Anxiety and depression linked to low thyroid hormones - publication

[Tina_Maria]

This subject came up on another threat and as many thyroid sufferers are getting their symptoms blamed on their mental state, I though I would share this, as it is a good publication, showing that low thyroid hormones can directly impact mental health outcomes.

Neuropsychiatric Manifestations of Thyroid Diseases

pmc.ncbi.nlm.nih.gov/articl...

This section is of particular interest:

From a scientific standpoint, the monoamine hypothesis [59], which connects mental illnesses to the action of monoamine neurotransmitters, is the most compelling explanation. In relation to thyroid hormones, triiodothyronine (T3) is known to control the levels and activities of serotonin and noradrenaline [60]. Depression and anxiety disorders can be brought on by low T3, and these illnesses are also associated with low serotonin and noradrenaline levels. According to a meta-analysis, 25% of cases with resistant depression were successfully treated when T3 was added to tricyclic antidepressants [61]. Serotonin and noradrenaline levels rise as a result of T3's effects.

So the next time a GP or endocrinologist states that you are just anxious or depressed and that it has nothing to do with your thyroid, you can show them that there is a physiological connection to low thyroid hormones, that should be investigated and corrected before even thinking about a mental health problem.

[Buddy195 Administrator]

Thank you for sharing Tina_Maria.

For me, heightened anxiety has been the worst symptom of having hypothyroidism and is significantly worse if thyroid medication is not optimal. Like many here, I was initially diagnosed as having ‘health anxiety’ and offered anti- depressants, when my adverse symptoms were actually thyroid related.

[lola1956]

does this mean also that having your meds cut drastically suddenly could cause anxiety ?

[Buddy195 Administrator in reply to lola1956]

Yes- that’s why I adjust medication (both increases and decreases) very slowly. Hopefully you can discuss this further with your practitioner, as per your earlier post.

[lola1956 in reply to Buddy195]

I can’t speak again this month he said no yesterday and it’s too expensive every time I need something to ask

[Tina_Maria in reply to Buddy195]

I remember when I was newly diagnosed I had a lot of anxiety and was on fluoxetine for a couple of years. I had difficulties with my PhD supervisor at the time as well, which obviously made the situation worse, as he had no understanding of my disease and even called me a hypochondriac!

However, once my thyroid levels were good, this anxiety went away and I could come off the fluoxetine without any issues.

[Tina_Maria in reply to lola1956]

Absolutely, if you have your meds lowered , especially if it is not warranted (T4 and T3 in the normal range), this could mean that you are left with too little thyroid hormones and as a result, your levels of serotonin and noradrenaline can drop, which can cause anxiety and depression! 😢

And GPs rather prescribe anti-anxiety medication or propanolol (which can cause other issues as well) than look at the actual root cause of the anxiety, which would be the thyroid hormones. Have you had your meds cut suddenly recently?

[Buddy195 Administrator in reply to Tina_Maria]

healthunlocked.com/thyroidu...

Link to lola1956 post

[Tina_Maria in reply to Buddy195]

Ah okay, thanks!👍😉

[buddy99]

I absolutely hate when thyroid hormones are added to antidepressants while the patient's thyroid is potentially undertreated. It offers the perfect excuse when later on the dosage of the thyroid meds is lowered again and the patient argues against it by pointing out how much better they felt on the higher dose as compared to before. Most likely the answer will be, "Yes, but you were depressed. That's why you took the antidepressants. And they made you better. It has nothing to do with the dosage of your thyroid medication." Also once you have been on antidepressants even for a short time, it will become the "obvious" reason in the future for any symptom, because you must be depressed again. And depression has so many faces that just about anything can be pinned on it. It's a fast and easy diagnosis that does not require much work, which makes it so popular (especially when looking at female patients).

[sylus_911 in reply to buddy99]

Hi BuddyI understand what your saying.But is it possible to be depressed even though you have thyroid problems?

I,ve been on thyroxine since 2011 after a thyroidectomy.I was put on Antidepressants to as I felt so bad but then I came off of them and given t3 which helped.But then I lost my son in 2018,then my brother last year I really felt down and depressed. So I went back on Antidepressants and I must say I have felt so much better in myself.I still have symptoms of hash,s and low moods now and again but now I know that it's the thyroid symptoms and re check my levels.

[humanbean in reply to sylus_911]

But is it possible to be depressed even though you have thyroid problems?

If I was depressed now it would suggest to me that my thyroid hormones or nutrients were not properly optimised. I would get a private test done and check my levels.

I had a lifetime of severe depression and anxiety before I started taking thyroid hormones and optimising my nutrients, and I could always think of reasons why I should feel the way I did, and I always blamed myself. But when I optimised what I could my depression reduced 95% and my anxiety vanished.

