10 physical reasons you may be depressed

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BODY AND MIND

Ways to treat depression that really isn't 'all in your mind'

In late November, Pennsylvania accountant David Ferguson started feeling blue. Really blue. He'd drag himself around, feeling depressed and anxious. He'd have trouble sleeping. And he'd start overeating on a major scale. His depression continued for months. And the thing was, he had no idea why---there was nothing in his life to be so deeply depressed about. What was wrong with his mind? he wondered. Why was he so depressed? Finally, in desperation, he contacted a local psychiatrist who listened to his symptoms, did some tests and realized that David's depression was caused by a physical disorder--actually the body's response to a sunlight deficiency--that afflicts 5 to 25 million people a year. David was treated and soon had more energy than he'd had in months. And over the next several weeks he even started losing his extra weight. What a relief!

And that's the good news about depression: Nearly one-third of all people diagnosed with it may actually be suffering from a physical illness masquerading as an emotional problem. Solve the physical problem, and in most cases the depression goes away.

This is so even though ongoing, unexplained (so-called chronic) depression is a major health problem and can seem (to the sufferer) hopeless.It can disrupt a person's normalroutine, causing lack of sleep and bringing on feelings of fatigue,inability to concentrate, changes inappetite and more.

There are as many as 75 hidden physical causes of chronic depression, says Mark Gold, M.D., author of The Good News About Depression (Bantam Books, 1986) and a pioneer in the field of physically caused depression. Dr. Gold says the best way to uncover these causes is a comprehensive physical examination, including a complete patient history and a battery of standard medical tests. And he urges depressed people or their families and friends to locate "biopsychiatrists" who understand the "medical mimickers" of major depression.

Here are 10 of the most commonly identified physical reasons behind these mental consequences:

1. PRESCRIPTION DRUGS

The very same drugs that boost your health may also cause depression. But correcting the problem may be as simple as changing drugs or adjusting your dosage.

Doctors are now generally aware that drugs may indeed have depressive side effects, says Arthur I. Jacknowitz, Pharm.D., professor of clinical pharmacy at the West Virginia University School of Pharmacy, Morgantown. In fact, it may be the first thing they consider with patients on regular medications who come to them complaining of depression.

So don't try to tough it out. Seek help right away, says Stuart C. Yudofsky, M.D., chairman of the department of psychiatry and behavioral sciences of Baylor College of Medicine, Houston. "If you're depressed, no matter what the cause, you and your doctor should take it very seriously."

Symptoms of depression may not surface right away, says Dr. Jacknowitz. If you've been taking a medication for six months to a year and then begin to experience the blues, it could still be your medication. On the other hand, don't automatically assume that a drug is causing your depression just because it's on a list of drugs with that possible side effect. Depression usually occurs in only a small percentage of the people taking any given drug.

Here, in a nutshell, are descriptions of the major categories of prescription drugs known to cause depression in some people.

Antihypertensives If you have high blood pressure, you may be taking reserpine, methyldopa, clonidine or beta-blockers. All of these may cause some symptoms of depression. Dr. Yudofsky, author of What You Need to Know About Psychiatric Drugs (Grove Weidenfeld, 1991), says most patients know when it's the drug that's causing the depression, but other factors may be compounding the problem.

Dr. Yudofsky considers a group of antihypertensives known as ACE inhibitors to be free of depressive side effects. These include Capoten, Vasotec, Zestril and Prinivil.

Other heart medications Antiarrhythmic drugs are used to stabilize an erratic heartbeat and to treat congestive heart failure. Digitalis, one of the most commonly prescribed antiarrhythmics, does cause depression in some people. Other antiarrhythmics may not have this same effect, and your doctor may decide to switch medications.

Cortisone and similar steroids If you have asthma, arthritis, psoriasis, severe allergies, colitis or one of a number of other ailments, you may be taking cortisone or other corticosteroids orally. These drugs are known to cause depression in some people.

If you suspect that corticosteroids may be causing your symptoms of depression, talk to your doctor about the options. Other nonsteroidal drugs may be available. In some cases, corticosteroids applied to the skin may be effective without depressive side effects. But do not discontinue your medication without your doctor's supervision. Stopping corticosteroids suddenly can lead to a very serious condition called Addison's disease.

Glaucoma medication Timolol, one of the beta-blockers used to treat high blood pressure, is also used in eyedrop form to treat glaucoma. And in both cases, the drug may lead to symptoms of depression.

