Been given 50mg Sertraline for depression and anxiety and worried about effects on Levothyroxine and worsening of mental health.

[Saltwater]

Hi, I just wondered if anyone out there has experience of being on both Levo and antidepressants. My mental health has deteriorated lately. I have battled depression and anxiety for probably 30 years, (insert sad face here) probably since I was a teenager but in the last few years it has stopped me from having what I would call a normal life and I have found myself withdrawing in order to cope.

It did seem to get worse having auto immune thyroid diagnosed last Autumn as I have found it so hard to focus even on small tasks and I feel like my brain is just unravelling. The depression has really set in too and I seem to have lost my ability to manage this.

I was already struggling to cope because of the depression and anxiety so the symptoms of the under active thyroid on top has been debilitating at times, so I am rather worried about messing with my already messed up brain chemistry and how bad I will feel once I start taking them. I know that it is necessary but I am scared in case I feel worse mostly because I have had problems with self harm and addictions in the past and don't want any relapse.

I have struggled for years because seeking help is stressful and I find all the doctors appointments now really difficult as I am forced to deal with this too.

I finally went to the GP this morning because I decided that I have had enough of feeling like this and owe it to myself as well as my family to get this sorted out, but I wanted to ask if anyone else has had experience of the two, because I am so worried about the first few weeks on the antidepressants because my head is not a great place to be and I am in it 24/7 as it is. The last thing I want is for them to make me worse or exacerbate the symptoms of my under active thyroid because there are times when I just want to curl up and sleep the whole thing off. I am still trying to get my levels right with the Levo and it has been a rough ride in the last few months with many unscheduled doctors visits that ended with the doctor passing me onto someone else. I am waiting to see an endo at the end of the month and I am waiting for my blood test results to see what happens next.

I am scared to rock the boat with the antidepressants. It sounds stupid, but I have gotten used to the way I feel. Although it is not normal, it is normal for me and I am scared of the uncertainty ahead. I know where I stand with how I feel right now even though it hurts to feel so low, but I am afraid of not being in control of my own emotions and antidepressants feel fake, like they are just masking the problem. It's what's kept me from taking them for years but if I want to feel better, I know I have to lose this fear and help myself. She also gave me a counselling number which I hope I can do (at some point...) I know that I won't get well by just addressing the hypothyroidism because there are other issues which need addressing too and if I can do this, I hope that I can stand a chance of living a happy, healthy, normal life again instead of just striving to get through each day which is what I am doing now.

I would be grateful if anyone can help or reassure because having the hypothyroidism diagnosed seems to have been the tipping point for me as it seems to have removed my ability to manage my depression. Not really sure which section to post this in, sorry. It's a bit of a mixed bag.

Thank you all for listening.

[Marz]

Have been reading your post and replies of 9 days ago. Sorry it's such a struggle for you. Did you manage to have the Private Testing done that was suggested ? I cannot help thinking if your B12 -Folate - Ferritin - VitD were good in their ranges you would be able to tolerate a higher dose of Levo/T4. This in turn would improve the FT3 over time - this is the Active thyroid hormone and if low in range will be the cause of so many symptoms - including the ones you mention .... 😊

[Saltwater in reply to Marz]

Marz, thank you for your response. It is very kind of you to comment. I sincerely hope you are doing well. You make a very valid point about vitamin levels and I suspect you are right. I have an appointment arranged for lab test for blood vitamin levels which I am having done in July. Still a way to wait, but glad that I am eventually getting it done.

My care has not involved talk of supplementation despite me saying regularly that I am struggling still with symptoms and even today with talk of the depression, I am still sent away with just a packet of pills in my '5 minute, one problem only' appointment. (as the sign reads on the door!) I even thought when I walked in that this style appointment may not be suitable for me! ha ha.

I have cut out the gluten too which I hope will help. I am so relieved to finally have opened up about the depression to my GP but I worry about not being in control on these drugs and if they will affect my thyroid treatment. I can talk myself into a panic attack quite easily and it is horrible how quick my mind goes from 0-60mph though I am really working on mindfulness to help with these irrational thoughts.

