Depression is the most common condition seen in general medical practice. About 10% of people experience depression over a lifetime. Studies show that up to 50% of patients with depression have a physical disorder that is either a direct cause of their depression or a major contributing factor.
Successful treatment of the underlying medical condition can bring relief of depression most of the time. Despite this fact, if the medical history does not reveal any obvious cause of depression doctors often skip the physical examination and prescribe anti-depressants in the majority of cases.
If you are depressed would you really not want to explore why you are depressed? Could it be your relationships or a neurotransmitter problem? Do you have emotional eating issues or underlying thyroid imbalance? Or could it be an overload of heavy metals or toxic chemicals you have accumulated in your body?
This treatment approach obviously takes more time and work than just handing out a prescription for an antidepressant, however it can give you a much more satisfying answer and better treatment outcome.
Based on medical history and a physical examination a doctor can usually order simple and inexpensive laboratory tests that can help to diagnose such disorders as hyperparathyroidism, subclinical hypothyroidism or nutritional deficiencies that can contribute to depression and could not be detected otherwise.
Physical and mental symptoms of thyroid disease often mask other illnesses that can lead to misdiagnosis or it can take a long time to find the real cause of depression. In many cases it can also be difficult to determine if an illness causes depression or the depression caused the illness.
Causes of Depression
There are 59! physical causes of depression that can be misdiagnosed as a psychological condition and should be ruled out first before anyone is put on antidepressant. Possible causes of depression can be mental, physical or environmental and include following conditions:
- Stressful life events or major life changes such as divorce, death of a loved one, financial struggles, moving, getting married, job change, retiring etc.
- Chronic stress
- Myxedema which is an advanced form of hypothyroidism
- Non-insulin dependent diabetes
- Negative thought patterns and beliefs
- Low self-esteem
- Leaky gut syndrome
- Pernicious anemia with low vitamin B12 levels
- Low folate
- Imbalances in brain chemicals and hormones
- Lupus can cause achy joints, depression and multiple psychiatric symptoms
- Celiac disease and gluten intolerance are directly linked to depression mainly due to nutritional deficiencies
- Lack of control over circumstances can make a person feel helpless and hopeless
- Huntington’s disease
- Any kind of chronic pain
- Coronary atherosclerosis and heart surgery
- Genetic predisposition and family history of depression
- Pancreatic cancer can lead to subtle symptoms including severe depression
- Altered brain structure and function including after a cerebrovascular accident
- Parkinson’s Disease
- Sugar addiction
- Addison’s disease
- Cushing’s syndrome makes about one third of patients deeply depressed and sometimes leads to a suicidal depression
- Postpartum depression that can occur within three to six months after a women gave birth or after a miscarriage
- Seasonal Affective Disorder when depression occurs due to sun light deprivation during the winter and low levels of vitamin D
- Erectile dysfunction that can be a consequence of other disease such as MS, diabetes, anemia or side effect of certain drugs
- Hashimoto’s disease
- Chronic fatigue syndrome (CFS)
- Multiple Sclerosis (MS)
- Hyperparathyroidism that can cause severe depression years before it is diagnosed
- Wilson’s disease a genetic condition found in young people when an excess of copper accumulates in the brain. If they can exibit only a symptom of depression then the disease is often misdiagnosed for other psychiatric disorders
- Drug dependence
- Alcohol dependence
- Substance abuse can cause a major depression in about 30% of cases
- Partial Complex Seizures (PCS) is a form of epilepsy when a person can get suicidal and is often misdiagnosed for primary depression
- Normal pressure hydrocephalus is a brain disease that is most common in elderly people and is accompanied by depression
- Panic attacks can be psychiatric or result in depression due to physical factors
- Iron deficiency can lead to depression
- Reactive hypoglycemia
- Allergies such as food allergy to gluten can be a cause of depression
- Pheochromocytoma is a type of tumors that can cause severe depression
- Unhappy relationships
- Physical, sexual and emotional abuse
- Unexplained symptoms and undiagnosed illness where depression is a common reaction
- Certain medications can cause depression as a common side effect
- Other personal problems such as social isolation, mental illnesses, being away from the family and friends
- Lyme disease
- Head trauma or injury
- Sleep disorders and insomnia
- Dysbiosis, intestinal imbalances and candida overgrowth
- Ovarian failure
- Testicular failure
- Lack or less often excess of any steroid hormones such as estrogen, progesterone, DHEA, testosterone, pregnenolone or cortisol
- Infertility can cause depression that is often worsened by a thyroid imbalance
Types of depression
Atypical depression is a common form of thyroid related chronic depression that occurs in hypothyroidism. The symptoms can be mild to severe, but overeating and oversleeping are important criteria that help to establish a diagnosis. Some women can also experience anxiety attacks, severe lethargy and fatigue that has a tendency to worsen in the evening. A woman often does not realize that she is depressed but suicidal thoughts are uncommon. This type of depression can be resolved with adequate thyroid hormone therapy.
