Is it “All in your Head”?
Common Medical Causes of Depression, Anxiety and Other Psychological Symptoms
Pat Elliott, ND
Apathy. Moodiness. Insomnia. Irritability. Sadness. Panic. Most people recognize these feelings as symptoms of psychological disorders. What many don’t realize, however, is that there are ailments of the physical body which can produce mental and emotional symptoms which are virtually identical to those of anxiety, depression, panic disorder, attention deficit disorder, and other commonly diagnosed psychological conditions.
Anemia is a decrease in the number of oxygen carrying red blood cells. It is typically due to either decreased production of the cells (often due to nutritional deficiency of iron, folic acid or vitamin B12) or increased loss through bleeding. The resulting lowered oxygen level associated with anemia can cause signs and symptoms easily confused with a psychological disorder:
· depression, fatigue, lethargy, social withdrawal, drowsiness
· restlessness, irritability
· anxiety, heart palpitation and/or rapid heart beat, chest pain, shortness of breath.
· decreased concentration, poor attention span (especially in children)
Some other signs which help differentiate anemia from a psychological disorder include paleness (especially apparent in the nail beds, lips, gums, and inside the lower eyelid), fainting or lightheadedness and a decreased tolerance for exercise. Pregnant and nursing women, women with heavy menstrual flow, growing children, vegans, those with digestive disorders and those with other significant medical disorders such as cancer, autoimmune disease and cancer are at increased risk to develop iron deficiency. Anemia is diagnosed by examining a blood sample. Treatment involves addressing the underlying cause and providing any deficient vitamins or minerals required for proper blood formation.
Problematic side effects from a single medication or from a combination of interacting medications commonly cause mental and emotional complaints. For specific information about the reported side effects of a medication or for information about how a combination of medications may interact, a pharmacist should be consulted. Because discontinuing a prescribed medication can be dangerous, treatment of an adverse drug reaction should always involve a discussion with the prescribing doctor regarding one’s options. Discontinuing the medication, replacing it with another drug, lowering the dosage to a tolerable level, and non-drug therapies such as dietary and lifestyle changes should all be considered as possibilities.
Common medications which may produce side effects that can be confused with psychological disorders include:
- Beta blockers (used for high blood pressure and some kinds of heart problems) can cause fatigue, insomnia and impotence
- Antidepressants can cause sexual dysfunction, irritability, agitation or insomnia
- Anxiety medications can cause mental slowing or confusion, depression, or insomnia
- Allergy and asthma medications can cause insomnia, nervousness, agitation, and drowsiness
- Seizure medications can cause fatigue, mental slowing, depression, irritability and hyperactivity
- Attention deficit disorder medications can cause irritability, insomnia, and anxiety
- Sleeping medication can cause drowsiness, forgetfulness or amnesia, and depression
- Prednisone/cortisone can cause restlessness, mood swings, euphoria, personality changes, confusion and hallucinations
It is also important to remember that sudden withdrawal from a medication may also provoke or worsen psychological symptoms in some situations.
Low Thyroid Function
Thyroid hormone controls the cellular activity of all bodily tissues including the brain and nervous system. When levels are decreased, symptoms of a seemingly mental nature, such as slowed thinking, dulled facial expression, forgetfulness, and fatigue, often occur. When significant depression of thyroid hormone levels occurs, personality changes may progress to the point of seeming psychosis or dementia. Other symptoms which can help lead to a suspicion of low thyroid function are coarse, dry hair and skin, intolerance to cold environments, reduced body temperature, weight gain, constipation, and heavy menstrual flow in women. Diagnosis is through blood tests which measure thyroid hormone (called T4) in the blood, and treatment is daily hormone replacement using natural or synthetic thyroid preparations.
Excess thyroid Function
Excess production of thyroid hormone, on the other hand, produces anxiety-like symptoms: sweating, tremors, palpitations, tension, edginess, pounding heart, insomnia, and distractibility with resulting difficulty concentrating. Despite feeling driven to keep moving, most affected individuals also complain of profound exhaustion and depression. When severe, delirium, anger outbursts and psychosis may occur. Signs which help differentiate this thyroid disorder from an anxiety state include weight loss despite increased appetite, irregular heartbeat and heart murmurs, elevated body temperature, diarrhea, thyroid gland enlargement, and scanty or absent menses in women. After being confirmed using a blood test for T4 levels, excess thyroid function is usually treated by surgical, radiation , or drug suppression of the gland.