I have other weird things going on in the last year, like I am jumpy all the time, cannot tolerate noise, everything seems loud, had to even take down clocks, and my ears pop all the time. My scalp is tender as are my neck and shoulders and I have tingling in my hands and feet and I have a lot of sweating too. When I wake up, whatever I have been laying on is sore and my skin feels bruised in places but it isn't. Especially on the points of my shoulders and my hips and elbows. Some times it feels like someone is prising my elbows apart. But there was no way I was going to fit all that in to my 5 minute GP appointment but at least I got the depression out in the open!

Wishing you well.

[Marz in reply to Saltwater]

Low B12 - Low VitD will cause many of the symptoms you mention ... also adrenals. On the phone so will post some links when I am on the PC. I live in Crete - we keep our own records and I organise my own testing - you can click onto my username and have a quick read of my Bio when you have time - only takes a couple of minutes ! Have mostly improved my health by reading here and clicking the links given ... you will get there. 😊

[Marz in reply to Saltwater]

thyroiduk.org.uk/tuk/testin...

If you are able to have Private Testing in the comfort of your home then click onto the above link to view the various companies that supply Testing kits. Medichecks have Special Offers on Thursdays so keep an eye on the News Feed here. From reading here it seems the NHS are clamping down on vitamin and mineral testing - especially VitD. The above link also takes you to the main website of this Forum where you will find so much useful information.

vitamindcouncil.org grassrootshealth.net

Click onto the heading Conditions in the above link to read how VitD affects so many illnesses. Both mine were connected to Low VitD - Gut TB and Crohns then Hashimotos followed. VitD is a steroidal pro-hormone as well as being anti-inflammatory and like T3 there is a receptor for Vit D in every cell in the body

b12deficiency.info/signs-an...

The above link takes you to the B12 Deficiency website - scroll down the page - neurological signs comes first ... lots more information in the Menu - under the heading Films are some videos that are well worth watching.

Sorry I was in a rush last night - we are two hours ahead and I was closing down for the night ! Early to bed as we wake early to complete the chores before the heat hits us !! I only suggested reading my Bio - as you can other members - to see that many of us have struggled to find wellness. There are around 12,000 Active members here with a membership of over 100,000 So lots of information shared ...

Am afraid Nutrition is not taught at Medical School - we need to follow the advice here and sort ourselves as very little is understood at GP level. The NHS is great for amazingly complex surgery - but when it comes to managing chronic or ongoing illness things are very different.

Thyroid hormone T3 is still used to treat mental conditions - the brain has more receptors for T3 than any other part of the body - so it seems to follow that an un-diagnosed or under-treated thyroid will cause issues as the FT3 is invariably low in the range. T3 required in every one of the trillions and trillions of cells in the body.

Your Thyroid and How to Keep it Healthy - is a great book by Dr Barry Durrant-Peatfield - to help with the complexities of the Thyroid in an understandable way ...

Have you found the Kelly Brogan website - an American psychologist who has moved away from drug treatments and is looking more at the gut ...

Apologies for the information overload ! A step at a time ! Hope things soon improve for you ...

[Saltwater in reply to Marz]

Your information is very much appreciated and I will enjoy taking it all in. I'm not sure the heat will be hitting us anytime soon, we are much more likely to need an umbrella than suncream though to be honest, any day is a good day if you feel well.

I am so happy that you have got to a place where you feel you are informed and in control of your health. There is nothing worse than feeling helpless, especially when everything the doctors give you does nothing to improve your symptoms. The worst thing for me (because of already existing depression) was being passed around and have the doctors EXPECT me to just get well on the Levo and when I didn't improve, I felt rushed in appointments and ignored. This tipped the blame back to me which did not help at all.

I agree with you about the NHS, definitely a blessing in many ways but unprepared in so many others. I think they definitely have their skill set but it is limited to more medicating than actually treating a patient. Medicine is often quick and cheap but 'care' is lengthy and expensive!

