Is It Really a Mood Disorder?

DeeDee newI recently had some lab testing to rule out polycystic ovary syndrome, a condition that produces a variety of symptoms, some of which overlap with bipolar symptoms. This brought up even more questions about the quality of care I had been receiving. I already knew it wasn’t great, but the fact that the first thing the new psychiatrist did was order more testing to rule out alternate causes of mood swings was a bit of an eye-opener.

When I first went in to a psychiatrist (several of them, actually) for diagnosis and treatment, no lab work was ordered despite my 20-year history of psychoactive medications. After a few months on Lamictal and getting stabilized on the new medication regimen, the PA I was seeing finally ordered a fairly comprehensive set of tests to verify that everything else was OK. It seems pretty obvious that the testing should have come before treatment, but at the same time, I was in bad shape then. I heartily agreed that it was more important to start treatment immediately, and that did end up being the right course of action. All of my tests have returned normal (or nearly normal) results.

But this does highlight the fact that there are a lot of other conditions that can cause similar symptoms to mood disorders. Just a few that come to mind include developmental disorders (like ADD), food or environmental allergies, deficiencies in various vitamins and minerals, hormonal imbalances, and thyroid problems. There are plenty more where those came from. Notably, not every condition is as easily mimicked as others; it seems depression is the most common mental health issue associated with a wide range of somatic illnesses. I haven’t come across any diseases that can cause symptoms that look remotely like mania, though there may well be something out there.

To most psychiatrists every complaint is a symptom of a mental illness, and medication is the foregone conclusion. That doesn’t mean they shouldn’t try to rule out other causes or conditions; they do have their MDs, after all, and I have seen mentions from many mental health bloggers about the importance of verifying that there aren’t other causes for symptoms leading to a diagnosis of a serious mental illness. But the fact of the matter is that it doesn’t always happen. Not all psychiatrists are created equal, and there are plenty for whom due diligence is whipping out the prescription pad and loading up the medicine cabinet.

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6 thoughts on “Is It Really a Mood Disorder?

  1. Caution: Extremely long comment ahead. 😉

    This is one that is especially near and dear to me right now, and I’ll tell you why later on.

    But first, I have to step up onto my soapbox and tell you what my own experience has been. I have had exclusively superlative psychiatrists. Yes, I’ve only been playing this game for a little over seven years, but my former and current psychiatrists, the numerous psychs I have been sent to for second (and third, and fourth) opinions, and even the multiple psychiatrists I interviewed in my search for a new one were wonderful (with one notable exception, and she was just a bitch). So, offhand, that’s more than half a dozen.

    Not one of them has ever looked for an underlying physical malady.

    Now psychiatrists can be excellent psychiatrists, but I have never, in all of my years, encountered one who was anything but an awful doctor (and I mean absolutely terrible). I learned very early on in the game to research the hell out of everything they told me, and to make sure to check for any interactions, side effects, risks, confounding variables, and alternative issues with my PCP as well (GPs, for you non US readers). He is an amazing doctor (even in light of the story I will relay in just a bit), and he has treated me for more than half of my life. Between his know-how and my own research, we saved my life – literally, not just caught some kind of nasty side effect or interaction – more times than I can tell you. I stopped counting after about a dozen.

    As I’ve said before, “‘Tisn’t right, but it’s true.”

    So it isn’t as simple as it should be. I think that most psychiatrists make the assumption that your primary care has ruled out physical causes before they have even referred you, and I also think that they aren’t especially wrong to do so. I agree wholeheartedly that before you are sent to a shrink, it’s your internist’s responsibility to be sure the cause isn’t physical.

    Now, on to my recent experience. I put on about 15-20 pounds from a psych med. It wasn’t doing me any good, so I discontinued it post-haste. Now everyone feel free to hate on me, because I lose weight very easily. Not mass quantities, but that amount should have dropped off, with little to no effort on my part, in about a month, maybe two.

    It didn’t. So my next step was to actually make an effort. I changed up my diet, became more active, did all of the things I was supposed to (and more), and I still did not lose one single pound over a period of another couple of months.

    Finally, I’d had it. I knew, beyond a shadow of a doubt, that something was amiss physically, and I was pretty damned sure it was my thyroid. So I went to my primary, and I told him, “Dr. S~, I think I’m hypothyroid. We need to check my TSH (thyroid stimulating hormone) level.”

    He grumbled – he grumbles a lot, it’s because he loves me, but after being my doc for so long, knows that when I get that tone in my voice, he will ultimately end up capitulating to my request. Okay, my demand. Also, he knows that I’m not stupid, and I know about this stuff, especially as it pertains to me personally. So he grumbled, “Ruby, you aren’t hypothyroid, you’re just at the point in your life where your metabolism is slowing, and you need to be doing more aerobic exercise.”

