Maybe it's not Depression

[shutterbug]

Maybe it's not Depression
From Leonard Holmes, Ph.D.,
www.mentalhealth.about.com


Imagine that you have the following complaints:

You are tired all the time
You have no motivation for things you once enjoyed
You are eating more (or you have lost your appetite)
You are lacking energy
You are sleeping a lot (or you have trouble sleeping)
You are depressed and/or anxious
Your doctor might diagnose depression - and he or she may be right.
While these symptoms are often caused by depression, thyroid problems and chronic fatigue syndrome can also result in these symptoms. It's even possible (although probably less likely) that you have fibromyalgia, sleep apnea, or an autoimmune disorder such as rheumatoid arthritis or lupus. I will give you some very sketchy information on these diagnoses. About.com has complete sites covering these disorders. Please visit the above links for more comprehensive information and for complete communities of persons who have these disorders or are interested in them.

Thyroid Problems can result in either weight loss and feelings of anxiety or weight gain and feelings of depression. They can can also result in a complex mix of symptoms that don't seem to make sense. Mary Shomon, About.com's Thyroid Guide, can help you sort out these symptoms. The traditional model of thyroid function suggests that hypothyroid - low thyroid - results in depression and weight gain; while hyperthyroid - high thyroid - results in anxiety and weight loss. The traditional treatment involves medications which bring your body chemistry under control. Mary's site does an excellent job of explaining the exceptions to this model and helping you understand your thyroid.

Chronic Fatigue Syndrome remains a controversial diagnosis in some quarters. The NIH is funding research on this syndrome, and other research is going on worldwide. The National Institute of Allergy and Infectious Diseases defines Chronic Fatigue Syndrome as:

a pronounced fatigue that comes on suddenly and is relentless or relapsing, causing debilitating tiredness or easy exhaustion in someone who has no apparent reason for feeling this way. (Chronic Fatigue Fact Sheet 10/99)

They write the following about the cause:

Several different routes to chronic fatigue syndrome may exist. In some people, a persistent viral infection may provoke CFS symptoms, and virologists continue to explore this possibility. Vulnerability to CFS may be associated with a subtle immune system defect. It also appears likely, however, that CFS involves interactions between the immune and central nervous systems, interactions about which relatively little is now known. Scientists' concerted efforts to penetrate the complex neuroimmunologic events in CFS have created a challenging new concept of the pathology of this and other illnesses. (Chronic Fatigue Fact Sheet 10/99)

Fibromyalgia seems to overlap with chronic fatigue, but persons with this disorder also have sleep disturbance and chronic pain. The disorder is usually diagnosed by tender points in certain muscles which respond with pain when touched a certain way. Sleep disturbance is common in chronic fatigue and in fibromyalgia. Some research suggests that we need deep (stage 4) sleep in order to repair our bodies on a regular basis. A disruption in this stage of sleep may contribute these conditions. Carol Eustice, the Arthritis Guide has more information on this disorder.

Autoimmune Disorders involve the immune system attacking the body rather than attacking germs and other invaders from the outside. Rheumatoid Arthritis and Systemic Lupus Erythematosis (Lupus or SLE) are examples of autoimmune disorders. Autoimmune processes have also been implicated in diabetes and multiple sclerosis (MS). These disorders almost always involve a complex symptom picture which can include depression. They aren't nearly as common as depression, but they can cause similar symptoms.

Sleep Disorders such as obstructive sleep apnea can also many of these symptoms. If you snore, or if you are aware that your sleep is disturbed you should look into these disorders.

Depression remains a more common cause of most of these symptoms. People are complex. It is important to remember that people can have more than one diagnosis at a time. There are certainly people who have both clinical depression and low thyroid, for example. Some symptoms are more common in one disorder than the other, and this can help you begin to explore what diagnosis might fit you best. People with hypothyroidism, for example, frequently gain weight. This can happen in depression, of course, but it is even more common with low thyroid. People with chronic fatigue can be depressed, but it is also common for them simply to be very tired (and not the least bit sad).

Your best bet is to work with your health care provider in exploring your symptom picture. Lab tests can help make a definitive diagnosis in some cases. Knowledge really is power, though, and using reputable sites on the Web can also help you sort out these issues.


