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Experience with thyroid medication for depression? (Ugh. What have I done by trying this?)
June 26, 2012 9:32 AM   Subscribe

I'm on thyroid medication for depression -- did I just start a permanent sentence without realizing it?

I just started taking thyroid hormones (liothyronine/Cytomel, 25mcg/day) for long-standing depression, started about a week or 2 ago. I still mostly feel like crap, tired, cloudy thinking, needing to rest all the time, etc (just had to stop home for a nap and call in that I'll be very late to work). My thyroid is normal according to labs, i'm taking this for depression and hoping it will help with the fatigue and massive weight gain over the past 3-4 months (~25 lbs).

I made it to about 1/2 my therapy session this morning, and at the end the therapist (not an MD) said that she thought once I start on this med, I can't get off of it even though it might not work. As in my thyroid won't return to normal. Is this true? Again, I was not prescribed it to replace the hormone -- my T3/T4/TSH was all in the lab's normal ranges, and my PCP didn't prescribe the med, my psych MD did. I've tried many many meds, and am currently regularly prescribed lithium, wellbutrin, ritalin, and klonopin (although that last one I take infrequently), and the Nuvaring.

Yikes, what have I done? I know YANMD but before I call my psych MD/wait for his call back and totally freak out on the phone, I thought it might help to get some input from people who took it before, and hear how it helped/didn't help them, too. I could have swore he said I could stop if it didn't work, but now I'm just sad and freaked out.
posted by ArgyleMarionette to Health & Fitness (17 answers total) 6 users marked this as a favorite
 
I recently started augmentation therapy with thyroid as well. I needed 50mcg/day, which is the usual protocol--I expect you'll be moved up to it at your next psych visit.

I have two thoughts about this: 1. of all the things to take on a long-term basis, especially compared to lithium, which is also used as an adjunct, I think it's not so bad. I was not told, however, that I could never go off of it.

2. I'm wondering if the thyroid augmentation might allow you to make the kind of dramatic lifestyle changes that can help with depression--that is, pick you up enough to get you exercising, eating better, using a lightbox, meditating, working on your sleep cycle--and then you might be able to reduce or eliminate it from your regimen. I think that a pretty serious change in lifestyle can really help (as with something like diabetes), but it can be hard to get started and to develop good habits. What if you thought about the thyroid as a tool to help you build a different life?
posted by liketitanic at 9:38 AM on June 26, 2012


There is a literal 0% chance that your doctor put you on a medication he or she knew you would have to take every day for the rest of your life without making this incredibly crystal clear. Really, that is just not possible.
posted by brainmouse at 9:41 AM on June 26, 2012 [6 favorites]


I am on synthetic thyroid for low thyroid functioning - my doctor told me that sythetic hormone dependence is a myth. I am not a doctor but this study has been cited to show that, after stopping synthetic thyroid hormones, hormone levels dropped for a period of a few weeks but returned to baseline in 4 weeks.
posted by muddgirl at 9:43 AM on June 26, 2012 [5 favorites]


And I should note that the patients in that study were women with normal thyroid functioning who had been taking the drug long-term (although I don't have access to the full text to say what 'long-term' means precisely). I assume that if this drug isn't working you'll stop it in a matter of a few months, not a few years, so withdrawal effects should be even more minimal.
posted by muddgirl at 9:47 AM on June 26, 2012 [1 favorite]


And I should note that the patients in that study were women with normal thyroid functioning who had been taking the drug long-term (although I don't have access to the full text to say what 'long-term' means precisely).

Oh hey, I do: "Studies were conducted in seven women, varying between 20 and 65 years of age, who had been receiving either desiccated thyroid or synthetic sodium L-thyroxine therapy for periods ranging between two years and 30 years. Two of these patients were being treated for nontoxic nodular goiter, and three for diffuse nontoxic goiter; two had no evident thyroid disease. All patients agreed to an abrupt discontinuation of therapy so that the present studies could be performed. All were in good general health and were receiving no other medications."
posted by shelleycat at 9:53 AM on June 26, 2012 [3 favorites]


I have a thyroid disorder and I will need to take thyroid medication every day for the rest of my life. I think it's rather odd to be prescribed thyroid medication for depression if your T3, T3 and TSH are normal -- that might've been the time to get a second opinion. But, I am not a doctor so I can't tell you if this thyroid medicine will permanently mess up your thyroid. What I can say is, thyroid medicine is very cheap, even without health insurance, and if you're taking thyroid hormone replacement to speed up your thyroid, very safe. So totally I understand your concern and wanting to get to the bottom of this and I think you should continue, but if it does turn out to be permanent, just know tons of people deal with it and it's not a big deal on the hierarchy of medical disorders to deal with. Good luck!
posted by AppleTurnover at 10:22 AM on June 26, 2012


I asked my doctor and she said it doesn't create dependence (I'm on 50mcg of Synthroid, have been for about 5 weeks.) Same with my Metformin - that the only reason my labs would be messed up after I got off of it, was because the drug was actually helping do something and we'd taken that away. They wouldn't be messed up more because I'd somehow broken my body by going on the drug. If that makes sense.

