Is It Depression?

Abraham Maslow, founder of humanistic psychology said, “When the only tool you have is a hammer, it is tempting to treat everything as if it were a nail.”  Psychologists, with The Diagnostic a Statistical Manual of Mental Disorders run the risk of treating all complaints as manifestations of psychological disorders, when in fact they may have a medical basis.

When a patient complains of feeling a lack of energy, many thoughts come to mind. Among those are two distinct diagnoses which have similar symptoms: Hypothyroidism and Depression. In both of these the symptoms such as tiredness, loss of energy and seemingly unexplained weight gain tend to develop gradually.

In order to make the right diagnosis I will inquire about a family history of thyroid disease (and other health problems) and will ask about the presence or absence of any other symptoms of hypothyroidism which are not common in depression. These include dry skin, hair loss, a puffy face and notable cold intolerance.  I also ask about substance use and a family history of depression.

Hypothyroidism is five times more common in women than men in the 30-50 year age range.  Overall it affects 10% of all women and the prevalence increases as we age.  Of those women in the 35-44 year age group the incidence is only 6%.  But the rate is more than 20% among women in their mid-70s.  Given these rates, in the USA it is estimated that more than 3 million women ages 45-64 have undiagnosed and therefore untreated hypothyroidism.

Unlike many other chronic health problems, African American women are far less likely to have hypothyroidism compared to white or Hispanic women.  However, knowing the symptoms and statistics is not sufficient to definitively make the diagnosis of hypothyroidism; in order to get a diagnosis one must have a blood test.  Hypothyroidism can be accompanied by high cholesterol levels and, if left untreated, can cause high blood pressure and infertility.

Treatment of hypothyroidism just involves taking a synthetic thyroxine replacement. The best psychological care cannot cure thyroid disease, but a good psychological evaluation can and should be able to help identify when symptoms of depression may be caused by hypothyroidism.

For more information on depression visit the National Institute of Mental Health web page on Depression.