Elsewhere on About
Thyroid.about.com
Sleepdisorders.About.com
Arthritis.About.com
Depression.About.com
ChronicFatigue.About.com
Fibromyalgia Clinical Trials

[OCEANANGEL]

Hi there...I can't stop reading...there is always another thread more informative than the last. I was wondering if anyone has a suggestion(s) for how to get doctors more interested in giving the patient further tests...and perhaps even an MRI...to help rule out other physical ailments...which could be contributing to the mood swings my daughter is having. They just "decided" that it's all a mental health issue...but I am concerned that she may have some other medical problem that no one is ever going to know about...due to the fact that no one is looking. I cannot take my daughter to the doctor myself because she becomes so violent that she is an inpatient at a mental health facility. I am working with Kaiser...but they don't seem to care about checking her for other medical problems. I just remember my father and also a man at my office whose diabetes got out of hand...and they became impossible to be around. My father was mean, angry and would say horrible things when his sugars were out of whack...I tried to get someone to set up tests for my daughter...but they won't do it.
I feel like something is being missed. What if her mood swings are being caused by something else?
~OceanAngel

[fuster]

Problem with addicts of any sort is they read this and think they have it. They read a thread somewhere else that describes some other condition, and voila', they identify with a bunch of symptoms and think they have that too.

Information is useful, but doing this in your head by reading and thinking without doing that all important consultation with an expert, face to face, is basically putting yourself into "enemy territory" (i.e., your own mind).

Chronic fatigue syndrome is something that might be diagnosed by process of elimination, not by pinpointing it. In other words, if they cannot find something else wrong and they have tested for all the obvious stuff, they might consider this diagnosis because they can't diagnose anything else. That being said, even if they did consider it, depression would not necessarily be ruled out but could be co-occurring. My understanding of CFS is that it contains physical symtoms beyond those found with depression, but they have to rule out other disorders. In addicts, liver problems probably would be looked at first.

[Don W]

Shutterbug, Thanks for pointing out that one needs to consult a professional when dealing with these symptoms. A physical ailment must be eliminated. Like fuster mentioned, there was a time that each time I read symptoms I'd start to think I had that also. I think this is why I feel it is VERY important to be upfront and honest with your doctor. Working in the medical field, I can tell you they are just cracking the surface of the mind/brain. So many of these mental issues can mimick each other. A good example is my sister. For years she was treated as a manic depresive. The problem was she hid her drinking from the doctors. Once she recieved treatment for alcoholism the symptoms disappeared. I met a person one time that had spent years in Bridgewater, Mass. Mental Institue. One he was there and away from alcohol his mental issues disappeared. The problem being, it took him almost 2 years to get released. Today, he has gone to college and is a professor at one of the local universities. When alcohol has been involved, a physical check up is important. Simply removing the alcohol won't cure some things. I say this because many of us have self medicated ourselves with alcohol.

[shutterbug]

Fuster....i always advocate seeing a doctore, but doctors are human too and i think self educations is VERY important.

WHY??? Because here I am....clinically diagnosed as bipolar and major depressive, and yet I have MANY physical symptoms such as severe fatigue and pain (like i wake up feeling like i've been ran over). I've emersed myself in learn about my bipolar disorder and depression over the past year and now i'm starting to realize that most bipolars and major depressives don't have this physical pain. And in all my research, I don't remember where severe fatigue and physical pain are listed as symptoms of either.

So i'm having to look else where to see what the doctors have apparently missed or misdiagnosed because in a year....i have not been very responsive to any of the meds that have been tried on me. And i've been in weekly counseling for the past 14 months too.

I was also diagnosed with sleep apnea, which my origninal psychiatrist said can totally mimic bipolar disorder and he's had to take patients off of meds once they got their sleep apnea under control because they were fine. I used my sleep machine religiously for like 6 months or more and felt better, but still had so many daily problems that I know there's something else besides just sleep apnea going on here.

And my family has a history of thyroid disease...my aunt has a very rare thyroid disease called Graves Disease and her mother (we believe) died of untreated diabeties.

Anyway...my aunt on my dad's side was also diagnosed with fibromialgia. And that....in addition to being tested once again for the thyroid functioning.....is why i'm headed back to a physical doc as soon as i can afford it.

Anyway..........my whole point is KNOWLEDGE IS POWER...........learning about stuff and taking that to your doctor is NEVER a bad thing. Doctor's don't spend 24/7 with you or in your shoes so you know best how you are feeling and verbally i don't do well explaining things to people. I told my original psychiatrist that i feel like i'm walking around wearing a cement coat and he said "That's why you need to excersize and lose the weight." I wanted to SCREAM! I've been over-weight for about 6-7 years now and i know what that feels like compared to this....and if a psychiatrist as good as him couldn't understand that....then this must be more of a physcial problem than a head problem - the feeling so tired and in pain all the time.

