DR. IZABELLA WENTZ, PHARM D

Thyroid Pharmacist

No, Doctor, I Don't Need Antidepressants

No, Doctor, I Don’t Need Antidepressants!

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One night, I had a lucid dream that brought me to the past. For those of you that have never had a lucid dream, in this type of dream, you know that you are dreaming and, thus you know that you will be safe no matter what happens and what you do. These dreams can be very liberating!

In this dream, I was taken back to a doctor’s visit back in 2006, when I first graduated from pharmacy school, and when I first began to have overt thyroid symptoms. In real life, I went in because I didn’t feel like myself, but my physical symptoms were ignored during the appointment. Instead of focusing on my neck pain, sore throat, palpitations, and fatigue, the doctor started narrowing in on my anxiety and obsessive compulsive tendencies.

I was nervous and fidgeting and somehow we got on the topic of my habits.

I remember explaining that I triple checked prescriptions before I filled them (this was, after all my job and requirement as a dispensing pharmacist), but somehow, describing my daily job duties made me appear crazy to him. He kept digging further, trying to paint as though everything physical I reported was in my head.

I remember he asked me if I frequently washed my hands. I said, “No, but I would if I was preparing intravenous (IV) drugs,” (which is also a requirement for pharmacists that make IVs). I was anxious and I almost felt like he was quizzing me like he would report me if I didn’t wash my hands enough—I was a new grad and was used to being quizzed by older authority figures… and so of course, I looked even more crazy to him.

My recommended treatment? Antidepressants!

In my younger days when I was a rebel without a cause, I would have told him to shove it and that as a trained pharmacist with a doctorate degree, I knew better and that I came in to address my neck pain, fatigue, and sore throat 🙂 But instead, I was polite and sheepishly took home a prescription for antidepressants that I never filled.

You see, somewhere in my mid-twenties, I began to censor myself. My teens and early twenties were all about seeking pleasure, being myself and speaking my mind… but then it changed. I don’t know if it was my professional training, my friends, peers or partners, or simply growing older, but as time went on, I became pathologically polite. And so, even though my needs weren’t met and even though I knew that my symptoms weren’t just in my head, I kept quiet.

I didn’t push and didn’t ask further questions…

Three years later I was found to have thyroid antibodies that were in the 2000+ range and a thyroid gland so damaged that I needed to start thyroid medications.

Research has shown that anxiety, depression and a general feeling of being “unwell” are early signs of an autoimmune attack on the thyroid and can be correlated to thyroid antibodies, even when the TSH number is still normal.

The most common type of anxiety disorder reported in people with thyroid antibodies is obsessive compulsive disorder (OCD). OCD is also more common in pharmacists and Type A’s, so I am intimately familiar with it 🙂 I can tell you from years of tracking that my OCD tendencies flared up with rising thyroid antibodies and reduced as my antibodies dropped. Remission helped me become calm and cool, while Hashimoto’s flares brought on OCD. Thus I now consider OCD an indication of an impending flare.

In retrospect, it only took me three years of feeling anxious to get a proper Hashimoto’s diagnosis, and only took me another three years or so to get into remission and to become calm once more. Some people are not that lucky. They struggle for years without proper diagnosis. It breaks my heart to think about the many thyroid patients who get labeled as “crazy” or “hypochondriacs” instead of being tested for thyroid antibodies.

Others, even when they do get diagnosed with Hashimoto’s, and even treated with thyroid hormones, still continue to struggle with anxiety, depression, OCD, and panic attacks…

Do antidepressants help these conditions?

I think it’s debatable. While I don’t discount that many people have been helped by antidepressants, giving a person mood stabilizing medications because of fluctuations in mood due to Hashimoto’s is like putting masking tape over the check engine light in a car instead of, you know, checking the engine!

Furthermore, antidepressants alone should never be the sole solution, even for a person with depression and anxiety!

As a pharmacist, I really got a kick out of this little Onion article 🙂

 

The Onion

There are many other strategies that can help a person with depression, whether used in conjunction with antidepressants or on their own: bright light therapy, T3 containing medications, meditation, counseling, nutrition, Omega-3’s… I could go on!

For thyroid patients, I’ve found Selenium and balancing blood sugar works like a charm for anxiety…

For OCD, there are supplements like 5-HTP and Myo-Inositol that can really help! As a side bonus, Myo-Inositol can reduce TPO antibodies, balance blood sugar and reduce TSH!

While I believe most medications have their time and place, the truth is, antidepressants are dirty drugs (this is official pharmacist lingo). They interact with many receptors leading to a smorgasbord of symptoms.

