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Originally published on 2nd April 2016 Last updated on 28th May 2019
TW: Mental Health, Depression
Hypothyroidism often comes hand in hand with mental health conditions such as anxiety and depression. I continue to speak about this at great length on my blog as mental health is such a big part of many people’s experiences of thyroid disease. After all, it was mine.
In thyroid patients of all ages, many of them may be labeled with psychiatric issues such as mental health issues, when they are actually due to hormonal insufficiencies such as hypothyroidism or adrenal dysfunction. In one study, it was concluded that by correcting the underlying hormonal imbalance, many patients’ mental health improved, with some patients having a total reversal of psychiatric symptoms. 
According to Thyroid UK’s survey in 2015, over 50% of the hypothyroid patients who responded, also reported living with depression. 
That’s more than half. A lot of people.
The survey also revealed that of those taking antidepressants, 47% said they saw no difference to their depression. Why? The underlying problem, being the non-optimally treated thyroid condition, or possibly adrenal dysfunction (as we will explore in this post), may not be being addressed.
Dr Barry Durrant-Peatfield also estimates that of the people on antidepressants, 30-50% will have unrecognised hypothyroidism. This is definitely food for thought.
I’ve said before that your thyroid and adrenal health work together and in balance, and this is due to them both being part of the endocrine system.
Taking Medication for Mental Health Conditions Isn’t Wrong
Of course, antidepressants, anti-anxiety meds etc. can be a great help to many people and it is important to not feed the stigma that taking them is ‘wrong‘.
I am not anti-medication, but I am pro-informed decision, which means making sure those that who are thyroid patients also experiencing mental health conditions, know that addressing their endocrine health fully may well resolve their mental health complaints.
I have taken various types of antidepressants myself in the past. However, none helped me at all, which is perhaps a sign that it was due to a physical imbalance of thyroid hormone. Especially as my mental health hugely improved when optimally medicated for hypothyroidism.
Your Thyroid and Mental Health
Some patients do have both a thyroid condition and mental health condition, but doctors should realise that depression isn’t a scape goat for all symptoms left from a non-optimally treated thyroid condition.
For example, there are some symptoms of depression that are the same as those for hypothyroidism, such as:
- Low mood
- Being slow in speech and/or movement
- Feeling more tired than normal
But equally, there are some that are not present in depression, such as:
- Thinning of eyebrows
- A puffy face
- Overwhelming fatigue
- Dry skin
- Hoarse voice
- Muscle weakness
- Slow heart beat
- Raised blood pressure
- Raised cholesterol
These are physical symptoms, and not caused by something mental, but something physically imbalanced. They could well be a sign that the thyroid patient isn’t optimally treated on their thyroid medication and this should be investigated. After all, if the physical imbalance is addressed, the need for further medications can be avoided.
When I raised these very concerns, I had two separate GPs tell me that it was all in my head and that I needed “to let it go”, which wasn’t useful at all! Read my article about medical gaslighting here.
We know our own bodies, and we know when something isn’t right.
The link between depression and hypothyroidism involves T3, the active thyroid hormone and one of the hormones a healthy thyroid produces. Unfortunately, most of the time, doctors in the UK especially will only prescribe T4-only medications (such as Levothyroxine) for hypothyroidism, so we’re relying on our bodies to convert some of that T4 in to the T3 we also need, and well… it doesn’t always work so smoothly.
How Are They Linked?
Having low Free T3 is a possible cause for depression, mood swings, anxiety etc. when on T4-only medicine, as once this is treated with direct T3 or conversion of T4 to T3 is otherwise improved, mental health often improves greatly. This was certainly true for me. When I switched from T4-only Levothyroxine to NDT, which contains direct T3, my anxiety, depression and over-emotional tendencies improved quickly.
T3 has an important role in the health and optimal functioning of your brain, including: cognitive function, the ability to concentrate, mood, memory and attention span and emotions and ability to cope with life’s stresses.
T3 interacts with brain receptors and makes the brain more sensitive to chemicals such as Serotonin and Norepinephrine, which affects your alertness, memory, mood and emotion.
So if your doctor failed to check a full thyroid panel (not just TSH), when you complained about the above symptoms, you may have mental health issues caused by an inadequately treated thyroid problem. If they did check them and say they’re adequately treated, make sure they are in fact optimised.
Hashimoto’s and Your Mental Health
Hashimoto’s, prevalent in about 90% of us with hypothyroidism, is reported to cause swings of TSH, with hyper and hypo symptoms to match. 
Hyperthyroid symptoms can include hyperactivity, anxiety, irritability and disturbed sleep, whilst hypothyroidism often causes fatigue and depression. Do those swinging symptoms remind you of anything? Bipolar Disorder perhaps?
