T3 Treats Bipolar Disorder

[DaveFoster]

T3 treats major depressive disorder (MDD), where hypothyroidism appears alongside various neuroses including generalized anxiety disorder (GAD), phobias including social anxiety disorder (SAD), personality disorders (which often feature elevated cortisol and low DHEA), and lastly obsessive-compulsive disorder (OCD).

This study shows that T3 can also treat bipolar disorder (even treatment-resistant bipolar disorder), both by itself or in conjunction with a drug such as lithium (with actions similar to sodium) or other anticonvulsants (such as lamotrigine).

"Patients had been unsuccessfully treated with an average of 14 other medications before starting T3. At an average dose of 90.4 mcg (range 13 mcg-188 mcg) the medication was well tolerated. None of the patients experienced a switch into hypomania, and only 16 discontinued due to side effects. Improvement was experienced by 84%, and 33% experienced full remission."

"A high percentage of bipolar II and bipolar NOS patients with treatment resistant depression improved on T3. Despite the use of higher than usual doses in many of the patients, the medication was well tolerated. Augmentation with supraphysiologic doses of T3 should be considered in cases of treatment resistant bipolar depression."

SOURCE: The use of triiodothyronine as an augmentation agent in treatment-resistant bipolar II and bipolar disorder NOS. - PubMed - NCBI

Original posted on the Foster Your Health blog: T3 Treats Bipolar Disorder

 

[pimpnamedraypeat]

Very nice.

 

[aguilaroja]

T3 treats major depressive disorder (MDD), where hypothyroidism appears alongside various neuroses including generalized anxiety disorder (GAD), phobias including social anxiety disorder (SAD), personality disorders (which often feature elevated cortisol and low DHEA), and lastly obsessive-compulsive disorder (OCD)....
"Patients had been unsuccessfully treated with an average of 14 other medications before starting T3. At an average dose of 90.4 mcg (range 13 mcg-188 mcg) the medication was well tolerated.... Augmentation with supraphysiologic doses of T3 should be considered in cases of treatment resistant bipolar depression."

SOURCE: The use of triiodothyronine as an augmentation agent in treatment-resistant bipolar II and bipolar disorder NOS. - PubMed - NCBI

This review covers multiple reports:
The use of triiodothyronine (T3) in the treatment of bipolar depression: A review of the literature. - PubMed - NCBI
“The few available studies are small and flawed. They do show promising results. We found many clues suggesting that T3 could augment and accelerate treatment response not only with antidepressants, but also with lithium and perhaps with other treatment options, that it might protect against rapid cycling bipolar disorder, as well as against relapse during the first few years of treatment.”

Even well meaning reviews are rarely ideal. It is optimal to look at each of the reports. Peter Whybrow has used very high doses of T4 over the years, with multiple reports and some success.
Levothyroxine effects on depressive symptoms and limbic glucose metabolism in bipolar disorder: a randomized, placebo-controlled positron emission tomography study
Supraphysiologic doses of levothyroxine as adjunctive therapy in bipolar depression: a randomized, double-blind, placebo-controlled study. - PubMed - NCBI

It is great that as a group psychiatrists have for decades been more willing to use thyroid beyond the (skewed) orthodoxy. I have not reviewed every study. The studies for protocol often used a fixed amount of dosing for thyroid supplement. The Kelly/Lieberman chart review series titrated gradually until improvement plateaued. AFAIK there have not been studies with combined T4/T3 and divided doses to keep T3 low and study throughout the day. The success in difficult “psychiatric” cases with uniform, sub-optimal thyroid treatment underscores the major insights of Broda Barnes, Dr. Peat, and others.

 

[HDD]

Along the same line, schizophrenia has been resolved in cases using 5 grains of NDT.
Thyroid and Schizophrenia - Abram Hoffer, M.D., Ph.D., FRCP (C)

@DaveFoster @aguilaroja How do you think the t3 was administered to achieve that high of a dosage? According to Ray Peat, the body will produce enzymes to deactivate an unphysiological dose. Do you think that possibly administering too high of a dose at one time would require higher dosages overall?

 

[CoconutEffect]

Can anyone explain the

Along the same line, schizophrenia has been resolved in cases using 5 grains of NDT.
Thyroid and Schizophrenia - Abram Hoffer, M.D., Ph.D., FRCP (C)

@DaveFoster @aguilaroja How do you think the t3 was administered to achieve that high of a dosage? According to Ray Peat, the body will produce enzymes to deactivate an unphysiological dose. Do you think that possibly administering too high of a dose at one time would require higher dosages overall?

