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What lab tests should I get?


Barbarannamated

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Barbarannamated

Ive been quite outspoken about my opinion that endocrine/hormonal/vitamin/mineral imbalances are the cause of much that presents as "depression/anxiety/mood swings/psychosis". When I read of doctors proposing to adjust meds in any way (starting or tapering), I immediately want to know what lab testing they perform or is reasonable before making med changes.

 

I now know that I was hypoestrogenic as well as hypocortisolemic and hypothyroid for several years and most likely the cause of original anergia treated with Zoloft in1993.

 

Also keeping in mind that these drugs CAUSE disruption of the HPA and gonadal systems, what testing and treatment is reasonable to address the underlying MEASUREABLE imbalances and deficiencies prior to disrupting the existing system?

 

Any thoughts appreciated.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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In the midst of a "problematic" discontinuation I'm not sure any testing would be all that useful since internal balance already disrupted.

 

In advance of starting medications, say antidepressants, in the first place... I think it would depend on a persons circumstances. Their age, symptoms, risk levels, sex, symptoms might suggest different tests. Of course tests are expensive and endocrinologists aren't even particularly good at reading results until the problem is advanced.

 

A metabolic panel never hurts and isn't expensive or hard to talk a doctor into. Of course, a totally drug-naive person doesn't yet know of the areas where physician ignorance is likely to present itself.... I do t think most people start oversighting their docs until after the damage.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Barbarannamated

This is one ive run across in literature, but never clinical practice:

 

TRH and Dexamethasone Suppression Tests (thyroid and adrenals)

Neuroendocrine Abnormalities in Affective Disorders

 

http://www.ncbi.nlm.nih.gov/m/pubmed/6809445/?i=4&from=/3105335/related

 

Most info on these tests was in 1980s, prior to introduction of SSRIs. That could have hurt sales.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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It seems to me that if I went to a doctor with symptoms of depression they'd prescribe an antidepressant because that's all they know to do to treat it.

 

Im confused a bit Barb. Are you wondering for tests for yourself or are you wondering about tests to eliminate false diagnoses and avoid a person from starting on in the first place?

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Barbarannamated

For others...treatment/diagnostic guidelines to prevent others from getting into this situation. Despite the debunking of the Chemical Imbalance Theory, I don't think serotonin drugs are being used less frequently. They are being used outside of general psychiatry in pain, women's health, and of course in adolescent and geriatric psych. Disturbing.

 

Retracing my thought process... I saw a doc added to list. Perusing her website, I saw that she will use psych drugs "when appropriate" (or similar wording) and returned to my circuitous thinking of "when ARE these drugs appropriate?" And how to decide which ones. Serotonin was the neurotransmitter of the decades I was being treated, but worsened my endocrine condition (blah blah blah...).

 

Bottom line... I have trouble trusting any use of these drugs except in emergency situations until stabilized and medical testing complete, which we know never happens, of course.

 

One of those "think out loud with me..." questions.

 

I am aware that some treatment guidelines say "Rule out medical conditions first" and list possibilities but, again, not done that I'm aware of.

 

And then I thought..."Psychiatry is a cult."

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Barb, I was at a doctor (a new one - long story, I'll be going back to my regular one) with some issues the other week and he talked a lot about stress, and about premenstrual stress. I told him that my PMS was *much* better since tapering off the SSRI and he was very surprised. Talked about there being good evidence for SSRIs for that. I guess I've planted the seed.

 

In his defence, he was very nice, and he didn't try to get me to start up the SSRI again. I did, however, tell him "never, ever again" and he was quite insistent that I not write it off permanently, even when I had told him I'd had side effects and knew that it was mostly placebo. Barb, you'll be pleased to know that when I mentioned my thyroid he immediately insisted in a blood test. I think Australian doctors seem to be quite knowledgeable about thyroid, at least mine have.

 

Oh, and one more thing, Barb. I firmly agree that at least thyroid testing should be done prior to any med. (There are probably other tests that should be done, but this is the one I have experience with. :) ) I also think it needs to be more than just the TSH, maybe a full (expensive) thyroid panel and antibody (Hashimotos) testing. I had post-baby hypothyroidism at 30. It passed, as it does, and after my subsequent baby, I had all the same symptoms. Doctor (not my current one) did a blood test and it came back perfect. Not just "in range" but "optimum". Long story, but I decided to change doctors over something else. Several months later another test (different doctor) came back such that I was definitely hypothyroid and immediately started on meds and told I'd probably be on them for the rest of my life. A few months later doc tested for antibodies, which were very high, therefore Hashimotos. (Doc still thinks two different conditions; I think testing is not currently adequate and missed the actual condition, one way or another.)

 

B

2005 St John's Wort / 2006-2012 Lexapro 20mg, 2 failed attempts to stop, tapered over 4.5 months in early 2012

January 2013 started Sertraline, over time worked up to 100mg

July 2014 Sertraline dropped from 100mg to 75mg, held for six months, slower tapering until 2019 22 Dec 3.2mg

2020 Sertraline 19 Jan 3.1mg, 26 Jan 3.0mg; 1 Mar 2.9, 7 Mar 2.8, May (some drops here) 24 May 2.5, May 29 2.4, June 21 2.3, June 28 2.2mg,  July 4 2.1mg, July 24 (or maybe a bit before) 2mg, early Nov switched to home made suspension; 29 Nov 1.8mg; approx 25 Dec 1.6mg)

 

My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/17/

CurrentSertraline: 24 Dec 2020 1.6 mg / Armour Thyroid / endless allergy meds, erg

 

 

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Before starting any psychiatric medication, one should get a thorough medical examination to rule out any medical cause for the symptoms.

 

This does NOT mean everyone feeling "depression" or "anxiety" has a thyroid issue, or any kind of endocrine imbalance.

 

Subclinical vitamin B12 deficiency is quite common. We don't get enough magnesium and omega-3 fatty acids in our diets. Some of us don't get enough vitamin D3. Low levels of any of these nutrients can masquerade as a so-called psychiatric disorder.

 

I guess you could get labs for vitamins and minerals to see if you have any deficiencies, and correct them before making medication changes.

 

Many people don't get enough sleep, ingest a lot of caffeine to compensate, and are too sedentary. Developing good sleep and exercise habits can go a long way towards reducing "depression" or "anxiety."

 

Many people have jobs or relationships that are too stressful, boring, or demoralizing. Instead of taking pills so they can stand the status quo, they need to change jobs or their relationships.

 

You should definitely get blood pressure, heart rate, and pulse baselines before adding or changing medication.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Many people don't get enough sleep, ingest a lot of caffeine to compensate, and are too sedentary. Developing good sleep and exercise habits can go a long way towards reducing "depression" or "anxiety."

 

Many people have jobs or relationships that are too stressful, boring, or demoralizing. Instead of taking pills so they can stand the status quo, they need to change jobs or their relationships.

 

To riff on Altos point...

 

I've learned that sleep, wholesome diet, stress management, avoiding chronic medications, satisfactory relationships and purpose in life... Well proportion these elements and the odds are pretty good for your health, IMO.