Dysthymic depression or chronic blues is a form of chronic depression that does not involve impaired thyroid function and affects about 6% of the general population during their lifetime. Women are usually unaware that they have depression, tend to overeat, however their appetite can be increased or decreased. Other symptoms can include fatigue, poor concentration, insomnia, low self-esteem, feeling hopeless and down but able to function.
Major depression is a severe feeling of disconnection from the surrounding world that can be accompanied by suicidal thoughts. Women can feel neither sad or happy, have insomnia and loss of appetite. Having hypothyroidism puts women at higher risk to develop a major depression even when a minimal thyroid imbalance occurs.
Manic depression or bipolar disorder can be triggered by a combination of genetic and environmental factors. It affects brain chemistry and is characterized by unusual changes in the mood, energy and ability to function. The term bipolar disorder refers to a switching of person’s mood and alternating between “poles” of manic and depressive episodes. Some people with mixed bipolar disorder can have both episodes together when a person feels depressed but energized at the same time.
Thyroid related depression
Depression is a very common symptom when any of endocrine glands such as thyroid, adrenals, ovaries or testicles, pancreas, parathyroids, pituitary or pineal glands malfunction and release too much or too little hormones.
Hypothyroidism is most common of these disorders and can either be a cause of depression or a major contributing factor.
Both hyper- and hypothyroidism cause physical symptoms and can lead to depression. The thyroid gland produces hormones that reach the brain and stimulate chemical reactions that support a feeling of psychological well-being. Adequate levels of thyroid hormones are absolutely necessary for regulation of the wide range of brain functions.
If the brain is oversupplied or deprived by thyroid hormone due to thyroid disease it can take a long time to recover. Due to low thyroid hormones a person can develop mild hypothyroidism and feel emotionally depressed or burned out. Thyroid disease can also worsen already existing depression creating a vicious cycle that unfortunately is often missed, misdiagnosed or not completely understood by many physicians. In addition, mental symptoms of hypothyroidism vary from person to person making it especially difficult to diagnose in borderline and low-grade cases of depression.
Depression and thyroid autoimmunity
The effects of depression on the immune system are similar to those that are caused by stress and include immuno-suppression that can trigger autoimmune disorder. Recent research studies show that there is a direct connection between depression and Hashimoto’s disease:
- Stress that often precedes depression can trigger overreaction of the immune system that can result in the autoimmune Hashimoto’s disease and progresses to hypothyroidism.
- Women with Hashimoto’s disease who have normal lab test results and are around perimenopause or menopause are affected by depression 3 times more often than those without thyroid imbalances.
- Even if their thyroid hormones are normal, women who develop postpartum depression are more likely to develop Hashimoto’s disease later on in their life as compared to those who did not have postpartum depression.
- Women who are hospitalized for depression have higher incidence of Hashimoto’s disease even if their lab test results are normal.
- Another study reported that autoimmune thyroid disease was observed 3 to 4 times more often in people with anxiety and mood disorders.
Thyroid imbalances are often unsuspected because fatigue, depression, stress, anxiety, emotional and mental issues, gynecological and hormonal imbalances can mask hypothyroid symptoms and many thyroid patients do not realize that they have depression. Major hormonal changes such as perimenopause and menopause and other hormonal imbalances such as PMS make women more vulnerable to depression, hypothyroidism and Hashimoto’s disease during this times.
Estrogen has many effects on the major neurotransmitter pathways. Women with healthy estrogen levels respond better to anti-depressants than elderly and those who are going through major hormonal changes such as menopause and/or have suboptimal estrogen levels. Often low estrogen is the missing link in the treatment-resistant depression in women.
