According to news reports out today, the use of antidepressants doubled between 1996 and 2005. Today, 10% of the population is taking antidepressant medication -- that's an estimated 27 million Americans. The question this raises for me is, how many of these people who have been diagnosed as "depressed" -- usually by primary care and family doctors -- are actually hypothyroid, but haven't been properly tested and diagnosed? How many of the people taking antidepressants may actually be misdiagnosed?
It's an important question. Because we know that depression can be a symptom of hypothyroidism. And we also know that there appears be a relationship between autoimmune thyroid disease/thyroid antibodies and depression. And we know that thyroid treatment can sometimes help as an adjunct to treatment for depression.
Consider the scenario. A woman goes to the doctor, complaining that she's feeling more tired than usual lately. She's gained a few pounds. And she feels down in the dumps, a bit blue and moody. Does the doctor think, "Hmm, fatigue, weight gain, depression -- these could be signs of hypothyroidism. Let me run a complete thyroid panel?" Sometimes. But more often, the doctor thinks "fatigue, weight gain, depression -- these are symptoms of depression, so I'll write a prescription for an antidepressant."
Why is this happening?
First, thyroid disease affects women, some eight to ten times more often than men. And women often describe our symptoms to doctors in a more emotional way. It's not uncommon for a woman to say: "Doctor, I feel just awful. I'm so depressed, I feel like a blob, and I'm so tired I can't think straight." And when doctors hear symptoms described like this, the tendency may be to assume a mental health diagnosis, rather than consider the possibility of an underactive thyroid.
Second, the typical family practice doctor or GP doesn't spend enough time in medical school studying thyroid disease or learning its many signs and symptoms. Much more time is spent, for example, on diabetes, which is actually less prevalent than thyroid disease.
Third, everyone who is depressed does not have a thyroid condition. (This is not an excuse to rule out thyroid disease as a cause of the depression, but it seems to be considered as much by some physicians.)
And finally, don't overlook the financial aspect. Sad to say, but there is cost containment going on. No tests are needed, and it costs almost nothing for a doctor in an HMO or managed care environment to write a prescription for an antidepressant and send a patient on her way. But blood tests for thyroid disease, followup, and thyroid treatment -- possibly even a referral to an endocrinologist for evaluation -- all cost time and money.
Unfortunately, even if in our scenario, the doctor was one of the more enlightened physicians who hears "fatigue, weight gain, depression" and immediately thinks thyroid, the majority of those doctors will run only the Thyroid Stimulating Hormone (TSH) test, rather than a complete clinical and laboratory assessment of the thyroid.
And here, we have another challenge. Since late 2002, the endocrinology community has recommended that the normal reference range be changed for the TSH test. They recommended that the range -- which usually runs from about 0.5 to 5.0 -- be narrowed significantly, to 0.3 to 3.0. That debate has raged for more than six years. Today, millions of Americans fall into the limbo of a TSH level between 3.0 and 5.0 -- where some doctors consider them hypothyroid and warranting treatment, and other doctors consider them "normal" and would assume depression to be primarily a mental health issue, and not a symptom of hypothyroidism. So the depressed patient with a TSH between 3.0 and 5.0 -- who has a doctor who isn't up on the latest thinking -- is likely to be dismissed with an antidepressant prescription -- and without thyroid treatment.
An added problem: Because laboratories like Quest and Labcorp are still using the old, outdated range, many doctors are not even aware of the TSH range controversy at all, because levels above 3.0 are not flagged on the lab reports as "high."
I'd like to see all 27 million people on antidepressants have their thyroid levels tested. And no, not just TSH tests, but TSH, Free T4, Free T3 AND thyroid antibodies levels. I'll bet that a significant percentage of the people on antidepressants have a TSH above 3.0, and/or antibodies indicative of autoimmune thyroid disease, or "normal" TSH but low or low-normal Free T4 and Free T3, and have never even been checked.
In my opinion, as a patient advocate, a complete thyroid panel should be required before any doctor prescribes an antidepressant. But, until it is a requirement, if you are experiencing depression, please ask for a complete thyroid evaluation -- and not just a TSH test.
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I am not american so I am not part of these statistics,but I have a diagnosed Hashimoto´s Thyroiditis and was nearly set on Antidepressants today because my doctor thought that my symptoms can´t all be related to a thyroid disease.
She was telling me that I am seriously depressed and that´s the reason for my fatigue and weight gain.
We need doctors who actually know what they are talking about.
Awesome article, Mary.
@Christina:
I understand your frustration and that of others who may have been misdiagnosed. But let’s not put complete blame on the doctors. It is the system that trains them (soon to be ‘us’). Chasing symptoms is the wrong way to approach health problems. Mistaking one illness with another (as in your case) is just one of HUNDREDS of reasons I can think of why medicine and science are going about helping people the wrong way.
