[waves]

Hi

from last week's visit with pdoc:

• THYROID... labs came back my TSH is somewhat elevated and T4 is normal but on the low end. my pdoc called it "compensated hypothyroidism." he told me there are different schools of thought on treating/not treating and what they were. He and I were both on the same page in that regard - i don't have many other typical sx, and the fatigue could be who knows what. So decision was to wait and retest later...
  .
• HYPOMANIA... i was getting real close to hypo and we decided to taper my Zoloft... not too fast, but not real slow either... initially down to 50 from 100mg for 10 days.
  .
• ZOLOFT-THYROID CONNECTION (possible).... the getting off Zoloft was convenient timing because the Zoloft could be causing the thyroid issue. So the idea was, get off the Zoloft and retest thyroid a month afterwards, which would be enough time for things to reset.

-----------------------------

Thus began the taper w/ 50 mg Zoloft

days 1-5 --- still on verge of hypo! (impulsive, got called on being too loud a lot, constant wordplay - more than usual, waaay less inhibited & sense of exquisite wellbeing close to euphoria...)

day 6 --- energy took a dive and mood markedly lowered.
day 7 --- mood plummeted. bye bye wellbeing, hello black hole. (that was yesterday/Monday)

Possible causes for mood switch:

• case 1: thyroid - low mood due to thyroid unmasked, or downcycling due to thyroid function

  --- OR ---

• case 2: Zoloft - low mood precipitated by too abrupt change in dosage.

Devil and Deep Blue Sea:

• case 1: best to remove Zoloft from equation as fast as reasonably possible in order to detect/corrrect thyroid issues.
• case 2: best to slow down Zoloft taper as much as possible, or even stop taper at a lower dose if depression persists.

i texted pdoc with concerns asking for callback or text for dosage. he ended up neither calling me back nor texting must have forgotten. i called him this morning.

he said i sounded bad and said to go back to 75 for now. well if we're gonna go that route, i asked to take 100mg today coz that will bring my plasma level up more immediately and i can hopefully feel better faster.

heck darn i hate this

waves on the thin ice

i hope this post is clear becausee it was hard to write. i want my almost hypomania back i'm tellin ya.

[bizi]

Dear waves,
I am sorry that your depression has returned,
it is amazing how quickly things get turned around with these meds.
I hear you on wanting some almost hypomania....
hugs to you my friend
((((HUGS))))
bizi

[waves]

Thanks Bizi.

if only we could stay in a stasis of almost-hypomania, eh?

waves

[mrsD]

What can cause TSH to rise.

http://www.thyroid-info.com/articles...luctuating.htm
It is a long list.

[waves]

Hi MrsD,

thanks for all that info. I am not currently being treated for any thyroid disorder. Consequently I do not have frequent thyroid tests. I get tested occasionally because of my meds.

Many years ago there was suspicion of hypothyroidism (again subclinical presentation this time with low FT4 but normal TSH). At that time i was tested Hashimoto's (negative). I have been euthyroid ever since stopping the carbamazepine. I've been on Zoloft lots of other times and been euthyroid so this could well be just a lab fluke.

As indicated in my post, there was a primary motivation to remove the Zoloft but, since SSRI's can cause changes in thyroid function in either direction, getting it out of the picture before the retest would be ideal. Then, at least, if my TSH is still elevated, or has risin even more, we will know there is problem unrelated to the Zoloft.

I do not take thyroid supplements, herbal supplements, estrogens or steroids. Exception when I feel I am getting sick i do a 2 week tx w/ echinacea but the last time was months back. Meds have not changed recently other than starting Zoloft late last year.

Very recent change to diet/meds are:
-- stopped using NSAIDs completely
-- stopped having spices (notably cayenne & garlic - i used to eat a lot of those) and some acidic foods, due to a GE mess up with NSAIDs.
-- added gabapentin 1200mg qd (300mg q6h) (i've taken it before)

My regular meds are
--Zoloft 75mg qAm (currently )
--Depakote ER 800mg qhs
--a long-acting benzo (N/A US) 2mg qhs
--lorazepam 2.5mg prn (very seldom)

I am not aware of the meds I listed (other than Zoloft/SSRIs) having potential to cause thyroid disturbances in adults (Depakote can in small children). If you have info to the contrary, I'd be interested as that would clearly be relevant.

I'd say, this is either a transient thing, a lab fluke, or due to the Zoloft.