In my past life, when I was working in consulting with mental health clients, I often got reports of people feeling like zombies, gaining weight, feeling dulled, living in a fog, having sexual dysfunction, becoming manic, and feeling worse on antidepressants.

One of the scariest side effects of antidepressants that I learned about in pharmacy school is increased suicidality. So people who were started on medications for depression would be more likely to die by suicide within weeks of starting them. The theory that was proposed to us students was that “people got more energy before their mood improved and thus, this burst of energy gave them the opportunity to take their lives.” This was so scary to me as a young practicing pharmacist. I remember one of my regular patients at a pharmacy who became very depressed and had just started on an antidepressant. I made her promise to call me to check in every few days to make sure she was OK, and I would call her at home whenever she didn’t visit the pharmacy for a few days…  Suicide is a permanent solution for a temporary problem and is devastating for loved ones of the deceased, who often go on to have post-traumatic stress disorder, survivor’s guilt, and even new onset autoimmune disease. One day I’ll write more about my personal connection to loss… but for now, if you’re reading this and struggling with depression, I want you to know that you can feel better—and you will feel better—and there are so many people and things that can help you. Don’t give up.

Antidepressants can also cause a downregulation of our internal production of neurotransmitters. What does this mean? This means people can become dependent on taking them. I have seen it first hand and have had to work with numerous people to wean them off antidepressants slowly in my past life as a consulting pharmacist.

This is because antidepressants prevent us from properly clearing serotonin from our brains so that it sticks around longer. Unfortunately, the body takes notice of all of this serotonin hanging around, and soon we began to produce less serotonin and we become less sensitive to the serotonin we do have—sometimes this may even be permanent (if not addressed). It’s funny, as a young pharmacologist I was exposed to the concept of permanent alterations in the body that pharmaceuticals could produce, yet most pharmaceuticals are not studied for longer than a few months at a time.

Furthermore, antidepressants are not always effective. I have seen this numerous times over in patients as a pharmacist, and less than 5% of people were found to be in remission from depression with SSRI drugs, even after using them for a year in a large-scale study known as the STAR*D trial!

This is why I’m such a raving fan of the work of psychiatrist Dr. Kelly Brogan, a woman with a powerful voice, who is trailblazing root cause treatments for depression and anxiety. And guess what? She NEVER uses antidepressants!

Dr. Brogan uses treatments like nutrition and lifestyle changes to help people awaken and turn on their inner healing capabilities to help them recover from depression and anxiety.

I had a chance to spend a couple of hours chatting with her in New York, where she said, “I make it very clear that I really don’t believe in mental illness fundamentally. I certainly don’t believe it’s a disease. I actually have such a broad perspective about what it is that it could be, from micronutrient deficiency or an endocrine imbalance all the way to a psycho-spiritual emergence.”

Dr. Brogan has also reversed her Hashimoto’s, so she really gets it and I truly consider her to be one of my Hashi sisters. I really think the most amazing women are affected with Hashimoto’s so that they can be given the opportunity to heal and help others do the same—and if you’re reading this, I think you are likely to be one of them!

Dr. Brogan and I discussed her unique approach to depression and anxiety without psychiatric drugs in a joint webinar, which was followed by 30 minutes of Q&A. The topics we covered were:

  • The role of autoimmunity and inflammation in depression
  • A natural, root cause approach to reversing depression and anxiety
  • How nutrition can heal your moods and help you reclaim your life
  • Some simple, yet powerful, meditations you can start your day with
  • Specific changes you can make today to reverse depression and anxiety

Dr. Izabella Wentz & Dr. Kelly Brogan
Sign-up to watch the replay anytime!

So going back to my lucid dream. I did things differently this time during that doctor’s appointment. I stopped him mid-sentence and said, “No, Doctor, I don’t need antidepressants. I came in because of my physical symptoms.” I may have thrown a swear word or two in there somewhere. And it was liberating—and you know what? Now that I’m a rebel with a cause—a Root Cause Rebel—my voice is getting stronger and my pathological politeness is getting weaker with each and every day.

So if you’ve ever been told that it’s all in your head, or that you need antidepressants, or that you should just settle for the status quo, say it with me, my fellow Root Cause Rebel: “No, Doctor, I don’t need antidepressants!”

