According to experts, in any given year, some 9.5 percent of the population, or about 21 million American adults, suffer from depression. The National Institute of Mental Health (NIMH) defines the most common symptoms of depression as the following:

Persistent sad, anxious, or “empty” mood

Feelings of hopelessness, pessimism

Feelings of guilt, worthlessness, helplessness

Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex

Decreased energy, fatigue, being “slowed down”

Difficulty concentrating, remembering, making decisions

Insomnia, early-morning awakening, or oversleeping

Appetite and/or weight loss or overeating and weight gain

Restlessness, irritability

Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain                         

Thoughts of death or suicide; suicide attempts

Sales of antidepressants make up a a profitable and significant segment of annual drug sales. And it’s no wonder. It’s very easy for a practitioner to diagnose depression. There are no blood tests needed. No clinical evaluation is necessary. The patient simply has to say that he or she feels sad, tired, fuzzy-brained, or irritable, is gaining weight, has a low sex-drive, or perhaps has vague additional symptoms, like headaches or digestive problems.

The doctor compares the symptoms against the above list, and…Voila! A prescription pad is produced, and the doctor scribbles out a prescription for any one of the popular antidepressants. No blood tests, and no specialists needed. (Except in severe and obvious cases of suicidal depression, most doctors don’t refer patients to a mental health expert for further evaluation, diagnosis or treatment. They diagnose depression based on a patient’s own descriptions of his or her symptoms.)

Interestingly, the list of symptoms of depression are almost identical to the symptoms of untreated hypothyroidism — an underactive thyroid.

The thyroid is the master gland of energy and metabolism, and when it is not functioning properly, as is the case for as many as 60 million Americans, cells, tissues, and organs are left without the energy they need to function properly. This leads to everything from slowed thinking, to depression, to low libido, to exhaustion and fatigue, to slowed digestion and constipation, to a slowed metabolism and weight gain. Aches, pain, headaches, eye problems, neck problems, hair loss, and a host of other symptoms are also common.

While feeling suicidal is not a common symptom of an underactive thyroid, every other symptom on the NIMH’s list could be straight out of a medical textbook’s description of hypothyroidism.

Why then, is evaluation for hypothyroidism not the first thing a doctor does when encountering these symptoms? Why are doctors more likely to prescribe antidepressants — which are not without side effects and risks — rather than investigate the possibility of hypothyroidism?

There are a variety of theories as to why this happens, but let’s set those aside for now, and focus on the most important question: what does this mean for you?

Basically, if your general practitioner, family doctor, internist, ob-gyn, or other doctor is recommending antidepressant therapy, you should also push for a thorough thyroid evaluation. That means the doctor will:
 
take a thorough family and personal history
conduct a detailed physical examination (including a check of your heart rate, blood pressure, and reflexes)
look for clinical signs of hypothyroidism, including puffiness in the eyes, face, and extremities, and loss of the outer edge    of your eyebrows, among other evidence
thoroughly evaluate and interpret your thyroid hormone levels, including antibody levels

You want the doctor to rule out undiagnosed and untreated hypothyroidism as a possible cause of your depression and other symptoms.

This is particularly important for those at the highest risk of thyroid disease: women who have just had a baby or who are going through perimenopause or menopause; seniors of both genders; and both men and women with any personal or family history of thyroid or autoimmune disease.

When researching my book Living Well With Hypothyroidism, thousands of thyroid patients shared their stories with me. The sad thing is, so many of them described similar experiences. They were women, suffering a constellation of symptoms — usually including fatigue, weight gain, and some aspect of brain fog and/or depression — and yet many of them were told they were suffering from stress, depression, PMS, menopause, or, “that’s just what happens when you get older.” These women were frequently seen for a few minutes, only to be told they were suffering from depression, and sent off, prescription in hand for an antidepressant. Getting the proper thyroid diagnosis that led to better health often required several visits to different doctors, or a consultation with a mental health expert. Psychiatrists, psychologists, and psychopharmacologists are, surprisingly, often better than general practitioners, family doctors, ob-gyns and others at differentiating actual mental health issues from the mood-related symptoms of an untreated thyroid condition.

For some people experiencing depression, getting proper thyroid treatment will resolve symptoms of sadness and depression, and eliminate any need for antidepressant therapy. The depression in that case is a symptom of a thyroid imbalance.

Of course, in some people, there is full depression, coinciding with the thyroid disease. Is the depression totally separate from the hypothyroidism, or did the hypothyroidism contribute to it or make it worse? It’s not often easy to answer that question, but in that case, even proper thyroid diagnosis and treatment may not fully or partially resolve the depression. For patients who experience lasting depression after thyroid problems are addressed, proper treatment for the depression is needed. That may include a referral to an expert mental health professional, talk or cognitive therapy, self-care options such as exercise and herbal supplements, and/or prescription medication. Your practitioner will be able to advise regarding treatments appropriate for your situation.

(July 2006)

 

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This entry was posted on Monday, April 30th, 2007 at 3:49 pm and is filed under Mary J. Shomon. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.