8 replies to this topic

[Berry]

Hi, I am curious to know if anyone else has had similar circumstances to mine or if someone could enlighten me about any of this. Here is my backstory:

I've had bad anxiety for most of my life, and in my teen years became very depressed. I got put on Paxil and only took it for a few months. It made me feel like a zombie, and after making the terrible decision to drink (I was a dumb teenager OK?) I ended up in the ER for having a seizure. Needless to say this scared me (even though it was my own dumb fault) and I stopped taking it immediately.

Fast forward several years later into my early 20's and my depression and anxiety had become so unbearable I decided to see another doctor for treatment. This time I was put on Effexor. At first I thought it was GREAT! It totally relieved my anxiety and depression. Not only that, but I had buckets of energy and felt so motivated, and I only needed 6 hours of sleep as opposed to 8 or 9. HOWEVER, it didn't take long for the bad side effects to kick in. I experienced the usual loss of sex drive which I expected, and it wasn't that big of a deal, but there were other, more unusual side effects. I was having crazy nightmares and very scary episodes of sleep paralysis accompanied by visual hallucinations. I constantly had the urge to pee, and when I woke up in the morning I would immediately have to (literally) run to the bathroom. And here is what concerned me the most--if I missed a dose, I would sleep for 18-24 hours straight. No exaggeration. So, after about 7 months of this I decided to wean myself off. I did this without the help of my doctor (because he ended up being a total creep and made very inappropriate comments to me. I walked out of my last appointment and never went back.) Anyway, I did my research on how to wean off properly, dividing up the beads and such. I did all this and the withdrawal was STILL ABSOLUTELY ATROCIOUS. I slept and slept and slept and slept and slept. I was so unbelievably tired all the time and no amount of sleep was enough. I had brain zaps and felt terrible all over for several weeks, and the fatigue never fully went away. Months went by, and I still felt like I never really recovered. My anxiety and depression was worse than ever, and on top of that I had serious chronic fatigue.

After a year had gone by, I found a new doctor. I explained to her what was going on and she immediately did some blood tests and found out that I had hypothyroidism. (I did NOT have hypothyroidism prior to taking Effexor.) I got prescribed Levothyroxine 75micograms. After months of taking this I still felt NO relief from fatigue, anxiety, or depression. So, I foolishly decided to go back on anti-depressants. My doctor agreed and gave me a prescription for Cymbalta 60mg.
Well, the Cymbalta helped somewhat at first. I definitely did not experience the crazy amount of energy and motivation that I experienced on Effexor, but the side effects were far less severe on Cymbalta. (If I missed a dose, it was not as drastic and I found out that this is because Cymbalta has a longer half-life than Effexor, so it does not leave your system as quickly.)

I ended up taking Cymbalta for about 6 months, and due to issues with my insurance, I stopped taking it abruptly at the beginning of this year. I did not wean off, I just ran out and never got it refilled. I will say that the withdrawal is no better or worse than when I weaned off of Effexor. I have been sleeping all the time and thyroid medication has done nothing for me.

This prompted me to do more research, and of course I ran across all kinds of information about Adrenal fatigue/insuffiency/dysfunction whatever you want to call it, and how it relates to hypothyroidism and the use of antidepressant drugs. I have heard many people who have gone on and off different anti-depressants develop these kinds of other health issues as a result. But much of the information I've found is very conflicting and confusing. It's hard to know what is true. Is there anyone who could explain or help me understand a little better? I am currently taking a thyroid support complex supplement and an adrenal support supplement, but I'm still suffering and I'm afraid I'm going to have these problems forever.

Any information is much appreciated. Thanks for reading.

[Berry]

I forgot to mention that during this withdrawal I've been craving LOTS and LOTS of SALT. First thing when I wake up I want to eat something really really salty, usually soup that I add a lot of salt to. This is not normal for me. I also have to pee more frequently than usual, it's as if I'm drinking coffee or some other diuretic all day every day, but I haven't been. And sure enough, I've read that salt craving can be a symptom of adrenal issues.

