Mental Health Week: combined treatment with high dose levothyroxine and rTMS for bipolar disorders
Today I am going to attempt an explanation of the treatment that has brought me to remission from a severe and prolonged case of bipolar type 1 disorder.
I am going to do this from my limited understanding and then attach a research paper with the technical medical terms and research for those who wish to know more details.
The treatment I received at The London Psychiatry Centre involved being prescribed high doses of levothyroxine which is a manufactured form of the thyroid hormone thyroxine (T4). This was administered in combination with something called rTMS (Repetitive Transcranial Magnetic Stimulation).
High dose levothyroxine
I started treatment at the London Psychiatry Centre in April 2019 when I was suffering from a 'mixed state' bipolar episode and hopelessly suicidal. Levothyroxine was titrated up slowly, 50 micrograms at a time over the course of several months. In conjunction with this I had daily forty-minute sessions of rTMS.
Dragging myself to London every day was not at all easy and some of my appointments had to be done on Skype because I was too ill to leave the house. Progression was slow to start with and recovery took much longer to achieve than it would usually because of all the damage to my brain from the failed antidepressants, mood stabilisers and antipsychotics, not to mention the ketamine infusions fiasco that nearly cost me my life.
But by month four or five I was starting to feel a lot more stable, and by month 8-9 I had stabilised completely. My depression eased gradually throughout the treatment process, and I felt as though a dimmer switch was coming on and off for a while until the light came back on in my brain at 750mcg and stayed on at 800mcg.
There were bumps in the road and it took me a further 12 months to regain my confidence because I’d been ill for such a prolonged period of time, but by the end of 2020 I was finally back to the authentic version of myself.
What is the science behind this combined treatment?
Thyroid function has long been associated with behavioral and mood disturbances and the use of levothyroxine for treatment of bipolar disorder is listed in the Maudsley Prescribing Guidelines.
I remember asking Dr Zamar how he had found out about the efficacy of high dose thyroxine and he told me that he had a patient that refused all other medications. She was sick and tired of experiencing such terrible side effects – I am so thankful to her for doing this because her resistance to the traditional methods will help so many people!
It is unclear exactly how high dose levothyroxine benefits patients with bipolar disorder, but several proposals and theories have been put forward. Details of these can be found in a research paper of twenty cases performed at the London Psychiatry Centre which can be found here.
In my limited understanding high dose levothyroxine works because bipolar patients have a thyroid conversion problem which is hardly ever picked up on a regular thyroid function test.
We produce thyroid hormones normally (T4) but lack the genetic profile to convert T4 to the active form of T3 which is needed in the brain. The two genes involved in this are deiodinase types 1 and 2 (DIO1 and DIO2 ).
I have posted the results of my genetic test below which shows mutation on both genes:
Having something tangible to account for the misery and brutal suffering that I’d experienced over the years was a huge relief and it was reassuring to know that the horrific swings and troughs of mood had a cause.
Explanation of rTMS
Transcranial Magnetic Stimulation (rTMS) is an effective, drug-free, non-invasive treatment for depression which uses magnetic stimulation to stimulate areas of the brain that regulate mood. It is a painless and safer alternative to ECT (Electro Convulsive Therapy) and carries none of the risks of memory loss or seizure. The patient is conscious throughout treatment, and it is easier to administer than ECT and less costly too.
The London Psychiatry website explains how rTMS works by saying the following:
“rTMS influences electrical brain activity through a pulsed magnetic field. This magnetic field is created by passing quick current pulses through a coil of wire. The coil of wire is encased in plastic and placed close to a client’s scalp in order for the magnetic field to be focused on particular areas of the brain. The magnetic field can safely penetrate the scalp and scull without pain, to create a current in targeted brain cells. Because this stimulation is given at regular intervals it is referred to as repetitive TMS, or rTMS.”
Even though it comes with such obvious benefits this treatment is virtually impossible to get on the NHS. There isn’t one in my NHS trust and I only know of two facilities available on the NHS in the entire country.
If ever get anywhere with this campaign I will obviously be fundraising to buy one! I’ll open my own treatment clinic if I have to because apart from anything I want to be able to access this treatment for myself without having to pay exorbitant costs!
Risks and side effects
I noticed no side effects or problems with rTMS even though I had reacted so catastrophically to other treatments in the past. rTMS isn't painful at all and you can chat to the nurse or listen to music while it's being administered. The only time I noticed pain was when I had something called a 'primer' protocol before my usual treatment. I had this to stimulate the brain even further when I felt I needed more than the regular treatment protocol.
ECT is the only real alternative to rTMS but it carries a risk of manic relapse or ‘switch’ (it can send people manic) which is why I resisted having it. I also have to admit that the thought of having an induced seizure and losing my memory wasn’t such an appetising prospect either! rTMS doesn’t carry any of these horrifying risks – but why isn’t it available on the NHS then?
Tomorrow I will be discussing this question because it would seem that the profession are not in agreement about how to treat depression and bipolar disorder – this is why finding treatment for the patient is such a minefield! I hope to help to change this!
If you would like to know more about rTMS; how it works, the risks and what it is used for, then you can find a series of informative videos on YouTube which I have added here.
Thanks for reading,
Speak to you soon,