BPI, BPII & Success of Thyroid
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Q:  BPI, BPII & Success of Thyroid

My husband was diagnosed as Bipolar(he is BPI- rapid cycling) nine years ago after being sent to a drug treatment facility. He has had one treatment or another since then, coupled with drug and alcohol abuse. He has been sober from drugs and alcohol for the past nine months, but has continued to be somewhat treatment resistant. In the past 6 months he has been hospitalized twice with acute manic symptoms. His depression has lessened, but he continues to have days where he is unable to get out of bed. The past two months he has been realatively stable in mood, but he is on 6 different meds that slow him down so much that he is unable to hold a job or even help much around the house. It seems sometimes that the treament can be just as debilitating as the illness.  I am very interested in your research concerning thyroid hormone as a treatment for bipolar illness. It seems that you have the most success with patients that are BPII and I was wondering if you think there is a big difference between the success of thyroid when it comes to BPI?  We sure would like to get him beyond stable to functional.Thanks! A

Dear A' --
I hope it was clear from my website that I've had patients who seemed to do well on T3/T4 thyroid, but that there is basically no real "research" on this approach, nothing to go on in bipolar disorder. There is some actual research support (as opposed to what I've written on my experience, which is guessing from clinical experience, a step which precedes true "research") for a T4 approach, as explained in that essay on bipolar and thyroid.

The point of all that is: we have so little research on any of this that we are far from being able to clearly distinguish BPI and BPII in terms of their responses to thyroid. However, there is some evidence that thyroid may have particular value in "rapid cycling" bipolar disorder, which simply consists of more than 4 mood episodes per year, and thus might apply in your husband's case -- and that's rather the extent of it as far as research goes regarding thyroid approaches and your husband's story as we have it here.

Now, let's look at the issue of 6 medications and function. It may well be that one or a combination of those medications is "holding him down" to the point where he can't really even help much around the house. As you point out, depression in bipolar disorder can also put a person in that position. So we can't be certain that the medications are responsible, and the point there is that I would caution against the 100% assumption that he can get back to a higher level of function if the medications are different. That is certainly to be hoped for, and worked toward, and I would agree with considering other mood stabilizer approaches if cautious lowering of one of the 6 leads to a sense that he is drifting toward another relapse.

When that consideration is made, though, you'll be weighing the evidence that the next medication approach will work versus the risk of a return of his symptoms, which sound very serious, especially lately. And thus you see, if as with thyroid approaches there is little to go on regarding evidence that it will work, then the risk side of things could easily outweigh the idea of relying on something like thyroid to prevent relapse. Usually in that circumstance I'd be adding the thyroid to the other medications, hoping to address his energy level, for example.

And finally, as you may be well aware, if lithium is among those six he's on now, then certainly you'd want to know that the lithium has not made him "hypothyroid", as it can do very frequently. So one of the first steps in any case, if it's not already been done, is to make sure his thyroid function now is all right.

Remember to be very gently and respectful and do some good ego-stroking as you make your inquiries about his thyroid test status and about some of the ideas you've got. Good luck.

Dr. Phelps

Published July, 2003


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