If you go to a doctor with symptoms of fatigue, persistently low mood, loss of interest in normal activities, insomnia and lack of appetite, don’t be surprised if you leave the clinic with a diagnosis of depression, a prescription for an anti-depressant, and a referral to a therapist.
After all, you have just catalogued the classic symptoms of clinical depression, for which the two pillars of treatment are anti-depressants and psychotherapy. However, the startling truth is that this syndrome of symptoms may be indicative of a variety of other illnesses besides depression. Treating them with a tweak of the diet, a boost of supplements, or drugs other than anti-depressants can cause the symptoms to abate.
In fact, research finds that the majority of people initially diagnosed with depression do not actually meet the criteria on careful re-evaluation. That is, doctors are diagnosing depression in people who don’t have it; what they have instead could be one of a number of other illnesses rooted in physical – not mental -- causes. Here’s a closer look at just four of the illnesses that mimic depression.
Hypothyroidism. The thyroid, that butter-shaped gland in the front of your neck produces hormones necessary to regulate the body’s metabolism, including the way that our body’s cells use nutrients to make energy. If the thyroid secretes too little hormone (a condition known as hypothyroidism), your metabolism slows down. This can have a profound effect on every part of your body, including your brain. You may then experience a number of symptoms, among them low mood, fatigue, slow reflexes, lassitude and excessive sleepiness, difficulty concentrating, forgetfulness and impaired libido – all hallmarks of depression.
But if you are also suffering symptoms like muscle stiffness and cramps, chills, hoarseness, lowered heart rate, dryness of the skin and hair, you might well be suffering from hypothyroidism, and not depression. Thyroid malfunction is highly prevalent in India (as it is globally), yet millions of Indians with an underactive thyroid don’t even know it. But the condition is easily diagnosed through a blood test, and treatment is relatively straight-forward; typically, it requires taking a daily dose of synthetic thyroid hormone.
Hypoglycemia (Low Blood sugar). Blood sugar levels drop when you are hungry. Hypoglycemia is a medical condition characterized by abnormally low levels of sugar (glucose), which is the body’s main source of energy. Diabetics can experience hypoglycemia when they overdose on insulin or skip a meal, which shunts too much sugar out of the blood. However, a variety of conditions can cause low blood sugar in people who don’t have diabetes. These include:
» Illnesses such as severe hepatitis, kidney disorders, extreme starvation diets as in anorexia nervosa, or a rare tumour of the pancreas which causes over-production of insulin.
» Medications: e.g., beta-blockers; quinine, used to treat malaria.
» Heavy alcohol intake without eating.
Whatever the cause, a drop in blood sugar causes moodiness, irritability and other depressive symptoms. The link between hypoglycaemia and depression runs thus: Hunger is a primitive signal that is known to trigger off the stress response. In those people who have a predisposition, this stress response can then trail in symptoms of anxiety and depression. Particularly prone are those who suffer from rapidly changing blood sugar levels on a regular basis. If your blood sugar is up and down every day, it could be a sign of a pre-diabetes condition called insulin resistance.
Hypoglycemia can be diagnosed through testing. Immediate initial treatment with a fast-acting carbohydrate (such as candy, glucose or a fruit juice – natural, not diet) will raise your blood sugar level. Later treatment is aimed at uncovering the underlying condition that’s bringing on the hypoglycaemia, so as to prevent it from recurring. As the physical symptoms are brought under control, so are the depressive symptoms.
Chronic Fatigue Syndrome. The Journal of Clinical Psychiatry cites the case of a 65-year-old woman whose doctor was convinced she was suffering from depression, but who steadfastly maintained she was not feeling depressed. “She is depressed,” her physician wrote when referring Ms. A. for a psychiatric consultation. “She has been feeling tired for more than a year and describes being exhausted most of the time, with headaches, joint pain and problems with her concentration and memory. Her fatigue is frustrating for her and for her family; she cannot function well even in the morning. She denies being depressed, and does not have any previous mental or medical illnesses. Every lab report I checked was normal. I still think that she is hiding her depression and manifesting it with all these somatic complaints.”