Antihistamines Antihistamines are commonly prescribed for allergic symptoms, including runny nose, itchy eyes, sneezing and itchy skin. If you have hay fever or other allergies, you may be taking antihistamines for months at a time. "After long-term antihistamine therapy, you're just out of sorts. You feel tired. You feel fatigued. And that could lead to depression," says Dr. Jacknowitz. In that case, you may want to discuss the newer, nonsedating antihistamines with your doctor.

2. THYROID PROBLEMS

More than seven million Americans suffer from thyroid problems. And thyroid malfunctions are a major cause of depression. In fact, says Dr. Gold, 10 to 15 percent of all depressed patients have some form of thyroid disease.

Fortunately, there are simple blood tests for detecting problems in thyroid function, including the T4 test and the thyroid-stimulating hormone test (TSH). The tests can determine whether you suffer from hypothyroidism, the most common thyroid disorder to be linked with depression, as well as other thyroid dysfunctions.

In hypothyroidism, your thyroid gland secretes too little hormone, and your metabolism slows. You may then experience a range of symptoms, including weight gain, dry skin, hair loss and constipation. Also, your sleep patterns will change. You may find yourself fatigued and sleeping more than usual. Your interest in sex may plummet. Yet many people with an underactive thyroid don't even know it. The Thyroid Foundation of America estimates that half of all people with hypothyroidism are undiagnosed or misdiagnosed.

Many hypothyroid patients are significantly depressed during the course of the disease. After the problem is diagnosed, treatment is available. The most common treatment is a synthetic thyroid hormone, taken orally.

3. PREMENSTRUAL SYNDROME

Most women suffer from some form of premenstrual syndrome (PMS), but about 5 percent experience depression so severe that it disrupts their daily lives. Symptoms include mood swings, food cravings, crying, emotional withdrawal and insomnia.

It shouldn't be surprising: A woman's body is buffeted by a hormonal whirlwind just prior to menstruation. Progesterone and estrogen levels rise and fall, and endorphins (as well as other hormones associated with mood) change during this time.

If you regularly experience symptoms of depression during menstruation, you should discuss the following possibilities with your doctor:

Researchers theorize that when women's estrogen levels rise during the menstrual cycle, the level of pyridoxine, or vitamin B6, changes in some of them. Since pyridoxine is involved in the body's production of mood-lifting neurotransmitters like serotonin, low levels of it may cause mild depression. Dietary sources of pyridoxine include chicken, fish, rice and whole-wheat products. Supplemental pyridoxine may help, says Barbara Parry, M.D., associate professor of psychiatry at the University of California at San Diego. Be careful not to exceed 10 milligrams per day, however. Excess pyridoxine can cause nerve damage.

Judith Wurtman, Ph.D., a nutritional researcher at the Massachusetts Institute of Technology, believes that a diet high in complex carbohydrates, like pasta and potatoes, may also beat PMS-related depression by boosting serotonin levels. And other doctors say that many of their patients with PMS have reported improvements in theircondition after eating a high-carbo-hydrate diet.

4. OTHER FEMALE HORMONAL DISTURBANCES

PMS may be the most frequent reminder that a woman's reproductive hormones are often out of balance. But there are three other common hormonal disturbances that can lead to depression in women:

Menopause "Several articles have been written about the `myth of depression at menopause.' I think that's a myth," says Dr. Parry. The "menopause blues" really do exist for some women. Fortunately, the problem is very treatable, she adds.

Symptoms of depression usually peak at around the age of 50 or 51, at the onset of menopause, when most women have their very last period. And the depression is not just an emotional reaction to the loss of their ability to bear children.

A woman's estrogen level drops at menopause, and some researchers theorize that this lack of estrogen might cause changes in other hormones or chemicals in the brain such as serotonin, which has been linkedto mood disorders.

Evidence suggests that regular, vigorous exercise can counteract the effects of this drop in serotonin by generally raising the level of good-humor hormones circulating in your blood.

Estrogen-replacement therapy alone may not relieve the symptoms of menopausal depression. However, if your symptoms are severe, it may be a necessary first step to further treatment. That's because antidepressant drugs won't work in the face of low estrogen levels. Estrogen-replacement therapy raises estrogen levels, making it possible to use antidepressants.

For mild depression, no treatment may be necessary. But ask your doctor to evaluate your situation and recommend treatment options.

Oral contraceptives The Pill is the most popular reversible contraceptive method in America. Yet up to 50 percent of the women who stop using oral contraceptives do it because of feelings of depression caused by the contraceptive.

