Q: Does It Matter what Med a Person Takes No Matter the Actual Cause of
Dear Dr. Phelps, I was referred to your site in June by a psych who
said to get educated on rapid cy./mixed state/Bi-po. I was also dia. 6 yrs. ago
as 'classic' Hyper-thyroid by an Endo. and treated for it (incl. Paxil/Celexa (quit
last spring) over 5 yrs. didn't really work). The psych. prescribed Geodone, but
after reading side-effects, I ran scared. In Aug. Endo said my symptoms (almost
all of what you describe on your site's Bi-polar 2 pg.) are hyper-thyroid
induced (he thought I'm going 'toxic' not Bi-pol., I am on the road to ablation
(NO! Help! ))I am a 53 yr. female...all symptoms 'could' be Bi pol./Hyper thy./or
peri-menopause...in desperation, saw another psych. in Nov., got same Bi-pol.
diagnosis, put on Lamictal, now at 125 mgs. (which I am taking for my daughters
sake) feel 'clearer minded' at times but am still 'up' (no shopping in Vegas,
just anger/irritability) or 'down' (the black hole)... SO, my endo. does not buy
the bi-polar and the psych. doubts the hyper-thyroid being the true culprit.
When I 'self-help' on the net, I see many references to 'may' be Bi-polar (with
various symptoms) if have no under-lying med. problem like Thyroid disease (I
am. dia. Hashimoto's/Graves), but with no info. on what to think/do if you DO
have under-lying disease..is it the chicken (thyroid) or the egg (brain)??? Your
site has helped me through many nights to hang on and not give in to the
insanity of it all. Does it matter what med. a person takes no matter the actual
cause of symptoms if it might help them? Thank you so much for your time!
Dear Leslie --
Well now. First thing to do, I'm going to calm down. I understand
your train of thought -- but it does rather get one revved up, doesn't it?
We might start at the end. I agree: ultimately, if you can get the
symptoms under control, really good control that stays stable, then you are
right -- at that point it does not matter so much that you understand exactly
what the problem was. So you are right to reassure yourself that there is a way
to do this without necessarily being able to figure it out precisely.
If you think the lamotrigine (Lamictal) has really done something,
for sure -- then you have an obvious next step, which is simply to wait until
the dose gets up to the standard 200 mg level, and then reevaluate. If at that
point, you are still certain that it helped, hopefully even more so by that
time, then I think most diagnosticians would agree that this strengthens the
"bipolar" hypothesis somewhat (inasmuch as it would be less likely, probably
much less likely, that a fundamental thyroid problem would respond to
Conversely, I think one could argue, with somewhat less certainty
though, that if you conclude lamotrigine really didn't help at all, that
strengthens the thyroid hypothesis somewhat. If you are still having irregular
menstrual cycles, i.e. not quite zero yet, then the perimenopause hypothesis
could fit in there as well.
Because your endocrinologist thinks you are hyperthyroid, I presume
that you have had some TSH results that are abnormal in that direction, less
than 0.5 or so. If that is the case, and especially if you have had some TSH
results down around zero, that substantially strengthens the hypothesis that
thyroid is the basis for at least some of the symptoms. Under these
circumstances, it sounds like ablation would be an appropriate approach.
On the other hand, if your TSH results have been normal -- and
particularly if you have had some that are closer to the hypothyroid end, say
3.0-4.0 or higher, this opens an interesting possibility. At that point I think
you should be discussing with all of your providers the UCLA approach to rapid
cycling bipolar disorder in women, using
high-dose levothyroxine (that link includes
a plain English explanation of the approach and a link to a review article by
the UCLA team).
After all that, listening to the story you have provided here
through psychiatric ears, it sounds like the next move would be simply to treat
your symptoms with standard combination-of-mood-stabilizer approaches. I hope
something in this note helps the process along --
Published May, 2008