Feeling down, pessimistic, grumpy, or irritable? You may be depressed, or you may be suffering from some other bodily ailment that mimics depression. Depression is a huge topic for highly sensitive people because we are more likely to be deeply affected by events that occur in our lives and spend more time processing the event emotionally and cognitively. That can lead us to depressive thinking, but in this article from NPR we learn that it is possible that some people may be wrongly diagnosed with depression instead of being tested for several notable exceptions: diabetes, hypothyroidism, and chronic fatigue syndrome at best and bipolar disorder at worst. The difference? Diabetes and hypothyroidism can be identified through a simple blood test. Chronic fatigue syndrome is a more complex issue with a diagnosis requiring a number of tests. Bipolar disorder is also a complex diagnosis requiring great skill and experience in adequate identification and treatment.
As a person who has had lifelong dysthymic depression (chronic low-level continuous depression) I feel a special kinship with those who may also be attempting to navigate the confusing, culturally-biased psychological community and their predilection for psychotropic drug therapies. As highly sensitive people we may be more easily affected by medications that can cause very serious side effects that may be worse than the dysthymia (in some cases). Certainly, anyone suffering through a major depressive episode should seek help, especially if they are having suicidal thoughts or thoughts of harming others but we should be more informed and aware of our bodies and the nature of what is appropriate and what is not regarding treatment. I am a witness to the veracity of hypothyroidism, for one, as a factor in mood and emotion regulation. One of the significant people in my life must keep very close tabs on thyroid levels. Even the smallest change can lead to drastic mood changes, irritability, and anger that is unwarranted for the situation.
The misdiagnosis that occurs in nearly 53% of cases of “depression” should give us pause and raise our skepticism at the validity of making a diagnosis based on self-reporting (the standard way clinicians gather information to inform a diagnosis). At the least, I recommend considering that you may be showing signs of hypothyroidism, diabetes, or CFS. My advice is to rule those out first, by a simple blood test in the case of hypothyroidism and diabetes, before resorting to psychotropic therapies. You may need to insist on testing from your family doctor in this regard.
There is a larger issue of what constitutes an acceptable range of behaviors and emotions that are profoundly influenced and controlled by our respective societies. I dispute and challenge the culturally-imparted notion that we should only display a narrow range of emotions and behaviors that are keyed to the dominant group in our society who tend to be more social, less introspective, reflective, or contemplative, display less empathy, and presume everyone in society should conform to an arbitrary notion of acceptable feelings, thoughts, or actions. In my view, this includes depression (especially at lower levels). In Thrill: The High Sensation Seeking Highly Sensitive Person I included a discussion of the creative force within each of us that may serve as one of the driving forces in advanced personality development. Depression, in this sense, is one aspect of a rich inner milieu that combines with the creative instinct of self-reinvention and is absolutely vital in breaking up lower versions of ourselves to make way for higher versions that are less controlled and influenced by society and more focused on altruistic thought and action in the world.
Depression is a complex construct that may, for many of us, fit into a context of self-development through the process of positive disintegration. Depression may indeed be disabling, but may also be viewed differently from a developmental perspective. For more on this topic please see chapter 7 of Thrill.
Tracy Cooper, Ph.D.
“It ain’t what you don’t know that gets you into trouble. It is what you know for sure that just ain’t so.”
This quote, frequently misattributed to Mark Twain, describes the dangers of believing something false with all your heart. Instead of focusing on treating the real problem, you put all of your effort into fixing an issue that bears little relevance to your future. This quote was famously used in the film An Inconvenient Truth to highlight the risks associated with denying climate change. Properly attributed or not, the wisdom is hard to ignore: When you believe in something false, you can suffer adverse effects. This is particularly true if that false belief involves your health.
A Common Misdiagnosis
Mental illness is often difficult to diagnose, particularly because there are few physiological tests to help clinicians make a diagnosis. Diabetes is diagnosed through blood tests, cancer is diagnosed through biopsies and medical imaging, but mental illness is largely diagnosed through checklists of self-reported symptoms.
