Have you ever felt down and miserable, despite the fact that life in general is great? What about bursts of anxiety so intense they leave you gasping, but you’re not actually worried about anything (or at least nothing that you think would reasonably result in a panic attack)? If you can relate to either of these two scenarios, then you are not alone.
Many clients – as many as one third – have physical conditions either causing, or contributing to, their emotional difficulties.
When a new client comes to a therapist for the first time they will ask be asked all kinds of questions. These will range from the historical (tell me about your mother types of questions), to the current (present sources of stress, what kinds of medications are you currently taking – including the contraceptive pill?) to the seemingly irrelevant (sleeping, diet and exercise habits). Believe us when we say we’ve had an eyebrow or two raised asking about things like allergies when a client has come to us with symptoms of severe anxiety, or asking about alcohol or drug use when the client is wondering how to manage the arguments they are having with their spouse. Many clients come to see us after struggling for years or even decades. Some have even been taking anti-depressant or anti-anxiety medication (again, sometimes for years), with limited or no benefit.
Audrey (named changed) came to therapy for the first time because her anxiety had grown so severe that she was having difficulty leaving her house. Her panic attacks were only barely managed by deep breathing and self-talk. She had recently gone to see her family doctor, who prescribed her an anti-anxiety medication and had suggested she talk to a therapist. So Audrey is talking to a therapist. And that therapist is asking all kinds of irrelevant questions, like when was her last medical exam, if she has recently given birth, and her general diet and sleep patterns. Answering all questions as honestly as she can, her therapist recommends some mindfulness techniques and a cognitive-behavioral technique designed to help manage panic and anxiety. And she also recommends that Audrey go back to her doctor to request a medical exam and blood work.
There are many medical conditions, (or indeed medication side effects) that at a minimum make symptoms worse and sometimes are the sole cause of depressive or anxious symptoms.
8 of the most common medical conditions that can look like depression:
- Anaemia (low iron)
- Thyroid Conditions (autoimmune and hypothyroid, hyperthyroid)
- Celiac Disease
- Sleep disorders
- Brain Injury
- Alcohol/Drug use/abuse/withdrawal
- Allergies (environmental and food)
If we look at the symptoms of all of the above conditions, we can see how closely they can resemble depression. A quick Google search (who doesn’t Google their symptoms??) reveals the most common symptoms of the eight medical conditions listed above:
The overlap and commonalities in symptoms across all of these conditions is obvious when you look at them. All of them include the most common symptoms associated with depression (fatigue, irritability, some disruption in thought processes and mood changes).
Therapists are human too, and unfortunately it is possible many clients have underlying medical conditions that they and their therapist (and even their medical doctor) are completely unaware of that are affecting their emotional presentation.
It turns out that the therapist hunch was correct: Audrey’s iron level was so low that she was anaemic (Audrey told her therapist that she suffered from prolonged and heavy menstruation each month since the birth of her first child thirteen months ago). With proper iron supplementation she was soon able to better cope with life’s hurdles, and felt she had the energy to start properly utilizing all the self-help techniques she had previously learned but struggled with doing due to her extreme lack of energy. Better still, the severity of her anxiety subsided dramatically as her sense of control increased. Audrey still had lingering anxiety and depressive symptoms, but therapy could now start to help her gain a sense of hope that she could make the changes necessary.
As therapists we advocate for clients to become experts in their own body, their own health. To be curious about and track when their symptoms are better, when they are worse.
We encourage clients to keep records of
- What is happening at that time (what have you eaten, done, where have you gone, who were you with?).
- Generally speaking, what helps to make the symptoms better?
- What makes the feelings worse?
What you can do to increase your chances of a correct diagnosis and proper treatment:
If you are taking medication for a mood related disorder, but you are not feeling any benefit from it, then we have some recommendations for you:
Firstly, go see your prescribing doctor. Tell them how long you have been taking the medication (at least 2-3 weeks), and what changes you have noticed from taking the medication: that will help them problem-solve as to whether this is a suitable medication for you, or if the dosage should be adjusted. There is no one-size-fits-all for mood-medication (despite what the pharmaceutical companies like to advertise), and some of them (SSRI’s) are falling into disrepute. Read Cracked if you’re interested in finding out more.
Secondly – talk to a therapist. Very often, a doctor is doing what they know and have been trained to do – take a patient at their word. They listen in the short time they have and hear what seems like symptoms of anxiety or depression and prescribe a mood altering medication.
Remember: Only a very small number of mood disorders have a purely physiological/biochemical cause. Therefore, if you are one of the majority, trying to treat your panic attacks or depression by simply taking a pill will likely only result in limited benefit.
Most medical doctors are qualified to assess and treat physical conditions – they are not trained to assess and treat the psychological reasons for emotional conditions. Treatment for mood disorders usually works best when there is both medical and psychological support in place.
Thirdly, realize that medication does have its place: many clients carry shame or fear about taking medication. We have both had clients where we have counselled them to TAKE medication, particularly so if they are having trouble sleeping. The analogy we use is this:
“If you were a good swimmer and found yourself in rough waters, would you refuse to use a life-jacket because you knew you could swim?”
Not all sad feelings are depression. Not all worry is clinical anxiety.
But if you or someone you love is struggling with significant mood issues, seek medical as well as emotional support. Schedule that ‘yearly’ physical that you’ve been avoiding for the past 5 years because “you’re perfectly healthy”. Because why? Because you’re worth it!