Too much information is certainly better than having none at all. I was told next to nothing when I was diagnosed and was very confused and uncertain how things would improve. I have not had a single blood test result since my diagnosis in September, despite asking for the results. I have had to sign up to access my information which is currently being reviewed, whatever that means! It is MY information about MY body and I have a right to see what they have tested and what they haven't! I really hope you continue to stay on top of things. It is really empowering to know that things can improve. This site is a treasure trove of kindness and information.

[Marz in reply to Saltwater]

Have you had time to look at the links ? - or my Bio ?

[Saltwater in reply to Marz]

Marz, I was both happy and sad to read your story. You have been through so much but you have also accomplished so much from your struggles to find wellness. You clearly are not taking this lying down! Good for you.

Apologies for the late reply, I tried to read the info you sent me earlier, but it felt like another language to me. I get so drained and confused some times, it's like I see the text, but I can't make sense of it and the words just merge together on the page. It happens when I am really tired. The episode has passed now, and I feel a little brighter for a rest and a nice fresh salad!

Looking at the info, it is fascinating the role of the diet and vitamins and minerals. They are so integral to optimum health. I am conscious of what I eat and I eat clean and well, but judging from the way I feel, it will not come as a surprise that I am probably lacking due to absorption issues etc. I get more sick than anyone else in my family and take care of myself far more. My body is clearly not working with me so I need to work out how to get it what it needs.

My head is so dark at times. Not a nice place to be. Years and years of depression have left its mark on me and I don't say very nice things to myself but I am learning to find contentment. The main struggle is just getting to the appointments. I have social anxiety and have struggled for years without help because I find it so hard to get in a room with a doctor or anyone for that matter.

It is easy to be overwhelmed with the amount of intervention I have going on but I am tired of putting up with being unwell so if I can help myself, I will though it puts a strain on me mentally. I am currently also being checked for bladder problems and heart rhythm. I know it sounds silly but it took all I had to get on the bed and have a cystoscopy done after years of struggling with urinary problems to the point that it stops me from going out sometimes. I can be in pain 10 minutes after emptying my bladder, go again, then still fill up and need to go within the half hour. Doctors can't tell me what's wrong or where it all comes from because I don't drink much. It can really ruin your day. People notice and comment and the social anxiety stops me from using public toilets unless I am really familiar with them or no one is in. I found the examination traumatising and they still can't tell me why I have to pee several times an hour.

I notice that you mentioned Fibro? Is this Fibromyalgia? I googled the symptoms and it sounds like what I mentioned earlier. Can you relate at all to any of my symptoms with this?

[Marz in reply to Saltwater]

You write beautifully and the words flow - so I do have a feeling you will soon be on the road to recovery. Baby steps are needed. We all find information an issue - so return and re-read when time and energy allows.

I am sorry you are having bladder issues which is very debilitating. I recently read that good T3 levels are needed to maintain the endothelial cells that line the bladder so again the thyroid has a role to play. I have also read that gut inflammation can affect the bladder - so close - inside and out !!

Heart issues - again it is a muscle and good levels of T3 are needed. Such a shame the NHS do not routinely test T3 but are more than happy to send people for endless testing for various conditions that could well be linked to low thyroid. There are over 300 symptoms linked to thyroid. !!

Fibro was a red herring as they did not rule out Hashimotos at the time. Nor were my Vits and Minerals tested - all so low due to the Crohns. I still have lots of aches and pains - mostly connected to eating wrongly or drinking the wrong wine 😴 - or just over doing it in the pool. Fibro can be a rabbit hole as once on your notes everything will be blamed on the Fibromyalgia.

Can you have Private Testing - posted link in earlier Reply ... it would be so good to get to the root cause of everything and build from there ...

Wishing you well soooooon !

[Saltwater in reply to Marz]

Ah, thank you so much for saying that Marz. I adore language and poetry. I have no trouble writing but I have a lot of trouble with memory and recollection that has definitely got worse in the last 6 months and also struggle to keep up with movies because I can't seem to keep up with the plot. I don't follow spoken language at all well these days and find that I have to ask people to repeat things.