Also known as manic depression, it could well be suggested that Bipolar diagnoses are actually masking Hashimoto’s cases, where patients swing between hypo and hyper symptoms, as the thyroid is attacked and destroyed, and thyroid hormone is released into the bloodstream in waves. If you also feel as if you swing from depression to anxiety, this is a for that possibility too.
The 2002 study: “High Rate of Autoimmune Thyroiditis in Bipolar Disorder: Lack of Association with Lithium Exposure”, found that Hashimoto’s antibodies were more prevalent in a sample of outpatients with bipolar disorder (28%), in comparison to a control group (3-18%). 
However, what complicates things is that bipolar patients are often treated with Lithium, a drug well-recognised to cause hypothyroidism and trigger Hashimoto’s. So was the thyroid condition there first, or did the lithium cause it?
Many studies also conclude a link between thyroid levels and mental health. In fact, suicidal patients have been found to have a higher incidence of thyroid disorders, with lower Free T3 levels than non-suicidal patients. 
Thyroid patient Jacqueline Falkowski sadly died by suicide in 2015, after twenty-six years of being misdiagnosed and improperly treated for her hypothyroidism.
She heartbreakingly shared in her suicide note:
“I have had an enormous uphill battle trying to get doctors to believe me and take my symptoms seriously. My GP was adamant that my thyroid was fine and my symptoms were all in my head… I had anxiety because he didn’t believe my symptoms were real – he persistently stonewalled me – and meanwhile, my hypothyroidism symptoms were becoming debilitating and intolerable.” 
Adrenals and Your Mental Health
Adrenal fatigue/dysfunction/insufficiency could also be causing or contributing to your depression and emotional health. I’ve covered what ‘adrenal fatigue’ is here.
Abnormal cortisol levels, adrenal fatigue, which is very common among hypothyroid patients, can result in cell receptors failing to properly receive T3 from the blood, which can explain why you may have some behaviour and symptoms typical of depression and continued hypothyroid symptoms, including:
- Wanting to be alone
- Unable to tolerate stress
- Jumping or feeling irritable at loud noises
- Emotional ups and downs
- Being a bit sensitive and taking things to heart more so than you used to.
You can test your adrenal function with a 24-hour saliva cortisol test, and work on fixing your cortisol output if it isn’t optimised. If your doctor won’t do this, you can very simply order it yourself and complete it at home. You can find testing options here and here.
Once adrenal dysfunction is addressed or when you are starting to recover from it, you may see your symptoms easing. It is then important to maintain good adrenal health to prevent relapsing in future. The book I reviewed by Dr. James Wilson was helpful in recovering when I confirmed I had adrenal fatigue.
Vitamin Levels and Mental Health
Low vitamin levels such as iron, ferritin, B12, D etc. can all also affect mental health. Your doctor can test for most of these as standard blood tests and correcting low levels can work wonders for ongoing mental health complaints as well as many physical symptoms.
So, if you have depression, anxiety, bipolar disorder etc. or you’ve been diagnosed with another mental health condition, and also have thyroid or adrenal problems, or suspect you do, explore the above ideas and ensure they are all in check. You may just find that checking your thyroid (especially Free T3), antibodies, vitamin levels, cortisol levels etc. help you.
Just trying to fix or even mask the poor mental health with more medication in the form of antidepressants for example, is simply masking the symptoms and not the actual cause. Masking the cause will only serve to make things worse in the long run. Doctors need to realise that giving us more and more medications that we may not actually need, instead of concentrating on making sure our endocrine health is optimised, isn’t helping in the long run.
Have you had mental health difficulties which have been helped by optimal thyroid treatment?
The book Be Your Own Thyroid Advocate: When You’re Sick and Tired of Being Sick and Tired, which covers how Rachel went from being suicidally depressed with an under-treated thyroid condition, to finally thriving in life again and coming out the other side.
THe following link has BEEN SPONSORED BY BetterHelp
As well as working on your thyroid hormone levels to improve mental health, you may benefit from seeking support from a therapist in the meantime, including those that can help you online: https://www.betterhelp.com/advice/psychologists/reasons-to-choose-an-online-psychiatrist/
You can click on the hyperlinks in the above post to learn more and see references to information given.
 http://www.scielo.br/scielo.php?script=sci_arttext& pid=S0101-60832018000100012
Written by Rachel, The Invisible Hypothyroidism
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Rachel Hill is the highly ranked and award-winning thyroid patient advocate, writer, blogger, speaker and author behind The Invisible Hypothyroidism. She has two books: ‘Be Your Own Thyroid Advocate‘ and ‘You, Me and Hypothyroidism‘. Her thyroid advocacy work includes writing, speaking on podcasts and co-creating Thoughtful Thyroid courses. Rachel has worked with The National Academy of Hypothyroidism, BBC, The Mighty, Yahoo, MSN, ThyroidChange and more. She is well-recognised as a useful contributor to the thyroid community and has received eight 2019 WEGO Health Award Nominations.