I wonder the same, and if the physiological millieu is different in a severe disease like bipolar disorder. I asked Ray this very question one year or so ago, about supraphysiological doses of T3, also attaching some studies showing benefit to bipolar, but he didn’t directly address my question

 

[DaveFoster]

Along the same line, schizophrenia has been resolved in cases using 5 grains of NDT.
Thyroid and Schizophrenia - Abram Hoffer, M.D., Ph.D., FRCP (C)

@DaveFoster @aguilaroja How do you think the t3 was administered to achieve that high of a dosage? According to Ray Peat, the body will produce enzymes to deactivate an unphysiological dose. Do you think that possibly administering too high of a dose at one time would require higher dosages overall?

Those dosages aren't too high really. Bodybuilders regularly run those dosages with no apparent deactivation.

The body may respond to the net effect of too much T3 (ie, hyperthyroidism,) and not the molecule directly in itself.

 

[aguilaroja]

...
@DaveFoster @aguilaroja How do you think the t3 was administered to achieve that high of a dosage? According to Ray Peat, the body will produce enzymes to deactivate an unphysiological dose. Do you think that possibly administering too high of a dose at one time would require higher dosages overall?

...
I wonder the same, and if the physiological millieu is different in a severe disease like bipolar disorder. ...

The series reported by Kelly/Liberman had a range of daily T3 dosage between 13 & 188, with an average of 90.4 mcg per day. There are too many unknowns for things beyond guessing. The report does not say how things were dosed but the reference to an earlier study implies once daily dosing.

As @HDD & @dilantoid note, this does not seem wise in light of both the short half life of T3 and inhibition by reverse T3. Probably most or all these subjects were taking other medications. Probably in some subjects other medications interfered with metabolizing T3. It could be, for instance, that higher doses of T3 either provided a partial window for symptom relief during the day, even if the dosing was too high & unsteady to be effective throughout the day.

In the (Dennis) Wilson syndrome approach (with so-called long-acting T3), and as @DaveFoster notes, there are some positive effects for some people with larger amounts of T3. Since the distribution of single daily T3 will vary throughout the day, my guess would again be that there is enough of a window of useful levels during the day to make some improvement.

I think it always makes sense to divide a daily quantity of T3 into many frequent smaller amounts. I have known very many people who have done better be dividing the T3 (or T3 as part of an NDT combination) throughout the day, and none who have done worse.

 

[DaveFoster]

The series reported by Kelly/Liberman had a range of daily T3 dosage between 13 & 188, with an average of 90.4 mcg per day. There are too many unknowns for things beyond guessing. The report does not say how things were dosed but the reference to an earlier study implies once daily dosing.

As @HDD & @dilantoid note, this does not seem wise in light of both the short half life of T3 and inhibition by reverse T3. Probably most or all these subjects were taking other medications. Probably in some subjects other medications interfered with metabolizing T3. It could be, for instance, that higher doses of T3 either provided a partial window for symptom relief during the day, even if the dosing was too high & unsteady to be effective throughout the day.

In the (Dennis) Wilson syndrome approach (with so-called long-acting T3), and as @DaveFoster notes, there are some positive effects for some people with larger amounts of T3. Since the distribution of single daily T3 will vary throughout the day, my guess would again be that there is enough of a window of useful levels during the day to make some improvement.

I think it always makes sense to divide a daily quantity of T3 into many frequent smaller amounts. I have known very many people who have done better be dividing the T3 (or T3 as part of an NDT combination) throughout the day, and none who have done worse.

With most drugs, I find dividing the dosage results only in improvement unless it interferes with sleep.

 

[BudsPeat]

I have spoken to Ray several times about this and he has repeatedly sighted instances in which persons took tabs of t3 and bipolar mania settled and did not return

 

[DavidGardner]

Has anyone here with bipolar noticed improvement from taking t3 or any thyroid formulation for that matter? I have tried all kinds of medications and supplements other than thyroid, but the writing on the wall seems to be pointing in that direction for me. Or does anyone even anecdotally know of someone who has seen improvement. Kind of desperate for answers right now.

 

[burtlancast]

Good find.

 

[boris]

Has anyone here with bipolar noticed improvement from taking t3 or any thyroid formulation for that matter? I have tried all kinds of medications and supplements other than thyroid, but the writing on the wall seems to be pointing in that direction for me. Or does anyone even anecdotally know of someone who has seen improvement. Kind of desperate for answers right now.

My dad is bipolar. I call it tripolar, with phases of senseless rage.
He has obvious energy problems (mouth breathing from slight exertion, etc.). One time when I visited I mixed about 5mcg T3 into his food and saw his mood stabilizing instantly.

 

[ecstatichamster]

My dad is bipolar. I call it tripolar, with phases of senseless rage.
He has obvious energy problems (mouth breathing from slight exertion, etc.). One time when I visited I mixed about 5mcg T3 into his food and saw his mood stabilizing instantly.

that is fascinating

 

[johnwester130]

woulda t4/t3 mix work ?

or just t3 alone

 

[DavidGardner]

That’s what I’m wondering too. Like TyroMix. Also, curious if there would be any interaction with stimulant meds, increasing adrenaline too much or triggering anxiety.