Tuesday, February 28, 2012

Mimicking Depression

There are two medical conditions that frequently show up in psychologists’ office as depression. These medical disorders outwardly mimic depression (and may even cause depression), but have distinctly different causes, and, untreated, can endanger a person’s health. If you are experiencing depression symptoms, you may want to consider seeing a physician, not for antidepressant medications, but rather to be checked for other problems that may mimic depression.

When I was in graduate school we were frequently reminded to consider hypothyroidism (insufficient release of thyroid hormone) in women who presented with depression. Both cause lethargy/fatigue and hypersomnia (sleepiness), are associated with physical pain in the joints and muscles, and involve lack of motivation, anhedonia (loss of enjoyment in things which use to be enjoyable), negative mood states (e.g., sadness, regret, or anger), mood swings, and weight gain. Many of the symptoms of hypothyroidism mimic depression and it is consequently frequently under-diagnosed, or misdiagnosed as depression.

No amount of anti-depressant medication will make the symptoms of hypothyroidism go away. Thyroid hormone affects many other bodily functions and low levels can negatively affect multiple organ systems. Untreated hypothyroidism can lead to goiter and heart problems and can even cause birth defects if a pregnant woman has hypothyroidism, so proper diagnosis is very important. More women than men present with depression symptoms, so awareness of this mimicking phenomenon is drilled into psychologists in grad school. However, it is also important that women be aware of the similarity so that they know to consult a physician (perhaps in addition to a psychologist) if they experience symptoms of depression.

Perhaps because men present for depression less frequently than women, being able to distinguish medical disorders from mental disorders is less emphasized in grad school. If a man presents with difficulty attaining or maintaining an erection, lack of sex drive, irritability, mood swings, negative mood states (e.g., sadness, regret, or anger), difficulty concentrating, lethargy/fatigue, a lack of motivation, and weight gain the psychologist is likely to diagnose depression, whereas the medical doctor will probably evaluate testosterone levels. These symptoms are common to both disorders and both would be reasonable diagnoses given the respective experts’ fields.

Many of the symptoms that might allow for differential diagnosis are not likely to be mentioned by men over 35 to either a psychologist or a physician. Hair loss is normal as a man ages, but is also accelerated by low testosterone. The development of fatty tissue in the breast/chest area probably also isn’t going to have attention called to it when presenting to a health professional—either because it is embarrassing or because it won’t even be noticed with the rest of the weight gain. But these are some of the things that can be used to assess if a man is suffering depression or low testosterone. Sometimes, though increasingly less so, male clients will not tell their psychotherapist or counselor about sexual dysfunction either. Even in the absence of these symptoms I have encouraged some of my male clients to have their testosterone levels checked.

Decreased testosterone is normal for a man over 40, but sometimes there is a precipitous drop in testosterone levels and that will lead to depression-type symptoms, along with health risks. Low testosterone is associated with heart problems and even susceptibility to broken bones. And, like hypothyroidism, anti-depressant medication will not address the symptoms, not even the mood symptoms, effectively.

Along with the normal drop in testosterone, there is a natural drop in sexual function and energy, which may be perceived as the normal part of aging—and for many it is—but even many physicians are not trained to ask about the effects of lessened testosterone in a way which would indicate lower-than-normal-for-age testosterone levels. It is important that men be aware of the symptoms and question the severity of the drop (and the mood features associated with low testosterone) in order to take care of themselves.

There is some controversy whether hypothyroidism and low testosterone mimic or actually cause depression. To me the distinction might be irrelevant. If after taking the medication the depressive symptoms do not go away after a few weeks, you might want to see a therapist to address whatever depression may have followed the body chemistry problems from the physical disorder. If the depressive symptoms go away from treating the primary physical problem, then the depression has gone anyway. But the main point is that, like with so many physical disorders, it is important to know to consider with the medical or mental health professionals all of the possibilities.

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