Dr. Phelps:

My 85-year-old father has been BiPolar for some 20 years.  He also is on Synthroid medication, and I've been reading about the connection you allude to between them.  

I'm frustrated trying to get help for him.  His psychiatrist seems bored with him, since my father is very non-compliant; and his internist is also not very interested.  He's a tough man, and I know he never received any love from his parents  -- no nurturing at all, and there may even be a possibility of parental abuse, either physical, which he denies, but which I know another sibling received, or mental, verbal abuse.

I know this because he's never been able to tell me he loves me; I too have not been nurtured; however, I am under the care of a good psychiatrist and have many loving and caring friends.

It's not easy for me to "help" him because he's always complaining about not feeling well, lots of nervous stress; can't keep his hands quiet when he's sitting in a chair; legs the same say; moans and constantly repeats "Mama" ad nauseum.  He's lost his partner, my mother, approximately two years ago, and they mostly fought, which I won't do.

I love him and would like to assist, but feel frustrated by the medical system and his illness, which I know he can't help.  Where should I start?  He's taking Remron at night, one pill; Celexa in the morning, one pill; Synthroid in the morning, one pill, and also a blood thinner for his heart.  His health is otherwise good; he eats well, but really has no appetite; he takes one pill for sleeping, and at the moment I can't think of that, but he does sleep well; just too much.  Money is not a problem; he's got lots to be grateful for but can't seem to get out of his own way;  I notice that he seems to have anxiety attacks; I know they are because that's one of the things I'm being treated for.

Should I just make an appointment with someone out of town and take him?  Anything you might suggest would be helpful, I'm sure.

Thanking you in advance for your assistance,

Dear Ms. W' -- 
This is a difficult circumstance.  You could ask for an appointment to see the doctor who's in charge of his medications, and wonder about substituting Depakote for the Remeron (Depakote can lower platelets and change their clotting, so you could acknowledge to the doctor that you're aware this could be a little tricky and require some more work on his blood thinner), as Depakote is a favorite of gero-psychiatrists even when bipolar diagnosis is not absolutely certain, because it is generally tolerated very well (especially using the "sprinkles" formula, a very low dose ultra-slow-release version).  You have a right to wonder aloud as if your father does indeed have bipolar disorder, management with two antidepressants is very unusual.  Even management with one without some mood stabilizer in there is also unusual.  

As you're alluding to, if T3/T4 is really different as a "mood stabilizer" than T4 alone (Synthroid), then maybe there's another angle too to wonder about, namely switching his Synthroid to a T3/T4 combination.  The article in my references in the thyroid section by Bunevicius et al (New England Journal of Medicine 1999) is not about bipolar, but about anybody who's taking thyroid replacement, so there are two reasons that article is relevant for your father.  

Remember to stroke the doctor first (something she does really well, or for taking time to see you), thank her/him for taking care of your father, acknowledge that she/he works hard, and that she/he may not really like it when patients (let alone family) bring in stuff from the internet.  Ask if you could just "wonder aloud" about some ideas and that you'll pay privately for the opportunity to do so.  Good luck; tricky, tough job ahead.  I hope you have some success. 

Dr. Phelps