 

Stinks to learn this now with nervous nerves disturbing sleep, stress, interpersonal functioning... And causing collateral health challenges... Seems to me that, generally, we were disserviced by other interests and factors in our lives which were out of whack. For me it was the dysfunction in my family when I was a teen occurring as antidepressants were in the honeymoon period, 1997 I started on ADs. In retrospect, I had no medical problem.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Barbarannamated

This brings me back to the question "When ARE psych meds appropriate?" Keeping in mind that they will likely be used for a long time if not lifetime. It seems that medical/lab testing is small price to pay before opting for a lifetime of drugging.

 

I should have never started - mine was clearly medical condition and lack of energy/fortitude to handle stressors leading to "constantly overwhelmed" feeling.

 

I agree, a medical evaluation is absolutely in order, but what does that entail? Vitals, height, weight..?

 

Something needs to be done to curtail this still-going-strong movement of medicating so readily. In absence of any concrete guidelines or differential diagnosis and attendance to lifestyle and biopsychosocial factors, this is NOT slowing down.

 

There are metabolic tests indicated prior to starting neuroleptics, but I dont know how regularly they are done.

 

This is a coping mechanism for me - trying to do anything to prevent others from the dangers we've been exposed to.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Um...haven't thought a lot about this but off the top of my head, I have to say that I think antidepressants should always be a last resort when everything else has been ruled out.

 

But I believe one of the main problems is looking for a "medical" type answer in the first place. The whole philosophy of "well, you aren't feeling good, it must be biochemical, there must be some way to fix it" is problematic. (Seems like I just read something about this on the Mad In America website.)

 

Personally I think the first thing that should be done is a basic panel of simple labs including a TSH; if it's a woman around the time of menopause, check the hormones involved with that; regardless, prescribe regular walking (or other appropriate exercise) and sunlight; prescribe an improved diet, no caffeine, and stress reduction; and start the person in therapy to explore what's going on with them in their lives, with a therapist who doesn't have the "quick fix" mentality but is open to helping a person explore all their feelings and look at all aspects of their life.

 

If after six months or so of this, there seem to be consistent inexplicable mood problems, then maybe exploring some of the more arcane hormones through lab tests might be considered.

 

Hormones don't usually just go wacky all by themselves; usually there are stressors involved, or normal changes of aging. I think lifestyle changes should always be tried first. There are rare metabolic syndromes that could be involved, but they're rare.

 

Of course, this ain't gonna happen until the news reaches the streets (metaphorically speaking--I mean, the level of doctors' offices) that SSRIs are bad news and there's no such thing as "chemical imbalance" in the brain causing depression.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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Barbarannamated

Um...haven't thought a lot about this but off the top of my head, I have to say that I think antidepressants should always be a last resort when everything else has been ruled out.

 

But I believe one of the main problems is looking for a "medical" type answer in the first place. The whole philosophy of "well, you aren't feeling good, it must be biochemical, there must be some way to fix it" is problematic. (Seems like I just read something about this on the Mad In America website.)

 

Personally I think the first thing that should be done is a basic panel of simple labs including a TSH; if it's a woman around the time of menopause, check the hormones involved with that; regardless, prescribe regular walking (or other appropriate exercise) and sunlight; prescribe an improved diet, no caffeine, and stress reduction; and start the person in therapy to explore what's going on with them in their lives, with a therapist who doesn't have the "quick fix" mentality but is open to helping a person explore all their feelings and look at all aspects of their life.

 

If after six months or so of this, there seem to be consistent inexplicable mood problems, then maybe exploring some of the more arcane hormones through lab tests might be considered.

 

Of course, this ain't gonna happen until the news reaches the streets (metaphorically speaking--I mean, the level of doctors' offices) that SSRIs are bad news and there's no such thing as "chemical imbalance" in the brain causing depression.

 

Exactly, Rhi! The problem is multifaceted:

1) wanting a quick fix in pill form for natural reactions to life events.

2) perception that SS/NRIs are innocuous and, therefore, prescribed readily and PROPHYLACTICALLY now for PMS, pain patients (for the comorbid low mood that most experience with chronic pain), benzo/alcohol/opiate withdrawal "depression", etc.

3) physiological conditions/vitamin deficiencies/medications that have "psych presentation"

 

There are guidelines for most medical treatments now. Dr. Healy has a treatment algorithm for depression focusing on types of depression and best agent. However, I have not yet found a full treatment plan taking all of the biopsychsocial factors into account.

 

I found the TRH challenge (to stimulate TSH) interesting but it appears to have gotten lost. I BELIEVE it's more accurate than a random TSH, most of which are misinterpreted due to outdated Reference Ranges.

 

I believe that in research, they do rule out medical/endocrine conditions to a point. Of course, many trials are also done on medication-naive subjects with no history of psych treatment.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Barbarannamated

Not realistic to rule out everything. Just sharing:

 

http://theeffexoractivist.org/forum/viewtopic.php?f=9&t=613

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Too bad that poster didn't include a source for the info. It appears to come from this blogger's site http://www.patrisser.com/updates/MedProbs.html

 

Also see Confusing Medical Ailments With Mental Illness from Wall Street Journal August 9, 2011 http://online.wsj.com/article/SB10001424053111904480904576496271983911668.html

 

Here's a more authoritative source (Medscape) :

 

Mental Disorders Secondary to General Medical Conditions

Author: Linda Chuang, MD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK)

Updated: Mar 15, 2012

 

[see article for links to information and references]


Overview

 

The psychiatric presentation of a medical disorder can be defined as "the presence of mental symptoms that are judged to be the direct physiological consequences of a general medical condition," according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR). Therefore, understanding common psychiatric symptoms and the medical diseases that may cause or mimic them is of the utmost importance.

 

However, evaluation of patients who present to hospitals or physicians with altered behavior and/or mentation can be time-consuming and difficult and may lead to symptoms being quickly and prematurely dismissed as psychiatric in nature. Nonetheless, the failure to identify the medical cause of psychiatric symptoms can be potentially dangerous because serious, and frequently reversible, diseases can be overlooked. Proper diagnosis of a psychiatric illness

necessitates investigation of all appropriate medical causes of the symptoms.[1] The following features suggest a medical origin for psychiatric symptoms:

  • Late onset of initial presentation
  • Known underlying medical condition
  • Atypical presentation of a specific psychiatric diagnosis
  • Absence of personal and family history of psychiatric illnesses
  • Illicit substance use
  • Medication use
  • Treatment resistance or unusual response to treatment
  • Sudden onset of mental symptoms
  • Abnormal vital signs
  • Waxing and waning mental status

Because multiple secondary causes of mental disorders exist, as shown in Table 1, below, this article discusses only the most common causes.

 

[see article for Table 1. Medical Disorders That Can Induce Psychiatric Symptoms]

 

Diagnostic considerations

Prior to attributing symptoms to psychiatric causes, medical disorders need to be investigated. It is prudent not only to obtain a psychiatric consultation but also to get a general physical examination with blood tests from the primary care physician.

The Academy of Psychosomatic Medicine provides information about specialists that work at the interface of psychiatry and internal medicine. Specialists in this field are primarily psychiatrists who have a subspecialty training and certification in psychosomatic medicine. Another Web resource of interest is Multiple Sclerosis and Depression.


