Worst Complaint is Insomnia
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Q:  Worst Complaint is Insomnia

HI,  really need help with this,, have been diagnoised with bipolar disorder a few years ago,, have been on several anitdepressants,, prozac and wellbutrin are the  two that work the  best however they seem to make my insomnia , that is my worst compliant is insomnia, and itchy skin and just not feeling well,,, and hair loss,, had my blood test done,, here are the results,, t3-26.4, t4-7.9 ,, and free thyroxine index was 2.0 is that border line for thyroid problems? plus I have anxiety and panic disorder, and I  can take restoril for sleep and it does not work which i find very strange, could that also be a inciator that i may have throid problems , thanks for you time and information,,, thanks brenda

Dear Brenda --
For the record -- pardon while my knee jerks here -- let's just be clear: the expert consensus on the treatment of bipolar disorder, including bipolar II, is to rely on mood stabilizers (as opposed to antidepressants). Whether antidepressants ought to be in there at all is a subject of considerable controversy and not enough data.

The point there was that if you've had the dx for several years and the emphasis so far has been on antidepressants -- helping with the depression, perhaps, from your report here, but worsening your sleep problems -- then there are plenty of options to consider. If you haven't already been there, you could read the "big picture" view of medication treatment of bipolar disorder, which reflects that expert consensus, on my website in the Treatment section of the Bipolar II material. I offer this because of the phrase in your note: "just not feeling well".

Now, as for thyroid, I'm sorry, my understanding of thyroid is, like most of psychiatry as far as I know, stuck back at the level of looking at your TSH and making sure it's in the normal range. What to do with particular values of T3 and T4, in the context of bipolar disorder, is still not known. Pretty primitive, I'll grant you. But even the endocrinologists are still struggling over whether to give T4 alone or T4/T3 together when treating simple hypothyroidism, so psychiatry is really not that far off, it seems to me.

Dr. Phelps

Published November, 2003 


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