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  1. Dear Dr. Izabella,
    I enjoy reading your emails and I have read your Hashimotos Guide book. You have really helped me during my Hashimotos journey. After your email about depression I was wondering if Holy Basil was safe to take? I just recently started taking the New Chapter Holy Basil. I read some reviews on Amazon that if you have low blood sugar or low blood pressure it should be avoided. I’ve had low blood pressure for about 5 years but my doctor says low blood pressure is good. I’ve always worked out regularly my entire life and never had low blood pressure. So I think I developed low blood pressure due to my adrenal fatigue and difficulty sleeping. I started to take Holy Basil for adrenal fatigue and difficulty sleeping. Seems to be helping a little but I’ve only been taking it 3 weeks. I was curious what you think about Holy Basil and if it safe to take with Hashimotos? I’ve tried Ashwaganda and Rhodiola but they make me feel worse.
    Thank you very much!
    Mary

    Reply

    • Mary- Holy Basil is an adaptogenic Herb, adaptogenic herbs can be any natural herb products that supplement the body’s ability to deal with stressors. In the 1940s Dr. Nikolai Lazarev defined adaptogen as “an agent that raises the body’s ability to resist stress by countering undesired stressors, whether physical, chemical, emotional, or biological.” Not everyone will need every single supplement! In fact, I believe that most nutrients should come from the diet, this is why I always list food sources for most of the nutrients, vitamins, minerals and probiotics that are depleted in Hashimoto’s in the book and on the blog. However, some may require/prefer supplements and the supplements on the website are a resource for those that do. I recommend getting tested for deficiencies to determine your need for a supplement as instructed in the book and blog. I also don’t recommend starting multiple supplements all at once. I recommend starting one at a time and then adding another a week or so later once it has been confirmed that the first supplement is not causing any harm.

      I do have a full supplements chapter in my book. Have you checked it out? Not everyone should be taking every supplement and the book will help uncover your root cause. This will help you figure out your supplementation.

      http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Reply

  2. Hi Kelly thank you for all you do! Can you direct me to research about the antidepressant dependence? (Re: “Antidepressants can also cause a downregulation of our internal production of neurotransmitters. What does this mean? This means people can become dependent on taking them..”) this is why I am asking: When asked by a new doctor why I take Paxil I say, “because I cannot get off of it.” They then want me to state why I was prescribed it in the first place. Of course the original doctor’s reason was “depression”. I later became leery of this diagnosis and have tried to wean off of it various times. It’s not depression that comes back – it’s full blown withdrawal. And even when I get past the horrible electric-shock waves to my brain, the nausea, the vertigo. Then I have to contend with terrible sensory issues that send me to a dark quiet room and the general feeling my brain is fried. I’m Irritable and volatile and all over the place. I was NEVER Like this before. This is not my depression “resurfacing”. When attempting to explain this phenomena I have been met with the patient, condescending looks of doctors one too many times and I’d like some research to back me up. Thank you so much!
    Joanna

    Reply

  3. Hi! I have been dianosed with hypothyroidism for well over a decade.. Who knows hown long I’ve had it for. Somewhere along that time, the word hashimotos was utteted. About a year ago, I opened the discussion about depression with my endocrinologist. She dismissed my claims and in more words, said it was my outlook on life. About seven weeks ago, I went to my primary and opened up the concersation about depression and anxiety again. How quickly she prescibed an antidepressant. I figured, well they should know, so I’ve been taking this with maybe some relief in anxiety, but none in the depression sence. Should I ditch my endocrinologist or primary? Any help?

    Thank you!

    Reply

  4. Hi Isabella
    I signed up for the webinar with Kelly Brogan but could not get the link to work. Is it possible to access a transcript of the session?

    Reply

      • Unfortunately that didn’t work either. I had emailed in a question re the link between high antibodies and severe depression – is it difficult to get depression under control if your antibodies remain extremely high?

        Reply

  5. Going through this ordeal with getting my doctor to believe me (even with the elevated TSH levels) has made me extremely synpathetic to any person who actually does have depression and sees a doctor. My doctor saw in my chart that I had been seen by a behavioral counselor some years ago (which is the only time I needed to see a doctor because my health had been pretty good) and then no matter what I said, even the blood tests, she just decided I was depressed. Finally I changed the doctor and the first appointment went home with a prescription for thyroid medication. Even with the new doctor, I felt like I was on trial and being judged whether I was a hypochondriac or not. I have been working with Dr. Wentz’s book The Root Cause already. The new doctor refused to be open to any possibilities that diet and lifestyle could affect/heal my thyroid. She said that allopathic doctors aren’t trained in that way. But, as a human, how can you not be open to something new and outside of your box??? What I really wanted was a partner for my healing and I don’t know if I will be able to find one. I was so happy to receive the discount on the course Dr. Wentz offered, but sadly I did not have the $200 available in the few days that I had to pay for the program. If it comes around again, I’ll be ready 🙂 <3

