Thyroid UK
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Do anti-depressants affect cortisol?

I'm getting so upset at feeling ill every day I have given in and started taking SSRI anti-depressants - Citalopram. Day 6 and I feel even more awful the last 24 hours.

I had a low in range waking cortisol reading from a 24 hour salivary cortisol test recently. Now wondering if the SSRI is affecting my cortisol. Does anyone know?

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Usually increases it. That’s a main reason why they work. A big con really

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Thank you Marsaday. I agree it's a big con in that case. So taking Citalopram shouldn't be making a low cortisol problem worse then? It is affecting my sleep badly though. That can't be helping.

Thanks for your previous replies to me about cortisol and T3 by the way. I did get a cortisol test done and was only about 30% into the lab ref range rather than nice and high. I spoke to a GP about it and was just not listened to, was told I was in the 'normal range' and didn't need cortisol and that I shouldn't read the internet. I am too nervous start a supplement on my own. Can't get another endo appointment until December.

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Hi Rocca

I really don't know about the Cortisol, but I've been on Citalopram for about 8 years (40mg per day/), but over the last 6 weeks I have been slowly weaning myself off after talking to my doctor about my Thyroid worries and having various tests. I have felt no effect from cutting them down, therefore I am wondering if it was a Vit B12 / Thyroid problem in the first place and the Citalopram masked this.

I would be reluctant to start Citalopram (or keep taking them in your case) before your cortisol/thyroid issue is fully investigated. I'm not medical, but this is something I've been wondering for some time.

I don't know where you are in tests/diagnosis, so really, that's just my opinion. I'm sure there are lots of others on here who would have a much better knowledge of this.

Katie

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Thank you Katie. I was really in two minds about starting them, now I've no clue which way to jump. As for where I stand, I am nowhere with the medical profession; I had a diagnosis of thyroiditis but now they are saying thyroid bloods back to normal, cortisol normal. Apparently I'm healthy at the moment. What a joke. They will accept I might have CFS/ME. Which can be triggered by hormonal disruption (or perhaps simply be hormonal disruption) but as there is no treatment for it, it is somewhat pointless to pursue that diagnosis and it will only have them prescribing anti-depressants and CBT again anyway. I feel like I'm stuck in a nightmare where every avenue I pursue, the meical profession blocks it and says no it's not that. I believe I have autonomic dysfunction, whatever they say, but again there is no known treatment for that either.

I hope you can come off your pills without too much trouble. I have taken them in the past and had to cut down very, very gradually.

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Oh Rocca

I’m so sorry for you, it’s awful isn’t it? I’m at the very beginning, being tested etc, and had to take my husband to the GP to back me up on Monday as I felt he wasn’t listening. I had a range of tests yesterday, so hopefully something will turn up. Have you had your vitamin B12 tested? In the end I had a private test with medichecks, and it showed a very low B12, with symptoms very similar to thyroid issues. I took the results to the GP, and asked for autoimmune tests as a result, as although my TSH, FT3 and FT4 are ok, I think it’s something to do with my thyroid too, lots of it my family.

Fingers crossed for you 🤞🏽

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Hi Katie, thanks for your kind thoughts. I'm sorry if you are feeling unwell at the moment too. I hope you can get the tests done that you want and you get further answers in addition to the B12 result. Good idea to take your husband along as advocate/witness - I might try to do that next time I see the GP. My B12 was fine last it was tested. I am about to do a private Vit D test to rule that out too.

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Too much serotonin can make you feel really rough with headaches and slightly hyper-type symptoms. There is no blood test to see if you have too much, too little or the right amount. And so no reason to prescribe SSRIs. No one really knows how they work.

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Thanks for your reply So there is serotonin to think about too? I will bear that in mind if I continue to feel worse. I agree the GPs have no real reason to hand out SSRIs as a solution to my illness. I have only reluctantly started taking them as I am getting very distressed and feel this mental state is bad for me and any recovery I might make. I have had Citalopram before and it was very helpful indeed. I hadn't had such thyroid issues then though so I am worrying about the interaction of the medication with my thyroid and adrenal hormones. Still not sure what the best course of action is. Thanks again.