I do remember hearing that lithium can permanently screw up your thyroid, though (I was told it was rare - that normally the thyroid stuff, if it happens at all, goes away once lithium is discontinued.) My own thyroid issues are of the "TSH keeps creeping up, you're still .04 below the top of the lab's reference range, let's put you on this and see if it helps your depression" variety; thyroid/weight concerns were in the (verbal, to freaked-out new patient me) list of reasons they didn't put me on lithium when I was first diagnosed with bipolar disorder. We skipped right on over to antipsychotics and anticonvulsants.

(I would be a bad candidate for a "let's see what happens if we take you off Synthroid" test, in any case - my TSH was creeping up by .3 or so every three months, after several years of being elevated-but-normal. According to the latest arguments, I have been hypothyroid for at least the last five years, though I've never been above whatever the current reference range was at the time of any given test.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 10:24 AM on June 26, 2012


The normal range for TSH, for example, is 0.4 - 4.0 mIU/L. With this being such a broad range, I can see why they'd use synthroid or levothyroxine as a conjunct with your antidepressants (one of its off-label uses), because while your thyroid levels may be within that broad normal range, they may still be too high or low for you, and may be contributing to your symptoms.

Generally, synthetic thyroid replacement therapy is a "on it for the rest of your life, can't ever go off of it" medication IF you've been diagnosed with underactive thyroid. That doesn't appear to be the case here, and as noted above, it's not a dependence-inducing drug. You should ask your psych MD just to clarify, but don't let your therapist worry you too much about it.
posted by scarykarrey at 10:34 AM on June 26, 2012 [2 favorites]


No, this is not true. I am on thyroid medication, but for actual low thyroid function. I have a family member who is a psychiatrist who often prescribes T3+T4 for depression and has a good success rate with it, including in patients who are within normal lab ranges for T3/T4 but near the edge of those ranges. It is not by any means a medication that you will have to take forever if it doesn't work. It's not going to make your thyroid stop functioning. Your MD will be able to confirm this.
posted by bedhead at 11:13 AM on June 26, 2012


I think it's rather odd to be prescribed thyroid medication for depression if your T3, T3 and TSH are normal -- that might've been the time to get a second opinion.

This is incorrect. It is used routinely for treatment-resistant depression.
posted by liketitanic at 11:33 AM on June 26, 2012


IANAD, but no need to freak out. You haven't done any harm to yourself or committed to taking this medication for the rest of your life. I actually think your therapist was rather irresponsible to suggest such a thing.

As for my personal experience, I'm someone who always exhibited many symptoms of low-thyroid but always tested "normal," so primary care doctors wouldn't prescribe me anything. Eventually, a psychiatrist put me on a low dose for my depression. I was monitored with regular blood-work, and while my thyroid hormones remained in the normal range, it made a tremendous difference in terms of how I felt. Don't get me wrong it's not a cure-all, I still take medication for my depression, but the synthroid is an important part of my regimen. Not only is it routinely prescribed for depression, but there's also some debate about what normal thyroid levels actually are. A lot of people are on the low-end of normal and benefit substantially from a low-dose of synthroid.

As for being on this forever, no, not necessarily. Your body won't become dependent, and your thyroid won't stop functioning because you are supplementing it with thyroid hormones. Just make sure you get regular blood work frequently in the beginning to make sure you don't tip into the overactive range and then monitor it as you would any condition. From everything you've said, while you are not seeing the benefit right now, it sounds like it could really help you.

As for still feeling like crap, it takes a while for your body to adjust, and my doctor told me to think of my thyroid & medication for it in terms of how much I take over the course of a week, not so much what I take each day. Also, you are on a really low dose. Your doc will probably increase it if you aren't experiencing any adverse reactions. It's worth giving this shot. You won't magically lose weight or suddenly not be depressed but it should alleviate some of your fatigue. It probably won't eliminate it (at least it didn't in my case), but quite possibly it will help. If not, no harm, no foul. You simply stop taking the thyroid medication and look for other solutions. Good luck!
posted by katemcd at 1:04 PM on June 26, 2012


I take double your dose for subclinical hypothyroid; my labs were in the "high normal" range, but I felt like crap/had the weight gain issues you describe as well as brain fog, exhaustion, and shivering cold all the time. (72 degrees F and my teeth would be chattering... even under a robe.)