Neurologic Disorders

 

Seizure disorder

....

Parkinson disease

....

Brain tumors

....

Other tumor-related psychiatric manifestations include the following:

  • Dominant temporal lesions - Can present with memory and speech abnormalities
  • Nondominant tumors - Can cause auditory agnosia
  • Bilateral lesions - Can lead to Korsakoff amnesia
  • Occipital lesions - Can cause visual hallucinations, agnosia, and Anton syndrome (denial of blindness)
  • Limbic and hypothalamic tumors - Can cause affective symptoms such as rage, mania, emotional lability, and altered sexual behavior;[17] they can also produce delusions involving complicated plots
Hallucinations, which are often considered the hallmarks of psychiatric illness, can be caused by focal neurologic pathology. The visual pathways all cross in the temporal, parietal, and occipital lobes; therefore, visual hallucinations can occur with lesions in any of these locations. Auditory hallucinations can also occur with temporal lesions but are apparently less common.

 

The diagnostic procedure of choice for a brain tumor is brain imaging with contrast head computed tomography (CT) scanning or magnetic resonance imaging (MRI). In many clinical cases, when a central nervous system (CNS) tumor is considered likely, initial CT scan findings may be normal, and MRI may be required to confirm the diagnosis.

 

Multiple sclerosis

....


Infectious Diseases

 

Neurosyphilis

....

Meningitis

....

Herpes simplex virus (HSV) encephalitis

....

HIV encephalopathy

....


Endocrine Disorders

 

Parathyroid disorders

 

Dysfunction of the parathyroid glands results in abnormalities in the regulation of electrolytes, especially calcium. Excessive excretion of parathyroid hormone results in a state of hypercalcemia. Such hyperparathyroidism usually occurs in the third to fifth decade of life and is more common in women than in men. The annual incidence is in the

0.1% range and affects up to 0.2% of the population older than 60 years.[26]

 

Hyperparathyroidism is frequently associated with significant psychiatric symptoms, which are caused by the resultant hypercalcemia and can precede other somatic manifestations of the illness. Patients can experience the following:

  • Delirium
  • Sudden dementia
  • Depression
  • Anxiety
  • Psychosis
  • Apathy
  • Stupor
  • Coma
....

Because imbalances of calcium and magnesium can cause psychiatric symptoms, serum levels of both electrolytes must be ascertained for diagnostic evaluation of any psychiatric presentation. While patients with hypercalcemia should have parathyroid hormone levels checked, they should also be evaluated for other causes of hypercalcemia.

 

Thyroid disorders

 

Hyperthyroidism

Hyperthyroidism is a common clinical condition caused by excess thyroid hormone. Because this disorder is so common, a high index of clinical awareness for thyroid disease and its complications is needed in any patient who presents with psychiatric symptoms. Always include evaluations of thyroid-stimulating hormone (TSH [thyrotropin]) and free thyroxine (T4) levels in the medical workup of patients presenting with psychiatric symptoms for the first time. Graves disease is the most common cause in the population. Some evidence indicates that stress can precipitate Graves disease and aggravate treated disease.[27] Toxic nodular goiter is most prevalent in the elderly population.

 

Patients can present in various ways but commonly present with symptoms of anxiety, confusion, and agitated depression. Patients can also present with hypomania and frank psychosis. When hyperthyroidism is suggested, standard clinical symptoms may be present, including the following[28] :

  • Heat intolerance
  • Diaphoresis
  • Weight loss despite increased appetite
  • Palpitations
  • Tachycardia
  • Exophthalmos
  • Hyperactive tendon reflexes
In most patients who present with depression or anxiety associated with hyperthyroidism without other psychiatric history, psychiatric symptoms usually resolve with treatment of the hyperthyroidism.

 

Hypothyroidism

Unless hypothyroidism stems from a primary pituitary disorder, it is usually caused by a lack of T4, which results in an elevated TSH level. Similar to patients with hyperthyroidism, those with hypothyroidism often present with depression and anxiety. The usual clinical features include apathy, psychomotor retardation, depression, and poor memory. However, when hypothyroidism develops rapidly, the psychiatric features are usually delirium and psychosis, a phenomenon that has been termed myxedema madness.

 

Physical signs and symptoms suggesting the diagnosis of hypothyroidism include the following:

  • Cold intolerance
  • Weight gain
  • Thin and dry hair
  • Facial puffiness
  • Constipation
  • Menorrhagia
  • Muscle cramps
  • Slowed and decreased deep tendon reflexes
Subclinical hypothyroidism can have either mild or no symptoms of thyroid hormone deficiency. It is fairly common, affecting 5-10% of the population, mainly women, and occurring in 15-20% of women older than 45 years.

 

T4 replacement in these patients usually reverses the psychiatric symptoms, although it may not necessarily reverse the cognitive deficits that occur because of changes in metabolic activity in the CNS.

 

Adrenal disorders

 

Addison disease

Adrenal disorders cause changes in the normal secretion of hormones from the adrenal cortex and may produce significant psychiatric symptoms. Few studies have been performed on the psychiatric symptoms of patients with Addison disease (adrenocortical insufficiency). This condition may result from fungal or, more commonly, tuberculous infection of the adrenals.

Patients with Addison disease can exhibit symptoms such as apathy, fatigue, depression, and irritability. Psychosis and confusion can also develop. Steroid hormone replacement is used to treat patients with Addison disease; however, cortisol is psychogenic in nature and may produce mania and psychosis.

 

Cushing syndrome

The existence of moderate to severe depression in up to 50% of patients with Cushing syndrome is well documented, with symptoms sometimes being severe enough to lead to suicide. Decreased concentration and memory deficits may also be present. Some patients present with psychotic or schizophreniclike symptoms.

 

Maintain a high index of clinical awareness for this disorder in patients who have additional clinical signs, such as central obesity, hypertension, striae, easy bruising, buffalo hump, diabetes, and osteoporosis.

 

In patients with depression believed to be etiologically related to hypercortisolemia, initiate antidepressant treatment while awaiting surgical or medical therapy for Cushing syndrome. Psychiatric symptoms usually resolve when the cortisol excess is controlled.

 

Pancreatic disorders

 

The most common pancreatic disorders that can have psychiatric presentations include pancreatic tumors and diabetes mellitus with resulting glycemic dysregulation. Either excessive exogenous insulin administration or endogenous production of insulin can cause hypoglycemia. However, hypoglycemia-induced mental status changes usually occur in persons with diabetes who are insulin dependent. Persons who engage in factitious use of hypoglycemic agents are an exception.

 

Initial symptoms of the hypoglycemic state usually include nausea, sweating, tachycardia, hunger, and apprehension. With progression, patients may become disoriented and confused and may hallucinate. Eventually, stupor and coma ensue. Persistent cognitive impairment can be a serious sequela to frequently occurring hypoglycemic states.

 

Severe hyperglycemia begins with weakness, fatigability, polyuria, and polydipsia. Symptoms of clinical worsening include hyperventilation, headache, nausea, and vomiting. With ketoacidosis, disorientation and confusion can occur; this state can be fatal if not properly identified and urgently treated.

