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    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
    can not 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.
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