@Mary:
“less prevalent than thyroid disease.” I’d venture to say that nobody on earth has a properly working endocrine system. This can be cause by a variety of reasons. But if one little, minor thing anywhere in the body is malfunctioning, it will have an effect on EVERYTHING else in the body. Second reason why current medical approach may not be as successful as it should be.
Prevention people! And never forget that the body can recuperate if given the right tools! Medications hardly ever fall into the ‘right tools’ category.
Thank you,
Kevin
Ah, but what does one do when already severely clinically depressed, on medication for that–for years, and THEN diagnosed hypo–while ON anti-depressants?
My biggest concern is that not only does DEPRESSION mimic hypo, most of the anti-depressant drugs’ SIDE EFFECTS are the same as those of someone with hypo!!!!
So being treated for hypo and depression, I still have the same symptoms… while taking drugs for both. Go figure.
I agree 100%!! If I do not take Cytomel 5mcg a morning with my 100mcg Synthroid then I will have a mental breakdown…My body does not convert T4 into T3…the Synthroid helped my energy level and tiredness but did nothing for my mental state of mind…Thank God my doctor realized that I needed both T4 and T3. Most of my family have depression and other mental illness problems and I have repeatedly told them to get their thyroid checked.
I was diagnosed with Graves Disease but before proper blood work was done, the doctor told me I was stressed out and needed to take antidepressant medication. I REFUSED and told him he needed to take further medical tests before he just “tossed me aside” on a rather, I don’t really care, diagnose. I lost a significant amount of weight, couldn’t sleep, and had trouble walking — these were easy symptoms to pick up on that there was a thyriod issue however, went ignored. Unfortuntately, I am sure there are many folks misdiagnosed. I changed doctors immediately thereafter….
YEs- I believe I was given a barrage of antidepressant meds for thyroid reasons-I was on Cymbalta for quite a while – felt BLEAH! Synthroid-then Armour and Cytomel for hypothyroidism..On June 20TH- I stopped taking the meds and am focusing more on the natural avenues. I am taking a Chinese medicine nervous fatigue formula by Nature’s Sunshine-along with a “Master Gland” blend. For ME- it seems to be working much better- My energy level is much better-my weight is stabalizing ( losing..) Perhaps this was all related to the female’s change of life? My last ultra sound shows no growth in the thyroid ( goiter).. Whew!
How right you are, Mary! But there is a lot more to this than just asking a doctor to test thyroid. Many doctors don’t know that the best tests to do are TSH, FT3, and FT4. And many doctors are so dependent on lab tests, rather than the way patients feel and function, that they don’t understand how to/won’t prescribe a T3+T4, or even T3-only regimen, that many patients will need to feel well.
But doctors are so in the pocket of Big Pharma, I doubt this situation is going to change substantially. Patients will continue to have their lives messed up by the side-effects that come along with prescription anti-depressants.
Before I was diagnoised with hypothydriodism I experenced the most profound depression!Due to underlying conditions ex. Lupus,I went a long time before I consulted my MD.He actually noticed a change in my skin color which prompted him to test my thyroid.I’m now on synthroid and doing well,but I almost took my life before I got help.I wonder how many with hypothroidism kill themselves with out any one knowing their condition?
i too was put on antidepressants for 5 years until thyroid test showed i needed more synthyroid.
The US population as of today is 307,126,015 so 10% of the population is 30.7 million people.
We, the thyroid patients, need to make it abundantly clear to our health care providers that thyroid hormones affect EVERY cell in the body, including the production of feel-good neurotransmitters in the brain. Treat the thyroid optimally and we won’t feel depressed anymore!
Since 1997 i have been taking a anti-depression med. And just today i was told it is my thyroid, wow was that a blow to the nerves. I have seen i want to say 20 doctors since 1997 and they never mentioned doing any test on me plus i never thought of doing these test. I have always been healthy out going till 1997 when i had a mild stroke. But hearing this could be the factor for me since my levels was bad it makes me think. If you are on anti-depression med,s ask the doctor to run a thyroid test on you, because you could be taking med,s you don`t need to be, and like me wow i hate taking pills. And it took for me to be so tired and no energy to finally go to the ER and they did the testing and found out i need med,`s.
Remember if your on any ant-depression med,s ask questions ask to be tested for thyroids i wish i would have in 1997. Good luck.
This happened to me too! I went for 10+ years before getting my Hashimoto’s diagnosis – and 7 of them being treated for depression on various meds. (they didn’t help much). Since getting diagnosed in ‘98 I’ve also been diagnosed with PCOS (’01). Frustratingly I still battle serious fatigue – which has never gone away
even though my levels are in ‘normal’ range (.5 – 1.5). It would be nice to not wake up tired everyday after sleeping for 8-10 hours and feel like someone beat me with a big stick!
