Depression

Depression (Photo credit: Wikipedia)

THE REAL CAUSE IS OFTEN A TREATABLE MEDICAL CONDITION

Many people suffer from “depression.” Many of our patients complain that they are depressed. Of course, if the substance they are ingesting is a central nervous system depressant, like alcohol or opioids, then this will certainly lead to feelings of depression.

However, what is depression? People with a varied set of symptoms label their condition “depression.” For our purposes, we will use the symptoms set forth by the National Institute of Mental Health. They are:

Ongoing sad, anxious or empty feelings
Feelings of hopelessness
Feelings of guilt, worthlessness, or helplessness
Feeling irritable or restless
Loss of interest in activities or hobbies that were once enjoyable, including sex
Feeling tired all the time
Difficulty concentrating, remembering details, or difficulty making decisions
Not able to go to sleep or stay asleep (insomnia); may wake in the middle of the night or sleep all the time
Overeating or loss of appetite
Thoughts of suicide or making suicide attempts
Ongoing aches and pains, headaches, cramps or digestive problems that do not go away.

All of us have probably experienced one or more of the symptoms listed above. However, most of us have overcome these feelings on our own, either through lifestyle changes or eating better or exercise, or just letting some time pass. Others seem to not be able to overcome these symptoms and they start adversely affecting their lives.

CAUSE OF ANXIETY DEPRESSION

CHEMICAL IMBALANCE IN THE BRAIN–AN IMAGINARY CONDITION
Dr. Ronald Pies, Boston’s Tufts University clinical professor of psychiatry, in an article entitled, Psychiatry’s New Brain-Mind and the Legend of the “Chemical Imbalance”, stated,

“In the past 30 years, I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim, except perhaps to mock it…In truth, the ‘chemical imbalance’ notion was always a kind of urban legend- – never a theory seriously propounded by well-informed psychiatrists.”

Despite the lack of any scientific proof and the disagreement from psychiatrists and medical researchers, many manufacturers of antidepressant and antipsychotic drugs are still active promoters of this chemical imbalance theory. Each of their drugs that are supposed to treat depression seek to increase the concentration of certain chemicals in the brain, which will supposedly correct the imbalance and eliminate the symptoms of depression. Of course, the problem with this explanation is that there are presently no medical tests to determine the amount of any chemical needed in the brain or even the amount of the chemicals that are there at any one time.

The drug companies admit in their labels that they don’t know exactly how their drugs work. The responsibility for determining if the chemicals which their drugs increase are needed by a person are left to the prescribing doctor—who doesn’t have any scientific way of determining if and how much of a neurotransmitter is needed. It is just a guess and often leads to a misdiagnosis.

MEDICAL CAUSE OF ANXIETY AND DEPRESSION

A growing number of health practitioners are convinced that many people who complain of anxiety and depression have an organic, physical cause that can be detected with blood tests. If there is a medical cause, once treated it will eliminate or greatly reduce the symptoms.

Analysis of the Medical Cause

The American Association. of Clinical Endocrinologists stated, “The diagnosis of subclinical (without obvious signs) or clinical hypothyroidism (low thyroid activity) must be considered in every patient with depression.”

In 1994, “Clinical Practice Guidelines For the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism Developed by the American Association of Clinical Endocrinologists and the American College of Endocrinology” were released, advising doctors that patients with hypothyroidism (under-active thyroid) and hyperthyroidism (over-active thyroid) could present (appear to have) the following:

Fatigue
Weight gain
Weight loss
Memory and mental impairment
Decreased concentration
Depression
Nervousness and irritability
Heat intolerance/increased sweating
Tremors
Mental disturbances
Sleep disturbances including insomnia

If you compare this list of symptoms with the list of anxiety and depression symptoms, you will see many are the same.

HOW COMMON ARE THYROID PROBLEMS?

A study reported in the February 28, 2000 issue of Archive of Internal Medicine revealed that of more than 25,000 people given blood tests, 9.9% had thyroid problems they probably did not know about. Another 5.9% were being treated for thyroid problems. This means nearly 16% of the population had thyroid dysfunction. Depression is a common symptom of poor thyroid function.