It's very possibly that i could have fibromialgia, bipolar disorder, major depressive disorder and the sleep apnea.....oh, and along with the other diagnosises of ADHD, PTSD and social anxiety disorder. But that's just too much to be wrong with one person. I'm just trying to figure this crap out and thought i'd share some info i found.

And i'm not advocating pinpointing FM or CFS as a root of all problems. This is the mental health forum and most people who come here have already recieved diagnosis's such as bipolar and such. This is just kind of added reading to say hey.....so many things mimic mental illness....that it doesn't hurt to explore all avenues.

[splendra]

good article thanx ((((shutterbug))))

[gelfling]

Again, Shutter, you've taken time to educate all of us. Thanks Sweetness. I am one of the people who had sleep apnea, (couldn't use the c-pap and had 2 surgeries to correct it), been diagnosed with fibromyalgia and chronic fatigue and rheumatoid arthritis and depression. I have 47 of the 58 symptoms of an underactive thyroid, but my labs say otherwise. I was on meds for it before my son was born for abut 7 years. The doc will not prescribe meds for me. Says until my labs say differently, he can't do it. He's not the only one. I've been to 2 endocrinologists and they all shake their heads and say, yeah, you've got all the symptoms, but we won't prescribe. And it's my gut feeling that if they were to give me meds for the thyroid, most of my symptoms of the other stuff would disappear. But hell no...it's much easier for them to say, "take this pill for this and that pill for the other..." Then the issue of sensitivity to medications kicks in and they again shake their heads and say, "maybe it's all in your head"...the sensitivity and symptoms. This really pissed me off when my internist said this...past internist. But they'll prescribe narcotics and pain killers in a heart beat. And I won't take them.

There are so many illness out there that mimic each other, it's hard to decide what's really going on and most docs don't want to deal with it.

[Don W]

One of the rules I go by now is if I'm thinking about it, I need to talk. I've come to understand my thoughts and feeling don't always make sense. Inside my head they can grow and infect my whole life. What I post or talk in group about is what is in my head. So many years I stuffed them in fear of being ridiculed or confronted. If I believe something and share it, even if it is wrong it is real to me. Sometimes I need to go back and check ones past posts to get a feel where they are coming from. Remember, many of these posts can be taken out of context. The question that arise could already have bee addressed. Again, I'd like to thank everyone for sharing./ Rarely do you not find someone that identify. Also, I find the more I take time to read the entire thread, the question I might have about one's post are answered. I think that someone that speaks of treatment, by their action, shows their belief that a professional should be consulted. It's all a process of elimination in medicene as a hole.
This is why doctor's practice medicene.

[fuster]

Shutterbug: I think you missed my point.......or you would not have made such a lengthy response.

[shutterbug]

maybe i did miss your point.............but i make VERY LENGTHY responses about 90 percent of the time....ask anyone around here.

So what was the point that i missed?

Hugs,
Jenna

[wolflet]

very good info......anyone with some of those symptoms should also look into CANDIDA

esp. the beer drinkers (past or present)...it's a systemic yeast infection (yes, men can have it too)....very diet related with a wide variety of symptoms including deppression, night sweats, bowel disorders, skin disorders, sugar cravings, appetite issues, .....the list is long

because it's very diet related folk with alcohol issues might want to look into it (& others).......not to jump on the "i've got this illness" wagon & spread "hypocondria" issues, but i do have it & it can be treated by a doctor or by natural medicines.........& most folk could benifit from the "diet" that helps control it, esp americans as our diet tends to lead us to "sugar" addiction (sugars being not only sugar, but carbs too)

just more info..take it or leave it

[shutterbug]

((Thanks Wolflet))....never heard of that...i'll look more into it.

[wolflet]

yeah sometimes i wake up feeling like i've "been run over by a truck".....may not apply to you but look it up

[shutterbug]

Just wanted to say that i happened across a magazine article today while waiting to see my head doc and it was talking about fibromialgia, body pains and Vit. D.

It said that 93% of those suffering from unexplained muscle and bone pains turned out to be Vit. D deficient, including those diagnosed with fibromialgia. Vit. D is produced in our bodies when we are exposed to sunlight.

Someone a while back said they often tend to the winter blues by fake baking in a tanning bed....now, after reading about the Vit. D stuff, that seems more logical to me.

What do you guys think?

[shutterbug]

Boy Wolflet most of these sound like me....i'm going back to look for more info about this

Clinical Manifestations of Candida (from www.http://www.doctorfungus.org)

Gastrointestinal. Heartburn, bloating, diarrhea or constipation.
Respiratory allergy. Rhinitis, sneezing and/or wheezing.
Central nervous system. Anxiety, depression, memory deficits and/or loss of ability to concentrate.
Menstrual abnormalities. Severe premenstrual tension and/or menstrual irregularities.
Other Systemic Symptoms. Fatigue, headache and/or irritability.

