Over four weeks in the Topic I will discuss how physical conditions can mimic symptoms of common mental health problems like depression, insomnia, anxiety and fatigue and in many cases cause mental health problems. I will discuss the impact on our mental health of hypothyroidism, low testosterone levels, sleep apnoea, alcohol abuse, infections, Parkinson’s disease, arthritis, fibromyalgia, chronic fatigue syndrome, dementia, multiple sclerosis, stroke, epilepsy, cancer, medication (both prescription and illegal drugs) amongst others. This will indicate that on certain occasions, simply getting a simple blood test and getting appropriate treatment for easily treatable conditions like low thyroid levels may relieve mood disorders such as depression. However, it must be borne in mind that many mental health problems are not caused by physical problems.
Psychological complications of physical disorders
The three most common mental health issues caused by physical illness include depression, anxiety and fatigue. Several medical disorders can cause anxiety and depression directly through their effect on the body.
Delirium is a state of confusion, disorientation and impaired consciousness. It is often a temporary mental state that often accompanies physical illness. It occurs in about 10 to 15% of patients in general medical or surgical wards in hospital and about 20 to 30% of patients in surgical intensive care units. It is more common in the elderly. Behaviour includes over-activity, irritability though some people tend to be underactive. Thinking is slow and muddled. Mood can is anxious, irritable or depressed. There can be visual hallucinations and perception may be distorted with misinterpretations.
Patients need reassurance and reorientation to reduce anxiety and disorientation. When linked to physical illness, it is generally short term. There should be a predictable and consistent routine for the patient and as few drugs as possible should be given to the patient as drugs can increase disorientation, especially drugs that can cause disorientation such as tranquillisers. The commonest cause of delirium in the elderly is infections of the urinary tract, chest, skin or ear; cardiac failure; side effects of drugs and strokes. Severe constipation, alcohol withdrawal and head injuries are other possible causes.
Conditions which mimic depression
Typical symptoms of depression include low energy, lack of interest in things once found pleasurable, fatigue and difficulty concentrating. Over the next 20 years, depression is expected to be the second leading cause of disability worldwide and the leading cause of disability in high-income nations such as Ireland.
Two medical conditions that most commonly show up as depression are hypothyroidism (mainly in women) and low testosterone levels (in men). These medical disorders can mimic depression as many of their symptoms are similar to the symptoms of depression.
Low levels of thyroid hormone (hypothyroidism) can cause depression while high levels (hyperthyroidism) can cause anxiety and agitation. In situations like this, it is not the mental health problem that needs treating with anti-depressants or mood stabilisers; it is treatment of the underlying cause that is needed.
Hypothyroidism should be considered when a person presents with first time depression, especially in those who have no previous history of depression. This is especially the case in women as hypothyroidism is more common in women. Many of the symptoms of hypothyroidism are similar to depression. These include lethargy or fatigue, sleepiness, lack of motivation, loss of enjoyment in things which use to be enjoyable, negative mood states (e.g., sadness, regret, guilt or anger), mood swings, and weight gain. As many of the symptoms of hypothyroidism mimic depression, it is sometimes underdiagnosed, or misdiagnosed as depression. Anti-depressants will be ineffective for depression type symptoms in patients suffering from hypothyroidism.
Low testosterone levels in men
Lack of energy and sexual function is considered by many men as a natural part of ageing; to a certain extent it is. However, in many cases it is caused prematurely by a significant fall in testosterone levels which is easily diagnosed and treated. There are many possible causes of low testosterone including damage to the testicles by physical injury, mumps or genetic reasons or there may be a problem with the pituitary gland in the brain which regulates the release of hormones.
Low testosterone levels can be misdiagnosed as depression in men. Symptoms of testosterone deficiency include difficulty attaining or maintaining an erection, lack of sex drive, irritability, mood swings, negative mood states (e.g., sadness, regret, or anger), difficulty concentrating, lethargy and fatigue, a lack of motivation, and weight gain. Testosterone levels should be checked in men who present with these symptoms, especially if there is no previous history of depression and if they are over 35 (low testosterone levels are more common in over 35’s)
A slow decrease in testosterone is normal for men over 40, but sometimes there is an unusually sharp drop in testosterone levels and it is this that will lead to depression-type symptoms. If there is a sharp drop in testosterone, other symptoms which indicate low testosterone levels is the problem and hence warrant a testosterone check include development of fatty tissue in the breast/ chest area; accelerated hair loss and susceptibility to fractures.
Like hypothyroidism, anti-depressants will be ineffective for depression type symptoms in men suffering from low testosterone levels. Treatment involves testosterone replacement treatment given as an intramuscular injection administered every 2 or 3 weeks or a patch or gel applied to the skin.
Upcoming talk on depression and mental health
Whelehans Pharmacy have organised an expert panel to discuss depression and mental health on Thursday August 6th at 7pm in the Greville Arms Hotel; some leading local experts on this subject will be talking. This talk will be open to all and will be free of charge. Keep an eye on this column in the coming weeks for more details. In order to avoid disappointment, you can put your name down on the waiting list for this event by calling Whelehans at 04493 34591
To be continued…next week I will discuss mental health implications of insomnia, sleep apnoea, alcohol abuse and infections.