It’s OK to tell people you are depressed. There is no shame in it. Depression happens to many people whether rich or poor, famous, infamous, or anonymous. Depression can be life-threatening, as in the case of the beloved Robin Williams, who took his own life and so many more people who take their lives every day. California Secretary of State Debra Bowen came forward in the media to declare that she has struggled with depression for many years.
But is your depression actually a brain malfunction? Depression can have other causes. Before you run to your primary care physician or a psychiatrist to be assessed for a mental illness, there are some other factors in depression you should be aware of before you start taking any mind-altering medication.
The wrong medication just won’t work. And if you aren’t actually experiencing depression from a brain-related deficiency, medication can trigger new problems and serious side effects. Hypothyroid can cause severe fatigue and depressive symptoms which will not be relieved by taking an anti-depressant.
The reason that a hypothyroid depression will not be helped much by anti-depressant therapy is that the most common anti-depressants work in the brain to increase the level of feel-good chemicals such as dopamine and serotonin. People who are hypothyroid do not produce enough thyroid hormones. The brain chemistry might be altered, but without fixing the underlying thyroid problem, the root cause of the depression will never be fixed – no matter if your doctor adds anti-depressant aids like Abilify.
DSM-IV indicates psychological diagnosis should include other medical problems, but doctors don’t often do their part. You can consult WebMD’s “Tests used to diagnose depression.” Did your doctor skip any steps? Thyroid function is checked via a blood test which is relatively simple. Hypothyroid has many symptoms in common with depression, so getting a blood test is vital. And if you have had a blood test you were told is “normal,” ask to take a look at the numbers. As for depression, there is no blood test which reveals levels of dopamine or serotonin.
Many people are not aware that in 2003 the normal range of thyroid stimulating hormone – TSH – was adjusted from .5 to 5 to a new normal of .3 to 3, according to the American Association of Clinical Endocrinologists. While this increased the number of people eligible for treatment, doctors and testing laboratories are slow to catch on. Primary care physicians are strong-armed by insurance companies to treat as much as they can themselves before making referrals to specialists as a cost-saving measure, even conditions about which general practitioners do not have a solid grasp.
Just to muddy the waters, women trying to conceive or who are pregnant have even narrower TSH windows, as TSH levels above 2.5 are associated with miscarriage. Thyroid dysfunction can cause infertility, something a reproductive endocrinologist is trained to detect and treat. But TSH levels don’t provide the full story, and it’s wise to also test T4, T3, and free T4 which test additional thyroid functions.
The 2011 New York Times article, “For some, psychiatric trouble may start in the thyroid,” addressing the relationship between thyroid and depression got the numbers wrong. The reporter does not appear very knowledgeable outside of the information given, so do not rely on the article beyond the woman who states that her symptoms of depression lifted when she began taking thyroid hormone. Additionally, the article does present reliable information about a 2006 study in which Chinese scientists found that treating subclinical hypothyroid improved cognitive functioning. Quite frankly, it ought not take a formal study, but verifying improved cognitive function with hypothyroid treatment via an MRI does sound cool.
Where doctors get their information about diseases and treatments may affect their decisions about your care. Watch TV for the day, and multiple ads for anti-depressants appear. Doctors experience direct marketing in the form of drug representatives who bring free samples and information about new drug therapies. However, not one of those new therapies will be related to the thyroid. Hypothyroid treatments are old news with few options, the last of them, levothyroxine, hit the market in the 1940s. Meanwhile, the popularity of anti-depressants rose dramatically with Elizabeth Wurtzel’s “Prozac Nation” which became a bestseller and a Hollywood film starring Christina Ricci in the less distant 1990s.
About.com features a full “Hypothyroidism risk/symptoms checklist” you can print out and take with you to a medical appointment. Here are some common signs you might have a thyroid condition:
- Depression, fatigue, or feeling tired all the time.
- Crying for no apparent reason. (Just as babies cry when tired.)
- Difficulty concentrating.
- Weight gain or inability to lose weight.
- Cold intolerance, or feeling cold all the time.
- Hoarseness or gravelly voice.
- Puffy face, eyes, fingers, and feet. You might think you don’t retain water, however, you might see bags under your eyes along with your rings and shoes feeling tight.
- Dry, brittle hair and nails.
- Dry, gritty eyes.
- Hair loss.
- Heavy, painful menstrual periods or severe PMS.
- Cold intolerance, feeling cold, or low body temperature.
- Infertility, or frequent miscarriages.
- Worsening allergies.
- Achy muscles and joints – do not allow this to be passed off as “fibromyalgia” if you have the above symptoms.
- Twitchy eye muscles, or tics.
- Light sensitivity.
- Slight to severe constipation. Your symptoms may be as minimal as firm stools and uncomfortable bowel movements while still using having a daily bowel movement.
- Swelling in your neck or goiter. (You may not have this at all.)
Symptoms such as puffiness in the hands and feet or hoarseness may be worse in the morning. While younger people do not typically have thyroid problems, do not allow age to be the deciding factor in obtaining a blood test. Don’t fool yourself into thinking that these symptoms can be relieved by vitamins or popular beauty treatments for hair, nails, or bags under the eyes. You might relieve one or two symptoms with some over-the-counter treatments such as drops for dry eyes, but you won’t really get better. And these symptoms will not be relieved by anti-depressants.
On a personal note, I presented these symptoms to doctors on numerous occasions and could not get a blood test. I was sent to a psychiatrist, or a psychologist, and diagnosed with anything from depression to ADHD, PMDD, and fibromyalgia. I was told I was too young to have thyroid problems until I was in my 30s. Instead, they tested for Epstein-Barr virus, which causes mono.
All of my symptoms were explainable with a diagnosis of hypothyroid and all disappeared with thyroid hormone treatment when I was finally diagnosed in 2013. I honestly feel a bit cheated by the system that I was dismissed and misdiagnosed for many years. I don’t want that to happen to you. In fact, I would tell Debra Bowen to get a complete thyroid workup if she were my friend.