For the sixth post of Mental Health Week, I am going to be discussing three other cases of remission from severe bipolar disorder.
Combined treatment with high dose levothyroxine and rTMS
I have detailed my own story in the preceding posts this week but just to recap I will outline a complicated story in a few sentences.
My story in a nutshell
I suffered terribly with bouts of mania and depression for nearly twenty years. I was treated with a myriad of antidepressants, mood stabilisers and antipsychotics, none of which made even the smallest dent in my depression, in fact they did nothing but worsen my condition and give me side effects and withdrawal problems.
Ketamine infusions made me manic and resulted in a traumatic hospitalisation, the aftereffects of which were bouts of insomnia and a horrific ‘mixed state’ where I was constantly suicidal and rapid cycling between simple depression (comatosed oblivion), agitated depression (heart pains and deep inner unrest) and depression with flight of ideas (manic racing thoughts but in a negative way). I saw Dr Zamar from the London Psychiatry Centre in 2019 and had high dose levothyroxine titrated up slowly to a level of 800mcg where I stabilised and reached remission from a disorder that had ripped a huge hole in my life.
Prior to this treatment I was bedbound most of the time, was reclusive, and could not engage with life or help myself in any way. I was reliant on my parents for everything and felt a constant ‘childlike’ vulnerability which meant that there was no way that I could live independently. I am now back to my authentic self, living independently and am confident in my own skin, happy and relaxed with life.
Other patient success stories
Dr Zamar and his team from the London Psychiatry Centre released a paper in 2017 detailing two cases of remission from severe bipolar disorder by using the same treatment protocol of high dose levothyroxine and rTMS. I am going to paraphrase both cases but if you would like to read the full research paper you can find it here.
Case A
This involves a 57-year-old female patient with a diagnosis of severe bipolar affective disorder. She was referred to Dr Zamar in 2008, with the diagnosis of recurrent depressive disorder and a two-month history of two episodes of hypo-mania and five episodes of depression following an admission to hospital due to suicidal ideation.
She had been suicidal on several occasions, had deteriorated when treated with antidepressants, marginally improved with courses of electroconvulsive therapy, and could not tolerate olanzapine, quetiapine or lamotrigine.
She was prescribed levothyroxine 200 mcg/day in addition to lithium carbonate and within the first month, patient and family reported an improved stability of mood. The dose of levothyroxine was increased to 250 mg/day. Over the past seven years the patient remains on levothyroxine 250 mg daily and she has not reported any mood instability.
Case B
This involves a 23-year-old male patient with 13-year history of increased anxiety, depressive symptoms alternating with periods of flight of ideas, pressured speech, agitation, loss of sleep and total breakdown in social functioning.
Previous diagnoses in childhood included depression, Attention Deficit and Hyperactivity Disorder and Asperger’s syndrome. A variety of antidepressants and stimulant medication were tried with little effect. The diagnosis of bipolar affective disorder was considered at the age of 18. Risperidone, quetiapine alongside sodium valproate were used for short periods and were discontinued on several occasions due to side effects.
Family therapy and cognitive behavioural therapy were tried. There was strong family history (mother’s side) of bipolar affective disorder. At the centre, a diagnosis of rapid cycling mood disorder was made. Sodium valproate dose was reduced to 1500 mg and levothyroxine 100 mcg started.
At month 12, sodium valproate was changed to Epilim maximum dose, levothyroxine dose increased to 300 mcg/day and repetitive Transcranial Magnetic Stimulation was started for six weeks. At month 14, levothyroxine was increased to 400 mcg. Mood was reported low with anxiety and agitation but reduced fluctuations. Addition of benzodiazepines and/or antipsychotics were not effective; therefore, all medications but levothyroxine 400 mcg were stopped. Regular reviews by Cardiologist and an Endocrinologist with bone densitometry scans were performed. No clinical signs of hyperthyroidism were reported or observed, and bone densitometry was normal. Mood became stable and ‘best ever’ for months 17–20.
Twelve months since initiation of levothyroxine, mood became stable and continues to be for the past 18 months. Mood is reported as ‘far better than ever before’. The patient has recently completed his university degree (1st Class), he is in a relationship, lives independently and travels alone. He also is a regular gym user with a substantial muscle bulk and fitness now. Prior to this, he was mostly bed bound, isolated and living with his parents in need of constant reassurance on many issues.
Case 3
A friend very kindly sent me a few paragraphs of her story recently. This is a shortened version of what she wrote:
I have had two extremely severe episodes of what Dr Zamar diagnosed as bipolar mixed states. These two mixed states were without question the toughest experiences of my life. I was extremely high and low at the same time, resulting in chronic agitation and restlessness alongside persistent negative thoughts.
One medication that was used at the height of my mixed state was quetiapine. Whilst this medication ‘suppressed’ the manic side of my illness, it a) did not solve my depression and b) resulted in me experiencing numerous unpleasant side effects. It significantly ‘blunted’ my personality, caused weight gain, left me with a total inability to sleep without taking it and, most seriously, caused severe heart palpitations, to the point where I tried not to take the drug anymore as it was posing a risk to my physical health. Years later, I still find myself having to take a low dose in order to try and get myself to sleep which I would much prefer to avoid.
Dr Zamar has now discovered another completely side effect-free and totally effective way to treat people like myself: high-dose Levothyroxine.
I take 350mcg per day and, ever since this dose had a chance to build up in my system, I have felt completely back to my normal myself; no other medications (and I had been on a lot) achieved this.
It has now been over four years since I have been taking 350mcg Levothyroxine and I have had no adverse effects. I have suffered no return of my mixed state since taking it, and I have also had no side effects. The only trouble I do still have is with sleeping, something which I can fully attribute to quetiapine.
I have suffered no symptoms of hyperthyroidism at all since taking 350mcg.
I have been so well and felt so assured in the power of thyroxine in keeping me in remission that I felt confident enough to undergo successful fertility treatment and had a baby boy 14 months ago. My pregnancy was uncomplicated, my baby was born very healthy and an extremely good weight, and he continues to thrive.
I would not wish anyone to suffer the mixed states or illness that I have suffered. It destroys lives. I believe with conviction that the only way to avoid this is with the use of high-dose levothyroxine to treat sufferers such as myself with a specific genetic mutation. It is cheap, side-effect free but, most importantly, completely effective.
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There are many other patients who have been treated successfully with a combination of high dose levothyroxine and rTMS. My aim is to get them all together one day, collate their stories into a book and present it to the NHS psychiatric bodies so that millions of others can be treated in this way.
What more do they need to know about this treatment? We are all functioning, well and content with life when all of us were previously in deep pain and suffering. This has got to be important, and I will keep writing and documenting this until I am noticed!
Thanks for reading,
Speak to you soon,
TR
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