Why a checkup is part of the picture
Mood lives in the body. Hormones, the heart, the brain and the medicines you take all affect how anxious or low you feel. That is why health organizations recommend ruling out physical causes early.
NIMH notes that certain medications and medical conditions, such as viruses or thyroid disorders, can cause the same symptoms as depression, and that a provider can rule these out with a physical exam, an interview and lab tests. MedlinePlus says the same about anxiety: diagnosis may include a physical exam and lab tests to make sure a different health problem is not the cause.
A medical cause does not mean the feelings are not real. It means there may be another lever to pull.
Thyroid problems
MedlinePlus explains that thyroid hormones affect nearly every organ, including mood. The two main thyroid problems pull in opposite directions:
- An underactive thyroid (hypothyroidism) can cause fatigue, weight gain, feeling cold, and depression. Because it develops slowly, people may not notice for a long time.
- An overactive thyroid (hyperthyroidism) can cause nervousness or irritability, trouble sleeping, tremor, and a rapid or irregular heartbeat, which can feel a lot like anxiety.
MedlinePlus adds that in adults over 60, an overactive thyroid may show up as appetite loss or withdrawal from other people, which can be mistaken for depression or dementia. MedlinePlus also lists thyroid problems and arrhythmia (an irregular heart rhythm) among the physical conditions linked to anxiety disorders.
Chronic illness
NIMH reports that people with a chronic disease are at higher risk of depression. It gives several reasons, which often overlap:
- The stress and worry of living with the illness
- Changes in the brain from conditions such as Parkinson's disease or stroke
- Medication used to treat the disease
- A personal or family history of depression
NIMH names autoimmune diseases, diabetes, cancer, epilepsy, heart disease, HIV, hypothyroidism, multiple sclerosis and chronic pain as examples of chronic disease. It also notes that people who have both a chronic disease and depression tend to have more severe symptoms of both, and that depression in turn raises the risk of conditions such as heart disease, diabetes and stroke. Pain gets its own article: Chronic Pain, Anxiety and Depression.
NIA describes a type called depressive disorder due to a medical condition, meaning depression related to a separate illness such as heart disease or multiple sclerosis.
Medications and substances
NIMH notes that medications taken for an illness sometimes cause side effects that contribute to depression symptoms. NIA lists substance- or medication-induced depressive disorder, linked to the use of or withdrawal from substances such as alcohol or pain medication. MedlinePlus notes that caffeine, other substances and certain medicines can make anxiety worse.
It is easy to overlook everyday contributors:
- Several cups of coffee, energy drinks or pre-workout supplements
- Alcohol, including the anxious morning after a heavy night
- Cannabis
- Over-the-counter sleep aids and supplements
- A new prescription, or a change in dose, around the time your mood shifted
If you suspect a medicine, do not stop it on your own. Talk with your prescriber before changing anything; they may be able to adjust the dose or switch to something else. For alcohol and cannabis specifically, see Alcohol, Cannabis and Mood: What to Know in Michigan.
Age matters here too. NIMH notes that older adults are more likely to have other medical conditions or pain that can cause or contribute to depression, and NIA lists heart disease and multiple sclerosis among the illnesses linked to depression due to a medical condition. MedlinePlus points out that in people over 60, an overactive thyroid can look like withdrawal or low mood rather than nervousness. If you are caring for an older parent whose mood has changed, ask their doctor whether a medical workup has been done.
Timing is also a clue. A mood change that began within weeks of a new diagnosis, a hospital stay, a new medicine or a dose change is worth pointing out, even if the connection seems unlikely.
What to bring to your appointment
NIMH suggests taking notes on your symptoms before a visit: when they began, how long they last, how often they occur, and whether they keep you from your usual activities. It also helps to bring:
- A full list of prescriptions, over-the-counter medicines, vitamins and supplements, with start dates
- Physical symptoms alongside the emotional ones, such as palpitations, weight change, feeling cold or hot, or changes in your periods
- How much caffeine and alcohol you have in a typical week
- Any family history of thyroid disease, depression or anxiety
You can say directly: "Before we treat this as anxiety, can we check whether something physical is contributing?" Asking which tests are being done, and getting the results, makes it easier to share them with a therapist later.
When it is both
Often the answer is not either-or. A thyroid problem can be treated and some anxiety can remain. A heart condition can be managed and the fear about it can stay. NIMH notes that depression is treatable even alongside a chronic disease, usually with psychotherapy, medication or both, and that you should tell every provider about all the medicines and treatments you receive.
Therapy can help with the emotional side of a diagnosis: grief for the life you had planned, worry about the future, and the strain illness puts on relationships. Dr. Lehmann, a licensed clinical psychologist in Franklin, offers depression therapy and anxiety therapy for adults, in person or by telehealth for clients located in Michigan, and does not prescribe. Coordinating with your doctors is covered in Coordinating Care Between Your Doctor, Prescriber and Therapist.