I don't know if anyone else gets this, or if it's even remotely thyroid related, but I also seem to have developed a kind of face blindness. I genuinely can't see the difference in faces some times, even though my family say they are not even similar. (I hope they never ask me to judge a police line up!) I tend to see the similarities in things, like if people are all wearing the same uniform, and all have the same hair colour, then I struggle to tell people apart. Crazy really but one of the many things that has been going on lately.

I have ordered a private test. I still have a month to wait for my hospital appointment, so I have decided to give it a go and see what turns up.

Also....the wrong wine, Marz???? Is there such a thing?

[Marz in reply to Saltwater]

Am sure when all the healing has begun things will improve for you... I have always found film watching difficult - especially American - I miss words depending on the accent ! Also I am uncomfortable sitting in one place - love to fidget and stretch out ... 😊

Which test did you order ? When you have the results and wish to share them it would be good to start a new post so more people see them and can comment.

Is it an Endocrinologist you are seeing in a month ? Have you been able to check him/her out on-line ? So many seem to be diabetes specialists - which I have only gleaned from reading here ...

Must try and sleep .. 😴😴

[Saltwater in reply to Marz]

Yes, I will post results on a new thread when they come back. Hopefully it will give me lots to work on.

Just checked the endo I'm seeing.....he is indeed a 'doctor of metabolic medicine and endocrinology specialising in diabetes'. (sigh)

[Marz in reply to Saltwater]

There is a list available from Thyroid UK - detailing Thyroid friendly Docs. Sorry I do not have the e-mail of the contact. Perhaps SlowDragon will come to the rescue !

[Marz in reply to Saltwater]

How did the Private Testing go ? Have I missed the results somewhere ?

[ILR2019]

I am so sorry you are experiencing this. I can certainly sympathise with you as about 5 years ago I started getting anxiety and panic attacks and it took me about a year to finally get treatment from my GP. I spent months on Sertraline (50mg was increased to 100mg and later 200mg). My attacks were debilitating. I withdrew from pretty much all social events and limited public interactions as much as possible which only led to further depression and anxiety.

I can only speak from my personal experience, but I wish I had never started to take Sertraline because weening myself off (not my doctors advice, I simply did not want to become reliant) took months and I went several steps backwards before I started to improve. I now know that the anxiety and panic attacks was almost certainly the result of my hypo symptoms. My doctor had (rather successfully) convinced me that all my problems were emotional rather than physical. I went to therapy sessions which helped and then I just became bloody minded to get myself through the attacks. 18 months or so later I can now just will the panic attacks away although I still get the odd attack that is uncharateristically strong and terrifying.

From my experience, my GP was more than happy to prescribe anxiety meds and refer me to therapy sessions. The former simply masked the attacks while the latter taught me how to cope. Neither however addressed the root cause and in my experience it is that which needs to be identified first otherwise you are only ever treating the symptoms, not the actual problem.

As the previous poster suggested, checking vitamin levels etc is a good starting place. Rule out any medical issues which could cause degraded mental health. Then take it from there. Whether you decide to remain or discontinue Sertraline will depend on your circumstances, but remember you ARE STRONGER than you currently think you are.

[Saltwater in reply to ILR2019]

Thank you for your reply. I really hope you have managed to find what works for you and that the attacks are getting more tolerable.Anxiety is a horrible thing to live with. I'm not sure anxiety ever goes away, I think we learn ways to cope with it, but as you say, it can be caused by physical problems, as well as emotional problems or can be a mixture of both.

I am not sure yet if my levels will come up because it's early days for the thyroid treatment and in time, I will feel better without the dependency on antidepressants. Also really worried about getting stuck on them. Not that they are addictive in that sense, but just because I know I will start to lean on them because I won't know if I am coping or coping just because I am on them.

I suppose not enough time has gone by yet to know if I will see improvement with my state of mind by treating the thyroid. Also, I have no idea how long the hashi's has gone undiagnosed and whether the worst of my depression can be traced back to undiagnosed thryoid problems because the depression and anxiety has really got worse in the last few years. All the GP said was that I had probably had hashi's a long time as my hair was really thinning and I lost outer part of eyebrow and colour in eyebrows went too. These days, if I don't colour them in, I don't have any!