After 6 weeks or so, I felt close to awesome again... pretty suddenly, too. Around that time, I started to feel like I'd had a quarter-cup of coffee every morning after taking my pill. Weight started falling off of me - a pound a week for 10 weeks - without any additional changes to diet/exercise. It stopped when I was in 3-4 lbs. of my original weight; I'd gained 16 lbs. in two months, in 4-7 lb. increments over a couple of days each, and had been unable to lose them again, even with 3-hour workouts on weekends and eating small meals every 2 hours.

My bloodwork a year later was markedly improved, and I've stayed on Synthroid ever since. Other weird things that improved I wasn't expecting:

- My hair got less dry/prone to split ends
- My skin became noticeably softer
- Bizarre and painful foot and leg cramps after cardio exercise became infrequent; before, I'd gotten them like clockwork
- I was able to sweat normally again at the gym; for some reason, I couldn't really get sweaty before? Not sure why
- Libido improvement
- Able to keep clear train of thought/remember things more easily throughout the day, including keeping up with my car keys (ugh, a lifetime of annoyance behind me!)
- Less tolerant of caffeine, but especially coffee; before I could pound down 2 Ventis a day

Basically I felt like a human being again, and not like a broken product that needed to go back to the Woman Factory because I'd fallen out of warranty and couldn't function correctly, though that's hard to articulate to a male doctor. Most of the weird symptoms I didn't even realize I had until they'd vanished from taking the medication.

I've also been treated for depression and taken antidepressants, and did not enjoy the side effects. Luckily, I must've gotten the right dosage from day 1, because my symptoms resolved without experimenting with different medication types/dosages (there's different brands and strengths of thyroid meds, just like any other).

My coworker had a spell of chest pains/arrhythmia and stopped her thyroid meds recently for 3 months to make sure it wasn't that particular medication; she had half of her actual thyroid removed at 18, and she's 58 now. She appeared to have no negative reaction to being off the medication for the first time after 40 years (well, she gained 6 pounds), but she's just gone back on with a different formulation and is in week 3 with no negative/noticeable side effects, so I'd think you're good to go.

Your therapist is probably inexperienced with these types of meds and therefore made her pronouncement out of ignorance.

My dad once told me that, as a consumer, it's important to act as your own best advocate for your health in ANY doctor's office; if you're ever unclear/confused about a prescription medication you're advised to take -- like how much, what the alternatives are, and why it's being prescribed to you -- remember that you have the right to:

- ask about alternative options, medications or protocols, including the side effects of each;
- not fill the prescription without first being given a sample to try (if possible);
- get a second opinion;
- ask to be referred to a specialist; OR
- simply change doctors altogether.

Taking a proactive stance about your emotional and physical health can definitely be a chore, but it's a worthwhile one - hope you feel better soon!
posted by Unicorn on the cob at 4:13 PM on June 26, 2012 [1 favorite]


IANAD but my experience was that I was on lithium, so my thyroid function became hypo (as far as I know I was normal before, although my metabolism has always been fast), and I was given synthroid. When I stopped the lithium, I stopped the synthroid, and my thyroid function became normal within a few weeks.
posted by sm1tten at 4:15 PM on June 26, 2012


One of the more disappointing things I've learned is that a remarkably high % of people in positions of authority or knowledge make authoritative statements without actually knowing what they're talking about. Your therapist heard someone say something once about needing to take thyroid hormones for the rest of your life, or heard the rumors that apparently exist about it causing dependence, and didn't ever follow up and find out whether it was true or not, since it's not her who prescribes these meds and needs to have the knowledge.

I'd be pretty pissed at your therapist here for giving you a scare like that without knowing what she was talking about.
posted by Lady Li at 4:41 PM on June 26, 2012


Been there, done that. Now off the cytolmel with no problems with my thyroid after going off. Please don't let your therapist scare you. Hopefully it'll help with the depression.
posted by kathrynm at 4:52 PM on June 26, 2012


Side note: consider that the nuvaring may be causing part of your depression. If you are especially sensitive, it can be just as mood destabilizing as the pill.

Hope you feel better soon!
posted by luckdragon at 5:47 PM on June 26, 2012


Thank you all!!! Yes, the therapist's small off-hand comment really put me in a tailspin. I tend to tailspin pretty easily (hence the therapy) though. Your comments help a lot and give me a lot of hope here. Both this therapist and my psych MD know my struggle with taking meds (acceptance, compliance, comments from family, quest for effective ones, etc) so it was a really weird and horrible feeling. They work in the same fricking clinic, so I will calm down then kindly let them know that they might want to chat... FWIW, my latest TSH level was ~3.0-3.1... older ones (<2> Thanks again.
posted by ArgyleMarionette at 8:42 PM on June 26, 2012


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