 

Pancreatic tumors, although uncommon, can manifest solely in depression. Despite a broad differential diagnosis, seriously consider this diagnosis in elderly patients with new-onset depression in the setting of back pain.


Systemic Lupus Erythematosus

 

Systemic lupus erythematosus (SLE) is an autoimmune disease of sterile inflammation involving multiple organs and multiple autoantibodies. Approximately 90% of cases are in women, usually of childbearing age. The incidence is 2.4 cases per 100,000 across genders and race; more specifically, the incidence is 92 cases per 100,000 for black women, and 3.5 cases per 100,000 for white women. Asians are also more often more affected than whites.

The diagnosis of SLE requires that patients have at least 4 of 11 criteria set by the American Rheumatism Association. Remember that the diagnosis usually cannot be confirmed in a single encounter. The myriad of symptoms and serologic abnormalities often occur over time; therefore, diagnosis involves compiling a thorough history. Organ involvement of the synovium and skin usually prompts rheumatologists and dermatologists to consider the diagnosis.

 

Neuropsychiatric manifestations

The neuropsychiatric manifestations of lupus can occur at any time during the disease, and most appear in the first few years or before diagnosis of the illness. Thus, patients with undiagnosed lupus may initially present in psychiatric clinics, neurologic clinics, or inpatient wards.

 

Neuropsychiatric manifestations of patients with lupus have a prevalence of up to 75-90%.[29] Major psychiatric symptoms include depression, emotional lability, delirium, and psychosis. The presence of severe depression or psychosis is associated with anti-P antibodies in the serum, which suggests an autoimmune mechanism for inducing mental symptoms.

 

Treatment of lupus is with high-dose steroids, which can precipitate or exacerbate psychiatric symptoms. However, most instances of psychosis in patients with lupus who are on steroid therapy are secondary to lupus cerebritis, and many patients improve with an increase in steroid dosage. When patients are on steroid therapy, remembering to exclude infectious causes of possible brain dysfunction is always important because steroids may mask fever, resulting in an atypical presentation of infection.

 

Because of the multiple organ systems involved in SLE and the complexities of this illness, it behooves the clinician to consult rheumatologists, neurologists, and psychiatrists as appropriate.


Metabolic Disorders

 

Sodium imbalance

Hyponatremia occurs in various conditions, being usually observed in postoperative patients and in patients with severe vomiting and diarrhea, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), extensive burns, cirrhosis, or endocrine abnormalities (eg, myxedema, Addison disease). Consider hyponatremic disorders in patients experiencing muscle weakness, nausea, and anorexia, as well as acute mental status changes, such as the

following[30] :

  • Irritability
  • Confusion
  • Anxiety
  • Delusions and hallucinations
Without proper treatment of hyponatremia, seizures, stupor, and coma ultimately ensue. Treatment consists of correcting the serum sodium level at a slow, but adequate, rate. Overly rapid correction of hyponatremia can lead to central pontine myelinolysis.

 

Hypernatremia usually results from inadequate ingestion of water or from the inability of the kidneys to conserve water. The elderly population is particularly sensitive to dehydration, and elderly persons can have acute mental status changes. As with hyponatremia, the rate of correction of hypernatremia is important. Overly rapid correction can lead to cerebral edema. Always consider cerebral edema if the patient has worsened mental status when hypernatremia has been corrected.

 

Hepatic encephalopathy

Hepatic encephalopathy is a complex neuropsychiatric syndrome that complicates advanced liver disease.....

....

Uremic encephalopathy

Uremia results from impairment in kidney functioning. Initially, patients feel nonspecifically and generally unwell and often describe a sense of fatigue. They may have difficulty with concentration and can experience some memory impairment. As uremia progresses, memory worsens. Depression, apathy, and social withdrawal become clinically apparent. In advanced uremia, patients may experience impaired mentation, lethargy, myoclonus, asterixis, and other neuropsychiatric symptoms similar to those in hepatic encephalopathy. Psychosis can also occur.

 

The differential diagnosis of psychiatric symptoms in persons with chronic renal failure is quite broad and should include the following (among many others):

  • Hypercalcemia
  • Hypophosphatemia
  • Hypernatremia/hyponatremia
  • Hyperglycemia/hypoglycemia
  • Hypertensive encephalopathy
  • Cerebrovascular disease
Adequate dialysis can reverse some of the psychiatric and mental abnormalities, but some subtle deficits in mentation may remain.

....

Acute intermittent porphyria

Porphyria is a disorder of heme biosynthesis that leads to buildup of excessive porphyrins. In the classic form, patients have a triad of symptoms, including colicky abdominal pain, motor polyneuropathy, and psychosis. Acute intermittent porphyria is an autosomal dominant disorder, and onset usually occurs in persons aged 20-50 years. Some studies have shown that 0.2-0.5% of psychiatric patients have undiagnosed porphyrias. Barbiturates precipitate attacks of acute porphyria and are therefore absolutely contraindicated.


Vitamin Deficiency States

 

Vitamin B-1

When discussing the appropriate differential diagnosis of new-onset psychiatric symptoms, consideration of vitamin deficiencies is necessary, especially deficiencies of the B vitamins. Chronic and severe deficiency of vitamin B-1 (thiamine) leads to pellagra, with neuropsychiatric symptoms of asthenia, fatigue, weakness, and depressed mood.

Much more commonly today, thiamine deficiency manifests as Wernicke encephalopathy, often, but not exclusively, in individuals who have engaged in heavy and prolonged alcohol use. The classic triad of symptoms in Wernicke encephalopathy consists of gait ataxia, global confusion, and ophthalmoplegia, most often involving the sixth cranial nerve (leading to the inability to abduct the eyes).

 

Immediate treatment with parenteral thiamine reveals that this syndrome is at least partly reversible, because the ocular palsy often resolves within hours. As the confusion improves, impaired cognitive functioning (amnesia) consistent with Korsakoff syndrome often becomes evident. Long-term treatment with thiamine may result in ongoing improvement over a period of months.

 

Although this is a clinical diagnosis, brain pathology is evident on imaging studies and at autopsy. Symmetrical lesions of the mamillary bodies, the third and fourth ventricles, and the periaqueductal areas are present.

 

Vitamin B-12

Deficiency of vitamin B-12 (cobalamin) is the cause of pernicious anemia. When a patient presents with megaloblastic anemia and neurologic symptoms from subacute combined spinal cord degeneration, and a low serum vitamin B-12 level is found on evaluation, the diagnosis is relatively straightforward.

 

Although the direct cause and effect of concomitant psychiatric symptoms is not always clear, depression, fatigue, psychosis, and progressive cognitive impairment can accompany neurologic symptoms.[32]

 

These psychiatric symptoms can predate the neurologic symptoms by months or years and may be present in the absence of anemia or macrocytosis. When suggested, even if the screening levels of vitamin B-12 are not revealing, measurements of serum methylmalonic acid and total homocysteine may be helpful diagnostically.[33]

 

Folate

It appears that folate deficiency is not rare and can cause or exacerbate psychiatric symptoms, with evidence suggesting that folate deficiency states are observed in patients with depressive or dementing syndromes. Patients with depression have consistently been found to have lower levels of serum and red blood cell folate than normal or nondepressed psychiatric patients. Decreased folate levels have been associated with lowered response rates to standard antidepressant pharmacotherapy; thus, patients may benefit from supplementation even with normal levels.[34] Because replacing folate in patients with B-12 deficiency can aggravate the progression of neurologic symptoms, it is important to search for and correct vitamin B-12 deficiency either prior to or concurrent with folate replacement.