Dr. Broda Barnes, author of Hypothyroidism: The Unsuspected Illness, estimated that as many as 40% of the public may have low thyroid function, much of which is not detectable by modern blood tests. He recommended a simple and more reliable body temperature test.

Dr. Barnes’ thyroid self-test, discussed in his book, is as follows: You take an old-fashioned mercury-type thermometer, shake it down and put it on the nightstand before going to bed (if you’re going to do it on yourself – on someone else just shake it down below 95 degrees before you take the temperature). In the morning on awakening, before arising or moving around, the person puts the thermometer snugly in his armpit for 10 minutes by the clock. If the temperature is below 97.8, the person likely needs thyroid supplementation or, if they’re on a thyroid supplement already, they need more. The temperature should be between 97.8-98.2.

Other Endocrine Problems Have Similar Symptoms

There is overwhelming clinical evidence that dehydration, vitamin, amino acid and mineral deficiencies and other endocrine hormone imbalances can create many of the same symptoms created by thyroid problems.

Psychiatrists Advocating Medical Cause Testing for Anxiety and Depression

In an article entitled Depression and Physical Illness, Dr. Alan Thomas, a psychiatrist and lecturer, said, “Mood changes and depressive illnesses are more common in people suffering from physical illnesses than in people who are well… There is good evidence that some of the above illnesses directly affect the parts of the brain and the chemical systems that control our mood and behavior. For example, vascular diseases (those affecting the blood vessels) and Parkinson’s disease damage important areas of the brain, making people vulnerable to depression… Endocrine conditions directly interact with, and upset, important chemical systems governing mood and other features of depressive illness.”

In his comprehensive study released in 2012, Richard C. W. Hall, M.D. and Courtesy Clinical Professor of Psychiatry at the University of Florida at Gainsville, reviewed many earlier studies and determined that there was a direct connection between anxiety and other symptoms associated with depression with physical causes that must be eliminated before treatment with psychiatric tools. Dr. Hall pointed out that DSM-IV discusses this point.

The DSM-IV defines the most common endocrinological conditions associated with anxiety states as hyper and hydrothyroidism, hypoglycemia, pheochromocytoma (a tumor on the adrenal) and hyperadrenocorticism. Anxiety may also occur following the exogenous administration of estrogens, progesterone, thyroid preparations, insulin, steroids and birth control pills… endocrine disorders presenting with anxiety, suggests that anxiety states frequently occur in association with adrenal dysfunction, Cushing’s Disease, Carcinoid syndrome, hyperparathyroidism, pseudohyperparathyroidism, hyperglcemia, hyperinsulinemia, pancreatic tumors and thryoid diseases including hyperthyroidism, hypothyroidism and thyroiditis.”

In his conclusion, Dr. Hall states:

“As  I  hope  we  have  demonstrated,  endocrine  disorders  can  and  do  produce  both  cognitive  and behavioral signs of anxiety, panic disorder, and at time, even obsessional  symptoms in patients.  These changes are generally not specfic and cannot be easily compartmentalized diagnostically.  They are often variable in their presentation and fluctuate in their severity.  To properly evaluate patients for these disorders,  one  must  first  entertain in the differential diagnosis the medical disorders  that  are  associated  with these conditions. The patient should receive a comprehensive history and physical examination as well as careful laboratory screening.(our emphasis added). The  initial  evaluation  should  carefully  define  the  sequence  of symptoms encountered and how they evolved, determine both personal and family histories for these endocrinological disorders, and include a detailed review of systems which is often helpful.  Physical examination may define signs and symptoms that distinguish between endocrine disorders and primary anxiety and panic states.  Once proper diagnosis and treatment are instituted, symptoms usually clear.”

As noted by Popkin, “Systematic studies with diagnostic rigor and careful attention to demonstrating the etiological relationship between the anxiety disorder and endocrine disease are few,” but as we hope we have demonstrated, such studies are increasing in both frequency and import. The older literature consists predominantly of case reports. The newer literature, however, does justify the construct of secondary anxiety disorders caused by endocrine disease. Defining the differences between the endocrine-produced anxiety states and “primary anxiety disorders” will represent a significant research challenge in the decades ahead.