I think I will put the Sertraline in the draw for now, and just do a bit more research before I take the plunge. What I will do right away though is start addressing the route cause because that is something that will really help me cope with the stress when it strikes, so I will definitely look into the counselling and if my thyroid levels come up with treatment, then that combination might be even more helpful than just popping pills.

[Sveistre]

So sorry you’re feeling so unwell...I was prescribed Sertraline couple weeks before starting Levo as I couldn’t cope with depression anymore (honestly I didn’t understand what was going on with me) which turned out to be caused by Hashi’s so after starting taking Levo along with Sertraline it didn’t work for me - Levo significantly reduced the effect of Sertraline if not reduced to 0. So then changed to like 3/4 other antidepressants but they caused me too many side effects.. as my hormone levels improved I ditched them, changed my diet completely (to Keto) started supplementing (Vit D, B complex, selenium, magnesium) and went on T4/T3 trial - I started to feel much better. Hope that helps and wish you to get well soon x

[Saltwater in reply to Sveistre]

Thank you Sveistre, I am not going to rush in to this. I have the meds and I can start them if I wish but I am not feeling quite ready to just yet. I am still adjusting to the Levo and have had all sorts of side effects with the medicine I am on and managed to deduce that Teva is really not good for me. I felt so bad on this that I didn't want to leave the house and felt like I was poisoned in some way. I did not sleep for days on the stuff. However, I still have weird side effects on other brands of levothyroxine which is why I am referred to a specialist. If I introduce these antidepressants into the mix as well, I worry that I am not going to really know what is bothering me or what is helping me and the antidepressants might mask other problems which need addressing. I think I would rather get my thyroid sorted first, or at least stabilised and then I can judge better how I feel about moving forward. Also, at least some of my depression and anxiety might be due to lack of vitamins and I should know that soon when I get tested.

Ideally, I would like the Thyroid treatment to improve my mental health and to keep trying with the exercise I have been doing and the GF diet. (I've lost 2 stone now and feeling at least empowered about that! :)) I really am not one for medication and I would prefer to try other things first but I also feel like I need to feel an improvement in mental health sooner rather than later, but definitely don't want to feel worse. I feel relieved just for getting the depression and anxiety out in the open with the GP but at the same time, I think the counselling and talking it out will benefit me more along with better attention to my thyroid care which I hope I will get from the Endocrine Specialist.

Thanks again for your kind words.

[Sveistre in reply to Saltwater]

Saltwater, I know how unwell you are feeling right now but believe me you’re in a much better situation than you might think and then many people including me are/were - you know you have thyroid issues and you can clearly think about it and address the problems what might be causing it, I didn’t even know what was happening with me, I thought I was going crazy. Correct thyroid meds and dosage will definitely improve your mental health, so if you feel you can stay away from Sertraline - do so. Other than that people here are very kind and helpful but try to research yourself too about symptoms, meds and dosage you’re on, diet, supplements etc, because we know our body the best xx

[jgelliss]

I'm so sorry your going through hard times . You might want to ask your Dr/Endo to lower your T4 dose and add some T3 . T3 is very potent and beneficial for every cell in our body and *Great* for treating depression .

Nutrients are *Very* important here too . Vitamin "D" /K2 , B-12/folate , B-Complex , magnesium , Iron if you test low , vitamin "C" , Celtic Sea Salt for adrenals/electrolytes .

Sending You Healing Hugs .

[Saltwater in reply to jgelliss]

Thank you. Do you think people with hashi's absorb easier from supplements than from food sources? If I take supplements, will I also struggle in the same way to absorb them as my gut is really sluggish and I cannot tolerate large meals, carbs or gluten well and I get indigestion frequently.

[jgelliss in reply to Saltwater]

You might want to visit a *Holistic* or *Naturopath* Dr's that can help you with healing your gut . I am gluten dairy sugar coffee soy free . I found that it was/is so very helpful for me . They say that the *Gut* is our the second brain . You would be very surprised how much it helps to heal our guts for our wellbeing and over all .

See if you can get hold of these books . They are very helpful .

