One night, I had a lucid dream that brought me to the past. For those of you that have never had a lucid dream, in this type of dream, you know that you are dreaming and, thus, you know that you will be safe… no matter what happens, or what you do. These dreams can be very liberating!
In this dream, I was taken back to a doctor’s visit back in 2006, when I first graduated from pharmacy school, and when I first began to have overt thyroid symptoms. In real life, I went in because I didn’t feel like myself, but my physical symptoms were ignored during this appointment. Instead of focusing on my neck pain, sore throat, palpitations, and fatigue, the doctor started narrowing in on my anxiety and obsessive compulsive tendencies.
I was nervous and fidgeting… and somehow, we got on the topic of my habits.
I remember explaining that I triple checked prescriptions before I filled them (this was, after all, my job and requirement as a dispensing pharmacist), but somehow, describing my daily job duties made me appear crazy to him. He kept digging further, trying to paint as though everything physical I reported was in my head.
I remember he asked me if I frequently washed my hands. I said, “No, but I would if I was preparing intravenous (IV) drugs,” (which is also a requirement for pharmacists that make IVs). I was anxious and I almost felt like he was quizzing me — and would report me if I didn’t wash my hands enough — I was a new grad and was used to being quizzed by older authority figures… and so of course, I looked even more crazy to him.
My recommended treatment? Antidepressants!
In my younger days when I was a rebel without a cause, I would have told him to shove it and that, as a trained pharmacist with a doctorate degree, I knew better and that I came in to address my neck pain, fatigue, and sore throat. 🙂 But instead, I was polite and sheepishly took home a prescription for antidepressants that I never filled.
You see, somewhere in my mid-twenties, I began to censor myself. My teens and early twenties were all about seeking pleasure, being myself, and speaking my mind… but then it all changed. I don’t know if it was my professional training, my friends, peers or partners, or simply growing older, but as time went on, I became pathologically polite. And so, even though my needs weren’t met, and even though I knew that my symptoms weren’t just in my head, I kept quiet.
I didn’t push and didn’t ask further questions…
Three years later, I was found to have thyroid antibodies that were in the 2000+ range, and a thyroid gland so damaged, that I needed to start thyroid medications.
In this article, I’d like to explore:
- The connection between Hashimoto’s and depression
- Conventional treatments for depression
- The root cause approach to better mental health
Hashimoto’s and Depression
Research has shown that anxiety, depression and a general feeling of being “unwell” are early signs of an autoimmune attack on the thyroid and can be correlated to elevated thyroid antibodies, even when the TSH (thyroid stimulating hormone) number is still normal.
Clinical depression, or major depression, is a mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.
Most people are unaware of how frequently depression occurs with Hashimoto’s. A study in 2004 found an association between the presence of a mood disorder, and the presence of anti-TPO antibodies. It has also been observed that a slight reduction in thyroid hormone secretion (such as that found in subclinical hypothyroidism) may affect mood as well. Thus, it’s possible that the depression you are feeling is related to your thyroid.
About one in 10 U.S. adults are affected by depression, which can impact their mood, thoughts, physical health, and behavior. Depression affects more women than men, and the symptoms and severity of depression can vary from person to person.
The most common type of mood disorder reported in people with thyroid antibodies is obsessive compulsive disorder (OCD). OCD is also more common in pharmacists and Type A’s, so I am intimately familiar with it. 🙂 Through years of tracking my symptoms, I found that my OCD tendencies flared up with rising thyroid antibodies, and reduced as my antibodies dropped.
Remission helped me become calm and cool, while Hashimoto’s flares brought on OCD. I now consider OCD an indication of an impending thyroid flare.
In retrospect, it only took me three years of feeling anxious to get a proper Hashimoto’s diagnosis, and only took me another three years or so to get into remission and to become calm once more. Some people are not that fortunate. They struggle for years without a proper diagnosis. It breaks my heart to think about the many thyroid patients who get labeled as “crazy” or “hypochondriacs” instead of being tested for thyroid antibodies.
The good news is that, once a diagnosis of Hashimoto’s has been made, we can start looking for and addressing the root causes that might be leading to feelings of anxiety or depression.
I’ve written a comprehensive article tailored to overcoming anxiety, while this article will focus on depression.