Exogenous Toxins

 

The role of exogenous toxins in mental disorders is a very broad subject. Because of the limited space and scope of this article, only a brief overview is presented. Toxins can include medications, drugs of abuse, solvents, pesticides, and heavy metals. Some of the most common drugs associated with induction of a psychoactive state are as

follows[35] :

  • Antihypertensives - Reserpine, methyldopa, beta blockers
  • Oral contraceptives S
  • teroids
  • Histamine-2 blockers
  • Cancer chemotherapy agents - Vinca alkaloids, procarbazine, L -asparaginase, amphotericin, interferon
  • Psychoactive substances - Alcohol, opioids, amphetamines (withdrawal), cocaine (withdrawal) Benzodiazepines
  • Barbiturates
Idiopathic major depression is very common, as is the use of medication, alcohol, and/or illicit drugs. Separating causal factors is not always easy. A high index of clinical awareness is helpful in considering underlying causes of conditions that can appear as primary idiopathic psychiatric illness. Knowledge of the time course can also be helpful; ie, comparing the onset of symptoms to the initiation of or change in dosage of the putative offending agent.

 

Laboratory testing with toxicologic screening of blood and urine can assist with or confirm a toxicologic diagnosis. Knowing exactly what drugs are screened for at any individual facility is important because different routine screens include different drugs. Depending on the clinical presentation, testing for additional individual drugs may need to be specified. For example, patients with phencyclidine (PCP) intoxication may present with psychosis and with particularly agitated and violent behavior; however, most routine drug screens do not test for PCP, which can nevertheless be measured when specified.

 

Alcohol

Although volumes have been written concerning the pathologic changes in patients who use alcohol for short and long periods, a brief review is appropriate because patients in alcohol withdrawal can present with numerous psychiatric symptoms that can be fatal if not identified and treated quickly.

....

Alcohol is a CNS depressant, and chronic abuse can be associated with significant depression that may, by symptoms alone, be indistinguishable from idiopathic major depression. However, among patients with depressive disorder from alcohol dependence who are monitored for 2-4 weeks without alcohol, more than 50% have full remission of symptoms without additional intervention for the depressive symptoms. A minority of patients, usually consisting of those with more severe symptoms, have a continued depressive syndrome despite sobriety and require additional treatment.

....

Cocaine

Cocaine is a powerful stimulant that initially causes euphoria, as well as increased alertness and energy. As the high wears off, the user may develop symptoms of anxiety and depression, often with drug craving. With continued regular use, symptoms of psychosis develop, with hallucinations and frank paranoid delusions. The psychiatric presentation can appear similar to that observed in patients with chronic amphetamine abuse.

 

Amphetamines

Amphetamines are also CNS stimulants and initially cause feelings of increased well-being, energy, and concentration. As with cocaine, however, amphetamine abuse can cause psychotic symptoms to develop.

 

Hallucinogens

A brief mention must be made of lysergic acid diethylamide (LSD), a potent hallucinogen that causes intense and vivid hallucinations in a clear sensorium. LSD-elicited hallucinations are usually of relatively short duration, but flashbacks of varying intensity may occur in a small number of users. Hallucinogenic mushrooms containing psilocybin and psilocin can have similar effects.

 

Ecstasy

Ecstasy (3,4-methylenedioxymethamphetamine [MDMA]), a designer drug synthetically derived from amphetamine, is often used in the context of large and energetic parties (raves) and at nightclubs. Initially, it causes mild euphoria, increased energy, and increased libido. Tolerance develops rapidly. Depression, anxiety, and psychosis have also

been described with regular use, and some of the symptoms persist for months after cessation of use.[37]

 

Solvents

Solvent abuse, or huffing, involves the inhalation of organic solvents for their euphoriant effects.

....

Heavy metals

Exposure to lead, mercury, manganese, arsenic, organophosphorus compounds, or other heavy metals can cause psychiatric symptoms. Exposure is usually industrial or environmental and should be considered in the appropriate settings. Often, CNS or peripheral nervous system signs and symptoms are present.

....

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Barbarannamated

Thank you, Alto.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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  • 2 months later...
  • Moderator Emeritus

Hello everyone,

 

I have just started a taper and am thinking of having some blood tests to see if I have any deficiencies.

 

I've searched the forum for ideas before posting this and so far I've come up with:

 

I was thinking:

 

Vitamin D

Thyroid;

General blood test

 

I don't know much about it and am not sure what to tests to ask for in 'Doctor-speak'. I'm from Australia so the lingo and terminology may be different too.

 

If anybody has any suggestions I would love to hear from you.

 

Thank you all in advance

 

Sonia

July 2001 prescribed 20mg citalopram for depression;
On and off meds from 2003-2006.
February 2006 back on 20mg citalopram and stayed on it until my last attempt at tapering in September 2011.
By far the worst withdrawal symptoms ever. Reinstated to 20mg citalopram
October 2012 - found this forum!
Nov 2012 to Feb 2013 did 10% taper, got doen to 11mg - was going great until stressful situation. Cortisol levels hit the roof, hideous insomnia forced me to updose to 20mg.
March 2016 - close to 100% back to normal!



****** I am not a medical practitioner, any advice I give comes from my own experience or reading and is only my perspective ******

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  • Moderator Emeritus

Hi basildev

 

The question of tests prior to tapering has been discussed here Link to tests discussion

 

 

How are you feeling having started your taper (I know it's only been a couple of days)

Please note - I am not a medical practitioner and I do not give medical advice. I offer an opinion based on my own experiences, reading and discussion with others.On Effexor for 2 months at the start of 2005. Had extreme insomnia as an adverse reaction. Changed to mirtazapine. Have been trying to get off since mid 2008 with numerous failures including CTs and slow (but not slow enough tapers)Have slow tapered at 10 per cent or less for years. I have liquid mirtazapine made at a compounding chemist.

Was on 1.6 ml as at 19 March 2014.

Dropped to 1.5 ml 7 June 2014. Dropped to 1.4 in about September.

Dropped to 1.3 on 20 December 2014. Dropped to 1.2 in mid Jan 2015.

Dropped to 1 ml in late Feb 2015. I think my old medication had run out of puff so I tried 1ml when I got the new stuff and it seems to be going ok. Sleep has been good over the last week (as of 13/3/15).

Dropped to 1/2 ml 14/11/15 Fatigue still there as are memory and cognition problems. Sleep is patchy but liveable compared to what it has been in the past.

 

DRUG FREE - as at 1st May 2017

 

>My intro post is here - http://survivingantidepressants.org/index.php?/topic/2250-dalsaan

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  • Moderator Emeritus

Yeah I had a read through that Dalsaan. I didn't really find what I needed but maybe I didn't look hard enough. I'll read through it again.

