Dr Phelps,

I fit a profile that you have on your site. I am someone that at one time was able to take antidepressants for panic disorder. After a few years I attempted to take them again with no luck just became very mania later was diagnosed with bipolar. I have not responded well to mood stablizers they either don't help or make me too tired to tolerate them.

The thing that I am interested in is the thyroid therapy you talk about. I had my TSH tested and I am on levothroid I now understand that there is another side to all this. Are there different test that need to be taken? It just seems that if I take a mood stablizer even if it works a bit then it seems to stop working. I just feel that there is something going on here in the back round that no one has bother to check. I just find it hard to believe that I am this treatment resistant.

Any help would be great.

Thank you...Brian

Dear Brian -- 
There is no additional test beyond TSH.  I wrote two mood experts at UCLA to see if this thing about T3/T4 is really "new news" and they say yes, publish this.  Point being, I don't think you'll find anything more to go on, e.g. to share with your doctor, than what you've read on my site.  You basically just have to try it, but if you don't take too much and become hyperthyroid, the risks appear at this point to be very low (you're just taking from the outside the same molecules your body is making from the inside, but somehow where it comes from seems to make a difference.  I've definitely seen people with TSH even as low as 1.0 get a very good response to these thyroid molecules, so it does not seem to be a matter of somehow "treating" an unrecognized hypothyroidism, at least not on the surface (there are other guesses as to what's really going on).  

Why are you so treatment resistant?  It sounds like you get partial response to a  mood stabilizer, but since it's only partial, you "cycle" underneath it.   Generally in this circumstance I add another mood stabilizer, and people can end up on three or four at low dose as we try to stay away from any side effects.  The Harvard group has published that in their Bipolar clinic, less than half of their patients are only taking one mood stabilizer; the rest are taking two or more, and many patients are taking 4 or 5 medications (counting a medication for sleep, for example; or a medication that's been added to control a side effect from one of the others).  It sounds terrible, but imagine if you could get your cycling to completely stop; it might be worth juggling a lot of pills, if you don't have to endure any side effects as a result.  Good luck with your search.

Dr. Phelps  

Published October, 2001