Conventional Treatments for Depression
In conventional medicine, depression is usually treated with medications and certain types of psychotherapy. “Antidepressant” is a common name for the type of medications used to treat depression, and for a lot of people, “Prozac” comes to mind, though not all of the medications work on the same pathways as Prozac.
That said, the most common form of antidepressants is called SSRIs (selective serotonin reuptake inhibitors). These include brand names such as Zoloft, Prozac, Celexa, and Paxil. These drugs work by decreasing serotonin (our “happy hormone”) reuptake (reabsorption) in the brain, which leaves more serotonin available in the brain to positively affect mood. Common side effects of SSRIs include nausea, sexual dysfunction, insomnia, nervousness, and tremors.
Another commonly prescribed group of antidepressants are called SNRIs (serotonin and norepinephrine reuptake inhibitors). Cymbalta, Effexor XR, and Pristq all fall into this category of drugs that work by improving serotonin and norepinephrine (a neurotransmitter and hormone in the nervous system) levels in the brain. Common side effects include nausea, drowsiness, fatigue, constipation, and dry mouth.
Wellbutrin (bupropion) is another medication that has a few different indications. Most commonly, it’s used as an antidepressant that works on the norepinephrine and dopamine pathway and may be given as a stand-alone medication, or in combination with SSRI’s, to counteract the sexual side effects and fatigue caused by SSRIs. This medication is also FDA approved for smoking cessation. I’ve written about the connection between smoking and Hashimoto’s before, and I personally took bupropion in college for the purposes of smoking cessation.
Interestingly, this medication also helps with weight loss, focus and energy. It can also lead to a suppression of TSH, the communication hormone that tells our body to make more thyroid hormone—potentially resulting in what is known as “central hypothyroidism, where the TSH is normal but the actual thyroid hormones (T3 and T4) are low because the communication pathway isn’t working properly.
I took this medication in college around the time I started having thyroid symptoms and I remember that I felt more focused and energetic when I took it. I often wonder if this medication either masked some of my symptoms, contributed to my thyroid hormones being low, or potentially led to a suppression of TSH, masking the fact that I was hypothyroid whenever I was checked. This is why I often recommend doing a full thyroid panel to screen for thyroid conditions, and why depression is a big red flag for me for thyroid conditions.
Additionally, medications that would be traditionally used for treating schizophrenia are now used as “add-on” therapies for treatment resistant depression. In the real world, as a consulting pharmacist, I saw a lot of heavy duty use of these medications, and this, in some cases, led to debilitating side effects (fainting, lethargy, loss of balance, sexual side effects, and metabolic syndrome).
In fact, statistics from 2014 show that 13 percent of the population was on an antidepressant, with 68 percent considered long-term users (2 years or more).
Do these antidepressants help depression?
I think it’s debatable. While I don’t discount that many people have been helped by antidepressants, I think it’s important to understand the root cause of the problem. Giving a person mood-stabilizing medications because of fluctuations in mood (due to Hashimoto’s), is like putting masking tape over the “check engine” light in a car, instead of checking the engine.
Furthermore, antidepressants alone should never be the sole solution, even for a person with severe depression and anxiety.
As a pharmacist, I really got a kick out of this little Onion article:
The Downside of Antidepressants
While I believe most medications have their time and place, the truth is, most mood altering drugs are dirty drugs (this is official pharmacist lingo). They interact with many receptors, leading to a long list of symptoms.
In my past life, when I was working in consulting with mental health clients, I often got reports of people feeling like zombies, gaining weight, feeling dulled, living in a fog, having sexual dysfunction, becoming manic, and feeling worse on antidepressants and other mood altering medications.
One of the scariest side effects of antidepressants that I learned about in pharmacy school is increased suicidality. People who were prescribed medications for depression would be more likely to die by suicide within weeks of starting them. The theory that was proposed to us students was that “people got more energy before their mood improved… and thus, this burst of energy gave them the opportunity to take their lives.” This was so scary to me as a young practicing pharmacist.
Suicide is a permanent solution for a temporary problem, and is devastating for loved ones of the deceased, who often go on to have post-traumatic stress disorder, survivor’s guilt, and even new onset autoimmune disease. One day I’ll write more about my personal connection to loss… but for now, if you’re reading this and struggling with depression, I want you to know that you can feel better — and there are so many people and things that can help you. Don’t give up.