 

Taper is going well! Thanks for asking. But it HAS only been 3 days and only a 5% taper. Still, I'm not racing to get down to zero. If I could even get down to half the original dose without feeling like crap I'd be happy.

 

So....one day at a time!

July 2001 prescribed 20mg citalopram for depression;
On and off meds from 2003-2006.
February 2006 back on 20mg citalopram and stayed on it until my last attempt at tapering in September 2011.
By far the worst withdrawal symptoms ever. Reinstated to 20mg citalopram
October 2012 - found this forum!
Nov 2012 to Feb 2013 did 10% taper, got doen to 11mg - was going great until stressful situation. Cortisol levels hit the roof, hideous insomnia forced me to updose to 20mg.
March 2016 - close to 100% back to normal!



****** I am not a medical practitioner, any advice I give comes from my own experience or reading and is only my perspective ******

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Hello everyone,

 

I have just started a taper and am thinking of having some blood tests to see if I have any deficiencies.

 

I've searched the forum for ideas before posting this and so far I've come up with:

 

I was thinking:

 

Vitamin D

Thyroid;

General blood test

 

I don't know much about it and am not sure what to tests to ask for in 'Doctor-speak'. I'm from Australia so the lingo and terminology may be different too.

 

If anybody has any suggestions I would love to hear from you.

 

Thank you all in advance

 

Sonia

 

 

go to your doc and say you want a complete checkup or wellness examine. they will do CBC. metabolic panel, etc and also physically examine you. You can also do something like the spectracell nutrient test which measures many things. maybe its better to find a holistic doc for this. I use a regular doc for check ups and an alternative/holistic MD for things like nutrient testing and other things.

Various SSRIs/SNRIs 7- 1/2 years

Went Cold Turkey from Celexa 2011, Stayed Off

Psych Drug Free and Loving Life (over 6 years and counting)

 

How I Stay Well: Diet, exercise, meditation, supplements, etc

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  • Moderator Emeritus

ok will do

 

thanks

July 2001 prescribed 20mg citalopram for depression;
On and off meds from 2003-2006.
February 2006 back on 20mg citalopram and stayed on it until my last attempt at tapering in September 2011.
By far the worst withdrawal symptoms ever. Reinstated to 20mg citalopram
October 2012 - found this forum!
Nov 2012 to Feb 2013 did 10% taper, got doen to 11mg - was going great until stressful situation. Cortisol levels hit the roof, hideous insomnia forced me to updose to 20mg.
March 2016 - close to 100% back to normal!



****** I am not a medical practitioner, any advice I give comes from my own experience or reading and is only my perspective ******

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  • 3 weeks later...

Not a blood test but has anyone done a ZYTO hand scan? My doctor has one of these gizmos and it runs a health report on you based on your ... i don't know how it works ... your energy or whatever. It's very Chinese-mediciny which I know nothing about but am open to.

 

Anyway the ZYTO has been denounced by quackwatch (so +1 there) and is marketed by a multi-level marketing outfit in Utah (so -1 there) but I found the report it made in large agreement to my known health issues.

 

The ZYTO report has four components. The first shows which organs and organ systems are currently stressed and to what degree relative to normal. For instance a viral infection of the lungs should, in theory, show highly taxed spleen and lymph nodes and weakend lung. The second shows hormones which are high/low. The third shows ZYTO's guess at the cause of the stress. And the fourth, which is meaningless, is ZYTO's recommendation for treatment.

 

I was pretty impressed with this tool. I have had two done. The reports confirmed what my doctor suspected and brought attention to some areas we've overlooked.

 

My most recent test showed the Lg intestine, stomach and hypothalamus to be my sickest organs, which is consistent with my symptoms. It showed the causes as well, and this, if the thing is accurate, may benefit others. My main stressors were: heavy metals, bacteria, viruses, environmental toxins. This renewed my attention at my elevated mercury labwork which I'd sort of forgotten about.

 

I hesitate to endorse the thing too greatly, but I have been impressed. A ZYTO screen/session at my doctor's office is $30.

 

If you do not want to spend a lot of money on blood tests but are concerned, perhaps look at a ZYTO screen if one is available in your area. I found it easy to locate a provider by emailing zytpo.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Barbarannamated

Alex,

 

I think I did but not certain of the name. Seemed hokey at the time, but, like you, alot of the results were in line with what I knew from prior testing. The practitioner is a PharmD/PhD who worked for Abbott Pharma long ago and got away from western medicine because people were not getting better, just taking more drugs. So, i liked his philosophy.

 

Unfortunately, after a few hours of testing showing various problems, he decided my main problem was candida and tried to sell me his program for $1500. I walked.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Thanks for the info Alex. All my blood tests came back good as gold.

 

Barb, $1500.00 is obscene. Candida seems to the the 'go-to' cause of just about anything. I don't buy it.

July 2001 prescribed 20mg citalopram for depression;
On and off meds from 2003-2006.
February 2006 back on 20mg citalopram and stayed on it until my last attempt at tapering in September 2011.
By far the worst withdrawal symptoms ever. Reinstated to 20mg citalopram
October 2012 - found this forum!
Nov 2012 to Feb 2013 did 10% taper, got doen to 11mg - was going great until stressful situation. Cortisol levels hit the roof, hideous insomnia forced me to updose to 20mg.
March 2016 - close to 100% back to normal!



****** I am not a medical practitioner, any advice I give comes from my own experience or reading and is only my perspective ******

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Barb,

 

Yea, I suspect that'd be the case with a lot of practioners. At my doctor's they farm the ZYTO out to the affiliated acupuncturist who works in the same office, I suppose because he's the Chinese medecine guy. Unsurprisingly, he recommended acupuncture.

 

The report was still pretty interesting to me. And as my treatment progresses, I intend to do another one.

 

Hopefully, there are some practioners who aren't selling the four-figure cure ... maybe that's too much to hope for.

 

Alex

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Barbarannamated

Barb,

 

Yea, I suspect that'd be the case with a lot of practioners. At my doctor's they farm the ZYTO out to the affiliated acupuncturist who works in the same office, I suppose because he's the Chinese medecine guy. Unsurprisingly, he recommended acupuncture.

 

The report was still pretty interesting to me. And as my treatment progresses, I intend to do another one.

 

Hopefully, there are some practioners who aren't selling the four-figure cure ... maybe that's too much to hope for.

 

I apologize if my previous post came across as dismissive of the testing itself. I actually found it very fascinating. He also did Nutritional Response Testing and a few others.

 

Just to clarify for others, ZYTO is NOT a blood test. It may be based on Galvanic Skin Response (?).

 

Here's the website of person I went to ( just for info, not advertising):

http://www.wholehealthamerica.com/designs/bp.php?idnum=87&zt=user&zn=2

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Oh, no Barb, I didn't think it was dismissive or anything at all. No worries.

 

love,

Alex

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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  • Administrator

....

I was thinking:

 

Vitamin D

Thyroid

General blood test

 

I agree with the above, plus the minerals and nutrients tests Zepp mentioned.

 

That ZYTO thing sure sounds dodgy. I'm not sure even my acupuncturist would go for it.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • Moderator Emeritus

great, thanks Alto.

 

I'll do those next.

