Feeling blue lately? Heart disease and diabetes troubles may be the last thing on your mind, but your sadness may be their first symptom. Read on to find out how depressive symptoms often mask other serious health conditions...
Shari, who was normally vibrant and active, started feeling tired all the time, as well as a bit down about her lack of romantic prospects.
The first therapist she saw thought she had mild depression. In fact, he was so convinced that he clung to that diagnosis even after Shari began having tingling sensations in her feet.
Fortunately, Shari’s primary-care doctor did a vitamin B12 test at her annual checkup. It turned out that she didn’t have mild depression at all. She had pernicious anemia, a condition that prevents the body from making enough healthy red blood cells because of an impaired ability to absorb vitamin B12 from food.
After Shari received B12 injections, her fatigue, tingling and depression – all symptoms of B12 deficiency – disappeared.
Sometimes other underlying health problems – a thyroid condition, heart disease, diabetes, multiple sclerosis or even medications – trigger mental symptoms that are mistaken for depression.
Psychological or mental symptoms don’t only happen with mental disorders, says Harvard psychiatry instructor Barbara Schildkrout, M.D., author of Unmasking Psychological Symptoms (Wiley), who discusses Shari’s case in her book.
“They just as often occur with medical conditions,” she explains.
At times, a physical disease is the sole cause for depressive symptoms, Schildkrout says. At other times, it’s an important contributing factor. What’s Lurking Behind Your Depression?When another medical condition affects your mood, depression is sometimes the first symptom noticed, or the one that prompts you to seek professional help.
There’s a plus side to this: It could lead to the diagnosis of a health problem that might otherwise have gone undetected.
But too often, as with Shari, depression is treated without digging deeper to find out what might underlie it, Schildkrout says.
Unfortunately, depression treatments like therapy or antidepressants alone are ineffective against a vitamin deficiency, hormonal imbalance or other physical disorder.
The result may be months or even years of frustration, unnecessary suffering and missed opportunities to prevent complications.
A proper diagnosis is vital, so read on for 7 common health factors that can cause depressive symptoms. 1. Heart DiseaseHeart disease is a prime example of just how complicated the relationship between depression and other illnesses can get.
If a heart attack or heart surgery reduces blood flow to the brain, this may cause damage that leads to depressive symptoms afterward, says Harvard psychiatry professor Jeff Huffman, M.D. (The same is true of a stroke.)
Add to that the psychological impact of having a serious illness.
“Among people predisposed to developing depression, a major source of stress and uncertainty, such as a heart attack, may trigger a depressive episode,” Huffman says.
But it cuts both ways: Having depression also seems to increase the risk for heart disease.
“People with depression have higher levels of inflammation, more activation of platelets [blood cells associated with forming clots], and poor function of endothelium [the lining of blood vessels],” Huffman says.
All these physiological factors can lead to heart problems.
“Plus, people who are depressed are less likely to follow a healthy diet, exercise, quit smoking, take medication regularly or go to cardiac rehab,” Huffman says. “These things can lead to a greater risk of developing heart problems and dying from heart disease.”In short, the interplay between untreated depression and heart disease, both physical and psychological, can lead to worse outcomes for both conditions.
That helps explain why up to 45% of people with coronary artery disease have significant depressive symptoms, according to a 2011 Cardiology in Review article coauthored by Huffman.
And once they’ve had a heart attack, people with depression are twice as likely to die compared to those who aren’t depressed.
2. Diabetes
People with diabetes also have a higher risk of becoming depressed than the general population.
“The reason for this elevated risk isn’t fully understood,” says Hillary Bogner, M.D., a professor of family medicine and community health at the University of Pennsylvania School of Medicine.
However, some research suggests that insulin-resistant people may have abnormal levels of serotonin, a brain chemical implicated in mood disorders, and be prone to depressive symptoms.
In turn, depression is a risk factor for poor diabetes outcomes, probably due to poor compliance with treatments, Bogner says.
“People with diabetes who are depressed are less likely to take their medications, follow dietary recommendations and stick with an exercise program,” she says.Treating both type 2 diabetes and depression at the same time led to improvements in both, according to a study headed by Bogner that was published in Annals of Internal Medicine in 2012.
3. Hypothyroidism
Shari, who was normally vibrant and active, started feeling tired all the time, as well as a bit down about her lack of romantic prospects.
The first therapist she saw thought she had mild depression. In fact, he was so convinced that he clung to that diagnosis even after Shari began having tingling sensations in her feet.
Fortunately, Shari’s primary-care doctor did a vitamin B12 test at her annual checkup. It turned out that she didn’t have mild depression at all. She had pernicious anemia, a condition that prevents the body from making enough healthy red blood cells because of an impaired ability to absorb vitamin B12 from food.
After Shari received B12 injections, her fatigue, tingling and depression – all symptoms of B12 deficiency – disappeared.
Sometimes other underlying health problems – a thyroid condition, heart disease, diabetes, multiple sclerosis or even medications – trigger mental symptoms that are mistaken for depression.
