Anti depresaants

[jwoodward5]

Anyone on levo and also sertraline? My daughter just being prescribed them and after first dose is feeling like death i know it says can have side effects at first but worried she feeling so bad they not agreeing with her .

[Lalatoot]

First time I started on citalopram I felt awful for a few days. Please be aware that some ssri drugs can reduce the absorbtion of levothyroxine so she might need to increase her dose. Anxiety and depression are symptoms of undermedication.

[jwoodward5 in reply to Lalatoot]

Her bloods last time showed taking maybe slightly too much levo so should be ok . Do u feel ok now?

[Lalatoot in reply to jwoodward5]

I am still on the journey to find my optimum! Because the medics only looked at TSH and FT4 and told me my bloods were fine, nobody realised that I had a conversion problem and that my FT3 was low. This meant that what I lacked in FT3 was being made up by adrenalin. Being busy or walking more on holiday for example gave me this edge of anxiety as the adrenalin stepped up to fill the gap. I knew something wasn't right so I gradually stopped citalopram and started altering levo dosages. It was some roller coaster but eventually it convinced the gp and the endo that I had a conversion problem and I have just been prescribed t3.

[greygoose]

Very few doctors understand how to dose thyroid hormones correctly, and leave their patients under-medicated.

When symptoms persist, instead of thinking that perhaps the patient needs an increase in dose, they decide she (because it's usually a she) has mental problems and needs an anti-depressant. It's very rare that the patient actually does need an antidepressant, though, she just needs an increase in levo, or some other adjustment to her dose.

But, if the patient knows nothing about thyroid or treatment - as most people don't, because why should they? - she won't know that, and won't challenge her doctor.

That is why forums like this exist. It would be great if your daughter were to join us here, and we could chat to her directly, and explain things. But, if she doesn't want to, it would be a good idea if she gave you her blood test results so that you could post them here. That would give us a better idea what's going on.

[jwoodward5 in reply to greygoose]

Her bloods are at rhe optimum as ive posted on here before and last results suggested tsh way too low if anything the depression and anziety is because of other issues in her life and a sickness phobia which is controlling her life . She has prob had anziety for a long time due to thyroid bit this was managable but now its not . Shes had stomach and back pain for 11 months with nausea headaches and now hair loss . Sofar tests have revealed nothing they now beleive its due to depression etc but in my mind i wonder if its thyroid as she never felt good even though bloods say ok and we did try all viramins etc for a while but no change

[greygoose in reply to jwoodward5]

Are these her last results, five months ago:

Tsh 0.01 (0.38-0.58)

T4. 19 (7.4-13.3)

T3 6.2 (3.8-6.2)

Her TSH is low, agreed, but that doesn't matter - it can't be too low. Her FT4 is way above range, but you said: Notmally she dont take the levo bit forgot this time she had bloods at 5 pm . So that's why her FT4 is high and her TSH low. So, these labs don't really tell us very much. As I said at the time. Did she manage to get them retested?

And, I have to say, I find that FT3 result suspicious, because it's the same number as the top of the range. Are you sure you didn't make a typo there?

Anyway, she needs new labs done - and done correctly: early morning blood draw after fasting over-night; 24 hour gap between her last dose of levo and the blood draw. And, until that has been done, you can't come to any conclusions about her thyroid status.

Depression is not a disease, it is a symptom. And, as she's hypo, it's more than likely to be a hypo symptom. All her other symptoms are more than likely to be hypo symptoms, as well.

we did try all viramins etc for a while but no change

Did you get vit D, vit B12, folate and ferritin tested before she took supplements? Nothing is going to help if she didn't need it. More is not better. So, these all need testing - best to get them retested now - and supplements taken according to results - if you don't take enough, that's not going to help either.

When you say 'all vitamins', you don't mean a multi-vit, do you? Because that wouldn't help, either.

[jwoodward5 in reply to greygoose]

We havent managed to get bloods redone as she has needle phobia and we wanted vitamins retested at same time as these were at lower end of range previously b12/vit d folate.our gp being an arse and saying as hd them done within last year and in range she wont authorise them !!! So trying to find one who will . The ft3 is what results said yes .Why do u need to fast overnight? If as u say all these symptons as a result she hypo how can she be so bad when actually on levo and bloods were looking ok previyosly

0.05(0.35-5.5)

19(9-23)

5.5(3.5-6.5)

[greygoose in reply to jwoodward5]

When were those bloods done? And how did she feel at the time? There's a big difference in the FT3, there. Which, again, makes me suspicious of the 6.2 result. Did you get a print-out? Or were those results given verbally?

In any case, it could be that she now has a greater need for T3. It happens. This isn't a static disease, it evolves. And it's not how the bloods look that counts, it's how she feels. And, she obviously isn't feeling good at the moment. Blood tests are only a guide. You can still feel bad no matter how good they look. Has there ever been a time that she felt well on levo?