Depression is also one of the symptoms in premenstrual syndrome (PMS). According to studies conducted by Dr. G.E. Abraham, there are two types of hormonal imbalances during PMS that can lead to depression:
- The most common form of PMS is characterized by high estrogen and low progesterone when a woman has tension, anxiety, irritability and cravings for sugar and dairy. In this case she usually responds well to bio-identical hormone therapy with progesterone and/or supplementing with vitamin B6 that raises progesterone and lowers estrogen.
- Less common type of PMS is when premenstrual levels of estrogen are low and progesterone is high. A woman can experience mental confusion, social withdrawal and severe to suicidal depression that can be alleviated by using estrogen patch.
Heavy or irregular periods due to hypothyroidism or loss of periods caused by hyperthyroidism that accompany depression are often misdiagnosed for hormonal changes and mistakenly attributed to peri- and menopause. When progesterone and estrogen therapy make the symptoms worse testing thyroid function can reveal the real cause of cycle disturbance and mood issues.
Do you need an antidepressant?
Although thyroid imbalances can cause depression, mood disorders and anxiety in most cases you will not need a psychiatrist. Women who have depression and hypothyroidism generally respond well to thyroid therapy and depression clears once thyroid imbalance is corrected. Diagnosis of hypothyroidism and adequate thyroid hormone therapy can also prevent major depression from progressing.
If thyroid dysfunction remains untreated conventional antidepressants will not help to alleviate depression.
Studies show that about half of patients who have major depression and do not respond to antidepressants have mild or subclinical hypothyroidism.
If a woman is depressed or had experienced depression before in her life she should get her thyroid tested especially if she has other thyroid symptoms.
According to Dr. Ridha Arem, in those who have depression and were diagnosed with hypothyroidism, thyroid treatment should be initiated first for 3 months. However, in some cases when hypothyroidism remained undiagnosed for long period of time, thyroid medication alone may not completely resolve depression and it may require additional treatment. If this is the case there are two options:
- Your doctor can add an antidepressant such as selective serotonin uptake inhibitor SSRI for 6 to 12 months
- Use a combination T4 and T3 thyroid therapy
If major depression is accompanied by hypothyroidism both thyroid therapy and antidepressant should be started immediately after the diagnosis was made. If a woman still has symptoms of depression after 3 months of treatment, switching to a combined T4 and T3 thyroid medication can resolve it.
If thyroid function is restored and symptoms of depression are alleviated for 12 months your doctor can consider stopping the antidepressant. If depression reoccurs and the thyroid function remains optimized and stable the antidepressant treatment should be resumed.
As one of the main components of the brain chemistry, active thyroid hormone T3 also affects serotonin production that is responsible for sleep, mood and emotions.
Thyroid medication can help people with depression and anxiety to stabilize their brain chemistry when conventional antidepressants have failed.
In opposite, untreated thyroid imbalance can progress to a destructive brain chemistry disorder accompanied by major depression, anxiety disorder or manic-depression.
Adding T3 medication can help with depression if it is caused due to brain hypothyroidism:
- Serotonin imbalance is an important factor that can cause depression. Brain chemicals especially serotonin and noradrenaline depend on the adequate levels of active thyroid hormone T3. Low T3 in the brain result in decreased serotonin levels and also makes noradrenaline work insufficiently that can be a chemical cause of depression and brain hypothyroidism in some people.
- Any problem with delivery of T3 to the brain can result in brain hypothyroidism and a variety of mood disorders ranging from depression to attention deficit disorder even with a normally functioning thyroid gland.
- In many patients low levels or abnormal distribution of T3 in the brain even when thyroid test results show normal levels in the blood, can be the cause of brain hypothyroidism and their depression.
- Impaired conversion from T4 to T3 or inability of T3 effectively regulate brain function can lead to brain hypothyroidism and depression
To some extent antidepressants can also help to restore normal levels of T3 in the brain. For example, Prozac supports the conversion of T4 into T3 in the brain raising T3 and serotonin levels and alleviating depression.
You can read more about causes of depression and other mood disorders associated with thyroid dysfunction, emotional and mental effects of thyroid imbalances and how to correct them in FREE Report Tips To Treat Depression
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