Psychological or mental symptoms don’t only happen with mental disorders, says Harvard psychiatry instructor Barbara Schildkrout, M.D., author of Unmasking Psychological Symptoms (Wiley), who discusses Shari’s case in her book.
“They just as often occur with medical conditions,” she explains.
At times, a physical disease is the sole cause for depressive symptoms, Schildkrout says. At other times, it’s an important contributing factor. What’s Lurking Behind Your Depression?When another medical condition affects your mood, depression is sometimes the first symptom noticed, or the one that prompts you to seek professional help.
There’s a plus side to this: It could lead to the diagnosis of a health problem that might otherwise have gone undetected.
But too often, as with Shari, depression is treated without digging deeper to find out what might underlie it, Schildkrout says.
Unfortunately, depression treatments like therapy or antidepressants alone are ineffective against a vitamin deficiency, hormonal imbalance or other physical disorder.
The result may be months or even years of frustration, unnecessary suffering and missed opportunities to prevent complications.
A proper diagnosis is vital, so read on for 7 common health factors that can cause depressive symptoms. 1. Heart DiseaseHeart disease is a prime example of just how complicated the relationship between depression and other illnesses can get.
If a heart attack or heart surgery reduces blood flow to the brain, this may cause damage that leads to depressive symptoms afterward, says Harvard psychiatry professor Jeff Huffman, M.D. (The same is true of a stroke.)
Add to that the psychological impact of having a serious illness.
“Among people predisposed to developing depression, a major source of stress and uncertainty, such as a heart attack, may trigger a depressive episode,” Huffman says.
But it cuts both ways: Having depression also seems to increase the risk for heart disease.
“People with depression have higher levels of inflammation, more activation of platelets [blood cells associated with forming clots], and poor function of endothelium [the lining of blood vessels],” Huffman says.
All these physiological factors can lead to heart problems.
“Plus, people who are depressed are less likely to follow a healthy diet, exercise, quit smoking, take medication regularly or go to cardiac rehab,” Huffman says. “These things can lead to a greater risk of developing heart problems and dying from heart disease.”In short, the interplay between untreated depression and heart disease, both physical and psychological, can lead to worse outcomes for both conditions.
That helps explain why up to 45% of people with coronary artery disease have significant depressive symptoms, according to a 2011 Cardiology in Review article coauthored by Huffman.
And once they’ve had a heart attack, people with depression are twice as likely to die compared to those who aren’t depressed.
2. Diabetes
People with diabetes also have a higher risk of becoming depressed than the general population.
“The reason for this elevated risk isn’t fully understood,” says Hillary Bogner, M.D., a professor of family medicine and community health at the University of Pennsylvania School of Medicine.
However, some research suggests that insulin-resistant people may have abnormal levels of serotonin, a brain chemical implicated in mood disorders, and be prone to depressive symptoms.
In turn, depression is a risk factor for poor diabetes outcomes, probably due to poor compliance with treatments, Bogner says.
“People with diabetes who are depressed are less likely to take their medications, follow dietary recommendations and stick with an exercise program,” she says.Treating both type 2 diabetes and depression at the same time led to improvements in both, according to a study headed by Bogner that was published in Annals of Internal Medicine in 2012.
3. Hypothyroidism
“When your thyroid isn’t working properly, it can affect every cell in your body,” says Marcelle Pick, MSN, an ob-gyn nurse practitioner and author of Are You Tired and Wired? (Hay House).
An underactive thyroid gland, known as hypothyroidism, leads to a general slowing down of physiological processes, including those in the brain, she says.
Symptoms include fatigue, sluggishness, depression, forgetfulness, dry skin, hoarse voice, constipation and feeling cold all the time.
It’s more common in women, especially those over age 50.
4. Vitamin D Deficiency
Vitamin D is another substance with wide-ranging effects throughout the body, including the brain. A study of more than 12,000 people, published in Mayo Clinic Proceedings in 2011, showed an association between low vitamin D and depressive symptoms.
“Low vitamin D could potentially lead to depression through vitamin D receptors in the brain,” says study coauthor Sherwood Brown, M.D., Ph.D., a psychiatry professor at the University of Texas Southwestern Medical Center.
“Primary-care doctors frequently screen for vitamin D deficiency, but psychiatrists don’t,” he adds.
Find out if you’re
5. Multiple Sclerosis“Multiple sclerosis (MS) affects women more often than men and is associated with episodes of depression,” Schildkrout says.
In fact, the risk for depressive symptoms with MS is higher than in people with other chronic, disabling conditions.
Something more than just an emotional reaction to the burden of the disease seems to be at work, according to research.
Researchers used high-resolution MRI to compare the brains of MS patients and healthy people for a 2010 UCLA study published in Biological Psychiatry.
They found a link between MS and shrinkage in a specific region of the hippocampus – part of the brain involved in mood and memory. The shrinkage was also related to over-activity in part of the neuroendocrine system that controls reactions to stress.
These changes occur in people whose depression is not caused by a medical illness.