July 2001 prescribed 20mg citalopram for depression;
On and off meds from 2003-2006.
February 2006 back on 20mg citalopram and stayed on it until my last attempt at tapering in September 2011.
By far the worst withdrawal symptoms ever. Reinstated to 20mg citalopram
October 2012 - found this forum!
Nov 2012 to Feb 2013 did 10% taper, got doen to 11mg - was going great until stressful situation. Cortisol levels hit the roof, hideous insomnia forced me to updose to 20mg.
March 2016 - close to 100% back to normal!



****** I am not a medical practitioner, any advice I give comes from my own experience or reading and is only my perspective ******

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That ZYTO thing sure sounds dodgy....

 

I need to affix a warning to my sig. I'm all in on the dodgy stuff these days.

 

Others should exercise their discretion, of course.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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  • 2 months later...
  • Moderator Emeritus

Hi,

 

I will be getting routine blood work done soon and want to make sure to ask to be tested for anything in addition to a routine profile that may be compounding depressive mood.

 

Ideas? I'm thinking vitamin B12, D & DHEA and omega 3? Can those even be tested for?

 

Thanks. Also , if you can rate whichever tests you recommend in the order of importance that would be helpful.

 

RU oh I am a 56 year old female.

Fall 1995 xanax, zoloft. switched to Serzone

1996- spring 2003serzone/ xanax/ lightbox.

b]Fall 2003- Fall 2004? Lexapro 10 mg. Light box /4 mg. xanax.[/b]

2004 - Fall of 2009 10 mg Lex, 150 mg Wellbutrin XL % 4 mg xanax

November 2009- Sept. 2011 10 mg lex., 300 Well. XL, 4 mg Xanax [/b

Sept.2012- July 2012 20 mg Lex 300 Well. XL, 4 mg Xanax

My mantra " go slow & with the flow "

3/2/13.. Began equal dosing 5 Xs /day xanax, while simultaneously incorporating a 2.5 % drop ( from 3.5 mg/day to 3.4 mg/day)

4/6/13 dropped from 300 mg. Wellbutrin XL to 150 mg. Difficult but DONE! Down to 3.3 mg xanax/ day / 6/10/13 3 mg xanax/day; 7/15/2013 2.88mg xanax/day.

10/ 1/2013...... 2.5 mg xanax… ( switched to tablets again) WOO HOO!!!!!! Holding here… cont. with Lexapro.

1/ 2/2014.. tapered to 18mg ( by weight) of a 26 mg ( by weight) pill of 20 mg tab. lexapro. goal is 13mg (by weight OR 10 mg by ingredient content) and STOPPED. Feeling very down with unbalanced, unpredictable WD symptoms.

1/2/2014- ??? Taking a brain-healing break from tapering anything after actively tapering something for 1.5 years. So… daily doses as of 2/2/2014: 18 mg by weight Lex, 150 mg Well. XL, 2.5 mg xanax, down from 26 mg by weight Lex., 300 mg well. XL, 4 mg xanax in August, 2012. I'll take it. :) 5/8/14 started equivalent dose liquid./ tabs. 5/13/14 1.5 % cut.

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Barbarannamated

Good question and I look forward to others' input.

 

In an undrugged state, i would suggest hormone levels, but these drugs are known to interfere with endocrine / hormone function, making it difficult to know your baseline. I'm dealing with that now.

 

This discussion might offer some ideas:

 

http://survivingantidepressants.org/index.php?/topic/2710-what-lab-testing-is-reasonable-prior-to-starting-or-tapering/page__fromsearch__1

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Hi,

 

I will be getting routine blood work done soon and want to make sure to ask to be tested for anything in addition to a routine profile that may be compounding depressive mood.

 

Ideas? I'm thinking vitamin B12, D & DHEA and omega 3? Can those even be tested for?

 

Thanks. Also , if you can rate whichever tests you recommend in the order of importance that would be helpful.

 

RU oh I am a 56 year old female.

 

I'd do B12, Vitamin D for sure. Thyroid: atleast a TSH but shoot for a full panel. HgA1C for blood sugar, since you're there. Lipid profile. Get copies.

 

Most 'routine' blood work also includes a blood count and a metbolic panel. Get copies of those too.

 

DHEA irregularity suggests adrenal issues, I believe.

 

Prioritizing the labwork? If you are worried about cost, how much does insurance contribute? Because buying online reduces the cost substantially. I do this sometimes. Buy em and take em to the lab and bring the results to my doctor.

 

Omega 3's can be tested, though I don't know if your doctor can do it. I got a test through metametrix, but most doctors don't use them. Metametrix is expensive but has been invaluable diagnositically (in my case). If you think you have an infection their stool test is very useful.

 

Alex

 

PS - Obviously, I am not a doctor

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Hi,

 

I will be getting routine blood work done soon and want to make sure to ask to be tested for anything in addition to a routine profile that may be compounding depressive mood.

 

Ideas? I'm thinking vitamin B12, D & DHEA and omega 3? Can those even be tested for?

 

Thanks. Also , if you can rate whichever tests you recommend in the order of importance that would be helpful.

 

RU oh I am a 56 year old female.

 

I'd do B12, Vitamin D for sure. Thyroid: atleast a TSH but shoot for a full panel. HgA1C for blood sugar, since you're there. Lipid profile. Get copies.

 

Most 'routine' blood work also includes a blood count and a metbolic panel. Get copies of those too.

 

DHEA irregularity suggests adrenal issues, I believe.

 

Prioritizing the labwork? If you are worried about cost, how much does insurance contribute? Because buying online reduces the cost substantially. I do this sometimes. Buy em and take em to the lab and bring the results to my doctor.

 

Omega 3's can be tested, though I don't know if your doctor can do it. I got a test through metametrix, but most doctors don't use them. Metametrix is expensive but has been invaluable diagnositically (in my case). If you think you have an infection their stool test is very useful.

 

Alex

 

PS - Obviously, I am not a doctor

 

Thanks. The reason I ask for a prioritization is for cost. Since this is routine everything would be paid for by my insurance and if I ask my GP to order a specific test and she agrees that would be covered as well. I wish I had a copy of last year's screening to see what is included in a routine screening but I don't.

 

My GP is up on all of my meds , that I am tapering etc. What I think I may do is simply ask her if there are any "extra" tests that she thinks I should have done specifically related to mood... but if anyone has a specific screening that would help me personally recognize something specifically in my diet for example, I'd ask for that test. RU

 

 

I'm reading this now, Barb. Thanks for posting that link for me. I think I will find some answers there!

Fall 1995 xanax, zoloft. switched to Serzone

1996- spring 2003serzone/ xanax/ lightbox.

b]Fall 2003- Fall 2004? Lexapro 10 mg. Light box /4 mg. xanax.[/b]

2004 - Fall of 2009 10 mg Lex, 150 mg Wellbutrin XL % 4 mg xanax

November 2009- Sept. 2011 10 mg lex., 300 Well. XL, 4 mg Xanax [/b

Sept.2012- July 2012 20 mg Lex 300 Well. XL, 4 mg Xanax

My mantra " go slow & with the flow "

3/2/13.. Began equal dosing 5 Xs /day xanax, while simultaneously incorporating a 2.5 % drop ( from 3.5 mg/day to 3.4 mg/day)

4/6/13 dropped from 300 mg. Wellbutrin XL to 150 mg. Difficult but DONE! Down to 3.3 mg xanax/ day / 6/10/13 3 mg xanax/day; 7/15/2013 2.88mg xanax/day.

