Some may think they have depression but may really be dealing with an endocrine issue or vitamin deficiency. Only by working with your doctor can you get to the root of your problem.
There are many medical illnesses that can mimic depression or can contribute to your symptoms. Only a trained medical professional can guide you through the necessary lab work, imaging, or other workup to bring clarity to your diagnosis and get the right treatment. Here are some cases exploring some of the most common medical problems that can be confused for depression:
Case #1: Rosa is a 28-year-old female who comes to her doctor feeling “down”. She states that she feels like she has “low energy” and feels “depressed” because she is gaining weight despite trying to change her diet. She denies any changes in interest, changes in sleep, feelings of guilt, poor concentration, or changes in appetite. On further questioning, she noticed she has been constipated lately and noticed “more hair clumping in the shower”. On laboratory examination, she had low thyroid hormone. Her symptoms eventually disappeared when she was given thyroid hormone replacement.
This is hypothyroidism: low thyroid hormone. This can be caused by a variety of mechanisms but is commonly caused by an autoimmune disease known as “Hashimoto’s Thyroiditis”. Classically, those with hypothyroidism have fatigue, loss of hair, weight loss, voice changes, constipation, and a constellation of other MDD-like symptoms.
Case #2: Lamar is a 53-year-old male who comes to his doctor feeling “deflated”. He states that he hasn’t “been able to do anything” because he feels “so tired and miserable.” Lamar states that he has stopped playing chess with friends, stating that he doesn’t “have the energy to get out of the house”. He feels guilty for being “such a bore to my wife”, and he feels like his concentration has worsened, not allowing him to make progress reading books anymore. He denies any changes in appetite or thoughts of harming himself. When asked about sleep, he says “I’m always so tired when my alarm goes off. My wife has to sleep in the other room because she can’t handle my snoring.” Lamar’s physician suspected he had obstructive sleep apnea, arranged a sleep study, and provided a continuous positive air pressure (CPAP) device. Lamar’s symptoms gradually disappeared as he kept using his CPAP. He began feeling well-rested and his mood returned to normal.
This is obstructive sleep apnea (OSA): recurrent, abrupt pauses in breathing during sleep due to our tongue or throat tissue closing our breathing tube. Most often identified in “snorers” whose partner notes pauses in their breathing or frequent snoring, OSA often affects obese individuals, or those with large necks. It leads to low blood oxygen and poor sleep quality, often leading people to feel tired and miserable.
Case #3: Yao is a 25-year old investment banker who comes to his doctor complaining of “depression”. He states that he feels “awful and extremely tired” and is unable to work due to being “unable to concentrate on anything.” He states that he doesn’t eat much, and suspects he has low energy because he has been “working long days for the past several weeks, drinking 5 coffees a day, and working all weekend”. On further questioning, he states that he was able to get out early yesterday and go out in the city with friends. He states that he “did some blow” before going to the club.
This is substance withdrawal or ”hangover”: a constellation of symptoms that results from suddenly stopping certain substances. There are many medications, legal consumer goods, and illegal substances that cause withdrawal when you suddenly stop consuming the substance. Many of these substances produce a withdrawal syndrome that mimics depression. Regarding medications, psychiatric medications (such as antidepressants), as well as steroids, thyroid and other hormonal medications may produce depression-like symptoms if you abruptly stop taking the medication. With consumer goods, the abrupt stopping of (especially) products with a stimulating effect (such as caffeine, herbal supplements, nicotine vaping and tobacco products) can produce depression-like symptoms as well. Regarding illegal substances, the abrupt stopping of stimulants (such as cocaine and methamphetamines), among others, can produce depression-like symptoms.
Case #4: Rajadi is a 17 year-old-female who comes to her doctor complaining of feeling “down” On further questioning, Rajadi states that she feels “sleepy” and “unable to focus on homework.” Her mother notes Rajadi has been taking more naps and seems less energetic. Rajadi denies feelings of guilt, changes in appetite, changes in her movement, and any thoughts about suicide. On further questioning, she states she “can’t keep up in gym class”, feeling “out of breath” and like she might “pass out”. She states that she has had heavy menstrual flow for the past few months and eats a peculiar diet, avoiding most meat and vegetables.
This is iron deficiency anemia: when the body’s blood stores are low due to having too little iron. Iron deficiency anemia is most common in women of child-bearing age due to the cyclical blood loss of menstruation; however, it can be seen in anyone with blood loss or too little iron consumption. The signs of iron deficiency anemia are fatigue, shortness or breath, sleepiness, dizziness, and feeling faint, amongst other symptoms. Given the similarity of symptoms, it’s easy to see how this could be confused with MDD.
Case #5: Reina is an 83-year-old female. Her husband has noticed that she seems increasingly “off” and “flat” and brings her in to the doctor. Reina states that she feels “foggy” and “cannot focus on anything”. She states that she has trouble remembering things lately. She feels like her energy level is lower, and she has been noted to take naps more often. She has a low appetite. She denies any ideas of suicide. On further questioning, her husband describes that she has been misplacing things lately, forgetting names of loved ones, and getting lost in familiar places (like her neighborhood).
This is dementia: a gradual decline in cognitive function most often related to protein accumulation in the brain and brain shrinkage. Depending on the type of dementia, those experiencing dementia may experience difficulty concentrating, loss of interest in activities, and changes in movement. Additionally, the aging process can naturally result in decreased sleep and decreased appetite. Taken together, these symptoms can mimic major depressive disorder.
As you can see from these mental and medical examples, there are many diseases and syndromes that mimic major depressive disorder. Although not fully explored in these examples, those with heart disease are at high risk of experiencing depression - especially those recovering from a heart attack. Those with neurological illnesses like multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, and Huntington’s disease are also at increased risk of depression. Patients with stroke, cancer, and erectile dysfunction have higher rates of depression, as well as those with certain nutritional deficiencies like vitamin B12 deficiency. Additionally, those with inflammatory diseases like lupus and certain infections like HIV, mononucleosis (“mono”), and hepatitis are at higher risk for MDD.
In addition to all of the medical illnesses related to depression, there are several medications that can be involved in someone’s experience of depression. Namely, steroids and certain blood pressure medications can create changes in our moods. Researchers are still debating whether birth control pills, certain antibiotics, and the blood pressure medication propranolol can impact our moods,,. While medications may contribute to one’s experience of depression, it requires the careful, personalized consideration of our doctors to help determine whether medications may be a significant cause of our depression, how important these medications are for our health, and whether our MDD is more likely due to other causes.
Together, medical illnesses and medications can account for up to 10-15% of all cases of depression, so it is important for us to visit a medical doctor if we or a loved one may have depression. Always mention any safety concerns to your doctor, especially if there are any thoughts about suicide, self-harm, or harming others.
This exploration of the mental and physical illnesses related to MDD is meant to demonstrate that making the diagnosis of MDD is a complex, difficult process which requires comprehensive medical knowledge. These are not all of the possible illnesses that mimic MDD but are some of the common causes of depression-like symptoms in otherwise healthy individuals. It is due to the complexity of these psychiatric and medical illnesses that major depressive disorder must be diagnosed by a healthcare professional. If one were to read this book and believe he or she has MDD, other psychiatric or medical diseases may go unnoticed and untreated, creating a dangerous situation. In order to diagnose MDD (and any mental illness), it is critical to rule out all other possible causes of the depressive symptoms. To do so requires skill, experience, and many tests, questionnaires and examinations. Therefore, whenever you or a loved one seems to be “depressed”, make sure to schedule a consultation with your doctor.
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