Antidepressants can also cause a down regulation of our internal production of neurotransmitters. This means that people can become dependent on taking them and have withdrawal symptoms when they try to come off of them.
I have seen it first hand, and have had to work with numerous people to slowly wean them off antidepressants when I was a consulting pharmacist.
This dependence occurs because antidepressants prevent us from properly clearing serotonin from our brains, causing it to stick around longer. Unfortunately, the body takes notice of all of this serotonin hanging around. Soon, we begin to produce less serotonin, and we become less sensitive to the serotonin we do have. When not addressed, this result may become permanent.
Furthermore, antidepressants are not always effective. I have seen this numerous times in patients as a pharmacist, and less than five percent of people were found to be in remission from depression with SSRI drugs, even after using them for a year in a large-scale study known as the STAR*D trial.
The Root Cause Approach
The amazing thing that I’ve learned with functional medicine is that many of the same root causes, triggers, and strategies that help Hashimoto’s, can also help depression. In fact, 81 percent of the participants in my Hashimoto’s Self-Management Program reported an improvement or resolution of depression!
While there are many different root causes, strategies, and solutions for depression, I want to focus on a few low hanging fruit that can help a person with depression, whether used in conjunction with antidepressants, or on their own.
These include common nutrient deficiencies, dietary changes, lifestyle changes, and supplements that have been shown to boost mood.
I have found that many people with Hashimoto’s who are experiencing depression are reacting to a food that they are sensitive to. Some of the most common food sensitivities that can lead to symptoms of depression are gluten, dairy, grains, soy, nuts and seeds. Sometimes, eliminating these foods from the diet can bring enormous relief to a person’s mood and mental state. In fact, 60 percent of the people with Hashimoto’s who I surveyed, reported symptoms of improved mood by eliminating gluten, 59 percent by going grain free, and 45 percent by giving up dairy. I recommend starting with an elimination diet to begin to uncover the foods that are problematic for you.
Additionally, balancing blood sugar levels is one of the most important components in reducing anxiety for people with Hashimoto’s, and can have an impact on symptoms of depression as well. When insulin levels swing from high to low, it’s like being on an emotional rollercoaster that can cause some of the extreme emotions that are characteristic of mood disorders. Of the people with Hashimoto’s that I surveyed, 61 percent reported improved mood with a low glycemic index diet, while 65 percent experienced improvement on a sugar free diet.
Nutrients for Depression
Addressing nutrient depletions can be a game changer when it comes to relieving depression. Often times, a deficiency in a key nutrient results in many of the symptoms associated with depression, and supplementing with a quality supplement can make all the difference in improving mood.
Nutrient depletions that are often seen in people experiencing symptoms of depression include:
- Vitamin B12: A deficiency in B vitamins, particularly B12, can have a huge impact on mental health. One study found that one quarter of women who were diagnosed with severe depression were deficient in this crucial nutrient. Of the readers with Hashimoto’s that I surveyed, 56 percent experienced improved mood when they began supplementing with B12.
- Methylfolate: Studies have shown that people with low levels of folate have a 7 percent response rate to treatment with antidepressants, while those with high levels of folate have a 44 percent response rate; therefore, it is often used in the treatment of depression.
- Iron (ferritin): Several symptoms of iron deficiency are similar to that of depression: fatigue, irritability, and brain fog. I personally became iron deficient while pregnant, and felt like I became tearful and emotional overnight… these symptoms are usually considered “normal” for pregnant women, yet iron deficiency is the most common deficiency in pregnancy. I was already taking an oral iron supplement, but ended up needing to supplement with two burgers a day and iron IV’s to stay happy. One day I told my husband that I didn’t feel loved because he hadn’t gotten burgers for me that day. 🙂 Testing iron and ferritin levels is incredibly important, and proper management may bring relief to symptoms of depression for many people. (As a side note, iron deficiency is more common in pregnant and menstruating women, while iron overload is more common in men and postmenpausal women. An overload of iron can also lead to mood alterations, so be sure to get tested and not just supplement).