10/ 1/2013...... 2.5 mg xanax… ( switched to tablets again) WOO HOO!!!!!! Holding here… cont. with Lexapro.

1/ 2/2014.. tapered to 18mg ( by weight) of a 26 mg ( by weight) pill of 20 mg tab. lexapro. goal is 13mg (by weight OR 10 mg by ingredient content) and STOPPED. Feeling very down with unbalanced, unpredictable WD symptoms.

1/2/2014- ??? Taking a brain-healing break from tapering anything after actively tapering something for 1.5 years. So… daily doses as of 2/2/2014: 18 mg by weight Lex, 150 mg Well. XL, 2.5 mg xanax, down from 26 mg by weight Lex., 300 mg well. XL, 4 mg xanax in August, 2012. I'll take it. :) 5/8/14 started equivalent dose liquid./ tabs. 5/13/14 1.5 % cut.

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Thanks. The reason I ask for a prioritization is for cost. Since this is routine everything would be paid for by my insurance and if I ask my GP to order a specific test and she agrees that would be covered as well. I wish I had a copy of last year's screening to see what is included in a routine screening but I don't.

 

RU,

You can ask for copies of old labwork. You'll hear this not just from me but from anyone on a chronic sickness forum -- get paper copies of every lab!

 

They're your labs, your body and your money!

 

best,

Alex

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Also see http://survivingantidepressants.org/index.php?/topic/3722-why-you-feel-better-taking-certain-nutrients/ for potential nutritional deficiencies.

 

Alexejice posted this excellent tip here http://survivingantidepressants.org/index.php?/topic/74-introductioncomp-sports/page__view__findpost__p__43470

....

UNless you live in a few states where overlords prohibit it, you can order tests through directlabs.com ... I think a D is $60 or so.

 

This months special is the CardioPlus for $29.

 

 

CardioPlus Includes

 

Glucose

Blood sugar level, the most direct single test to uncover diabetes, may be used not only to identify diabetes, but also to evaluate how one controls the disease.

 

 

Kidney

 

Uric Acid—A by-product of protein metabolism eliminated through the kidneys. Uric acid is an indicator of kidney function.

Bun (Urea Nitrogen)—Another by-product of protein metabolism eliminated through the kidneys. BUN is an indicator of kidney function.

Creatinine, Serum—An indicator of kidney function

Bun/Creatinine Ratio—Calculated by dividing the BUN by the Creatinine

 

Fluids & Electrolytes

 

Sodium—One of the major salts in the body fluid, sodium is important in the body's water balance and the electrical activity of nerves and muscles.

Potassium—Helps to control the nerves and muscles

Chloride—Similar to sodium, it helps to maintain the body's electrolyte balance

 

Minerals and Bone

 

Calcium—A mineral essential for development and maintenance of healthy bones and teeth. It is important also for the normal function of muscles, nerves and blood clotting.

Phosphorous—Together with calcium, it is essential for healthy development of bones and teeth. Associated with hormone imbalance, bone disease and kidney disease. It is found mainly in bones and teeth. NOTE: a temporary drop in phosphorus level can be seen after a meal.

Iron, Serum—An abnormally low test result may indicate iron deficiency anemia.

 

Liver

 

Protein, Total—Together with albumin, it is a measure of the state of nutrition in the body.

Albumin—Serum one of the major proteins in the blood and a reflection of the general state of nutrition

Globulin, Total—A major group of proteins in the blood comprising the infection fighting antibodies

Albumin/Globulin Ratio—Calculated by dividing the albumin by the globulin

Bilirubin, Total—A chemical involved with liver functions. High concentrations may result in jaundice.

Alkaline Phosphatase—A body protein important in diagnosing proper bone and liver functions

Lactate Dehydrogenase (LDH)—An enzyme found mostly in the heart, muscles, liver, kidney, brain, and red blood cells. When an organ of the body is damaged, LDH is released in greater quantity into the blood stream.

Aspartate Aminotransferase (AST or SGOT)—an enzyme found in skeletal and heart muscle, liver and other organs. Abnormalities may represent liver disease.

Alanine Aminotransferase (ALT or SGPT)—an enzyme found primarily in the liver. Abnormalities may represent liver disease.

GGT—Also known as Gamma-glutamyl transpeptidase, GGTP Formal name: Gamma-glutamyl transferase helps to detect liver and bile duct injury. Some doctors use it in all people they suspect of having liver disease, others use it only to help explain the cause of other changes or if they suspect alcohol abuse.

 

Lipids

 

Cholesterol, Total—A sterol in the blood. Knowing your cholesterol may be as important as knowing your blood pressure. Elevated cholesterol is associated with an increasing risk of coronary heart disease.

HDL—Cholesterol High-density lipoproteins are believed to take cholesterol away from cells and transport it back to the liver for processing or removal. They have become known as the "good" cholesterol as persons with high levels of HDL may have less heart disease. Low HDL could be the result of smoking and lack of exercise.

VLDL—Very Low Density Lipoprotein (VLDL) is one of three major lipoprotein particles. The other two are high density lipoprotein (HDL) and low density lipoprotein (LDL). Each one of these particles contains a mixture of cholesterol, protein, and triglycerides, but in varying amounts unique to each type of particle.

LDL—Cholesterol Low-density lipoproteins contain the greatest percentage of cholesterol and may be responsible for depositing cholesterol on the artery walls. For that reason, they are known as the "bad" cholesterol.

Total Cholesterol/HDL Ratio—Calculated by dividing the total cholesterol by the HDL cholesterol. Ratio used by physicians in determining your relative risk for developing cardiovascular disease.

Triglycerides—Triglycerides are fat in the blood responsible for providing energy to the cells of the body. Triglycerides should be less than 400 mg/dl even in a non-fasting state.

 

Labwork like this would cost $200+ via a doctor's office.

 

You can find thyroid tests as well.

 

The Thyroid Panel, Special runs $89 and will get your FT3, FT4 and TSH. If TSH is high or T3 low, then perhaps seeing a doctor about thyroid antibodies would be the next step. Or asking about an iodine measure. I really like directlabs, they've allowed me to confidentially direct my own care while saving money at the same time.

 

Best,

Alex

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 8 months later...

Saw the acupunturist today and did another ZYTO hand scan which again seemed very useful showing pretty signifiant stress in Colon and Nervous System just what I'd expect being on a load of malaria/helminth drugs and having recently quit the BZD. Also pineal glad, liver stress... My acupuncturist does the ZYTO for me free of charge b/c it's been laborsome due to my impaired blood circulation but otherwise charges $25... I am willing to put the scan on the internet if anyone is interested in seeing what the full report looks like. I endorse the ZYTO as an added inexpensive diagnostic tool and data stream...

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Barbarannamated

I'm interested in seeing it, Alex. I believe this is test I had awhile back.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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