[Buddy195 Administrator in reply to humanbean]

This is also my experience too humanbean - optimal thyroid medication reduced incidents of high anxiety by 95%

[Tina_Maria in reply to sylus_911]

There are people who have a normal thyroid function (for them) or do not have thyroid disease and are depressed, the thyroid does not always have to be the culprit.

Some people can have a genetic predisposition to depression or anxiety, which could mean that they might naturally produce lower serotonin and noradrenaline levels and these could lead to mental health problems.

Chronic stress or bereavement can significantly impact serotonin levels in the brain, potentially leading to mood changes, anxiety, and other mental health issues, as serotonin is a neurotransmitter crucial for mood regulation. Stress can disrupt the brain's ability to produce and utilise serotonin, potentially leading to low serotonin levels.

Stress can also trigger the release of cortisol, a stress hormone, which can further impact serotonin levels and contribute to a cycle of stress and low serotonin.

So depression and anxiety does not always need to be connected to low thyroid levels. However, if for example you have low thyroid hormone levels and your doctor is not believing you that this is causing your problems and just thinks that you are depressed, the stress and anxiety this attitude can cause you, added to the already low thyroid hormones, could potentially make a bad situation much worse.

[sylus_911 in reply to Tina_Maria]

Hi Tina_Maria.Thanks for your reply.

This what I'm trying to understand.As I said, last year was a bad year for me,I forgot to mentioned my husband had a stroke not long after my brothers suicide.My family kept telling me I should try anti d,s because I was very bad.Reluctanly I did take them and I did start to feel a lot better.Their are 3 siblings in my family that take them.

I kept saying that because of all the stress it would affect my levels, I knew that..

I just can't seem to get my levels where they should be. If my t4 levels are ok then my t3 levels are either high or low, and visa versa...

The Antidepressants have made a difference but then I know all the time my levels are not optimal I'm not going to feel great either.Bit of a contradiction really..

[Tina_Maria in reply to sylus_911]

Thyroid conditions can be quite difficult to fine-tune with medication, after all, it is not that easy to dose with medication like a healthy thyroid could do.

If your T4 levels are still high, have you tried to reduce your levothyroxine a little bit as you were advised a while back? I appreciated that it can be quite tricky to find the sweet spot for your medication, but maybe you need a bit more time to see where the best thyroid hormone levels are for you.

Even if your serotonin and noradrenaline levels have been low for a long while, these changes (unless its genetic) are not permanent, as the brain has the ability to adapt and re-form neural pathways. So once your thyroid hormones have been optimised and the stress has significantly reduced, your natural neurotransmitter production should be getting much better again. But until that has happened, you may still need some additional support in the form of anti-depressants?

[sylus_911 in reply to Tina_Maria]

Hi, yes I did reduce my thyroxine. I need to have a blood test again to see where I'm at.Thank you so much for replying.

[thyroid-warrior in reply to sylus_911]

Hi sylus_911 wanted to share my personal experience. I’ve had hypothyroidism for most of my life since I was a child and was always on 75mcg. I had periods of anxiety which I always thought was due to the stressful uncertain situations in my life. Never did it occur to me that stress and unoptimised thyroid hormone levels could be related. Back in 2017, I was going through a period of uncertainty and that huge amount of stress accumulated and spiralled into depression and anxiety. The first time after 30 years my dosage was raised to 100mcg and I was prescribed 100mcg of sertraline. Definitely it helped to soothe my nerves and I felt more normal. At the same time I also sought therapy to work through some of the issues and negative emotions/memories that emerged during that period. After about two years i decided to slowly wean myself off sertraline and I seemed to be fine. One year ago I went through another life change and I became depressed and anxious for over half a year. I didn’t want to take sertraline as I was trying to get pregnant but I did seek therapy again to manage depression and anxiety. I’ve now acquired some tools to help manage my anxiety. Interestingly this happened over autumn and winter. There is some research that we might need different amounts of thyroid hormone during winter and summer so it adds another layer of complexity.

Over summer, I became more normal again. It was only last October, I started on a journey of figuring out about the need to have optimized thyroid levels, despite having normal range TSH and T4. I experienced extreme fatigue, cold intolerance and brain fog. It became very difficult to work and I decided to raise my own dosage and felt much better almost immediately.

Found out in January that my conversion of T4 to T3 was poor. These days I still fluctuate with anxiety for a few hours and clarity of mind as my body is still trying to get to maintaining consistent optimal levels. While I started t3 on top of my current T4, I also aimed to maximize t4 to t3. This includes maintaining the right vitamin levels, eating more carbs (which can apparently affect conversion) and a daily short walk to start up the body.