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That's what SSRIs affect, as the name suggests: serotonin (Selective Serotonin Reuptake Inhibitor). So unless you had been somehow proved to be deficient in serotonin, there's no reason to take them. For some people they can improve conversion to T3 apparently, but with risk of far nastier side effects (including aggression and suicide, as well headaches and addiction etc) than optimising vitamins or just prescribing T3. And several studies have shown that T3 is more effective for depression than SSRIs.

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Hello Rocca. I have no idea about Cortisol but yes I can tell you about citalopram. Few years back, I used to feel really stressed and upset and was unable to sleep when doctor prescribed me. In the beginning they were so bad as they supposed to work like that. With the passage of time, they started their relaxation effect and I used to sleep with them comfortably. Then gradually I felt at a point to cut them down and slowly slowly stopped them without telling my doctor.

After a while I feel little uncomfortable in sleeping again when I told my doctor that I have stopped them and she prescribed again. When I started them again, they were so bad that I used to even wake up while of nights so doctor told me that’s due to withdrawal effect as I stopped taking them previously. At that point I stoped taking them.

Now for your concern if u think u will have a habit of taking them forever. It’s not like that. Any time you can stop taking them but gradually not suddenly as I have taken these antidepressants twice and stopped taking them as well. So don’t worry about these things and it’s completely your decision. Try for 1-2 weeks and then speak with your doctor if you don’t feel good. Hope this story will help 😊

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Hi Bajajnidhi. Thanks very much for sharing your experience. It is interesting that your sleep was affected at first but then improved. I am rather hoping for that now but want the sleep to settle down quickly as I am very sleep deprived this week and don't want to take pills which give me insomnia and potentially affect my cortisol the wrong way. Thanks again.

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I wish God bless all and especially you. I can completely understand how a person feels when deprived of sleep. Another suggestion from me is whenever u are trying to sleep use a yoga therapy. Just loosen all the body parts starting from foot to head and when u feel all the body parts are relaxing start concentrating on your breath. Like just concentrate on what happens when u breathe in and breathe out and try to remove everything else in your mind. With this when you will sleep even for 2 hours u will feel u have slept more. Hope to hear something positive from you soon. XX

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Or try TM - a much simpler and easier form of meditation as it involves no control or concentration. CenterPointe in the US do a very nice sleep CD (not cheap but excellent) and there are various companies in the UK that do sleep CDs also

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Hi and thank you very much for the sleep CD idea. Sounds good. I have slept much better the past couple of nights after stopping taking the Citalopram. It must have been that which was affecting me.

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Thanks for your good wishes. Meditation is a great idea. I have slept much better the last couple of nights - but I stopped taking the ant-depressants! I feel much better for the sleep though.

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If you are NOT on levo (ie you are unmedicated) SSRIs apparently reduce thyroid hormones. "With antidepressant treatment, the most common change in thyroid hormones is a decrease in T4 and free T4 without a significant reduction in TSH. Of note, these changes are generally within the euthyroid range of values. Some studies have shown that responders to antidepressants show a greater decrease in T4 levels compared with nonresponders." For those on levo, apparently the decline is less and free T3 stayed in euthyrpid range (but was it rock bottom, we ask?)

"Baseline thyroid function, as measured by serum TSH, may predict a patient's response to antidepressant treatment with SSRIs. Optimal thyroid function, beyond simply being within the normal laboratory values, may be necessary for an optimal response to antidepressants. "

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Thanks so much for this, it is very informative. I just couldn't find anything very informative when I searched the net. I am unmedicated and my thyroid hormone levels are around the middle of the lab reference range. Well having had two better nights' sleep off the Citalopram I have made a decision for better or for worse not to continue taking them - for now, anyway. I feel so much better for more sleep and having had two 'better days' in general that I realise I am not depressed, only exhausted with feeling ill and then not sleeping well on top of that. Sorry for my late reply, I have had two family birthdays to focus on so all my energy has gone into that this week.

I have also realised I have another, non-serious, health condition which has been affecting my sleep and the way I feel.

Thanks again to all on the thread for helping me think all this through during a bad week.

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