Advice needed please

[carnation]

Well stressed this evening. My youngest daughter is 31 and has hashis. She was diagnosed 6-7 years ago and is on 200mcg (I think) of levo, and also (possibly) citalopram. Sorry if this is a bit vague but she has lived in London for a few years now. I found out about the citalopram by accident and she does not know that I am aware of this.

Anyway my oldest daughter had a phone call yesterday from one of her sisters friends saying how worried they are about her, because she is really unhappy, and has started to harm herself. Apparently she was seeing a councillor last year but she did not know if she had continued. It seems likely that it was too expensive. She is also drinking a lot. When we see her she always says she is fine. She is a very private person.

I have decided to fake a blood test request at the doctors (she is still registered at the family doctor) and plan to persuade her to go.

I do not know much about antidepressants, should citilopram be taken with levo - I suspect she takes them all at once!

Any other advice what to do next would be appreciated as we are all rather shaken. I have been very stressed out about my Mum who has Alzheimer's and has deteriorated rapidly this last few months, so I have not been well either. I know very little about depression but know how bad I have felt in the past when under medicated. I should be seeing her next weekend.

Thanks for reading my long post.

[rosetrees]

Difficult. There's the possibility that your daughter will resent and resist any intervention from yourself or her sister. You know how it is with families - it's easy to feel the ones who love you are the ones who are interfering in your life and think they know what is best for you.

I wonder if your daughter's friend might be willing to try to help. The fact that she is worried enough to contact your other daughter makes me think she might.

My immediate thought is that your daughter might fare much better on NDT. Could you send her friend some articles about how it has helped other patients? Her friend might be able to show them to your daughter on the basis of "look what I've found, I wonder if this would help you". Your daughter might feel more able to communicate with her friend than her family.

Do you know what kind of diet your daughter eats? Gluten free, I think, helps many with Hashis, along with plenty of fruit and vegetables.

The problem with people who are depressed and have dug their heels in, refusing to seek or accept help, is that it is impossible to help them unless or until they are ready to accept that help.

I'm wondering, does she feel (and does she have grounds to feel) that every time you talk to her you raise her condition and try to help - which she might see as attempting to push her into treatment she doesn't want to seek. If so, maybe bite your lip and have some conversations where you deliberately don't raise the issue of her health. This might start to change her perception and encourage her to reach a point where she raises it for herself.

Maybe someone here will have been in either your or your daughter's shoes and will be able to offer some much more constructive advise.

[carnation in reply to rosetrees]

Hi thanks for your comments. There is a good possibility that she will resent interference, but we feel we have to say something, if very cautiously.

My son in law is meeting her friend for lunch for more info - my daughter got very upset on the phone. We are reluctant to ask too much of her, she has a job and 2 small children, but we will give it some thought.

As for her diet, I suspect it is whatever is easy and inexpensive, but she doesn't usually eat junk. May suggest gluten free if things go well!

As for discussing her health, if anything I have said too little. She always says she is fine when I ask. Am trying to think of ways to ask what help she needs, without causing any upset.

[Clutter]

Carnation, I'm not sure how faking a blood test will get your daughter to open up to her GP. Unfortunately, drinking too much when depressed is very common and can make the depression worse. Did the same myself and was mightily offended if anyone suggested moderating my drinking. I stopped seeing my family for a while because I didn't look at all well and didn't want to worry them which, of course, worried them more. I've also been a bit hostile to well meaning suggestions from family members in the past. I sort of took on board their concerns but often didn't act on them until I was either feeling better or worse.

I'd be inclined to be frank with your daughter and say that you're reluctant to invade her privacy but a concerned friend has contacted her sister who has confided in you and although you don't want to pry or interrogate her about her health, you are also concerned. Flat out refuse to name the friend in case it backfires and spoils the friendship. Ask your daughter whether she takes Levothyroxine and Citalopram at least 2 hours apart and explain taking them together reduces effectiveness of Levothyroxine which can make her symptoms worse. Suggest she sees her GP to see whether further counselling can be arranged if she found it helpful first time around and suggest she has a thyroid blood test to check her levels. Offer to get her results interpreted on here if it would be helpful but don't press her if she says no. If your daughter refuses to discuss her health at all, don't be offended, just tell her you're concerned because you love her and talk about something else.

[carnation in reply to Clutter]

Hi Clutter, thank you for your comments. I was actually going to suggest a blood test and maybe post the results on here. With her permission of course. She did say she needed to go but was too busy at work. That was some months ago.

I was not aware that you should take citalopram 2 hours away from levo so I suspect she is not either. Neither of us were ever given any useful information. I used to take my levo straight after breakfast till I joined this site!

I suspect she will easily guess which friend has spoken to us, but as you say we can only offer to help and accept a refusal with good grace. We have decided that if she wants to resume counselling we will find the money.

[Clutter in reply to carnation]

Carnation, for maximum absorption and uptake Levothyroxine should be taken with a glass of water on an empty stomach, one hour before or two hours after food, 2 hours away from other medication and supplements and 4 hours away from iron, calcium, vitamin D and oestrogen.

Offering to help pay for counselling if it previously helped her is very positive. I hope your daughter isn't as ungracious as I sometimes was. I'd give a lot to be able to tell my mother how much I appreciated her concern even though I appeared to reject her help at times.

[shaws]

If she has been taking levothyroxine with an anti-depressant it may cause an interaction.

Also if she is on levothyroxine and dose isn't high enough she can become depressed as not sufficient T3 may be converted. T3 can also help in depression and I don't know why doctors don't supplement this to a hypothyroid patient.

evolutionarypsychiatry.blog...

drmirkin.com/morehealth/g17...

Our brain contains the most T3 receptor cells and, again, I don't think doctors have a clue about how thyroid hormones interact with everything.

I wasn't depressed but felt very unwell on levo but when T3 was added it was an amazing difference.