As it turned out, the woman was not suffering from depression but from Chronic Fatigue Syndrome (CFS). Marked by prolonged, debilitating fatigue that does not improve with rest and which can seriously impede daily functioning, CNS is one of the most challenging conditions to diagnose. In fact, there is still some debate about whether such a condition actually exists. It has been trivialized by doctors and lay people alike, and dismissed as mere malingering. However, with around 5000 research studies having been conducted on it, there is far wider acceptance today that not only is this condition real but that it is a complex, multi-system disease that dramatically limits the lives of those it affects. They are more functionally impaired than those with Type 2 diabetes, multiple sclerosis and congestive heart disease – all of which are known to be grave illnesses. At some point in their lives, 1 in 3 CFS sufferers will be bedridden or housebound because of the disabling effects of the disease which frequently strikes people in their 40s, 50s and 6os.
CFS remains undiagnosed in an estimated 80 % of people who have it. And it is misdiagnosed as depression in a high number of sufferers.
But a doctor who is attuned to patient testimony and does not dismiss what the sufferer is saying will get down to a thorough history-taking, followed by tests to rule out other ailments such as fibromyalgia, auto-immune disorders, hypothyroidism, and sub-acute infections, all of which are also characterized by prolonged fatigue. There is unfortunately no medical test, as yet, that will conclusively diagnose CFS. But there are helpful cues by which a doctor can arrive at the correct diagnosis. For one thing, CFS is known to have clear physiological markers, including diminished cardiovascular function, even after exercise; slowed information processing in the brain; and orthostatic intolerance (light-headedness, blurred vision, and other symptoms that develop when the person stands up). In other words, it is an organic disease – one rooted in the body rather than in the mind – and this is one of the chief characteristics that distinguishes it from depression.
Also, the “fatigue” that CFS sufferers experience is not the regular tiredness that the word conjures up in our minds. It ranges from severe flu-like feelings to an acute sense that one’s body cells have lost all their energy, making it difficult to get enough air to call out for help.
In addition, people with CFS often have physical symptoms that aren’t commonly associated with depression. These include:
» joint pain
» tender lymph nodes
» muscle pain
» sore throat
Depression and chronic fatigue syndrome also affect people differently when it comes to their daily activities. People with depression often feel very tired and aren’t interested in doing any activity, regardless of the task or the required amount of effort. On the other hand, those with CFS usually want to engage in activities but just feel too tired to do so.
A person with major depression will report a persistent low mood, but will often be unable to identify a reason for the depressed mood. On the other hand, those with CFS will report feeling depressed and discouraged because their lack of energy leaves them unable to begin or complete tasks.
A depressed person will typically report a loss of interest in pleasurable activities. Persons with CFS say they would engage in favourite activities more if their energy level permitted it.
A depressed person may report no interest in food or, on the other hand, may overeat. Persons with CFS have not lost their interest in food, but find shopping and cooking fatiguing. They may opt for fast foods, takeaways or easy-to-prepare meals.
Vitamin D deficiency. It’s commonly known that a lack of Vitamin D causes bone problems. But this vitamin’s role in the body is not limited to the bones. D is a synthetic hormone that impacts virtually every cell in the body. Apart from its suggested links to heart disease, diabetes and cancer, a growing body of research is indicating that low levels of this key vitamin can cause symptoms similar to those of depression.
Just last month, the world’s leading authority on Vitamin D deficiency, endocrinologist Michael Holick, warned that deficiency of this vitamin is reaching epidemic proportions in India. Indian research in recent years indicates that around 70 % of Indians are deficient in this vitamin. The population of seniors is at higher risk, in particular those who are pure vegetarians.
A blood test can establish whether a deficiency of Vitamin D exists. If you fall in the at-risk group, you will need to take a Vitamin D supplement, besides boosting intake of D-rich foods and increasing exposure to sunlight.