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Q: Worst Complaint is Insomnia
HI, really need help with this,, have been diagnoised with
bipolar disorder a few years ago,, have been on several anitdepressants,, prozac
and wellbutrin are the two that work the best however they seem to
make my insomnia , that is my worst compliant is insomnia, and itchy skin and
just not feeling well,,, and hair loss,, had my blood test done,, here are the
results,, t3-26.4, t4-7.9 ,, and free thyroxine index was 2.0 is that border
line for thyroid problems? plus I have anxiety and panic disorder, and I
can take restoril for sleep and it does not work which i find very strange,
could that also be a inciator that i may have throid problems , thanks for you
time and information,,, thanks brenda
Dear Brenda --
For the record -- pardon while my knee jerks here -- let's just be clear: the
expert consensus on the treatment of bipolar disorder, including bipolar II, is
to rely on mood stabilizers (as opposed to antidepressants). Whether
antidepressants ought to be in there at all is a subject of considerable
controversy and not enough data.
The point there was that if you've had the dx for several years and the
emphasis so far has been on antidepressants -- helping with the depression,
perhaps, from your report here, but worsening your sleep problems -- then there
are plenty of options to consider. If you haven't already been there, you could
read the "big picture" view of medication treatment of bipolar disorder, which
reflects that expert consensus, on my website in the Treatment section of the
Bipolar II material.
I offer this because of the phrase in your note: "just not feeling well".
Now, as for thyroid, I'm sorry, my understanding of thyroid is, like most of
psychiatry as far as I know, stuck back at the level of looking at your TSH and
making sure it's in the normal range. What to do with particular values of T3
and T4, in the context of bipolar disorder, is still not known. Pretty
primitive, I'll grant you. But even the endocrinologists are still struggling
over whether to give T4 alone or T4/T3 together when treating simple
hypothyroidism, so psychiatry is really not that far off, it seems to me.
Dr. Phelps
Published November, 2003
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