[fishinghat]

Welcome Berry
 
You have run across a pet peave of mine. Adrenal insufficiency. I have a master's degree in physiology and my thesis was on Chronic adrenergic stress which is a fancy name for the "flight or fight" scenario which is at the hearty of anxiety. Adrenal insufficiency is very controversial (as you probably found out). Way too many holistic experts have jumped on this to explain nearly every type of metabolic problem or psychological disorder.
 
First of all notice the definition in Wikipedia...

"Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones, primarily cortisol; but may also include impaired production of aldosterone (a mineralocorticoid), which regulates sodium conservation, potassium secretion, and water retention.[1][2] Craving for salt or salty foods due to the urinary losses of sodium is common.[3]"
 
First of all it is a condition not a disease. Just like a headache from a brain tumor would be considered a condition while the tumor would be considered the causative disease.
 
Second, look at the symptoms ....

"Signs and symptoms include: hypoglycemia, dehydration, weight loss, and disorientation. Additional signs and symptoms include weakness, tiredness, dizziness, low blood pressure that falls further when standing (orthostatic hypotension), cardiovascular collapse muscle aches, nausea, vomiting, and diarrhea."

 

These are common with many many conditions especially psychiatric depression related conditions and can not be considered standing proof of the existence of adrenal insufficiency and certainly not of anxiety.

 

Whew!!! I feel better I got that off my chest.

 

Now let us turn our attention to the hypothyroidism. It is a common side effect of the use of ssri/snri antidepressants. The medicine inserts that come with antidepressants nearly always warn of the risk of developing hypothyroidism and/or liver damage. These chemicals (medicines) are often suppressive to the function of these tissues. It is standard procedure that a psychiatrist will stop the use of ssri/snri for 3 months to allow the thyroid to recover (which it almost always does unless actual damage is done to the tissue). At that point a different ssri/snri will be used to see if it can be used without effect on the thyroid. Zoloft is the one with the best record. It is important to note that it is essential to consider any radiological testing that may have been done around the same time. It has been shown that around 30% of the abdominal cat scans use enough contrast iodine to produce hypothyroidism. It is usually asymptomatic and does return to normal within a 6 to 9 month period. A simple 24 hour urine sample can show if iodine toxicity is the source of the hypothyroidism.

 

By the way, strange cravings are a fairly common side effect of most ssri/snri withdrawal but you are also correct in that it can be a sign of many other conditions, especially kidney problems. Have you had a blood workup lately? Especially a CMP (Complete Metabolic Panel) which will have a gfr as part of its analysis which reflects kidney function.

 

If you have any other questions or wish further details on any of these subjects then let me know.

[Berry]

Thank you so much for the informative response. I was never informed that hypothyroidism is common side effect of taking antidepressants and upon doing research I have found very little information about the link between hypothyroidism and these drugs (besides other people's testimonies). Doctors should warn about this, but I was never warned. And my doctor never, ever mentioned that Effexor could have caused the hypothyroidism. I figured that out on my own. The only thing doctors have told me is that I would have hypothyroidism for the rest of my life and always be dependant on the synthetic T4.

So if it is possible that the hypothyroidism is a temporary condition, how does one recover? The Levothyroxine doesn't seem to be relieving symptoms, and I've been taking it for about a year now. They say my levels are normal, but I definitely don't feel normal. I haven't felt any improvement at all! And of course the Cymbalta withdrawal has made things sooo much worse. I feel as though these drugs have completely thrown my system out of whack and there's no end in sight!

I read a few articles which claimed that if your adrenals are, for whatever reason, not functioning properly, then synthetic thyroid hormones will not be effective. Something to do with cortisol levels preventing the synthetic T4 from properly converting to the active hormone T3. And that it is necessary to address the adrenal problems first in order for the thyroid medication to work. Do you know if there is any merit to this?

Btw, I haven't gotten any cat scans, and my iodine levels are normal. I am deficient in vitamin D but I do take supplements for that.

[fishinghat]

Thank you for the response Berry.
 
First of all I think I have some medical information in my library on ssri/snri and hypothyroidism. I will try to dig it out and post it to this string in a little bit.
 