- Omega-3: A number of studies show that omega-3 fatty acids can be very effective against the treatment of major depression disorder and other psychiatric disorders, with no associated side effects. I generally advise 1-4 grams per day for most people.
- Vitamin D: Most people, especially those of us living further away from the equator, are deficient in vitamin D, and a deficiency in this important nutrient has been linked to elevated thyroid antibodies and depression. Sixty-four percent of my readers have reported improvements to mood when they’ve taken a D3 supplement. 5000-10000 IU per day is what it usually takes to get your Vitamin D levels in range. I do recommend testing for vitamin D, and supplementing accordingly.
- Magnesium: Multiple studies have linked magnesium and depression, as this vital nutrient plays a key role in hormone balance and brain chemistry. Magnesium is also an important component in thyroid hormone production, and helps balance blood sugar — key factors in mood stabilization.
Stress Response Support
Treating hypothyroidism without treating the adrenals is one of the biggest reasons people continue to feel exhausted despite receiving treatment with thyroid hormones, and it can lead to symptoms of depression.
The adrenal glands release hormones, such as cortisol and adrenaline, that impact many important functions throughout the body: among them, stress tolerance and mood.
In cases of chronic stress, the never-ending presence of stressful, yet non-life-threatening situations, can lead to the constant activation of the stress response. To help meet the demand for cortisol, your body will decrease the production of other hormones normally produced by the adrenals, such as progesterone, DHEA, and testosterone.
Eventually, with enough chronic stress, your body becomes overwhelmed and desensitized to the usual feedback loop, and stops sending messages to the adrenals to produce more hormones or less hormones, no matter what’s happening. We call this adrenal fatigue.
If you think stress could be at the root of your depression, you may want to look into supporting your adrenals. As a starting point, I recommend the ABC’s — Adaptogens, B Vitamins and Vitamin C.
Adaptogenic herbs support the body’s ability to deal with stressors and are thought to work by normalizing the hypothalamic-pituitary-adrenal (HPA) axis. Some herbs, such as Ashwagandha, can help normalize thyroid hormone levels, as well as support the body’s stress response. Of the readers I surveyed, 77 percent said they’re mood improved when they took adaptogenic herbs.
The B vitamins and vitamin C become depleted during high cortisol production. Pantothenic acid (B5) and biotin deficiency, in particular, have been linked to decreased adrenal function in animals and humans. Meanwhile, vitamin C helps to regulate cortisol and prevent blood pressure from spiking in response to stressful situations.
If your TSH is elevated or suppressed, you may need to initiate or adjust thyroid hormones. The ideal TSH for most people is between 0.5-2 μIU/mL. Levels that are too high or too low indicate an imbalance of thyroid hormone levels and have been associated with various symptoms, including depression and anxiety.
Taking a T3 containing medication, in particular, has been shown to reduce symptoms of depression. You may want to read my articles on understanding your thyroid labs and taking thyroid medications for more information on how adjusting thyroid medication dosages can help optimize your thyroid hormone levels and elevate your mood.
There are many types of therapies, exercise, and activities aimed at reducing depression — the important thing is finding one that will work for you. This may take some experimentation, but a few of my favorite forms of mental health therapy include:
- Bright light therapy: Bright light therapy (BLT) is considered among the first-line treatments for seasonal affective disorder (SAD), yet a growing body of literature supports its use in other mental health conditions, including non-seasonal depression. BLT uses a lamp to mimic sunlight to adjust the person’s circadian rhythm and elevate their mood. I’m a big proponent of being out in nature and enjoying the sunshine (especially on a beach vacation), however, those of us living in colder climates may not always have the ability to escape. In that case, you can purchase a therapy light online to sit under for 15 minutes a day, in the comfort of your home.
- Meditation: Stress and anxiety are major triggers of depression, and meditation can alter your reaction to those feelings by training the brain to sustain focus, and return to that focus when negative thinking arises. Meditation has even been found to change certain regions of the brain that are linked with depression. There are many apps that can help you begin a meditation practice (Headspace is a popular one), but even just closing your eyes, sitting still, and focusing on your breath for five minutes is a wonderful place to start.