No Grain No Pain By Dr Peter Osborn

Brain Grain by Dr David Perlmutter

[SlowDragon Administrator]

So you are currently only on a very low dose of Levothyroxine

25mcg/50mcg alternate days

This has the affect of reducing your own thyroid production down low, as TSH (the message from pituitary) gets turned down by taking Levothyroxine and your own thyroid hormones from Thyroid drop

But because you are only taking a small dose of Levothyroxine, it's not enough replacement. So it's common to feel very low and under treated until dose gets up nearer 100mcg.

But many Hashimoto's patients have to increase dose slowly

With Hashimoto's the gut is often badly affected. Our vitamin levels are nothing to do with how good our diet is. It's to do with how poor nutrient absorption can be.

Hashimoto's is as much a disease of the gut as the thyroid

Have you noticed an improvement on gluten free diet?

How long have you been on 25mcg/50mcg ?

Bloods should be retested 6-8 weeks after each dose increase

Many people find Levothyroxine brands are not interchangeable.

Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients

Email Dionne at Thyroid Uk for list of recommended thyroid specialists

please email Dionne at

[e-mail]

[SlowDragon Administrator]

Just noticed on your profile you have added propranolol

Are you on propranolol?

If so how much?

You might find reading my profile interesting. I was stuck on propranolol for almost 20 years.

[Saltwater in reply to SlowDragon]

I was prescribed propranolol for anxiety, not for a heart problem as such but because my anxiety was causing heart palpitations, 10mg to take as and when I feel symptoms of anxiety, up to 3 times a day. Anxiety is long standing condition for me, coupled with depression. However palps got really bad in January as thyroid levels went high on 50mcg Levo so dropped back to 25mcg and then levels went too low. Now been alternating between 50 and 25mcg for 5 weeks and due a blood check next month. I don't take the propranolol on regular basis as it makes me feel fuzzy and detached, only in particularly stressful situations.

I feel less sluggish from a gut perspective on GF diet and maintaining healthy weight, but mentally, no improvement hence talk of starting antidepressants for negative thoughts and depressive low mood. Anxiety is making the thought of taking these medicines really difficult as I genuinely just want to get myself well in a more pro active way like diet and exercise but at the moment, it seems my body and brain is just not working with me. I have disturbed sleep and really crazy dreams that make me feel exhausted when I wake up.

Honestly, I feel better GOING to bed than when I wake up. I have more energy post 6pm till bed time than at any other time of the day.

I am having a very difficult time getting the same brands of Levo. The pharmacy's have tried to ring around suppliers but keep being told that Teva is cheap and they mostly stock that. Seems to be the same story where ever I go. I tend to consistently be given Wockhardt in the 25's but in the 50's I have had many different brands. None of them have bothered me though like the way I felt on Teva and I have just been to the pharmacy to exchange the Teva they gave me for Actavis as the doctor can't justify giving me a specific brand of Levo on prescription and just say to ring around.

At some point, can I expect to be alright on 50mcg a day, even though it sent me high earlier in the year and probably settle on a much higher dose later on? At the minute, I could not tolerate a full 50 a day. Everyone keeps telling me I am on such a small dose but I tried higher and was ill on it with 3 heart skips a minute that lasted for 2 weeks, insomnia and horrible sense of doom and dread and I lost several pounds in just 3 days.

[SlowDragon Administrator in reply to Saltwater]

Your GP should write on all future prescriptions

"No Teva brand of Levothyroxine"

Thousands react extremely badly to Teva

healthunlocked.com/search/p...

Also fill in yellow card

yellowcard.mhra.gov.uk

The fact you feel better in evening is classic sign of adrenal exhaustion

Daily vitamin C can help support adrenals

Adrenal cocktail can help too

stopthethyroidmadness.com/a...

Personally when I was at that stage of adrenal exhaustion, regularly taking propranolol helped enable dose of Levothyroxine to be increased. You need to discuss with endocrinologist

[Saltwater in reply to SlowDragon]

Wow, I never thought about that. That is definitely something to think about as my body and brain felt like it really needed the increase in Levo, but my heart (coupled with the anxiety) wouldn't tolerate it. Thank you so much for responding and for the email info. I will definitely take a look at your profile.

Much appreciated.