SSRI's & thyroid/adrenal

[t3rcam]

My daughter is really struggling & I wondered if anyone could throw some light on the following blood test results. First some context, she was diagnosed with Post Natal Depression about a year ago after her second child was 9 months old. From his birth he was an extremely sicky baby. She was breast feeding, he was colicky and had reflux. He was really unsettled and not a happy baby. My daughter was convinced that he was dairy intolerant but her concerns were ignored. Blood in his nappy resulted in a hospital stay, where dairy intolerance was confirmed. The reason I mention this is because she thinks that this was the trigger for her Post Natal Depression. She was prescribed antidepressants but experienced severe seratonin toxicity, a different antidepressant was prescribed but the same happened after an increase to 30mg a day. She currently takes 20mg citalopram a day. For about 6 months she has been repeatedly complaining of extreme tiredness and "crashing and burning" in the afternoon. I have seen her literally struggle to keep her eyes open and to keep up with my grandson as he toddles round the garden. I have accompanied her to GP appointments and requested that thyroid, iron and vitamin levels were checked. As I have Hashimoto's and adrenal issues I can totally relate to the exhaustion she is experiencing. I have read that some antidepressants can affect cortisol production. Has anyone heard of this? Can somebody interpret the following results for me -

free T4 - 14pmol/L (10-25)

TSH - 3.09 mU/L (0.55-4.78)

sodium - 144 mmol/L (133-146)

potassium - 3.8 mmol/L (3.5-5.3)

chloride - 109 mmol/L (95-108)

urea level 4.2 mmol/L (2.5-7.8)

creatinine 74 umol/L (50-100)

Vitamin B12 288ng/l (200-700)

Ferritin 69.6ug/l (7.0-150.0)

Folate 6.5 ug/l (3.0-20.0)

Haemoglobin estimation 136g/l (120-160)

Red blood cell (RBC) count 4.4x10^12/1 (4.0-5.0)

Haematocrit -PCV 0.40 l/l (0.37-0.47)

Mean corpuscular volume (MCV) 91fl (82-99)

Mean corpusc. Haemoglobin (MCH) 31 pg (27-32)

Platelet count 239x10^9/1 (140-400)

Total white cell count 4.8x10^9/l (4.0-10.0)

Neutrophil count 2.7x10^9/l (1.5-7.0)

Eosinophil count 0.19x10^9/l (0.1-0.5)

Basophil count 0.04x10^9/l (0.01-0.10

Lymphocyte count 1.7x10^9/l (1.5-4.0)

Monocyte count 0.2x10^9/l (0.2-0.8)

Large unstained cells 0.05x10^9/l (0.05-0.50)

Thyroid antibodies were not tested.

I am determined to help my daughter to get to the bottom of the excessive tiredness and hope that your expertise will help rule things out or otherwise. Thank you.

[bluebug]

Her TSH is in range which means the NHS will do nothing. However it is over 2. I suggest you pay to get her thyroid antibodies tested privately.

Her Vitamin B12 and folate levels while above range are too low. Go over to the pernicious anaemia society on health unlocked for more advice making it clear that your daughter has postnatal depression. Low vitamin B12 and cause depression plus other symptomse.g. tiredness.

There isn't a vitamin D test result. This needs to get tested as low vitamin D can lead to depression, other symptoms e.g tiredness and can possibly muck up her absorption of other nutrients. Again you may have to do this privately as GPs tend to look at people and decide they don't fit into the category to have this done . City Assays do a test for £28. Or you can do it with the thyroid antibodies if it is cheaper.

[startagaingirl]

Hi, to add to bluebug's reply. Since your grandson is dairy intolerant, have you thought that your daughter might be also and that could be causing gut problems, hence the malabsorption of vitamins and minerals? I have personal experience of this as I am also intolerant (in my case of gluten, dairy and soy), but didn't realise this till I was diagnosed with Hashis hypo and cut out gluten and dairy. This made no obvious change, but a few months later when I accidentally ingested gluten and dairy separately, I had a bad reaction to both, followed by a bad reaction to soy. So the gut healing then showed me the real picture. To add to this my daughter who has suffered since practically birth with bad eczema, also cut out first dairy, with a subsequent reduction in itching but eczema still spreading. She then cut out gluten and the eczema cleared up. Now she can tell almost instantly if she has any cross contamination. Her 3 year old toddler has also developed eczema so we suspect the same, and her 3 month old is having characteristic sneezing fits already - it's a family trait! - so we figure she is going the same way.

Sorry for length, but I gave that to show different manifestations of inherited allergies/intolerances. With Hashis, you could also be affected.

I hope she finds a relief from the symptoms, I can totally sympathise as we have all been there to various degrees, but it must be hell with a small child.

Gillian

[Gambit62]

SSRIs can affect adversely affect folate in some people leading to seratonin syndrome.

suggest you speak to pharmacist/GP about possibility and seeing if supplementing with some folic acid affects the situation.

B12 could be an issue but given that your daughter has already had bad reactions to a couple of anti-depressants - which I presume were SSRIs think folate is more likely to be the problem

[adin]

I think the problem is from antidepressants. When I used it (escitalopram, is better then citalopram) my fT4 it's dropped from 22 to 15,7 and I felt "crashing and burning" in the afternoon same as your daughter. I was on 10 mg Cipralex and when I reduced to 5 mg I felt better and my fT4 jumped to 18(10-22). I take T3 too.

[t3rcam in reply to adin]

Thank you for your reply adin. My gut feeling is that it is the anti depressants but given my history there is a niggle that she may be hypothyroid. We will get antibodies tested one way or another and see where that takes us. I have made an enquiry regarding a private psychiatry referral, the cost is astronomical but if it helps my daughter it will be worth it and my understanding is that the psychiatrist will have more choices regarding different medication. Can I ask if you are taking T3 because of being hypothyroid? I have heard, or read, that T3 can be used by psychiatrists for depression.

[adin in reply to t3rcam]

Yes, my mood has improved since i took the T3(12.5 first in the morning and 12,5 mcg afternoon) and levo.

[Charlie3055]

Hi, yes, SSRIs can affect cortisol production. It may be worth your daughter having an adrenal stress index test done via Genova diagnostics to check how her cortisol and DHEA levels are. Also her B12 should really be at the top of the range for her to feel well. I take Betteryou B12 spray. I noticed also there wasn't a free T3 result - that's so important to have to get a clearer picture of where her thyroid health is at. You can get private tests and people on here can advise next steps. Wishing you loads of luck, I hope you get to the bottom of it for your daughter.

[t3rcam in reply to Charlie3055]

Thank you for your replies admin and Charlie3055. Would the fact that she is taking the antidepressants give a clear picture of cortisol production or would she need to wean off anti depressants prior to the saliva testing? I have had Genova testing done personally so I know how reliable they are. I will discuss the options with my daughter and re post how things progress. I think we'll try a different GP to see if they will agree to the antibodies and the T3 testing & if not we'll go down the private route. Thank you all so much your support and guidance is invaluable.