Secondly if you do not have any of the following symptoms  then you would be classified as asymptomatic hypothyroidism.

Fatigue
Increased sensitivity to cold
Constipation
Dry skin
Weight gain
Puffy face
Hoarseness
Muscle weakness
Elevated blood cholesterol level
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Heavier than normal or irregular menstrual periods
Thinning hair
Slowed heart rate
Depression
 
The weight gain, depression and slow heart rate would be the most significant signs.
 
The fatigue you are suffering from is a classic symptom of Cymbalta withdrawal but I didn't notice any of the other symptoms in your description. No brain zaps, swooshing in the head on rapidly turning the eyes to one side, emotional swings, and significant digestive issues.
 
By the way the frequent urination is a sign of Cymbalta withdrawal. Serotonin, which is controlled by Cymbalta. is the regulatory neurotransmitter in the bladder. Once your body adjusts this should go away.
 
NO good endocrinologist would put you on thyroid medicine immediately after blood tests suggesting hypothyroidism unless you are very symptomatic and in despite need for help. I was diagnosed with HypoT after being on Cymbalta. My primary care dr said I would have to be on thyroid medicine for life. I went to my endocrinologist and he threw a fit. I was informed, but was already aware, that many conditions can causes hypoT blood test results including the radiation, aspirin usage and some of the other nsaids, many other medicines, as well as infections. All clear when the causative agent is removed. Even a seafood diet and/or heavy iodine salt usage can cause this.

"I feel as though these drugs have completely thrown my system out of whack and there's no end in sight!"
 
It has and they are. lol  Seratonin is the most common neurotransmitter in the body and assist in the regulation of most everything. And as you are probably aware norepinephrine (also called noradrenaline) is a strong neurotransmitter and your body also converts it to adrenaline (now called epinephrine). Your body must learn to regain control and stabilize nearly all of the systems in yiour body. Research shows that these type of neurological effects often takes 3 months to 2 years to stabilize. That is why when it comes to withdrawal I always preach time and patience.
 
The thyoid function is controlled by the hpta axis which is "The hypothalamic–pituitary–adrenal axis (HPA axis or HTPA axis) is a complex set of direct influences and feedback interactions among three endocrine glands: the hypothalamus, the pituitary gland (a pea-shaped structure located below the thalamus), and the adrenal (also called "suprarenal") glands (small, conical organs on top of the kidneys)." Wiki. Thyroid hormones then effect virtually all system reactions speed and responses. It affects the pituitary, adrenaline, cortisol, thyroid, testosterone, etc. In actuality the thyroid would still be affected by the hormones you are taking but the adrenal glands could be effected. To address the "adrenal problems first" is a guess. We have too many variables, did the ssri/snri effect the thyroid which effected the adrenals, did the ssri/snri directly effect the adrenal glands (almost certainly). did the thyroid medicine effect the adrenal gland. Flip a coin. Based on my experiences with this phenomena and not any direct medical info I would say it is most likely that the ssri/snri effected the thyroid as would the control of norepinephrine by the ssri/snri. Once withdrawal is over these symptoms should resolve. In addition, I am not certain that you even need the thyroid medicine at all as hypoT symptoms may have just been a side effect of the ssri/snri and may not even be contributing to the issues.

More to follow....

[fishinghat]

Found it...


Antidepressants
reboxetine - TSH reduced and T4 increased.
sertraline - TSH increased and T4 reduced.
https://www.ncbi.nlm.../?term=18262705

sertraline and fluoxetine showed reductions in TSH,T3 and T4 levels.
https://www.ncbi.nlm.../?term=15486607

Fluoxetine decreased T3 and T4, increased TSH
https://www.ncbi.nlm...d/?term=6413229

https://www.ncbi.nlm...pubmed/22450350
Escitalopram-induced subclinical hypothyroidism. A case report.

https://www.ncbi.nlm...pubmed/20851281
Reversible escitalopram-induced hypothyroidism.

https://www.ncbi.nlm...pubmed/17874352
Reversible paroxetine-induced symptomatic hypothyroidism.

https://www.ncbi.nlm...pubmed/11054982
Depressed patients should be screened for hypothyroidism. In hypothyroid patients, depression may be more responsive to a replacement regimen that includes T3 rather than T4 alone. Therefore, inclusion of T3 in the treatment regimen may be warranted after adequate trial with T4 alone.

https://www.ncbi.nlm.../pubmed/7779834
Effects of long term treatment with sertraline (Zoloft) simulating hypothyroidism in an adolescent.

