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 or some other physical component. The mind and the body influence and impact each other in many, many ways.
When a patient complains of feeling a lack of energy, one must consider how much of the problem is psychological and how much is physical. There are are at least two diagnoses which have symptoms such as tiredness, loss of energy and seemingly unexplained weight gain: Hypothyroidism and Depression.
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, a family history of depression, and will consider the demographics of the person.
I know for instance that 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. Neither the best psychological care nor an anti-depressant can cure thyroid disease, but a good psychological evaluation can and should be able to help identify when symptoms are more mind or more body.
Weight gain is another symptom that may be due to depression or hypothyroidism. It can also be the result of a physical process put into motion by stress. We know that some people attempt to cope with stress by eating. Stress impairs our ability to think clearly and make wise decisions about food choices and weakens our abilities to resist temptation. Stress also amplifies the reward seeking system in our brains.
Stress also causes the production of chemicals which, among other things, encourage more and fuller development of abdominal fat cells. This chemical reaction, in combination with more high calorie comfort or junk food, results in weight gain.
And, whether eating more or not, some stressed individuals may seek “comfort food” in particular; foods which remind them of times when they felt nurtured and comforted. Many comfort foods and food items people chose when stressed are often high in carbohydrates and this may be due to the fact that eating carbohydrates increases the level of serotonin in the brain which produces a feeling of calm. Anti-depressant medications also alter the level of serotonin in the brain.
Another physical thing that stress does is cause the release of the hormone cortisol. And, excessive or prolonged exposure to cortisol can cause the body to develop a decreased sensitivity to cortisol over time. This results in an inadequate ability to regulate the body’s inflammatory process.
Research has found that chronic inflammation is associated with an overall poor immune response, as well as with some specific physical health problems such as heart disease and mental health problems such as depression. A recent study found that when anti-inflammatories are prescribed in conjunction with antidepressants, the response to treatment is improved.
From the above snipets about thyroid disorder and depression, as well as stress, inflammation and depression, it should be abundantly clear that the mind and the body, the emotional and the physical, are intimately intertwined. Treating one without paying attention to the other is like having only a hammer as a tool.