    Reply

  6. Hi Izabella,

    First of all thank you, I really like all the writing you have. I ordered the book and can’t wait to start reading it. I have been diagnosed with Hashimoto hypothyroidism like two years ago.High level of TPO, like 9989, anxiety, tremors, agorafobia and lots more. The doctors thought I was depressed, he wasn’t listening to me, and what”s more they gave me no medication. Two year in suffering. When I had a miscarrige pregnancy I decided to go to find another doctor. So my new doctor gave me selenium and Tirosint ( is in ml) I take like 17 drops in the morning. But am not feeling very good. Today for example I was tired and had tachycardia. I will stop to eat gluten and I will follow your diet. Thank you!!! I will write you again )

    Reply

    • Enela- Thank you so much for your support! I’m looking forward to hearing your progress on this page. Make sure to take the book slow, take notes, highlight, and establish a baseline when making changes. 🙂

      Reply

  7. I have sle. Thyroid interactive. Raynauds. Along with a slew of gastro issues. Im so bugged out from everyhing. I take also the patch. Im very. Depressed. And don’t know where to turn.

    Reply

  8. Hello,
    I found your post about antidepressants while searching for any information about goiter and thyroid yet again. About a year ago my nurse practitioner tried to convince me that I need to “at least try” antidepressants. I am a people pleaser and felt like she thought I was a hypochondriac or just depressed. My husband had gone to this appointment with me and I finally had the guts to say no to antidepressants. She continued to press the issue and told me to discuss it with my husband some more while she left the room. I was in tears from the frustration that I had already said no. I started question myself. My husband brought me back to reality and was supportive of my decision. She came back in the room and continued her sales pitch even after I said no several more times. I finally said to go ahead and send it to the pharmacy if that made her feel better but that I would not pick it up. Which she did. I switched practitioners within the group so I didn’t have to see her anymore. I never did fill the prescription. Instead I read all I could I could about my symptoms and realized it was likely thyroid. Shortly afterwards my husband and daughter noticed that my neck was swollen. My doctors still didn’t listen. I recently went to the walk in clinic due to some bug going around. While there another nurse practitioner and I were talking. On a whim I decided to say something about my swollen neck and showed her thinking I would be ignored again. To my surprise she said it’s likely a goiter which was confirmed by an ultrasound. However, the diagnosis was to do nothing! My bloodwork came back within range. Shortly after a friend told me to go to a local nutrition shop. The fame had been in the business for 30 plus years. I walked in the door not knowing what I was looking for when asked. I pulled down the neck of my tee shirt and started to ask a question. The owner stopped me and said I have a goiter and to try iodine and magnesium taurate. I did and actually felt better for months until I got very busy and ran out. I picked up more and started taking them again. However, my neck swelled again and I have been very OCD. I had not linked the obsessive need to clean the house as another symptom. Thank you for bringing it to my attention. I have finally found an endocrinologist that I am willing to see and am cautiously optimistic. I am worried because I have witnessed my mother and several female friends struggle with medications like synthroid. They seem to get worse rather than better. I’ll keep reading all I can. What I have learned is that I have to speak up and be proactive about my care. I am not depressed nor am I a hypochondriac. I can’t rely on my doctors to know what is best for me.

    Reply

  9. Hello,
    I was diagnosed with hashimotos about 2years ago, at about the same time I went thru menopause. I also was diagnosed with lupis in my 20s and have been seeing a rheumatologist ever since. What is frustrating is that I feel this is all connected yet the docs I see; obgyn, rheumatologist, and general practitioner see no relation. I recently visited my rheumatologist and mentioned that I thought diet was a huge factor, I had recently gone off gluten and she just shook her head and stopped me before I could finish my sentence. I discovered your book and have begun to gradually start changing my diet, I have been off gluten for about a month, and have lost 7 lbs, Yay! I have some anxiety/ depression but have had this all my life so i have learned to deal with it mainly by exercise, yoga, diet and and doing things I enjoy. I take b12, and biotin for about a year now and my hair has quit falling out. I’m considering going off the estrogen replacement for menaposal symptoms and was wondering what effect estrogen has on hashimotos symptoms

    Reply

  10. Forgot to mention I take 88mg. of synrhroid and levels are normal. But every year they gradually increase it to maintain those normal levels.

    Reply

  11. At my latest endocrinologist appointment my doctor said that my TSH was in the normal range with help from Synthroid and other than doing a higher dose of that and increasing my risk for osteoporosis there wasn’t anything more she could do. Her suggestion? Check with my family doctor about a possible mental health issue. I have a B.A. in psychology and while there were plenty of times in my studies I would have diagnosed myself with pretty much anything in the DSM IV I knew that my physical symptoms were not in my heaď. Brain fog and fatigue are stealing my life and it is a shame doctors seem so unconcerned with treating the root cause of the problem.