[shutterbug]

Found this while I's look'n:

Low Folate and Vitamin B12 Linked to Depression
From Cathy Wong, N.D.,
Your Guide to Alternative Medicine.
http://altmedicine.about.com

Deficiency of vitamin B12 and folate may put people at risk for depression and heart disease.

What causes a deficiency of vitamins B12 and folate? The most common are aging and poor diet. Vitamin B12 deficiency is an issue for many older adults, with multiple factors such as poor diet, atrophic gastritis, reduced intestinal absorption, and drug interactions contributing to the problem. Some experts suggest a daily multivitamin to maintain adequate B12 levels.

Folate deficiency has been linked in clinic studies to depression, persistent depressive symptoms, and poor response to antidepressants. One study found that people with major depression had folate levels lower than people who had never been depressed.

In North America, not eating enough vegetables is one major cause of folate deficiency.

Vitamin B12 and folate help lower the level of homocysteine, a derivative of the amino acid methionine that's found in blood.


Homocysteine is thought to contribute to hardening of the arteries (atherosclerosis) and appears to be a risk factor for the development of heart disease. Researchers have also found that people with depression are more likely to have high levels of homocysteine. The fact that these two conditions -- heart disease and depression -- share this finding suggests that they may be related and that vitamin B12 and folate may help prevent and treat these conditions.

Mildly and moderately depressed women are approximately 50 percent more likely to die of heart attacks than other women.

The message? Eat your vegetables. A multivitamin with folic acid and vitamin B12 can also help. If you are taking an antidepressant and not responding to it, consider talking to your doctor about testing your homocysteine level and trying to supplement with these vitamins. It may help.

References

1. Fava M, Borus JS, Alpert JE, Nierenberg AA, Rosenbaum JF, Bottiglieri T. Folate, vitamin B12, and homocysteine in major depressive disorder. Am J Psychiatry. 1997 Mar;154(3):426-8.
2. Morris MS, Fava M, Jacques PF, Selhub J, Rosenberg IH. Depression and folate status in the US Population. Psychother Psychosom. 2003 Mar-Apr;72(2):59-60.

[shutterbug]

And here's a nother'n:

Vitamin for Depression?
From Nancy Schimelpfening,

A Good Vitamin Supplement Could Be Just What the Doctor Ordered
Did you ever wish that you could take a vitamin for depression? Well, for some of you it may be just that simple. There are a variety of vitamin deficiencies that can lead to depression symptoms.

The B-Complex Vitamins

The B-complex vitamins are essential to mental and emotional well-being. They cannot be stored in our bodies, so we depend entirely on our daily diet to supply them. B vitamins are destroyed by alcohol, refined sugars, nicotine, and caffeine so it is no surprise that many people may be deficient in these.

Here's a rundown of recent finding about the relationship of B-complex vitamins to depression:

-Vitamin B1 (thiamine): The brain uses this vitamin to help convert glucose, or blood sugar, into fuel, and without it the brain rapidly runs out of energy. This can lead to fatigue, depression, irritability, anxiety, and even thoughts of suicide. Deficiencies can also cause memory problems, loss of appetite, insomnia, and gastrointestinal disorders. The consumption of refined carbohydrates, such as simple sugars, drains the body's B1 supply.
-Vitamin B3 (niacin): Pellagra-which produces psychosis and dementia, among other symptoms-was eventually found to be caused by niacin deficiency. Many commercial food products now contain niacin, and pellagra has virtually disappeared. However, subclinical deficiencies of vitamin B3 can produce agitation and anxiety, as well as mental and physical slowness.
-Vitamin B5 (pantothenic acid): Symptoms of deficiency are fatigue, chronic stress, and depression. Vitamin B5 is needed for hormone formation and the uptake of amino acids and the brain chemical acetylcholine, which combine to prevent certain types of depression.
-Vitamin B6 (pyridoxine): This vitamin aids in the processing of amino acids, which are the building blocks of all proteins and some hormones. It is needed in the manufacture of serotonin, melatonin and dopamine. Vitamin B6 deficiencies, although very rare, cause impaired immunity, skin lesions, and mental confusion. A marginal deficiency sometimes occurs in alcoholics, patients with kidney failure, and women using oral contraceptives. MAOIs, ironically, may also lead to a shortage of this vitamin. Many nutritionally oriented doctors believe that most diets do not provide optimal amounts of this vitamin.
-Vitamin B12: Because vitamin B12 is important to red blood cell formation, deficiency leads to an oxygen-transport problem known as pernicious anemia. This disorder can cause mood swings, paranoia, irritability, confusion, dementia, hallucinations, or mania, eventually followed by appetite loss, dizziness, weakness, shortage of breath, heart palpitations, diarrhea, and tingling sensations in the extremities. Deficiencies take a long time to develop, since the body stores a three- to five-year supply in the liver. When shortages do occur, they are often due to a lack of intrinsic factor, an enzyme that allows vitamin B12 to be absorbed in the intestinal tract. Since intrinsic factor diminishes with age, older people are more prone to B12 deficiencies.
-Folic acid: This B vitamin is needed for DNA synthesis. It is also necessary for the production of SAM (S-adenosyl methionine). Poor dietary habits contribute to folic acid deficiencies, as do illness, alcoholism, and various drugs, including aspirin, birth control pills, barbiturates, and anticonvulsants. It is usually administered along with vitamin B12, since a B12 deficiency can mask a folic acid deficiency. Pregnant women are often advised to take this vitamin to prevent neural tube defects in the developing fetus.

