Thyroid Before SSRIs for Depression/Anxiety

You’re depressed. You get a prescription that carries weight gain and decreased sex drive as side effects. What if instead you bump your thyroid performance and rev up your metabolism?

That is the choice I would like to explore. This is the second installment of looking at thyroid first before adding popular prescriptions. Please have a look at part 1 where treating with thyroid before statins for cholesterol is intriguing as this one won’t go as deep.

Low Thyroid and Depression/Anxiety

First, we need to tie the two together. Sixty (60%) of hypothyroid patients exhibit signs of depression or anxiety¹.

SIXTY PERCENT

Ok, so that qualifies to me as a sufficient relationship.

Thyroid, Depression And Energy

Thyroid hormones are major energy regulators at the cellular level. Less active thyroid, less energy.

Depression displays symptoms of low energy, fatigue, and tiredness.

Connecting these dots are straight forward.

Prescription Data Analysis

I built a database to analyze a couple years of prescription data so we could look at real life usage of antidepressants, anti-anxiety agents, and thyroid.

Antidepressant Or Anti Anxiety Users

For those on drugs with a therapeutic classification of antidepressant or anti anxiety, 89% have NOT used a thyroid prescription in the same period.

I take this to show these thousands of patients have potentially missed an opportunity.

On the flip side, 62% of thyroid prescription users have zero prescriptions filled for and anti anxiety or antidepressant. While this is not as overwhelming as the other way, it is still a vast majority. The other factor I cannot tease out for this analysis, is which came first. If someone started Prozac and later added thyroid and then came off Prozac, it would still show in the 38% of those who had thyroid and antidepressants. Also, thyroid is not a magic bullet, and depression is a tough condition to treat. The expectation would not be that thyroid is a cure all, but it can be part of the arsenal.

These data sets strongly suggest thyroid support as an avenue to avoid antidepressants.

Thyroid Testing

The standard thyroid test is Thyroid-Stimulating Hormone (TSH). It tells your thyroid to crank up production of thyroid. Higher the value, lower the thyroid function. It is not specific enough to tell the whole story, but it is enough to provide a sign of the situation.

The problem lies in the “normal” reference range. Although some labs may vary, the adult range is 0.40 – 4.50 mIU/mL (milli-international units per liter of blood)². They build “Normal” ranges to include 95% of “healthy adults”. “Normal” is not optimal.

A 2017 study found a more statistically reliable upper cutoff for TSH regarding depressive symptoms at 2.5³. If we used 2.5 as the range where thyroid prescriptions are considered, maybe less would have to go down the antidepressant road? I have seen many people between 2.5 and 4.5 receive thyroid prescriptions and have symptoms improve rapidly. I have one such example in the success stories section.

This patient was on antidepressants for depression and fibromyalgia. Fibro is a low energy condition like depression and chronic fatigue syndrome. Her TSH levels were 2.65, and her doctor wasn’t interested in thyroid therapy because of “normal” levels. Working with me and a new doc, we started thyroid replacement, and then soon thereafter no fibromyalgia symptoms. Read more about her here.

Where to go from here

Can thyroid help depression/anxiety? Yes. But adding another prescription is not where we begin. Depression is complex and its causes are multi-factorial. Same for thyroid. This article is not all-encompassing, but a starting point to consider additional tools.

Thyroid Support

I spent several paragraphs on thyroid support in the thyroid/cholesterol article, click here for a direct link to these recommendations. Starting with gluten and fluoride avoidance, plus adding nutritional support can go a long way.

Depression Support

Exercise is the single best medication for depression I have come across. Adding in sunlight and sleep optimization are also quality interventions. Rhonda Patrick is an excellent researcher. She has documented many interventions for depression, including sauna. Her resources are excellent, have a look here.

Brain Inflammation is part of depression. Please have a look at the recommendations in a 20+ page paper I put together on this topic.

Take Away

Thyroid activity is crucial to health. The prescription data presented above show 89% of the people using antidepressants and/or anti anxiety meds are NOT using thyroid support. To me, this is a missed opportunity. We should use this information to start further discussion. Please do NOT alter any treatments without the involvement of your medical provider. Discontinuing or lowering doses of these medications can cause harm if done too fast. I have seen thyroid supplementation help in patients with “normal” TSH levels. Please reach out if you want help in working with your provider to evaluate if this is an option for you.