Most depressive side effects are related to the dosage of the hormones estrogen and progestin contained in the Pill. So talk to your family doctor or gynecologist about the depression you're experiencing and ask if you can be given a different dosage.

The high levels of estrogen in many contraceptive pills may also inhibit the levels of vitamin B6 found in certain predisposed PMS sufferers, says Dr. Parry. Again, supplemental B6 may be helpful in some women with mild symptoms, under a doctor's supervision.

Postpartum depression Like PMS and oral-contraceptive-induced depression, the so-called baby blues may also be triggered by changing levels of reproductive hormones. During pregnancy, depression is uncommon. But during the first month after the baby is born, the incidence of depression shoots up dramatically and stays up for six months. Fifty to 80 percent of all mothers experience the baby blues, which are characterized by crying, rapid mood shifts and irritability.

First-time mothers are especially at risk. So are women with a history of depression. There are treatment options your doctor can recommend, including antidepressant medications for those who are seriously depressed.

5. DIABETES

Could you be one of the nearly seven million Americans who have diabetes but don't yet know it? If so, the depression you experience may be caused by this untreated condition. And even if you know that you have diabetes, depression may result if you don't control the disease by a special diet or insulin shots or pills.

Insulin is the body's sugar-delivery van. When too little insulin is produced, or when the body can't use it properly, sugar pools in the bloodinstead of being delivered to cells, where it's needed for energy. This high level of blood sugar can lead to low energy, fatigue and sleeplessness, which you may experience as depression. If your problem is, in fact, diabetes, these depressive symptoms will be accompanied by increased urination and excessive hunger and thirst.

To diagnose your condition, your doctor may measure your glucose (blood-sugar) levels or perform a glucose-tolerance test. (After an overnight fast, a sugary, high-glucose beverage is given, then blood is drawn at regular intervals to track blood-sugar levels.)

Just the opposite of diabetes, hypoglycemia (which is caused by too little sugar in the blood) causes symptoms ranging from weakness and nervousness to shallow breathing, confusion and rapid heartbeat. Some diabetes patients experience hypoglycemia when they overdose on insulin or skip a meal, which shunts too much sugar out of the blood.

6. RAPID-WEIGHT-LOSS DIETS

If you're on a diet that leaves you hungry, you're bound to get depressed, says Prevention advisor George L. Blackburn, M.D., Ph.D., chief of the Nutrition/Metabolism Laboratory with the Cancer Research Institute at New England Deaconess Hospital,in Boston.

"For every person who's depressed, there'd be a lot more if there were no food! Food is one of the great tranquilizers. Food is mostly the solution," he says. And when you're on a crash diet and getting too little food, you're on the road to what Dr. Blackburn calls "brain pain," a complex mix of factors that boils down to the fact that your mind and body are in pain from lack of food.

So depression may be a warning sign that you're pushing your diet too far, too fast. Not only will that leave you feeling depressed, the depression itself is likely to sabotage your diet, as well, says Dr. Blackburn.

That's why he recommends an adequate, healthy diet that satisfies you and doesn't leave you feeling hungry. "If the diet you're on makes you feel hungry, it's not going to work. So stop doing it, and read Prevention, which can help you establish a diet that's healthy and will do what you want without making you hungry. Undoubtedly, it will have a lot of fluid and fiber, and it's going to be grazing--eating five to six times a day."

7. LACK OF EXERCISE

In 1989, Prevention reported on a study of 1,900 people suggesting that lack of exercise was an independent risk factor for moderate depression, especially among women. Regardless of other factors like household income or employment status, those with low activity levels were at significantly greater risk for depression.

Now, a more recent study confirms this research and even takes things a few steps further. Researchers at the Human Population Laboratory of the California Department of Health Services surveyed 6,928 residents of Alameda County, California, and found that the link between lack of exercise and depression also exists for men. And their findings suggest something very positive: When inactive people finally do start exercising, they are less likely to have depressive symptoms. "Just as quitting smoking can lower your risk of lung disease, it appears that beginning to exercise can actually reduce your risk of depression--even if you were a couch potato," says Terry Camacho, research analyst and co-author of the Alameda County study.

8. SUNLIGHT DEFICIENCY

The accountant we described at the beginning of this story was suffering from a condition known as seasonal affective disorder, or SAD. SADvictims exhibit all the classic symp-toms of chronic depression--all be-cause of too little sunlight in the falland winter.