If I can't remove the Zoloft quickly enough we may just retest and treat if it is worse. Maybe it will normal and then I'll know it isn't the Zoloft. Unfortunately, I cannot test too often because they are very expensive tests... the state limits how often it can be done even if pathology is suspected.

My lipid profile is very good which is hopeful since thyroid pathology often turns up some sort of dyslipidemia.

Again thank you for the very informative link. I do appreciate it and these will be things to bear in mind going forward, especially in the event I should need treatment.

waves

[Mari]

I could not follow this well enough to respond in a helpful manner. I can try again later.

I am going to come back again

i hope this post is clear becausee it was hard to write. i want my almost hypomania back i'm tellin ya.

Your post is very clear. I just have been having two difficult days.

M

[bizi]

I am sorry that you are having difficult days mari.
(((((HUGS)))))
bizi

[Mari]

Originally Posted by waves

Hi

from last week's visit with pdoc:

Dear Waves,

I am going to repeat to make sure I get it right. I realized that I know nothing about thyroid. That is why I had to read about five times to figure out the thyroid issue


THYROID --- one test is a little high and the other is a little low. This could effect mood. This could be something serious enough to necessitate periodic testing if one lived in a world that was willing to pay for the test/s.
Compensated Hypothyroidism = mild thyroid failure. The pdoc is aware of the problem

HYPOMANIA --- After a taper of Zoloft from 100 to 50 mgs you still felt on the verge of hypo after being at 50 for 10 days. You tapered from 50 and by day 6 you felt an energy nose dive. On Day 7 your mood plummeted. Zoloft seems too low or the taper was too fast or the thyroid is an issue.

ZOLOFT-THYROID CONNECTION (possible) --
This possible connection is tricky as all connections are tricky.

-----------------------------
Devil and Deep Blue Sea:
case 1: best to remove Zoloft from equation as fast as reasonably possible in order to detect/corrrect thyroid issues.
case 2: best to slow down Zoloft taper as much as possible, or even stop taper at a lower dose if depression persists.

If it were me, I would get the Zoloft at the mood place I needed it and put possible thyroid problem out of my mind for now. Thank goodness you have the pdoc for these matters.


=-=-=-=-=-=-=

he said i sounded bad and said to go back to 75 for now. well if we're gonna go that route, i asked to take 100mg today coz that will bring my plasma level up more immediately and i can hopefully feel better faster.

The pdoc is prioritizing SURE mood issue over POSSIBLE subclinical thyroid issues. That makes sense.

You are on thin ice only because you feel yucky right now. You are safe.
You do not have to decide anything. The pdoc already made the decision for you.

Are you at 75 or 100?

M

[Mari]

Originally Posted by waves

As indicated in my post, there was a primary motivation to remove the Zoloft but, since SSRI's can cause changes in thyroid function in either direction, getting it out of the picture before the retest would be ideal. Then, at least, if my TSH is still elevated, or has risin even more, we will know there is problem unrelated to the Zoloft.

Waves,

It looks like you are not going to remove the Zoloft for now.

The pdoc will come up with a plan for testing.

We make these compromises.
We have to take care of the mood first.
Everything else is secondary.
The pdoc is taking care of you. Let him work this out.
Stay balanced with the Zoloft for now. Thyroid is going to happen at a future day.
I hope that this made sense.
My life is a mess right now. I have no idea what is going on in my head.

M

[waves]

Dear Mari

thank you for the thoughts. i know you are trying to reassure me. that will be difficult in this case.

hypothyroidism, even "subclinical" can cause:

1. depression and fatigue

2. mood swings and cycling

forgetting about thyroid not good idea, especially since Zoloft can upset the thyroid and mine is apparently not happy. i have been assuming drug-induced problems are reversible (coming off drug) but come to think of it i don't know or don't remember.

--------------------
i see pdoc today. he probably won't know what we will do either. probably this will all be a "wait and see how you feel." my guess is if i am ok on 75 for a while, we will taper again.

i am at 75 mg. i figured though, since he was leaning on a "too fast taper" interpretation, i could take a 100 mg the first day to bump my levels back up.

--------------------
this is upsetting. i want to know what is going on. i really can't because all the variables will change. nothing i can do. must accept non-control over this. i don't think i am a control freak but i do like to know what is going on with my body. or rather i dislike not being able to find out.

waves who is in a rotten mood today stinky phooey rotten bleeahhh


p.s. i am sorry your life is a mess. I will try to find a thread that explains.