For this reason, mental illnesses, including depression, are sometimes misdiagnosed. According to a 2012 article in Current Psychiatry, 26 to 45 percent of patients referred for “depression” did not meet diagnostic criteria for a depressive illness. A 2009 meta-analysis discovered that general practitioners can only correctly identify depression in 47.3 percent of cases—and many doctors diagnose depression in people who just don’t have it.
Here are four conditions commonly mistaken for depression, both by clinicians and the public:
1. Bipolar disorder.
Like depression, bipolar disorder involves periods of intense lows. During these lows, people with bipolar disorder experience the same symptoms found in depression. They may feel hopeless, worthless, or even suicidal. Unlike depression, however, people with bipolar disorder also experience high periods, or mania, in which they feel confident, productive, or on top of the world. Sometimes this manic phase is so pleasant that people with the disorder are unable to recognize it as part of their illness, and so they only seek help during their low periods.
According to a study published in The British Journal of Psychiatry, up to 22 percent of people with bipolar disorder are mistakenly diagnosed with depression. Another study found that people with bipolar disorder experience an average gap of 10 years before they receive the proper diagnosis. But recognizing the difference between bipolar disorder and depression is vital because the medications used to treat depression can often worsen the symptoms of bipolar.
In this condition, the thyroid gland does not release a sufficient amount of hormones. Because these hormones are necessary for the brain and body to function, people with this disorder typically experience fatigue, diminished concentration, and a low mood—all characteristics of depression. Researchers estimate that as many as 20 million Americans have a form of thyroid disease, but up to 60 percent of them are unaware of their condition. Instead, they erroneously believe that they are easily fatigued, lazy or, yes, depressed. Unlike depression, however, people with hypothyroidism are overly sensitive to cold temperatures—and may feel cold all the time. They’re also more likely to experience dry skin, hair loss, and a hoarse voice. Hypothyroidism can be properly diagnosed through a simple blood test, and treatment requires only one pill a day.
People often develop Type 2 diabetes without recognizing it. They may suddenly find themselves losing weight, feeling fatigued, and growing irritable. Because all of these symptoms are also associated with depression, people may fail to recognize that their body is having problems with insulin. One precursor to Type 2 diabetes, insulin resistance, has been significantly linked to depression.
People with diabetes are also at risk for “diabetes distress,” a condition that mimics depression. A 2014 study found that people diagnosed with both diabetes and depression experienced reduced depression symptoms after receiving interventions to help manage diabetes. In other words, their symptoms were not due to depression, but the stress of living with a chronic illness. “Because depression is measured with scales that are symptom-based and not tied to cause, in many cases these symptoms may actually reflect the distress that people are having about their diabetes, and not a clinical diagnosis of depression,” said Lawrence Fisher, Ph.D., ABPP, the lead author of the study.
4. Chronic fatigue syndrome.
Also known as myalgic encephalomyelitis or systemic exertion intolerance disease, this condition is characterized by extreme fatigue that has no apparent cause. Chronic fatigue syndrome also involves difficulty concentrating, muscle pain, and problems with sleep—all symptoms associated with depression as well, which is why people with chronic fatigue syndrome are so frequently misdiagnosed. A study published in The Primary Care Companion to the Journal of Clinical Psychiatry found that chronic fatigue syndrome is under-diagnosed in more than 80 percent of the people who have it, with depression being the most common misdiagnosis.
Thankfully, there is at least one clear difference between depression and chronic fatigue syndrome: People with depression are both exhausted and uninterested in their hobbies, while those with chronic fatigue may still want to participate in their interests despite their lack of energy.
Does anyone have depression?
Depression is a very real, very serious illness that affects millions of people each year. The majority of individuals who are diagnosed with depression are diagnosed correctly and able to recover with proper therapy and medication.
Still, a misdiagnosis is always possible. If you are being treated for depression but aren’t feeling better, it is entirely possible that you have a disorder that mimics the condition. Before starting an antidepressant regimen, it never hurts to take a blood test to rule out one of the commonly confused conditions, such as hypothyroidism or diabetes.
Remember, “It ain’t what you don’t know that gets you into trouble. It is what you know for sure that just ain’t so.”
Contributed by Courtney Lopresti, M.S.