Why Do I Feel Flat On My Medications?

QUESTION:

Dear Doctor,

After my psychiatrist recommended Tegretol for Borderline Personality and to help with Bipolar Type II, I read your website and your book.  The Tegretol, which I have taken for over a year, has been helpful to control many symptoms like anger, daily problems with suicidal impulses, sleeping, the worst part of anxiety, and the worst symptoms of depression.

Unfortunately since I have taken TEGRETOL everything feels flat.  Nothing is fun, even things that were fun before the medication like medication.  Nothing is funny.  I do not enjoy living, as it feels like I am just dragging myself through the day for the sole purpose of paying the rent.  Is this flat feeling a side effect of the Tegretol?  It is not helped at all by taking SSRI depressants.

My relationships also all feel flat.  I do not feel loving towards people and I do not feel loved by them even when they do very nice things for me or say that they love me.  Is this flatness also caused by the Tegretol?  It may be influenced in that I still have a lot of fear/anxiety around people and mostly I do not want them to hurt me.

Does Depakote also have this flat feeling to everything?

ANSWER:

What you're describing is called "melancholia" - and developed in approximately 18% of individuals treated with Tegretol.  It's usually due to a low thyroid problem, often "non primary hypothyroidism," and goes away with thyroid supplementation.