Overweight, Sluggish & Falls Asleep Easily
Hello Dr Phelps.
have been diagnosed with Thyroid disorder (LOW) and Bi- Polar 2 disorder. I also
have 7.7 cholestrol and a strong family history of heart disease. I am a 46 year
old female. I am 5.1" tall and weight is 12 stone.
carbamazipaine 600mgms daily
thryroxine 150mgms daily
statins 40mgms daily
Prozac 20mgms daily
have had depression for most of my life, having tried to take my own life three
times in my 20s. It took ten years to get diagnosed : CLINICAL DEPRESSED. 18months
ago I was further diagnosed Bi polor 2 and thyroid LOW.
question is I STILL AM NOT WELL. I am grossly over weight despite being
careful what I eat, I am sluggish and fall asleep easily at the drop of a hat ?
Please help if you can shed some light.
Dear Karen --
Here are some ideas to talk
about with your doctors. Please don't even think about taking any steps on your
own based on these ideas: some of them could make things worse, depending on
information from your history you couldn't possibly provide here.
First, there is a complex
relationship between thyroid problems and bipolar disorder. You can learn more
about their relationship, and about a research-level approach to the treatment
of bipolar disorder, using thyroid hormones, on my webpage about
thyroid and bipolar.
Second, your dose of
carbamazepine is on the low side. If you have not had that medication up to
1200 mg, there might be some room for further improvement at higher levels. If
you recall that when you first went on this medication it worked much better
than it does now, one of the potential explanations for that is that the
medication has changed your metabolism such that you now have a much lower blood
level of carbamazepine than you did when you started. This is a recognized side
effect/complication of using carbamazepine. So, that's one easy option.
However, carbamazepine gets trickier to manage as the dose goes up, so you
should definitely not do this on your own. It could make you quite sick.
Third, although this is much
more controversial: many mood specialists think that antidepressant medications
can keep an otherwise effective "mood stabilizer" (like carbamazepine, at least
at perhaps a higher blood level) from doing what it is supposed to do. In other
words, antidepressants can have a "destabilizing" effect. If you or your
psychiatrist or primary care physician would like to see more information about
this controversy in this country, I keep a running summary of articles on the
subject, translated into simpler although not plain English, on my webpage
Antidepressant Controversies (see Controversy #2). So, if Prozac was in
there before carbamazepine, one of the options to consider now would be
gradually taking out the Prozac. It is always nice to try to solve a problem by
taking medications out, rather than putting more in. However, things can get
pretty bumpy on the way down. An experienced mood expert has recommended taking
four months for antidepressant tapers, and I think he is right (as reflected in
another of my webpage is about
Finally, although the list
here is probably not exhaustive, your daytime sleepiness/sluggishness could be
due to "sleep apnea", given your weight. That is something you would ask your
primary care physician about. It could be very difficult to get your sleep, and
your daytime sleepiness, and your symptoms, under control if you had sleep apnea
in the background that wasn't treated.
I hope that one or several of
those ideas prove to be useful for you. Good luck with that.
Published April, 2009