[QUOTE=Alexander]
I was on lexapro for a year, but discontinued due to constant fatigue, insomnia, sexual dysfunction and apathy and anhedonia. Problem is now 9 months later, these problems persist!
I got some testing done to get a look at my hormones. Here goesFree T4 1.9 Ok range (0.7-2.5)
Free T3 3.6 Ok range (2.5-6.5)
TSH 3.3 H range (0.5-3.0)
TPO 17 Ok range (0-150) 70-150 borderline
Cortisol levelsMorning (7.9) Ok range (3.5-9.5)
Noon(4.7) H range (1.2-3.0)
Evening( 2.4) H range (0.6-1.9)
Night (0.4) Ok range (0.4-1.0)PSA(2.1) Ok <0.5-4 optimal range(0.5-2.0) Estradiol (blood spot) 35 Ok pg/ml 12-56 Testosterone (blood spot) 559 Ok ng/dL 400-1200 (Age Dependent) Ratio: T/SHBG (blood spot) 0.6 L .7 - 1.0 DHEAS (blood spot) 318 Ok ug/dL 70-325 SHBG (blood spot)* 34 Ok nmol/L 15-50 Symptoms generally are Chronic fatigue Thin, dry skin, decreased sweating Sexual dysfunction Problems emptying bladder Anhedonia Poor cognitive abilities, vigilance, articulation, short term memory etc. Chronic constipation Furtherly drained by vigourous exercise Increased fat in abdomnial area and increase in weight, about 30 pounds. I'm 21 years old [/QUOTE]
Generally, when a person has mental health problems, one is dealing with a complex illness involving the nervous system, endocrine system, immune system, and metabolism – which to me are parts of the mind – along with nutritional problems.
Psychological problems have to be addressed in therapy whenever they exist since they also contribute to physiologic changes in the mind. One’s environmental stresses have to be evaluated. Physical activities are an important component in maintaining health. Note that psychotherapy can have as good a response as any single psychiatric medication. Thus if one is not engaged in improving oneself psychologically (e.g. skills in emotional regulation, distress tolerance, problem solving, stress reduction, relationship and social skills, etc.), then one is not maximizing the outcome of treatment.
The use of a single medication – such as an SSRI – only addresses a small part of the complex multi-problem illness. This is why one cannot generally expect remission of the illness with the use of a single treatment. The other problems continue. Further, one has to consider the effects of a single treatment on the other signaling systems and on metabolism. For example, an SSRI, if the dose is too high, may reduce dopamine excessively and increase norepinephrine excessively, further causing problems unless measures are done to address these problems, if a particular dose is necessary.
In research studies, what is interesting is that “remission” is defined often as half of the lowest score for response. This leaves a person still ill despite being found to be in “remission”. Thus research studies use weasel words to define successful treatments – which are not.
It often takes multiple systemic breakdowns to create depression, for example. If low thyroid is the entry breakdown, then mood is generally maintained by compensations in the other systems. But when these compensations become excessive (such as in sympathetic nervous system activity or immune system activity) or impaired (such as in adrenal anti-stress signaling), then mood regulation breaks down and the person becomes dysfunctional. Breakdowns in the dopamine systems may contribute to anhedonia, sexual dysfunction, impaired memory, impaired attention, impaired drive, movement problems, etc. Breakdowns in the serotonin systems may contribute to increased stress, anxiety, etc. Excessive sympathetic nervous system activity can lead to insomnia, paranoia, vigilance, excessive inflammation, insulin resistance, adrenal fatigue, etc. Low thyroid signaling may lead to lack of energy, impaired thinking, lack of libido, increase in stress, as well as physical signs such as dry skin, constipation, etc. Excessive insulin signaling may lead to weight gain, excessive inflammatory signaling, which lead to other systemic problems. Each of the signaling systems strongly interact with one another. Piecing together what is happening then would require detective work examining the interactions of all these systems.
In regard to lab testing, for thyroid testing, total T4 is important to give one an idea of how much thyroid replacement therapy can be done.
Thyroid hormone can fall rapidly during the transition from childhood to young adulthood, contributing to mental health problems and/or physical health problems, which may be only partially addressed by maturation of the reproductive system.
When excluding people with Hashimoto’s thyroiditis, the average TSH become approximately 1.0 . Thus, assuming the nervous system is working well and assuming that TSH is a good measure of thyroid activity, then a TSH far from 1.0, such as 2.0 and above could be considered a sign of low thyroid hormone.
Thyroid hormone interpretation can be complicated because the brain could be considered a separate compartment from the rest of the body because of the blood-brain barrier., Astrocytes in the brain convert thyroid hormone from T4 to T3 at a rate different from the Liver, Kidneys and other organs. In Alzheimer’s disease, this conversion is lower in the brain than the rest of the body, thus the brain is in a relative hypothyroid state.
Even if one is low in thyroid hormone, thyroid replacement is not always simple. One has to pay good attention to nutrition otherwise one can get heart problems from thyroid. One has to attend to the adrenal glands otherwise thyroid treatment itself may cause adrenal fatigue. Etc. Thus even single treatments can become complicated when the whole picture / person has to be considered.
Belly fat is a very active organ which can cause significant increases in inflammatory signals, contribute to insulin resistance, excessive estradiol signaling, liver problems, etc. Some of these problems are in bad positive feedback loops. For example, excessive insulin (insulin resistance), can lead to increased belly fat, which can increase estrogen signaling, which then can lower thyroid signaling, which can lead to increased stress and insulin resistance, which then increases insulin signaling, and so on. Additionally, the increased insulin can lead to lower testosterone production, which increases insulin resistance and insulin signaling. These positive feedback loops are vicious biological traps. Addressing one or more links in the chain is necessary to break it and improve health.
Once the physiologic contributes to mood problems are identified – including signaling problems in the nervous system, endocrine system, and immune system, as well as metabolic problems and nutritional problems – then a comprehensive treatment can be designed to address them. Generally, this can be a more successful treatment than using single treatments. And it makes sense.
Dr. M