6. Sleep DisordersInsomnia or oversleeping is a symptom of depression. But it’s a two-way street: Having a sleep disorder can contribute to becoming depressed in the first place. For one thing, severe sleep apnea may cause lowered blood oxygen levels during sleep, and that may affect brain functioning all day long, Schildkrout says.Beyond that, having a sleep disorder that causes daytime sleepiness may set off a chain of events that culminates in feeling stressed and depressed.
“You have less gusto, and doing everything is more effortful,” Schildkrout explains.
Plus, constant drowsiness can create tension in relationships. “If you’re falling asleep at your computer at work, your boss isn’t going to like that,” Schildkrout says. “If you’re falling asleep at dinner, your partner is likely to be angry.”
Ultimately, you may be left with the nagging sense that life just isn’t going well.
“Disorders that frustrate people in their life goals may secondarily lead to the person feeling depressed,” Schildkrout says. “This is especially true with undiagnosed learning disabilities, ADHD and sleep disorders such as narcolepsy or restless legs syndrome.”
7. Medication Side EffectsMany medications can cause depressive symptoms in some users.
Birth control pills and many drugs used to treat high blood pressure fall into this category, according to Schildkrout. Also, “fertility treatments utilize hormones that often affect mood,” she says.
If you start a new medication and experience a sudden change in mood, talk with your doctor. Unmasking a Hidden Medical CulpritIf you’ve been having depressive symptoms and wondering whether a medical illness might be behind your mood, Schildkrout recommends taking these steps:
In fact, the risk for depressive symptoms with MS is higher than in people with other chronic, disabling conditions.
Something more than just an emotional reaction to the burden of the disease seems to be at work, according to research.
Researchers used high-resolution MRI to compare the brains of MS patients and healthy people for a 2010 UCLA study published in Biological Psychiatry.
They found a link between MS and shrinkage in a specific region of the hippocampus – part of the brain involved in mood and memory. The shrinkage was also related to over-activity in part of the neuroendocrine system that controls reactions to stress.
These changes occur in people whose depression is not caused by a medical illness.
6. Sleep DisordersInsomnia or oversleeping is a symptom of depression. But it’s a two-way street: Having a sleep disorder can contribute to becoming depressed in the first place. For one thing, severe sleep apnea may cause lowered blood oxygen levels during sleep, and that may affect brain functioning all day long, Schildkrout says.Beyond that, having a sleep disorder that causes daytime sleepiness may set off a chain of events that culminates in feeling stressed and depressed.
“You have less gusto, and doing everything is more effortful,” Schildkrout explains.
Plus, constant drowsiness can create tension in relationships. “If you’re falling asleep at your computer at work, your boss isn’t going to like that,” Schildkrout says. “If you’re falling asleep at dinner, your partner is likely to be angry.”
Ultimately, you may be left with the nagging sense that life just isn’t going well.
“Disorders that frustrate people in their life goals may secondarily lead to the person feeling depressed,” Schildkrout says. “This is especially true with undiagnosed learning disabilities, ADHD and sleep disorders such as narcolepsy or restless legs syndrome.”
7. Medication Side EffectsMany medications can cause depressive symptoms in some users.
Birth control pills and many drugs used to treat high blood pressure fall into this category, according to Schildkrout. Also, “fertility treatments utilize hormones that often affect mood,” she says.
If you start a new medication and experience a sudden change in mood, talk with your doctor. Unmasking a Hidden Medical CulpritIf you’ve been having depressive symptoms and wondering whether a medical illness might be behind your mood, Schildkrout recommends taking these steps:
- Get a thorough medical checkup. “Ask your primary-care doctor to investigate whether there could be a medical problem underlying your mental symptoms,” Schildkrout says. Tell your doctor about all symptoms you’re having or changes you’ve noticed, even ones that seem irrelevant.
- Ask for common medical tests. For example, ask your doctor to do a blood test on your vitamin D and B levels and thyroid function.
- Use language that describes what you’re experiencing, not what you think the diagnosis will be. “Say ‘dull pain on the right side of my forehead’ rather than ‘migraine,’ for example,” Schildkrout explains.
- Bring a list of all your medications to your doctor’s visit. Include vitamins and herbal supplements.
- Be honest with your doctor about any other substances you use. Alcohol and recreational drugs can also affect your mood.
- Keep a daily diary of symptoms. Write down associated information, too: menstrual cycle, sleep times, stressful events such as a fight with your partner. Then share the information with your doctor.
- Tell your doctor and therapist about any symptoms you’re having – even ones that seem unrelated to your mood. “Medical diseases usually present with additional symptoms along with depression,” Schildkrout says. “It’s important to look at the whole picture – accompanying mental symptoms such as anxiety or hallucinations, any physical symptoms, and the timing of all these.”
“When you’re depressed, you may feel utterly hopeless and sometimes suicidal,” Schildkrout says. “No matter what the underlying causes for these feelings, you may need professional mental health care.”
For more information and expert advice, visit our Depression Health Center. By Linda Wasmer Andrews, Special to Lifescript
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