- Exercise: Research has shown that exercise works as well as antidepressants for some people with depression. While high-intensity exercise releases the body’s feel-good chemicals called endorphins, low intensity energy over a sustained period of time causes the release of proteins called neurotrophic (or growth) factors. These proteins cause nerve cells to grow and make new connections, which improves brain function and makes you feel better. My favorite forms of exercise to give me a mental boost are hiking, yoga, and walking with my little family. 🙂
- Art therapy: The healing power of art is emerging as an evidence-based therapeutic modality for depression. One meta-review published in 2015 examined the impact of art therapy on depression, anxiety, trauma, distress, inability to cope, and low self-esteem. It concluded that patients receiving art therapy (using the process of creating artwork as a form of mental therapy) had significant improvements in 14 out of 15 randomized control trials. By immersing themselves in the art of creation, people with depression are often able to push back against the darkness inside their minds and find ways to express themselves when words fail. You don’t have to consider yourself an “artist” to explore this form of therapy — it’s all about the process of creation, not the final product.
- Yoga: Gentle forms of yoga, such as Yin Yoga and Hatha Yoga, have been shown to calm the nervous system and relax the mind. Many controlled studies have found benefits from yoga for depression and its symptoms, such as difficulty concentrating and lack of energy. The combination of meditation and physical movement involved in yoga provide two important elements for relieving depression: meditation helps allows a person to clear their mind, while controlled, focused movements help strengthen the body-mind connection.
- Sauna therapy: Infrared saunas provide many benefits for Hashimoto’s, including stress relief and mood elevation. The sympathetic nervous system and HPA-axis try to respond to compensate when the body is stressed by the body temperature rising. When a person is in the infrared sauna, the norepinephrine levels rise, but the body’s stress hormones epinephrine and cortisol do not. Growth hormone, beta-endorphins and prolactin also increase. Beta-endorphins account for the reason a sauna session feels so pleasurable. The muscles also relax, allowing the body to release any tension and be free of stress. During this time, the body’s parasympathetic nervous system takes over, putting the body in a state of complete relaxation. In my 2015 survey of 2332 readers with Hashimoto’s, 74 percent of people reported that using a sauna boosted their overall mood.
- Neurofeedback: This is a form of biofeedback therapy that uses real-time displays of brain activity to help self-regulate brain function. Research has shown its effectiveness for a variety of brain-related conditions, including depression. I like the Neuroptimal system and recommend finding a local neurofeedback practitioner in your area who has one.
- Therapy: If your depression results from events that occurred in your past, utilizing therapy may be the path to healing. EMDR, or Eye Movement Desensitization and Reprocessing, is a method used by psychotherapists to help people eliminate the lasting effects of traumatic events. Francine Shapiro, PhD, who noticed that certain eye movements reduced the intensity of her disturbing thoughts and made her less anxious during a walk in nature, initially developed this method. She tested the method with trauma victims and published her findings in 1989, establishing it as an evidence-based level treatment for trauma and post-traumatic stress disorder. I highly recommend working with a therapist who specializes in EMDR if you have encountered traumatic events in your past. I assure you, you can get past them.
Additionally, up to 80 percent of the people with Hashimoto’s that I surveyed reported that alternative therapies such as acupuncture and massage therapy improved their mood.
Though this is not a comprehensive list of all of the therapies available to treat depression, they are easy places to start if you are looking for alternatives to prescription antidepressants. Speaking with a counselor or therapist is another important step toward mental health for many people. Sometimes, talking through the problem can be the best way to find the root cause — especially if past trauma is a factor.
Please note that, if you are currently taking prescription anti-depressants, it is important not to stop taking your medications without the oversight of your physician or therapist.
Going back to my lucid dream… I did things differently this time during that doctor’s appointment. I stopped him mid-sentence and said, “No, Doctor, I don’t need antidepressants. I came in because of my physical symptoms.” I may have thrown a swear word or two in there somewhere. And it was liberating!
Now that I’m a rebel with a cause — a Root Cause Rebel — my voice is getting stronger, and my pathological politeness is getting weaker with each and every day.
So if you’ve ever been told that it’s all in your head, or that you need antidepressants, or that you should just settle for the status quo, say it with me, my fellow Root Cause Rebel: “No, Doctor, I don’t need antidepressants!”
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