Millions of Americans suffer from SAD, says Dan Oren, M.D., a senior clinical investigator in the clinical psychobiology branch of the National Institute of Mental Health. And 83 percent of those afflicted with SAD are women between the ages of 30 and 50. So don't rule it out, even if you haven't noticed a cycle to your depression--especially since it can be treated quite effectively.

Doctors feel that some people with SAD may have an ultrasensitivity to a hormone called melatonin. In darker months, melatonin levels are high because this hormone is only produced at night or in the absence of light. In the presence of light, melatonin secretion is inhibited.

So the first-line treatment for SAD is light therapy administered by specially trained health professionals. During light therapy, you are exposed to regular sessions of bright, full-spectrum light that are basically equivalent to looking out of a window on a clear spring day with lots of sun. The sessions usually range from half an hour to six hours daily, depending on the intensity of the light and the severity of the depression.

9. INADEQUATE NUTRIENT INTAKE

"Anytime the body doesn't get enough of a nutrient, activity levels are impaired, which can mimic depression and be labeled as such," says David Levitsky, Ph.D., professor of nutrition and psychology at Cornell University. However, there has been little research into the emotional effects of mild nutritional deficiencies. And severe deficiencies--leading to major depression--are rare. Still, preliminary research indicates that a number of vitamin and mineral deficiencies may lead to symptoms of depression. We discuss several likely possibilities below. If you suspect a deficiency, talk to your doctor.

Iron Advanced cases of iron-deficiency anemia can lead to feeling depressed, listless and lethargic, says Ernesto Pollitt, Ph.D., professor of human development at the University of California at Davis. Countless clinical reports by doctors suggest that even mild anemia may have a similar effect on mood. Unfortunately, says Dr. Pollitt, there is simply no research that's been done to document this. But, he says, "if you are tired, listless and apathetic in a way you're not used to, you'd better check your iron levels"--especially if you're a premenstrual woman or someone with medical problems that could affect iron levels. The problem can be diagnosed with a hemoglobin test.

Thiamine In older people, even marginal deficiencies of thiamine can lead to weight loss, sleep disturbances, inactivity, irritability and depression. In a recent study of 80 older Irish women with moderate thiamine deficiency, thiamine supplements improved their sleep patterns, decreased fatigue and restored appetite and general well-being. The authors of the study, from the department of nutrition at the University of California at Davis, recommend having your thiamine levels checked (with a blood test) if you are over 65 and experiencing these symptoms of depression. The Recommended Dietary Allowance (RDA) for thiamine is 1.5 mg. for men and 1.1 mg. for women.

Selenium Even moderately low levels of selenium may result in a low mood, anxiety and tiredness. Researchers at the University College, Swansea, Wales, found that when dietary intake of selenium went down, reports of anxiety, depression and tiredness went up. The good news: Supplements of 100 micrograms of selenium per day improved mood and anxiety levels. The RDA for selenium in men is 70 mcg. and for women, 55 mcg.

Magnesium Low magnesium is very common, says Daniel Kanofsky, M.D., M.P.H., assistant professor of psychiatry at the Albert Einstein College of Medicine, in New York. Its symptoms can include depression, irritability and confusion. There is not yet enough evidence, however, to conclude that supplementing with magnesium can alleviate these symptoms. If you suspect a magnesium deficiency, get a blood test to confirm it.

In some fascinating but preliminary studies, low magnesium levels were also found to be present in sufferers of chronic fatigue syndrome. In one of those studies, injections of magnesium sulfate significantly improved energy level and emotional status. More research is definitely needed to confirm these findings.

10. INADEQUATE CARBOHYDRATE CONSUMPTION

If you always eat your complex carbohydrates--like rice, bread and cereal--together with some protein source, you may be at risk of mild depression, says Dr. Wurtman, author of Managing Your Mind and Mood Through Food (Rawson Associates). She speculates that that's because the amino acids in protein prevent tryptophan from getting into the brain. And tryptophan is essential for producing serotonin, the brain chemical that keeps your moods stable. Her theory is that when eaten alone, complex carbohydrates boost serotonin production in the brain. "This theory certainly holds up in animal studies," says Harry Gwirtsman, M.D., chief of the mood-disorders program at the National Institute of Mental Health. "But it still has not been shown to be true in humans. We need further research to help clarify it." Dr. Wurtman recommends getting at least one meal a day that is very high in complex carbohydrates, with little or no protein. Rice, potatoes and plain pasta are good choices, but fruits won't work. They contain simple sugars, which don't stimulateserotonin release and that ensuingcalming effect.

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