Q: Skin Problems- Possible Thyroid? Any Ideas?|
Dear Dr. Phelps:
I am a 33 year old male who has been struggling with bipolar disorder and
severe depression for many years now, has consulted three or more psychiatrists,
two therapists, tried lithium, depakote, tegretol, trileptal, several SSRI's and
other antidepressants, and a number of benzodiazepines. Nothing really seemed
to stop the spending sprees leading me into a bankruptcy, panic attacks and
chest pains at work (in front of crowded classes of high school students,
alcoholism, and suicide attempts (3 or 4, for which I ended up both in the
county and private mental hospitals).
A combination of things has led to four of the happiest, most stable months I
have experienced (I know this may not seem like a long time, but I'm really
hoping this is the start of something great. I have a remarkable psychiatrist,
a specialist in ECT (a modest individual, but he seems to have lots of students
who come to learn his technique; I once asked him when he was putting the
electrodes on if it was unilateral or bilateral, and he used another term for
it, which I can't remember, as I went to sleep shortly after). I am on a
monthly schedule at this point, and the timing seems just about right. The fact
that the outpatient teatments are performed in a psychiatric hospital means that
there is an excellent nursing and anesthesiological staff present.
My therapist has helped a great deal, too, providing necessary support and
suggestions. I had a terrific attorney, who helped me resign without quarrel
from a very stressful job of 8 years. And I can't leave out my girlfriend and
her family as well as my own family for their love and attention during the
I'm sorry to ramble, but I feel I owe my life to these people. My question: My
psychiatrist (the ECT specialist), also seems very interested in newer
medications, which I have no problem with, except that there seems to be
something new coming out every week so that it's tough to keep up with the
various side effects and potential interactions. What's been working for the
last 4 months or so is a combination of Lamictal (400mg), Effexor (300 mg),
Remeron (15 mg), Seroquel (800 mg), and Topamax (100 mg, although we are
tapering off on this as it doesn't seem to be doing much for weight loss or mood
stability). Both my psychiatrist and therapist have been very good about
pushing exercise to help combat the weight gain; I'm just starting a fitness
class that I hope will help.
My primary care physician has me on Pravachol (40 mg), aspirin (81 mg), Zantac
(150 mg as needed), and Synthroid (.05 mg). I've been off the alcohol for
about five years now, and take no other drugs than those prescribed.
Though, as I say, moodwise, I feel great, I do have the following symptoms,
which neither my primary care doctor nor my psychiatrist seem sure of: frequent
(almost daily) heartburn; very dry, itchy skin, especially when I get out of the
shower and including some reddish, flaky patches; and sleepiness.
I can't really fault my medical people for not knowing whether the drugs are
responsible or not, since, as I say, their newness makes it a little tough to
get a handle on their interactions with each other, though both say that the
combination of medications may have something to do with it. The dry skin is
the biggest pain right now (possible thyroid link?) Do you have any ideas on
Thanks for your help, and also thanks for your interesting question and answer
site, which I spent some time reading through. All the best.
Dear Mr. W' --
Certainly what stands out to me as I read this is the particular mix of
medications you're currently on, as if read correctly, that's in addition to
maintenance ECT. Your doctor seems to have been able to get your symptoms under
control with this mix, though, and that's the final answer in any wondering
about what medication approaches are appropriate.
At the same time, I can tell you that I don't have any patients taking two
antidepressants; very few taking lamotrigine (Lamictal) and an antidepressant;
and few on Seroquel, especially compared to the number of folks I have on
Zyprexa (the absence of which stands out a bit on your list, if that was not an
oversight, because there is evidence it may be our best mood stabilizer, better
than Depakote and maybe even lithium, but worse in the weight gain department
which you indicate is already an issue -- so perhaps it was avoided to date on
that basis). So you're "off the map" of my experience and I can comment only on
your side effect questions.
As you may have learned, skin problems when someone is taking lamotrigine are
to be taken seriously until it appears to be very clear that they are not the
allergic reaction which can lead to a condition called "Stevens-Johnson
syndrome", which is a very nasty problem you don't want to have. So
first, you should get an assurance you can trust from your doc's that whatever
your skin is doing, it's not possibly SJS.
Second, as you point out, hypothyroidism is associated with dry skin so it
would be worth it to make sure that your current replacement dose is getting
your TSH down well into the normal range -- i.e. hanging around near the top of
that range, which is the hypothyroid end of things (the numbers are all
backwards with TSH, which is the signal from the pituitary to the thyroid that
say's "make more hormone", and thus goes up when you're actual thyroid
levels are down), is not where you want to be. Or put another way, it
would be nice to know for sure that simply raising your Synthroid isn't going to
solve this problem, which it probably won't if your TSH is already low. I hope
that wasn't too confusing there...
Good luck, and I hope your current "feeling great" sticks around for you.
Published July, 2003