It's best to fast because it is believed that the TSH drops after eating. I admit, we have no proof that it does - but we have no proof that it doesn't, either. So, to be on the safe-side, I always fast for all my blood tests. Actually, in France, where I live, they don't even do bloods after 10 am, so I get there when they open at 8 am, and go straight to the boulangerie opposite, afterwards, for breakfast! It's a good system. But, certainly, having coffee before the blood draw will affect the TSH. So, best to fast.

Have you considered getting the nutrients done privately? Details of private testing here:

thyroiduk.org/tuk/testing/p...

[jwoodward5 in reply to greygoose]

Yes we got a printout for bloods . Think previuos ones 3 months before those latest ones . No she never felt much better on levo but now shes at all time rock bottom . We need all bloods done at same time to save distress i know ill have to press them to authorise them

[greygoose in reply to jwoodward5]

The NHS are never going to do all the labs you need at the same time, which is why it would be a good idea to get private labs done. And perhaps a finger prick test would be easier for her?

It could be that levo just isn't right for her. Has she always had the same brand?

[jwoodward5 in reply to greygoose]

We tried a different brand and she felt worse we also tried t3 only privatley sourced and she felt no better just in despair . You said it dont matter what result tsh is does it not make u hyper if goes below 0?

[greygoose in reply to jwoodward5]

No, it doesn't. TSH doesn't make you anything. It is a chemical messenger between the pituitary and the thyroid. The less thyroid hormone the thyroid makes, the higher the TSH rises, meaning that you are hypo. But, it doesn't make you hypo. The more thyroid hormone the thyroid makes, the lower the TSH drops in response. But, it is just a response, not a driving force.

What makes you hyper is the thyroid making much too much thyroid hormone, so that the FT4/3 are well over-range. Taking exogenous thyroid hormones cannot make you hyper, even if your FT3 is over-range. You can be over-medicated, but not hyper.

So, to recap, when on thyroid hormone replacement, the TSH is important if it's high, because that tells you that you are under-medicated. Once the TSH goes below one, it doesn't tell you anything at all. You need to look at the FT4 and FT3 to see the levels on any particular dose - most importantly, the FT3. But, even then, bloods are only a rough guide, they cannot tell you how you feel. And, how you feel is the most important factor.

[jwoodward5 in reply to greygoose]

Thats good inwas worried tsh too low . Just need bloods as u say redone and go from there

[greygoose in reply to jwoodward5]

That's right.

[sidneymark70 in reply to greygoose]

Can you help me Greygoose. I’ve been called back to my GP after a blood test. I’ve felt so awful I really thought it would be about my thyroid but it’s about my cholesterol. I want to ask for a print out which I’ve done before but it never contains much information. What kind of print out do I ask for please? - one that will contain all the results I see on here. Then I can put it on here for advice. Thank you

[greygoose in reply to sidneymark70]

I don't know, really. Just tell them you want all your results, with the ranges, from your last blood test. The odds are, they didn't do much in the way of tests, so that's why they don't give much information. A lot of doctors only test the TSH, because they mistakenly believe that that's all they need. So, that doesn't take up much room on a print-out!

If your cholesterol is high, the odds are your FT3 is low. But, doctors don't know about the connection and don't test FT3, anyway. Do not be bullied or badgered into taking statins. A bit of extra cholesterol will not hurt you. It will not give you a heart attack or a stroke, whatever your doctor pretends.

[sidneymark70 in reply to greygoose]

Greygoose, thank you. I wish I was as knowledgeable as you. So if GPS only test TSH (what does that stand for?) what does a private blood test test? My cholesterol is 5.7 apparently, is that very high? I’d already decided I wouldn’t take statins. I am very surprised about it anyway as since Christmas I’ve been on a Sugar free diet, lost weight and trying to do an exercise plan (but this is really hard as I am so exhausted). Just don’t know where to go from here as I imagine my GP won’t be any help tomorrow. x

[helvella Administrator Thyroid UK in reply to sidneymark70]

Abbreviations and Acronyms

Some years ago, I started compiling a list of abbreviations and acronyms that appear here regularly. The idea was to make it relatively quick and easy to look up abbreviations and acronyms without being too waylaid by the many irrelevant possibilities web searches tend to return.

I continue to update the document quite frequently!

dropbox.com/s/2423slilh0or6...

If you have not downloaded a copy for some time, perhaps months or years, I suggest you download a new copy.

Please, if you think there is anything missing or wrong, let me know. Post on the forum or send a Private Message.

TSH - Thyroid Stimulating Hormone

[greygoose in reply to sidneymark70]

TSH = Thyroid Stimulating Hormone - which is what it does, and only what it does - apart from stimulating conversion of T4 to T3. It does nothing to bones or hearts whatever your doctor might believe/say/pretend. So, you can understand that it doesn't give them very much useful information about what dose you should be taking!