Low Adrenal Gland Function
Cortisol and aldosterone, the primary adrenal hormones, have many important functions throughout the body such as blood sugar control, immune system regulation, stress adaptation and maintenance of proper fluid and salt levels. Some of the symptoms of low adrenal function – fatigue, decreased appetite, nausea, and decreased sex drive and/or impotence – may be mistakenly attributed to and emotional problem. The additional presence of low blood pressure, low body temperature, weakness between meals, frequent urination , dizziness upon standing, abnormal salt levels in the blood and increased tanning and freckling of the skin help to distinguish this disorder. Specialized blood tests are required for definitive diagnosis. Or, a newer, progressive and less invasive alternative test which is beginning to be used by physicians (especially those practicing naturopathic medicine) to evaluate adrenal function. It utilizes multiple saliva samples taken throughout the day which are then analyzed for their free cortisol content. This test is especially helpful for identifying those who are experiencing mild or early forms of adrenal dysfunction. Treatment of low adrenal function involves correction of complications, such as dehydration and low blood sugar, and daily hormone replacement therapy using hydrocortisone or natural adrenal gland preparations.
Excess Adrenal Gland Function
Psychological disturbance is a common finding in those with excessive adrenal hormone production. Symptoms of depression, fatigue, moodiness, insomnia, anxiety, restlessness, memory and concentration difficulties, and even confusion and delirium may occur. Other findings suggestive of this diagnosis include high blood pressure, muscle wasting and weakness, easy bruising, poor wound healing, thinning bones and increased frequency of infection. Once again, diagnosis is achieved via specialized blood tests or the salivary cortisol test. Treatment depends upon the cause of over secretion, then surgical removal is indicated. Because the adrenal gland is stimulated by stress, many Naturopathic Doctors test for and identify many cases of mild to moderate adrenal dysfunction in individuals with long histories of chronic stress. Whether an excess of deficiency of adrenal function is present, naturopathic therapy would therefore include stress management as a crucial element.
Low Blood Sugar
An abnormal drop in blood sugar, due to any of its many causes, can trigger a discharge of the nervous system and the resulting characteristic symptoms of nervousness, tremor, sweating, faintness, and fatigue. More severe drops can produce inappropriate behavior and confusion. Low blood sugar may be differentiated from anxiety by its associated hunger and by the relief from symptoms which eating often produces. A blood sugar measurement after an overnight fast may reveal a low blood sugar problem, but a more prolonged and specialized glucose tolerance test, which measure blood sugar variation over a period of several hours following ingestion of a measured does of sugar, may be required to reveal some forms. Treatment invariably includes recommendation of small, frequent meals and replacement of dietary simple sugars with complex carbohydrates.
Although sleep and its effects are insufficiently understood, it is generally accepted that a syndrome of traits may arise in some individuals who are deprived of an adequate quantity and normal quality of sleep. Among those symptoms described are fatigue, confusion, decreased arousal and alertness, personality changes, and feelings of depersonalization and disorientation. Individual need for sleep varies greatly and must be determined on a case by case basis. Many experts agree that individuals who are consistently awakened with the assistance of an alarm clock may not be getting enough sleep and are at risk for at least mild sleep deprivation. Other factors which can contribute to sleep deprivation by disrupting the quality of sleep include chronic use of sleep medications, alcohol, caffeine, and a disruptive sleep environment.
Food Allergy and Intolerance
Vastly underestimated as a trigger of mood disturbance and mental symptoms, reaction to food is an extremely common condition that may mimic virtually any psychological disorder. Many naturopaths and other food allergy specialists would recommend allergy testing for anyone suffering from chronic psychoemotional distress especially if it has proven unresponsive to therapy. Reactive foods may be identified using elimination/challenge diets, skin testing, or through the use of blood tests. Often a combination of approaches yields the most accurate and complete results. Avoidance of the offending food(s) is the mainstay of treatment.
Decreased levels of a multitude of vitamins and minerals may produce psychological and mental symptoms. A diet analysis and medical evaluation by a naturopath or other nutritionally oriented physician can be helpful in revealing such deficiencies. The treatment of nutritional deficiency includes the use of vitamin/mineral supplements, at least temporarily, and nutritional education.
The above are but a few of the conditions which can present similarly to a psychological disorder. There are many others. Most of these conditions will reveal at least clues to their existence during a complete medical history, basic physical exam, and a screening blood chemistry panel. Therefore, it is advisable that individuals experiencing psyschoemtional distress be sure that they have received this minimal screening before receiving a psychological diagnosis and the psychotropic medication that usually accompanies it from their doctor. If a particular physician seems unresponsive to one’s concerns regarding this topic , a second opinion or alternative approach should be sought.
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Read more articles by Pat Elliott ND
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Low Thyroid Function
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Pat Elliott, ND
Elliott Health Care
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Bellingham, WA 98225
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