And many more articles.

ssri/snri replacement is a viable option.

https://www.drugs.com/pro/effexor.html
Side effects
"Endocrine system—Rare: goiter, hyperthyroidism, hypothyroidism, thyroid nodule, thyroiditis."

https://dailymed.nlm...54-00144ff88e88
The same is mentioned in the section on 'adverse reactions' in the drug insert for Effexor.


http://www.ehealthme...hypothyroidism/
65,121 people reported to have side effects when taking Effexor.
Among them, 420 people (0.64%) have Hypothyroidism

http://www.ehealthme...hypothyroidism/
An FDA supported website.
84,701 people reported to have side effects when taking Cymbalta.
Among them, 292 people (0.34%) have Hypothyroidism

https://dailymed.nlm...f2-c185fbad64ba
Drug insert.
Endocrine Disorders — Infrequent: hypothyroidism.

[Berry]

Thanks again for responding, God-like. As I mentioned earlier, after I completely stopped taking Effexor I continued to suffer for an entire year (from what I thought was withdrawal symptoms that never went away) before I finally found a new doctor and discovered that I had developed hypothyroidism. During that year and ever since then I have suffered from:

Chronic fatigue
Intolerant to cold (and my hands and feet are always like ice which makes my whole body feel cold)
Dry skin
More hair falling out than usual
Muscle weakness and aches
Severe depression

Weight gain has never been an issue for me for some reason. I've always been a petite, slender person and the only thing that ever made me gain weight was birth control, but I do not take any forms of BC anymore (and haven't in years).

I think my heart rate is normal, but I do have low blood pressure. My cholesterol level is actually too low.

Anyway, the Cymbalta withdrawal has been as you described--"brain zaps, swooshing in the head on rapidly turning the eyes to one side, emotional swings" all of those things yes, but no digestive problems. The fatigue, however has been ongoing ever since I stopped taking Effexor. The Cymbalta withdrawal only exacerbated the fatigue I was already experiencing and made it 10x worse. Sleeping all the time and never feeling rested, even after 16 hours of sleep, waking up tired and sluggish but having more energy at night.

I just have a hunch that my adrenals got screwed up first (as a side effect of Effexor) and since I didn't know, it went untreated and then that led to the hypothyroidism. I could be totally wrong, but that has been my assessment so far.

[Berry]

Wow, thanks for all the links! I hope I'm one of the lucky people who can overcome hypothyroidism. I'm only 26, I don't want to suffer from it for the rest of my life all because I took a prescription drug for 7 months. That is so insane to me. I mean, I knew there were risks but if I had known all of that I don't think I would have ever taken those drugs in the first place. Such a shame that American doctors so often fail to properly inform people. Even when I told my doctor that I suspected Effexor was the cause of my hypothyroidism, she never said it was a possibility, nor did she ever tell me that it could be temporary. All I was told was that I would have it the rest of my life and that was that. I'm so frustrated.

Anyway, thanks again for all the info!

[fishinghat]

No problem Berry and you may be right that the Effexor started the cascade effect with it beginning at your adrenaline gland. It would be interesting to see if the thyroid issue would clear up after coming off the Cymbalta withdrawal. By the way, once of the C and stable you would need to wean off the thyroid medicine (I think that takes one month if I remember right) and then it takes the thyroid around 3 months to rebound back to normal.

 

Good luck with everything and ....P.S. My user name is fishinghat not god-like. This website gives you the name god-;ike after so many posts. Weird.

 

Please keep us posted on your progress as that is how we all learn.

God Bless