The subject of this post hits very close to home for me. Apparently it does for a lot of us without a thyroid because it is a very popular topic in thyroid groups online. The mental health aspects after thyroid loss is profound. For me it is the first hint that my levels are off.
Most medical professionals think that anxiety belongs to hyperthyroid and depression to hypo. But I’m here to tell you that for me, anxiety is at both ends. When I’m hypo I am anxious and when I am hyper I am anxious. There are differences in hypo and hyper mental health challenges, but it all feels like the same kind of terrible.
Anxiety
I’ve been, I guess you could say “housebound” with anxiety twice in my life. Once about 7 years ago when I was on 175 mcgs of Synthroid and entering menopause and then again 3 months ago. Both times it was because my FT4 was high and my FT3 was low. High T4 anxiety is a special kind of hell that is hard to even describe. It feels very different than your usual run of the mill anxiety. You can’t meditate, reason, rationalize or even medicate it away.
I find that my mental health medications can’t even compete with jacked up thyroid levels anxiety. It has taken me about 7 years to figure this out. The scenario in the past when I would have a major anxiety meltdown was: go to the doctor, change or adjust thyroid meds, change or increase SSRI, take more benzos. None of this helped in the short term or usually even in the long term either. Usually the best course of action is waiting, and waiting and waiting….patiently. Because nothing in regards to thyroid disease moves quickly.
It always amazes me how this disease can mess up my mind. I know that this is an unpopular opinion among medical professionals, but I truly believe that my anxiety is driven, caused and perpetuated by my lack of thyroid and inadequate levels of thyroid hormone. From depression to panic attacks, OCD, agoraphobia, rumination, fears and phobias, health anxiety: I’ve had them all on this journey to adequate thyroid hormone replacement. It is the hardest part of the journey for me. It is embarrassing and degrading when you look just fine but you are paralyzed with fear of leaving your house, babysitting your grandkids or just doing everyday things.
So for me, keeping my mental health in check has become a priority and below are some things that I have found to be helpful. All of the items below are of course in addition to trying to keep my thyroid levels balanced which is a struggle all it’s own.
Meditation
It’s often regarded as an unhelpful suggestion when you are suffering with debilitating anxiety, but meditation really has helped me immensely. My doctor is a meditation pusher. He’s been harping about meditation for 5 years now. Every time he would suggest it, I’d roll my eyes and think he was crazy if he thought meditation was going to stop my panic attacks. Let me be clear, it doesn’t stop the anxiety but it does give me some time to connect with myself in peace. It’s hard, really really hard to meditate when you are anxious but the more you do it, the easier it gets. Sitting with myself in meditation, has been a great addition to my daily routine.
I use the app Insight Timer and highly recommend it. I’ve only ever used the free version and find that it has everything I need, but there is a paid version that unlocks even more content. They have a wide variety of material: meditations, sleep stories, yoga, courses and lectures. I usually do guided meditations. A guided meditation keeps my mind from wandering and oftentimes that can be a struggle. I also use the sleep stories when I wake up in the middle night and can’t stop ruminating. It really is a great app. Check it out and let me know what you think.
Therapy
I was kind of on the fence about a therapist until this past winter. I’ve tried four times to connect with one and just didn’t feel like it was helping. I would always put them in the same category as other medical professionals – they just don’t understand. But I think I was approaching therapy from the wrong angle. It turns out, they don’t need to understand the in’s and out’s of thyroid treatment and thyroid levels to be of help. And really, anxiety is anxiety no matter how you get there. Therapy is to help you deal with it regardless of it’s origin.
My current “therapist” is truly a gift that was recommended by my PCP. My therapist isn’t even technically a therapist. I thankfully have found the most help working with a health and wellness coach. Our sessions aren’t solely focused on my anxiety but instead on empowering me to live my best life without a thyroid and practicing anxiety management tools when I am struggling. She just came at it from a totally different angle than any therapist I’ve had in the past. She understands the health aspects but we don’t dwell on that. We focus on self improvement and the management of symptoms. So please, look into a variety of mental health professionals that might be a good fit for you. You never know where you will find someone that you just connect with and can lead you to fulfillment and mental wellness.
Medications
I have a long and sordid past with mental health medications. You can read more about this in my story and various other posts on our site about mental health and anxiety. Levothyroxine and SSRIs go hand and hand for me, especially as I’ve gotten older. I just can’t hold my T4 like I used to be able to!
I’ve tried many and given up on most of the SSRIs that I’ve tried. The start up phase of an antidepressant sucks, there’s no sugar coating it. I’m very sensitive to medications, because of course I am, why wouldn’t I be…. So, a little bit of antidepressant goes a long way in my body. The only two that I have been on for an extended period of time are Lexapro (2 years) and Celexa (3 1/2 years), both in low doses or they make me an anxious slug. I am currently on Celexa 20 mcgs. This is a high dose for me. Most of the time during the past 3 1/2 years that I’ve been on it, I usually can get by with 10 or 15 mcgs. The average maintenance dose for Celexa is 30-40 mcgs in most people with anxiety.