[shutterbug]

okay....here's the best link i found about Candida. http://www.ei-resource.org/Articles/candida-art04.asp that didn't try to sell you something. I'm not sure about this one though. There are so very many ailments included in the symptoms that it seems like a catch-all, too good to be true, kind of illness....but i'm always open about exploring everything.

(((Wolflet))) Would you mind sharing what diet and other natural treatments have helped you??

[RN92]

Another disease process that has the same symptoms is Iron Deficiency Anemia. I suffered a long time thinking I was just lazy. My iron got so low that the Doc couldnt believe I was still functioning. MD's dont always check iron levels with routine labwork. I was tired, sleepy all of the time. Just sitting or standing up would make me weak. My heart rate stayed above 100 all the time. Muscle burning with any activity, decreased appetite, absolutely NO energy, shortness of breath. If iron storage stays low long enough, your blood count will drop. I required 2units of blood. You may also crave strange things like dirt, detergent. I never did, but it appearantly happens with a lot of people.
As a nurse, I know that generally, Doctors are going to look for the obvious stuff. If they know you have depression (or any other documented illness), they may write everything off to that. You do have to educate yourself so that you can ask the Doctor to check for specific things. Most of them dont mind. They will do it to please you and who knows, they might find something.

[shutterbug]

Originally Posted by RN92

You do have to educate yourself so that you can ask the Doctor to check for specific things. Most of them dont mind. They will do it to please you and who knows, they might find something.

my point exactly....thank you RN....
My doc is now running a thyroid test and other blood tests to check out some other things.

Never hurts to ask....i always say...

[mateo]

Good for you Shutterbug--ask away.

IMO I think docs are often too quick too slap on a psych label without ruling out possible underlying medical conditions. They may not care for your questions, though, -- i have found they tend not to appreciate anything that rocks their boat so to speak...

[shutterbug]

Originally Posted by mateo

They may not care for your questions, though, -- i have found they tend not to appreciate anything that rocks their boat so to speak...

OMGosh...you are SO right! 98% of all my former general docs have been this way and my current pdoc is especially this way. I don't understand why though....no bodies right 100 % of the time and it's the patients time and money so why not listen and try?

[mateo]

Simple answer: I think they take it personally.

They've spent a lot of time (8+ years of education?) and money becoming medical professionals and i believe they start to think of themselves as having all the answers... even when there are many areas of science and medicine that still have large "unknown" areas. For example, we know more today than ever about how the human brain functions, yet there is still much we don't know. If you read the smaller print about many medications, you will often see statements to the effect of "although we are not exactly sure how Med X works for Disease Y, studies have shown it to be effective in treating the symptoms".

That, and the fact that they deal with dozens of mental patients everyday with more than their share of quirks who may or may not respond to meds the way they hope has got to be frustrating... There is often a high rate of burnout in many of the helping professions.

[splendra]

(((shutterbug)))

The article that you posted about candida refers to the work done by William Crook who is the person who wrote the book "the yeast connection" the book will tell you how to and what to eat to rid yourself of candida. Dr. Crook believes that many people who suffer with candida have had long term courses of anti-biotics and also birthcontrol pills. Basically though the "candida diet" is about no sugar or carbs. It is not a diet that you can stay on for long periods of time. It will make you loose weight and it will also make you be able to tell what foods contribute to the condition of candida. The "bad foods" will make your tongue burn when you are cleaned out of candida and they might also make you congested...

[shutterbug]

Thanks mateo and Splendra