A private test would test whatever you want it to. You could get one just testing FT3, but that's not advisable. The best one is a bundle consisting of:

TSH

FT4

FT3

TPO antibodies

Tg antibodies

vit B12

folate

ferritin

And you could get vit D tested separately. And that will give you a pretty good picture of what is going on with you.

5.7 is not very high. Top of the range used to be 6, I believe, but they keep moving the goal posts so as to get more and more people taking statins! It's evil and unprofessional, but that's medicine for you, these days. It's all about money.

Cholesterol has nothing to do with diet or exercise. It's made in the liver - and it's made in the liver because it is essential for your well-being. A large percentage of your body is made up of cholesterol - cell walls and the brain, for example. It's just that when the FT3 is low, the body cannot process cholesterol properly, and excrete excess, so it builds up in the blood.

So, assuming that your FT3 is low, given that your cholesterol is 'high', you should not be over-exercising. Just gentle walking or swimming until your FT3 level is higher. It won't do you any good to over-do things.

Where do you go from here? Well, first step is to get private testing done, to see exactly where you are.

[sidneymark70 in reply to greygoose]

Thanks again. So if I have private testing which test do I ask for please?

[greygoose in reply to sidneymark70]

thyroiduk.org/tuk/testing/p...

The above link will tell you all about private testing. I would suggest you get the bundle that includes all the tests I mentioned above. Can't remember what they call it.

[Wetsuiter]

What do you actually mean? From other comments, it sounds like she was already on Levo, so she's had one dose of Sertraline?

What actually are her symptoms? (First few days o an SSRI can increase feelings of depression, anxiety, phobias)

[jwoodward5 in reply to Wetsuiter]

Yes already on levo started set been 3 days has headache nausea sweating feels skin tight around face cant be bothered to move loss of aperite anxiuos and more

[Wetsuiter in reply to jwoodward5]

OK, it sounds like 'usual' starter dose symptoms. If worried, speak to Dr or Pharmacist. She shouldn't just suddenly stop taking them, cos that could make things worse.

I wouldn't be surprised if things start to improve soon.

[humanbean]

There are loads of anecdotal reports online of people with depression improving tremendously if they switch to a ketogenic or low carb, high fat (LCHF) diet. The Diet Doctor website is worth browsing.

Another problem that affects a lot of (mostly) women is that they simply don't eat enough, particularly if they are hypothyroid and start gaining weight, because they are so worried about getting fat. But a state of semi-permanent starvation, even if it is mild, will make anyone depressed. In that situation the solution to curing depression is more food, not an addictive drug.

....

One thing your daughter could try for depression, instead of the sertraline NOT in addition to it, is 5-HTP. It's an over the counter, no prescription required, anti-depressant with far fewer side effects than an SSRI from a doctor. I've been on it since 2011. I have taken 50mg per night for most of that time. More than that makes me jittery.

5-HTP raises cortisol. If it gives people the jitters then it suggests they are taking too much, or it isn't a good fit for them.

5-HTP is one of those things that helps some people and has no effect on others. 50mg is the lowest dose available on sale that I've found, but some people take far more than that, and take it in several doses throughout the day. (Doses are available online up to 400mg per capsule, but taking that as a starting dose would be insane.)

Anti-depressants of any kind should never be mixed, whatever their source, which is why I underlined that 5-HTP and sertraline should not both be taken. It's definitely one or the other. There is a risk of serotonin syndrome which is a dangerous and potentially fatal condition caused by having excessive serotonin in the body.

en.wikipedia.org/wiki/Serot...

Note that if 5-HTP is going to help someone they will know within a couple of weeks or less. It isn't worth continuing to take it if it doesn't help, so anyone buying it for the first time should start with 50mg capsules, and only raise the dose if they get no effect, good or bad, at all. (For example, buy 50mg capsules, start taking 1 capsule at night, and raise the dose to two capsules after a week if there is no effect. If 2 capsules works well then in future buy 100mg capsules.) Don't buy loads of them either, because it could end up with money being wasted. Once they know the dose that works for them they can buy a suitable dose.

One thing I like about 5-HTP is that being an over-the-counter supplement I have complete control of my dose, and I don't get quizzed about depression every time I see a doctor. GPs tend to think that if a person is depressed then every symptom they have is caused by being depressed and don't look any further for the cause (e.g. if the person is hypothyroid and is on the wrong dose of thyroid hormone for them).

If you look up 5-HTP on Amazon you can read the reviews and get a better idea of whether you or your daughter might want to try it.

[jwoodward5 in reply to humanbean]

Ok will read up on it thanks. Trouble is she seems intolerant to wheat dairy yeast lactose so diet limited she is eating plenty but of same thing