Discussion about using thyroid hormones in psychology and psychiatry is all too rare. For that reason, even short papers like this have their own value. It is not that there haven't been papers - but there aren't that many and, by the time we see them, they can appear as if they are historical documents!
And, I suspect, viewing them as alternative augmentation strategies to non-thyroid medicines, would look less rational if there were better understanding of the meaning of "hypothyroidism" and its diagnosis. Seems feasible that thyroid hormone is at least more likely to be effective in those who are officially (i.e. by TSH) not hypothyroid but many here would suggest actually do have thyroid issues. Maybe low thyroid hormone within reference intervals, TSH not sufficiently elevated, etc.
Thyroid Hormone Use in Mood Disorders: Revisiting the Evidence
Alterations in thyroid functioning have been of long-standing interest in the research and treatment of depressive disorders. Thyroid hormones may play a role in mood regulation by modulating serotonin and norepinephrine neurotransmission. As such, thyroid hormone therapy (THT) has been investigated as a treatment option for depression and has been used clinically to treat mood disorders in patients with and without hypothyroidism.1–3 What follows is an overview of the available literature discussing the potential benefits and harms of THT in the management of unipolar and bipolar depression.
Conclusion
Thyroid functioning can play a pivotal role in mood disorders, with even minor perturbations leading to unstable mood states. Careful use of T3 and L-T4 can be critical mood-stabilizing options, especially for depressive illness that has not responded to first-line therapies, and can provide an alternative to other augmentation strategies such as atypical antipsychotics, lithium, or esketamine/ketamine.
Published online: August 15, 2022.
Rest of short paper here:
To cite: Singh B, Sundaresh V. Thyroid hormone use in mood disorders: revisiting the evidence. J Clin Psychiatry. 2022;83(5):22ac14590.
The ASCP Corner, edited by Leslie L. Citrome, MD, MPH, is a collection of brief peer-reviewed, evidence-based articles, authored by American Society of Clinical Psychopharmacology members, that examine the practice of psychopharmacology through the lens of clinical experience. The information contained herein only represents the opinion of the author(s).
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helvella
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Thanks for posting Helvella; it’s useful to have papers to back up what so many of us have experienced. My GP repeatedly offered me anti depressants to curb my increased anxiety, but this medication wasn’t needed, as following forum advice to get key nutrients and thyroid levels optimal greatly improved my mental (& physical) health.
Many GPs are completely ignorant with anything to do with a patient who may have a problematic thyroid gland.
The day before I was diagnosed (by mysellf) one of the doctors phoned to tell me that blood test was fine and I had no problems. The biggest problem was the doctor as he was completely ignorant that a TSH of 100 had any meaning.
Just thinking could this be an option that some could explore if they are also seeing a psychiatrist and could discuss with them hormone replacement Levo/T4? If their GP and also their endocrinologist won't prescribe thyroid hormones despite having below range levels and are also symptomatic?
I know that psychiatrists can consider prescribing T3 for their patients with resistant problems but didn't even think about them prescribing Levothyroxine?
Would it be bad medical etiquette for a psychiatrist to be seen to undermine the decision of a GP and an endocrinologist?
Or if the psychiatrist is treating the patient for a resistant mental health issue and decides to prescribe hormone replacement (Levo) would that be considered to be acceptable and not undermining the no treatment decisions made by the gp and endo?
As I see it, the patient should come first. Not the etiquette and ethics of which doctor has primacy!
My sarcastic side is coming up with the idea that you should get both doctors to put in writing what they intend doing. Simply seeing them writing "This pleasant lady/gentleman should not get the opportunity to see if thyroid hormone will address their life-long psychological/psychiatric issues. This is because some patients have side effects from thyroid hormone supplementation."
Maybe I could make it easier for them and get a letter written and printed off so all they have to do is sign it! 🤣
Though I was laughing at myself as I'm trying to consider the feelings of the gp and endo and to not upset them!? I need to learn that the patient (myself) should come first.
My endo is being particularly evasive so getting him to put anything in writing would be a miracle in itself! My appointment last week was cancelled and I was relying on that to ask questions about my care post imminent thyroid surgery and their reluctance to prescribe replacement hormones.
My psychiatrist did say if I need any help in between appointments to contact his secretary. I think that's what I'll do. This may be my way forward!
Hedgeree, ' I need to learn that the patient (myself) should come first.'
Actually, if doctors made that their priority, you would have already learned it, probably without even realising. It's what we all tend to expect when we first encounter medics, but they soon disabuse us of such an apparently ridiculous notion.
an NHS Psychiatrist is presumably limited by the same regional prescribing limitations as their local Endo's/GP's are:
eg in 'Lancashire and South Cumbria Medicines Management Group'.. it's use for treatment resistant depression is coded black , which pretty much means "you can't prescribe it for that reason "
(This area is currently reviewing it's codes for the prescribing of Liothyronine for Hypothyroidism (awaiting publication of decisions)..... but the prescribing code for 'treatment resistant depression' has not been reviewed~ it stays firmly 'black')
I'd challenge that assessment on grounds of potentially racist language.
Black = bad
Black = do not allow
And they are using Black (and Red) as proxies for meaningful statements. The assumption is clearly that anyone seeing either of those words will back off and not prescribe. Nothing in medicine is so simple, so trivial, so obvious that it can be expressed as a single symbol - simply application of the colours without even a single word. But that is how their entire approach operates.
Is it the same for Levothyroxine? That's what I'm going to be asking the psychiatrist about.
It doesn't matter how much research I put in front of or mention to my gp or endo they will still not prescribe replacement hormones for me despite being symptomatic and having a persistently below range FT4.
I either get told it's my mental health problems or it's ....'my normal' so I'm stuck unless I self source T4 hormones.
don't know about Levo , obviously it's a lot easier to prescribe than lio ~ if they wanted to (and could justify it with eg a below range T4 level), then i'm sure they'd be 'allowed to' .Hopefully you can have an intelligent conversation about your low T4 as psychiatrists should hopefully be well aware of thyroid hormone implications in their field .
Yes that's what I'm hoping. Also my psychiatrist is very approachable and has said to contact his secretary if I need any help.
I've briefly mentioned my thyroid issues to him previously so will hopefully be able to discuss them in more detail. Not sure why I didn't consider this before? He may be able to help me.
helvella, 'Discussion about using thyroid hormones in psychology and psychiatry is all too rare.'
So very true. The psychiatrist and counselor that I was referred to absolutely refused to acknowledge any relationship between my mental and thyroid health. I took printouts of old papers (Richard Asher maybe?) for them to read, but they wouldn't even look at them and immediately pushed them away. Same with my GP.
Prozac and counselling is what you need. No, I absolutely did not!
I refused the anti-Ds, and terminated the counselling sessions, much to their great annoyance. I knew that what I needed was appropriate thyroid medication, and the only way forward was to take control of that myself.
Sex HRT for women is currently making big headlines. If you read, listen to or watch any of the personal experience stories by women in peri or post menopause etc., you will know how much these hormones affect mental health. And how many women needing HRT get put on anti-Ds instead.
I consider thyroid hormones to be the God and Goddess (T4 & T3) of hormones. Without appropriate levels of thyroid hormones, all other hormones will likely also be out of kilter.
Endocrinology is the field of hormone related diseases. An endocrinologist is supposed to diagnose and treat hormone problems. And yet it seems that the vast majority of them have no clue about sex hormones, thyroid hormones, or the relationship between these hormones and mental health.
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