Utilizing a range of methods can be helpful. The sertraline definitely was helpful for that period to calm my nerves and made me feel more normal. Therapy was also helpful to identify the root causes of stress and work through managing them better and come to better acceptance. Poor thyroid levels seem to be a trigger for anxiety for me, amplifying stressful and negative experiences. Now looking back, I can see how extreme stress could accumulate and affect my thyroid hormone levels. I’m still not 100% where I want to be yet, similar to many of us on this forum it’s a journey of trial and error and it’s not very straightforward. Luckily we have a supportive group here to share our knowledge and help to navigate this path that’s not so fully understood yet by the medical world.

[buddy99 in reply to sylus_911]

Of course it is possible to be depressed in addition to thyroid problems. From what I understand depression can influence thyroid hormones, and thyroid dysfunction can contribute to depression. The relationship between the thyroid and mental health is complex and bidirectional. My concern was that rather than putting effort into finding the cause (which in your case seems obvious), prescribing antidepressants is the faster option. Since low levels of FT3, for example, are often not even on the radar when TSH is the only reference point, giving antidepressants is a quick way to get the patient out the door.

The further concern was that once the patient has been on antidepressants, whether for the right or the wrong reason, this becomes an easy way for doctors to not put in the work in the future and check thyroid, nutrients, cortisol etc. and just presume that any symptoms must be mental health related. In case of thyroid, TSH based medicine, that excludes FT3 (and even FT4), has thus an easy "excuse" to lower the dose of the thyroid medication in order to bring the TSH in line, dismissing any possibility that low thyroid hormones are the culprit. With medicine starting to take the route of fast food, I see this as a real danger.

[Tina_Maria in reply to buddy99]

I think the development of antidepressants has been a blessing and also a curse. A blessing for those that suffer from anxiety or chronic depression, so they can have a better quality of life.

However, it can also be a curse in the sense that it makes GPs lazy and immediately jump to the conclusion that you are anxious or depressed, without even entertaining the fact that it could be caused by something else entirely. And that is increasingly seen in general practice.

A staggering 8.7 million people were on antidepressants in 2023/24 (nearly 15% of the population), with 89 million antidepressant drug items prescribed. More and more people are also on long term antidepressant treatments. There is also a rising trend for prescribing antidepressants in teenagers, which even NHS England admits is concerning.

[connyankee in reply to sylus_911]

My sympathies for your losses.🙏

[Eazybiker]

Thank you. I'm increasingly convinced that the depression "umbrella" is one of the great medical scandals of our time. So much easier than finding root causes including thyroid problems, nutritional deficiencies or high sugar intake.

[Jingley]

Luckily, before my hypo diagnosis, I had a joined-up-thinking GP who said that my explanation of some of my symptoms sounded like I was down and depressed but she refused to prescribe anything at all until my thyroid levels had been checked. I did help that she was also hypo herself and recognised it.

There are some good ones out there. Unfortunately, she's now left the practice 😢

[connyankee in reply to Jingley]

She left the practice. Can you track her down?

[sparkly]

This has always been the case for me. A T3 increase makes me feel so normal and happy. I feel the difference within an hour of taking my higher dose, so does my family.

[sparkly in reply to sparkly]

Also I'd like to say that testosterone had the same effect. Energy, no brain fog, happy, well-being feeling and got rid of all my aches and pains too

[jgelliss]

You are so right. That enxiety and moodiness have so much to do with being underdosed. In my case at least after my T T I was dosed with high T4 only. I experienced palpitations insomnia anxiety etc.. After much begging for T3 the Dr gave me 5mcg . But lowered my T4 very low. I felt awful. I tried splitting The T3 and T4 that didn't work either. Raising back my T4 back with added 5mcg T3 made a huge difference.

[Bridkid67]

Yea I had a similar experience with my DR he suggested mental health issues when I questioned my TSH level at 2.9 when on levothyroxine i quoted NICE guidelines on it been ideally under 1 he git back to me after reading the guidelines and said your right and increased my dose

[Holidays4]

For me it has been the opposite. I didn’t have any anxiety or depression until starting Levothyroxine. Perhaps my body was producing more T4 and T3 than the hormone replacement was/is. Even with increases I don’t experience any change in symptoms although realise now from this forum that I am still very under medicated and am also working on vitamins. My anxiety spikes with a dose increase in T4. I also take anti depressants and anti anxiety meds which don’t make any difference. I walk and swim to try and get rid of the anxiety and boost my mood and that doesn’t work either so it must be my thyroid. Hoping to get to the right dose and see if that helps.

Thank you for posting this, I’ve taken a screen shot to show to my GP although I doubt she would agree to an increase in my T3 prescription.

Hope this helps others that suffer the same problems.