorff, W Kaschka.Antithyroid antibodies in depressive diseases.Acta Medica Austriaca, 1999, Vol 26, Iss 4, pp 126-128.
4) A Steiger.Thyroid gland and sleep.Acta Medica Austriaca, 1999, Vol 26, Iss 4, pp 132-133.
5) Jackson IM .Thyroid 1998 Oct;8(10):951-6.
6) Refractory depression: treatment strategies, with particular reference to the thyroid axis. Joffe RT . J Psychiatry Neurosci 1997 Nov;22(5):327-31 .
7) Thyroid hormones in depressive disorders: a reappraisal of clinical utility. Lasser RA , Baldessarini RJ, Consolidated Department of Psychiatry, Harvard Medical School, Boston, Mass., USA. Harv Rev Psychiatry 1997 Mar-Apr;4(6):291-305
8) The hypothalamic-pituitary-thyroid axis in major depression.Sullivan PF , Wilson DA , Mulder RT , Joyce PR University Department of Psychological Medicine, Christchurch School of Medicine, New Zealand. Acta Psychiatr Scand 1997 May;95(5):370-8
9) S Ramschak Schwarzer, W Radkohl, C Stiegler, HP Dimai, G Leb. Interaction between psychotropic drugs and thyroid hormone metabolism - an overview. Acta Medica Austriaca, 2000, Vol 27, Iss 1, pp 8-10.
10) Dorn et al. Baseline thyroid hormones in depressed and non-depressed pre- and early-puberty boys and girls. J Psychiatry Research 1997(Sept_Oct);31(5):555-67.
11) Birkenhager TK et al. An open study of triiodothyronine augmentation of tricyclic antidepressant in inpatients with refractory depression. Pharmacopsychiatry 1997(Jan);30(1):23-26.
12) SK Rack, EH Makela. Hypothyroidism and depression: A therapeutic challenge. Annals of Pharmacotherapy, 2000, Vol 34, Iss 10, pp 1142-1145.
13)Triiodothyronine augmentation of selective serotonin reuptake inhibitors in posttraumatic stress disorder. O Agid, AY Shalev, B Lerer. Journal of Clinical Psychiatry, 2001, Vol 62, Iss 3, pp 169-173.
Checked 2/8/09
Posted by yellowbird01 on April 6, 2009, at 17:27:44
In reply to Re: cytomel - worsening depression? » yellowbird01, posted by Phillipa on April 6, 2009, at 13:56:49
Interesting. Thanks Phillipa. I'm going to try to do some more research myself and see what I can learn.
Posted by PeterJ on April 7, 2009, at 9:05:32
In reply to Re: cytomel - worsening depression? » yellowbird01, posted by SLS on April 6, 2009, at 7:25:17
> Be careful when trying to "out-think" the brain using our best of logic because our understanding of it is so limited. To your brain, it makes perfect sense that T3 (triiodothyronine / Cytomel) would make your depression worse. It is what it is. In the meantime, we must respond to such observations with an inductive logic that will allow us to conclude that T3 is probably exacerbating your depression.Words of wisdom, my friend. I'm reminded of a quote -- I' sure you've heard it:
If the human brain were so simple
That we could understand it,
We would be so simple
That we couldn't.(Attributed to Emerson Pugh)
Of course we are forced to try to understand, in order to treat ourselves and our ailments, and we constantly need to change our theories when we encounter new facts, like this one.
PeterJ
Posted by SLS on April 7, 2009, at 12:33:39
In reply to Re: cytomel - worsening depression? » SLS, posted by PeterJ on April 7, 2009, at 9:05:32
Nice to see you again!
:-)
- Scott
This is the end of the thread.
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