Q: Anything Endocrine Related Contributing to Mood Disorder & Weight Loss?

Dear Dr. Phelps,
I have had some symptoms of BP since I was a teenager.  I have compensated for them most of my life, and my symptoms were almost nonexistant during the pregnancy/infancy of my 3 kids.

However about 1 1/2 years ago my insomnia became intolerable and my mood problems worsened. In addition, during the 5-6 months that it took for me to get in to see a psychiatrist I began to lose weight.  (While I have short episodes of depression, I never attributed my weight loss to the depression).

I was subsequently diagnosed with BPII, and now take lamictal, geodon, klonopin and lunesta.  My symptoms aren't gone, but greatly improved.  My sleep problems have been the most difficult symptom to get under control.  However, I continue to lose weight, and have gone from my normal 103-104 lbs to 92.

My PCP ordered blood work and saw nothing remarkable.  It has been suggested to me that an endocrine disorder may be playing a part in the BPII, and that I see an endocrinologist, particularly one who works with psychiatrists.

I'm wondering if you think there could be  anything endocrine related that would not show up on a typical blood panel that could a) be contributing to my mood disorder b) causing the weight loss. Thank you for your help.
Sincerely,


Dear Ms. M' -- 
To my knowledge there is nothing in the literature on bipolar disorder regarding "endocrine" conditions other than thyroid that are sufficiently understood to be routinely checked for in this context. I'm no expert in this respect, however.  Most lab "chemistries" on a routine screen would include calcium (might be abnormal if parathyroid hormone was abnormal) and several blood chemicals like sodium and potassium that would be abnormal if certain parts of the adrenal glands were not working right. Regular menstrual cycles rule out major abnormalities in the pituitary-gonadal hormonal axis (but other tests are warranted if periods are not regular). What's left after that? Cortisol production by another part of the adrenal gland, regulated separately from the part that regulates blood chemicals like sodium. Cortisol regulation is extremely complex. There is no simple way to test cortisol levels, as even a standard blood test can raise them and they very tremendously over a 24-hour cycle. Prolactin is another hormone under pituitary gland control but we don't routinely check it as low levels are not known to signify a problem and high levels usually announce themselves through abnormal menstrual cycles (or no cycles) or breast milk production. 

I'm working on an approach to sleep problems that will take several years to confirm but has the advantage of being cheap and harmless, so it might be worth looking into now. I don't make any money on it (first thing to check when there are no data on effectiveness!). Here's the story of Light and Dark in bipolar disorder which leads to the idea, namely blocking certain wavelengths at night to simulate, for your brain, complete darkness, even while you stay up to study or read or something.  If you get some smashing result (careful, you can pretty easily break the glasses....), let me know. 

Dr. Phelps