I met with someone at our clinic this week about working together locally to help people safely discontinue their psychotropic medication and address their anxiety, depression, and other psychiatric concerns using less invasive therapies. He told me the story of someone he knew. This wasn’t the main focus of our conversation, so it’s a bit fuzzy, but here’s how I remember the story: This person went to their doctor, as a teen, for an unrelated concern and left with a depression diagnosis and a prescription for an SSRI. Think Prozac, Paxil, Zoloft, etc. These are all in this medication class—SSRIs. Anyway, this is where the story gets a bit fuzzy in my memory. He told me that the person was also diagnosed with Hashimoto’s thyroiditis, an autoimmune thyroid disorder, around that time and that she eventually had a pretty difficult time discontinuing the SSRI when she wanted to later in life.
Here’s What’s Wrong with this Story
Based on the DSM-5, the book that contains the guidelines that are used to make any psychiatric diagnosis, you cannot diagnose a person with depression if there is another medical reason for their fluctuation in mood. In fact, the DSM-5 says verbatim that in order for a person to be diagnosed with depression, the following must be true:
The episode is not attributable to the physiological effects of a substance or to another medical condition.
Essentially, if you have a condition that can lead to depressed mood, then it’s impossible to tell if your mood changes are caused by that condition or you’re simply depressed. If you’re reading between the lines, the underlying assumption here is that the depression is likely to resolve when the medical condition is well-managed.
Let’s Look at the Thyroid
I’ll spare you the details and tell you that the thyroid is a gland in your neck that produces hormones that are responsible for growth, metabolism, and a lot of other symptoms. Having an overactive thyroid gland can lead to feelings of anxiety, mood swings, irritability, and related emotions. Having a sluggish or underactive thyroid can lead to depressed mood, weight gain which often leads to depressed mood, and more.
Sometimes, the body can create antibodies to the thyroid (and related structures) which can lead to autoimmune destruction. Basically, the body “unintentionally” attacks itself. This is manifested as autoimmune thyroid disorders like Grave’s disease and Hashimoto’s thyroiditis.
Back to our Story
The person I described above should have never been diagnosed with depression and therefore shouldn’t have been put on anti-depressants. She was diagnosed with Hashimoto’s thyroiditis around the same time that she was given the prescription which means that she should have either (1) never been given the prescription if the Hashimoto’s diagnosis came first or (2) in light of the outcome, the fact that she would have been taking the drug for only a short period of time, and the fact that both she and her family questioned the diagnosis from the beginning, it would have been better for her to have been weaned off of the drug until her thyroid function was under control and then for her to have been reassessed.
I’m a strong advocate of functional medicine, which entails uncovering the underlying cause of a concern (in this case, thyroid dysfunction) and addressing it in order to help the body return to a state of wellness (as opposed to treating symptoms like depression as they arise). I’m also a strong advocate of the therapeutic order, which means using the least invasive treatments and those with the lowest side effect profiles first, and saving medication as a last resort.
Thyroid Tests that I Run on My Patients with Anxiety, Depression, and Other Psychiatric Diagnoses
The majority of doctors only run one to three tests when evaluating thyroid function. The most common is thyroid stimulating hormone (TSH). Some doctors go a step further and run the thyroid hormones, T3 and T4. When I am evaluating thyroid function for my patients, I like to run a more complete thyroid panel. I’ll tell you what that includes and I’ll briefly tell you why.
Thyroid labs I run (at the bare minimum) include:
- TSH: provides information about the thyroid gland’s ability to produce the amount of thyroid hormone the brain is saying to produce
- Free T3 (fT3): provides information about the active form of thyroid hormone, T3
- Free T4 (fT4): provides information about the form of thyroid hormone that is mainly produced by the body, T4. T4 is converted to the active form, T3, in the body
- Anti-thyroid peroxidase antibodies (anti-TPO): provides information about whether or not your immune system is attacking your thyroid
- Anti-thyroglobulin antibodies (anti-TG): provides information about whether or not your immune system is attacking your thyroid
There are a few other tests that I may run depending on the circumstances, but these are the thyroid labs I run on everyone with a mental health or mood concern, at least initially. Your doctor should be able to run these test and your insurance should cover the cost, but if for some reason your doctor isn’t able to do so or if you don’t have insurance, you can purchase the comprehensive thyroid tests directly (without your physician signing off on it) through this lab. You’d then need to go to one of their approved labs to have your blood drawn. Simple as that! You typically receive your results within 4 days. There are a few different direct access labs out there, but I’ve found this one to be the most cost-effective, and that’s one of the reasons why I highly recommend them.
Can’t I Just Run the Other Labs and Check the Antibodies Only if They Come Back Abnormal?
Many practitioners refrain from checking thyroid antibodies until labs are abnormal and some don’t check antibodies at all. In fact, I’ve had patients who have been diagnosed for years with hypothyroidism but who stated that they had never had their antibodies checked and who have never been told that there was an autoimmune component to their thyroid dysfunction.
I’ve also had patients who had perfectly normal labs (TSH, fT3, fT4, etc.) but, when I ran their antibodies, we found that they were in the early stages of Hashimoto’s thyroiditis. They had elevated antibodies, indicating that their thyroids were being attacked by their immune systems, but their other labs had not yet been negatively impacted. They showed symptoms of thyroid disorders, such as fatigue and depression, even though the majority of their thyroid labs looked great. Their bodies were compensating.
Had I skipped out on running thyroid antibody labs in those patients, we would have completely missed the opportunity to catch this autoimmune thyroid process in its early stages and address it before it grew out of control and demanded more invasive modes of treatment.
The Conclusion of it All
In case you skipped to the bottom, here’s my point: thyroid disorders can lead to mood disorders such as anxiety and depression. As a matter of fact, doctors are not even supposed to diagnose you with anxiety or depression if you have a thyroid disorder since they can lead to anxiety or depression and there’s no real way to tell if your changing mood is due to your poor thyroid health or a primary mood disorder. For anyone considering taking medication for anxiety or depression, I always recommend having their thyroid checked first, and I make sure to tell them to have a full thyroid panel done and not just TSH or even TSH, free T3, and free T4. If your doctor isn’t willing to do comprehensive testing, you can have it done yourself here. Including thyroid antibodies can allow you to gain valuable information about whether or not an autoimmune process is taking place and negatively impacting thyroid performance.