    Reply

    • Becky – thank you for following this page and for sharing.

      Most conventional physicians use the TSH test to determine if one has a thyroid disorder and to dose thyroid medications.

      However, this test can often time be misleading, as levels of circulating hormones may fluctuate at different times, such as in Hashimoto’s, the person affected may fluctuate between highs and lows.

      Additionally, when scientists first set the “normal” ranges of TSH for healthy individuals, they inadvertently included elderly patients and others with compromised thyroid function in the calculations leading to an overly lax reference range.

      This resulted in people with underactive thyroid hormones being told that their thyroid tests were “normal,” based on this skewed reference range.

      WHAT TO DO IF YOUR TSH IS NORMAL AND YOU ARE ANYTHING BUT
      https://thyroidphramacist.com/blog/what-to-do-if-your-tsh-is-normal-and-you-are-anything-but

      Here are the tests you need for diagnosis. Most endocrinologists don’t run them all so you will have to request them. Make sure to request a copy of your labs as well.

      TOP 6 THYROID TESTS FOR DIAGNOSIS
      https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

      Reply

  12. I guess that I am the last person in the world with Hyperthyroidism/Graves, since I never see it addressed anymore. I feel bad for any out there who might
    be ‘Hyper’, since no one seems to want to address its existence anymore!!

    Reply

    • Mildred – thank you for reaching out. Graves and Hashimoto’s are both autoimmune conditions that affect the thyroid. They are thought to be closely related. Sometimes one turns into the other. The difference is the site of the antibody attack. In Hashimoto’s, the antibodies are found to thyroglobulin (in 80%) and thyroid peroxidase (TPO) enzyme (in 95% of people) Hashimoto’s results in hypothyroidism and is usually treated with Synthroid and replacement hormone.

      The same antibodies may be present in a smaller percentage of people who have Graves, but the main antibody is to the TSH Receptor (TSHR-Ab). Usually, people with Graves have hyperthyroidism, and they are treated conventionally with thyroid suppressing drugs (methimazole) or radioactive iodine to destroy the thyroid. At that point, the thyroid will no longer produce hormones on its own, and these people end up on Synthroid as well.

      Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target.

      We need to rebalance the immune system to prevent this. Sometimes the autoimmunity can be reversed as well! The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition. Here are the links to my books:

      Hashimoto’s Root Cause
      http://amzn.to/2DoeC80

      Hashimoto’s Protocol
      http://amzn.to/2B5J1mq

      Reply

  13. I have started taking Zoloft 25mg per my primary care physician. I do have an appointment Jan 21 with an endocrinologist. Will taking Zoloft affect any testing the ending may do for thyroid, adrenal, etc?

    Reply

  14. Mines a little different than the others ,around 10 years ago had an allergic reaction,ended up in the ER where I work as a nurse in respiratory arrest .I was intubated then flown out to a bigger hospital and trachestomy was done ,in ICU for a week .Had the trach for another week before being removed ,something wasn’t right having a hard time breathing when I bent my head down ,well went back had to go back into surgery for a revision that’s when they found out I ad nodules in back of my thyroid which looked cancerous so thyroidectomy was performed ,test confirmed it was stage 3 pappilary CA .DR said I must of had an angel on my shoulder cause they wouldn’t have found it ,if I didn’t come back ,sorry my story is long ,had radioactive iodine tx put on synthroid.Since this happened to me I have never been the same ,lost me .Hair loss ,mood changes ,can go on but I’m not the same tried discussing this with Dr didn’t go anywhere just to busy making sure your in there for a short time not hearing anything treatment is the same for all ,but we are all different shouldn’t be that way what’s normal for one person might not be normal for another .They keep messing with the mcg Higher than lower right now it was changed again I’m taking 100 mcg .Haven’t been able to find anyone who could help and understand me ,so I have been praying for help so I can be me again lost so much because of my changes.Again I apologize for this being so long ,hoping you can help me .My Dr doesn’t hear me just feels he treats the lab numbers .Thank you ! Hoping this is an answer to a pray

    Reply

  15. Hello, your information has come to me at the perfect time. I have had severe anxiety and panic attacks come on over the past 2 weeks, and my TSH level, at its lowest, was .393. My primary Dr stated I have subclinical hyperthyroidism and is referring me to an endocrinologist next week. How do I get by until I see the specialist? I am taking Ativan just to get me through the anxiety.
    Thank you ~

    Reply

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