I think part of the reason could be that in the 50’s and even early 60’s, mental illnesses like depression were highly stigmatised. As doctors and society became more edicated the stigma not only dissappeared but the pendulum swung too far in the other direction and doctors freeley habded out antidepressants for everythign from PMS to empty nest syndrome. This has continued to be the case for thyroid disorder withoutnthe doc even organised further tests related to depression or counselling / cognitive behavoural therapy for use alongside the antidepressants – not to mind organising blood tests for other likely problems resultant from the symptims the patient has.
10% of We The People have been told we need an antidepressant. That is the crooked antidepressant superindustry, plain and simple.
Doctors don’t need to do an antidepressant screening. If you walk in with the look of severe pain on your face, a bad limp and hardly able to talk–then you get an antidepressant prescription. Doesn’t matter what’s causing your disabling illness.
What’s important to most doctors is 1.) drug sales and 2.) that they get you out of their office ASAP so they can get in the next patient and make even more money.
With most doctors in the US, whether the patient is helped or not is irrelevant.
We hardly need doctors anymore. Our healthcare system could save piles of money by instead hiring clerks to sit in the chair that “doctors” sit in now.
I’m dead serious. That’s the painkiller, statin and antidepressant superindustries.
When a patient walks in the office, the clerk could just write a prescription for an antidepressant. Or for a painkiller or a statin. Pick one. The next time a patient goes in the office to see the clerk they can simply write another script for what hasn’t been prescribed yet: a painkiller, a statin or an antidepressant. When the patient revolts–they can be easily fired.
They ought to get the so-called “doctors visit” down to less than a minute. Congress will be proud. Follow the money.
This is happening–right now–most of the time with most of the doctors in the US. I know: I have severe hypothyroidism–but I also chronic Lyme disease, a frightening, dangerous and disabling bacterial disease. It put me on Social Security Disability.
Most every doctor pretends that chronic Lyme disease does not exist. Just ask chronic Lyme patients–they’ll tell you! We’re typically prescribed antidepressants for saying we think we could have Lyme disease. In one way or another, the typical doctor response is that it’s “all in your head.” Even if you’re in a wheelchair or using a walker or a cane: doctors think an antidepressant will cure us and when we persist, that a painkiller or a statin will shut us up and get us out of their office.
This is truly happening and it is widespread.
Right now.
You have to fight for your medical care!
For those who don’t believe it, then you may be 1.) fairly wealthy and can afford to pay for a doc who hasn’t been “bought”, 2.) you do without a lot of things, right down to the bone, so you can pay 100% for a good doc, or 3.) you have no idea what it is to have a devastating chronic illness–and be before most doctors in the US who deny appropriate treatment. Please listen to those who do have a devastating chronic illness, because they have the experience. They know.
Executives for the superindustries of most painkillers, statins and antidepressants are evil. Why are we at war in the middle east, when there is a war to be fought with some US corporate pharmaceutical executives?
We are in a painkillers, statins and antidepressants sales war with not many troops to fight the good fight–and President Obama will NOT listen. He still thinks most docs are decent human beings.
Patients with MS, lupus, Parkinson’s, rheumatoid arthritis, fibromyalgia and so forth, after years or decades of being prescribed drugs that essentially do not work for them and can be harmful making their condition worse, must also contend with some drug companies making very, very expensive experimental drugs that actually do not treat these patient–but which do make piles of money for these corporations.
The US medical community, for decades, has boasted that they are the best in the world and all countries should bow and tow to them because they are the medical leaders.
Dear God, help us all.
My primary care doc was quick to offer antidepressants. I refused and told him I was depressed because I felt awful! Went to an endo who has helped bring my levels up to a “livable” place. My husband was misdiagnosed with depression for several years – we paid for counseling and meds for 5 years with his condition continually worsening. Asked the doc to check his thyroid because it had caused me so much depression. Thankfully the doc checked his testosterone also – he was extremely low – another cause for depression in men (a very serious depression and personality change), yet how often is it checked?
This is because Dr’s need to go back through school and get better training. They know NOTHING at all about thyroid disease and act like they do- most people who have hypothyroidism have to treat it themselves because when you go to the Dr you are told you are depressed and when the antidepressant doesn’t work they keep trying to give you a slew of other ones. None of them learn to think for themselves and think outside the box at all. This is why I go to a holistic doctor- they look at everything from a bigger picture- most conventional doctors are worthless. I would still be sick if I went to them
If you are on anti-depressants and synthroid/generic, you may want to have your doctor do a complete thyroid panel and consider a thyroid med like Armour thyroid or nature-throid or west-throid. I was on both and could hardly get out of bed. The armour thyroid gave me my life back because it has T4 and T3! I still need a minimal dose of anti-depressant due to my cycle, but it is about 1/2 of the normal therapeutic dose.
Karen : )