I have found Celexa to be relatively kinder than others. The start up wasn’t too terrible and I don’t think I have any side effects from it. But of course there is a flip side to that, because I don’t think that it works as well as Lexapro did for my anxiety. When I finally got through the terrible start up phase with Lexapro (six weeks of terrible anxiety, insomnia and upset stomach) it totally wiped out my anxiety. But it also wiped out any feelings that I had. I literally could not cry, zero emotion to things that should have caused some tears to fall. I also had sexual side effects from Lexapro. While it worked great for my anxiety, I just couldn’t stand the side effects. So basically, I’ve traded those unnatural side effects from Lexapro for less efficacy with Celexa.
Do I like taking an antidepressant? Do I think I need one? Both questions I ponder daily, probably too often due to my health anxiety. I don’t mind taking it I guess but I also know that when my thyroid levels are balanced that I don’t need it. The crappy flip side is, when my levels are really off, the drugs don’t even help. I have had periods of time without mental health meds but as soon as my thyroid levels go wonky, I am back in the trenches fighting anxiety and wishing I hadn’t weaned off my SSRI. Because of this, I have resigned myself to the fact that it is probably best if I just stay on a low dose that doesn’t cause me any side effects. It is what it is.
I’ll save you from the lecture on benzodiazepines. Yes, they can become an issue if taken regularly at high doses. You can find plenty of info about them online and I’m not here to tell you what to take or be a PSA about benzos. I have experience with 2 benzos, Xanax and Klonopin. My Xanax relationship was relatively short, like three .25 mcgs tablets. I was afraid to take them so I would break them into quarters and felt no relief so I chalked them up to being useless. Klonopin, I have taken on and off for 3 1/2 years. Also in very low doses. So low that my doctor usually rolls his eyes when I tell him how much I’m taking. I am currently taking 1/4 to 1/2 of a .5 mcg pill daily and I have been taking it daily for the past few months since I have been in lopsided hell.
I personally have never felt great relief from a benzo. I think because either it’s no match for my messed up high T4 anxiety and/or because I’ve never taken a therapeutic dose. I’m just too chicken and worried about dependance. It really is a slippery slope. Scared to take them or scared to stop them. But, if they work great for you and it’s what your doctor has prescribed for your anxiety then you’ll get no judgement here. You do you!
Mental heath medications are as unique and individual as thyroid meds. You just don’t know until you try. Everyone has different outcomes and side effects. I am in no way suggesting that a low dose is better than a therapeutic or large dose of a SSRI or any other medication. If I could take a larger dose and have good results, I would, but I have found that it doesn’t work that way for my body chemistry. At the end of the day it isn’t about dose size, it is about finding relief from your symptoms and taking a dose that is appropriate for you.
Hobbies
Thank goodness for my hobbies, and I have many. I have always been creative but I’ve never depended on it like I have in the last 5 years. My creative outlet these days is quilting and knitting. Having something to totally submerse yourself in can be life saving and sanity restoring. It helps distract me when things are crappy. I’m still looking for a hobby that burns calories though….
Depression
I don’t generally suffer from depression but this post wouldn’t be complete if I didn’t also mention it. I know that so many of us suffer from depression in relation to not having a thyroid and levels being off. Because I am usually over medicated and not under medicated I have only had depression a few times when my FT4 and my FT3 were both low. When I do have depression it is usually wrapped up in crazy mood swings. One minute I’m crying and depressed and then the next I am anxious. It’s scary sometimes how quickly I can swing in each direction. Depression can present it’s self in a variety of ways. And lets face it, this journey of finding balance without a thyroid can be depressing.
While doing research for this post I have come across the quote below, (or something similar) numerous times. It is disheartening and careless that we aren’t represented very often in scientific/medical research~
“No formal research has been done to study the prevalence of depression in euthyroid or subclinical hypothyroid patients after thyroidectomies over an extended time period. Given the observational data suggesting that current replacement therapy may not serve as a fully functional replacement for psychological well being, there may be a population suffering from mood symptoms after a total thyroidectomy. Further research is needed to determine whether physicians should monitor for mood symptoms after thyroidectomy and whether physicians should modify the current thyroid replacement regimen to maximize FT3”
Have you struggled with mental health issues in relation to your thyroid levels? What has worked for you?
Here are some of my findings in regards to mental health after thyroidectomy~
An interview with Dr. Antonio Bianco: Fat, Foggy, and Depressed After Thyroidectomy?
https://hsrc.himmelfarb.gwu.edu/gw_research_days/2018/SMHS/124/
https://www.koreabiomed.com/news/articleView.html?idxno=6493
https://jes-online.org/pdf/10.16956/jes.2018.18.4.219
Because this is a chronological blog you guys get to experience our failures and successes in a time stamped fashion. We hope that this will enable our readers to learn from our past experiences, symptoms and screw ups, while gaining knowledge from what we have been through.
Please always keep in mind that our posts are written from our experiences. We too are always learning, reading, researching and trying to figure out the needs of our bodies. Sometimes what we say in our posts changes over time: we do more research or we have settled into a dose that we thought was right but now just isn’t. Things change…. and so do we!
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