    (For further insight for my relationship with my PCP – and my doctors, generally – feel free to check out my post Inactions Speak More Loudly Than Words.)

    I’ll spare you the rest of the exchange, but of course I got my TSH level checked, and lo and behold, I was subclinically hypothyroid. Barely, I might add. Had it been a different lab (each has its own intervals for normal which vary ever so slightly), I would have been definitively hypothyroid. Dr. S~ wanted to repeat in two months, which initially I was alright with, though not particularly thrilled.

    Then I started developing all sorts of other issues. I’ve had migraines almost daily, my anxiety shot through the roof with no warning or provocation, my mood has been a bit. . . low, and I’ve been sleeping a minimum of 12 hours a day. I don’t believe that any of these are strictly psychiatric symptoms, and not because I’m in denial, either. They came on too rapidly, and otherwise my mood is great.

    So today I saw my PCP again (though I do have an appointment with my psychiatrist tomorrow, I’m not so cocksure as to not cover all of my bases). I told my primary that I wanted prescribed liothyronine (brand name Cytomel), a thyroid supplement. I’ve used it in the past, with great success, to treat depression, as I cannot, under any circumstances, take anti-depressants.

    He gave me my prescription, but added (grumbling), “I don’t think this is going to solve all of your issues.”

    I refrained from mentioning that he also didn’t think my thyroid needed checked to begin with.

    I guess that my point is to never rely on a psychiatrist for medical matters. In a perfect world, you should be able to, but we don’t live in a perfect world. We have to take what we’ve got.

    Incidentally, if you don’t mind my asking, did they definitively diagnose you with PCOS?

    • The assumption that your GP has ruled out other conditions assumes you have a GP. It assumes you would complain of these things to a GP. Many, many of my symptoms are things that I take for granted and would never have brought up in this context – especially the PCOS symptoms. They just always seemed to be the way things are, not something that could be remedied.

      And I haven’t had a proper GP in years. I have a referral sheet for a few local internists and I have to start calling around soon. I have no idea what to do with a GP, though. Pretty much all of my concerns are mental!

      As it turns out (and a forthcoming post will shortly explain) I do not have PCOS, although my testosterone levels are on the high side of normal. She said we’ll keep an eye on it.

      I do suspect subclinical levels are something to consider more seriously, and I’m not convinced that they are handled well by lab-based cutoff ranges. I just barely missed the bar for diagnosis with hypoglycemia, for example, but anyone with two eyes (or even one) could look at my symptoms and say without a moment’s hesitation that I am indeed hypoglycemic. The same thing goes for PCOS – I have many of the symptoms but just shy of the level of severity that is required for diagnosis. Lucky me, eh?

  2. This post, and the comments, are spot on, and really bring home the fact that nobody is as invested in our health, mental or physical, as we ourselves are. Thank you for helping to spread the word that everyone needs to be their own advocate.

  3. Interesting. My GP also suggested polycystic ovary syndrome during a recent checkup. Not because of my mental condition (we didn’t talk much about that, though I mentioned what I was taking and why), but because of other signs I exhibit. I still need to do more tests for that. (I’ve been out of town so haven’t had time to do them yet.) I was also almost certain I had a thyroid disorder. Not because of mental issues, but other symptoms. Plus, my parents both have a thyroid disorder. But apparently my thyroid is fine.

    My father’s thyroid diagnosis process is interesting. Apparently he was exhibiting symptoms of depression, and the doctors (GPs, I think) just assumed he had depression. It wasn’t until he went back to his home country and saw a doctor there that he found out about the thyroid condition. So, I guess GPs can screw up, too. Although my dad’s experience was a long time ago.

  4. My first psychiatrist, the one who worked for the university health services, did an excellent job in terms of ruling out possible physical causes. Thyroid issues, vitamin D, lyme disease, and some B vitamin levels before diagnosing me with bipolar disorder. But, it might be explainable because in the uhs system, most students don’t have a primary care doctor and can schedule an intake without referral. But he also did a lot more lab work than my current psychiatrist. Before going on any antipsychotic, he did a battery of health tests, and afterwards did several follow ups to make sure that I didn’t develop diabetes. My current psych is less scrupulous with the diabetes but is intense in monitoring my lithium levels as well as other levels like electrolytes.

    But the same can also be said for PCPs. I’ve had some spectacular ones who read research in between scheduled visits and tried to find out what was wrong before sending me to a specialist, thus preventing me from entering a revolving door of specialists. And others who seem to barely care, handed me some pills, and told me to call if it didn’t help.

    • The experience seems to really vary across individuals. I’ve been a UHS customer for 5 years now, so it’s going to suck to have to find a PCP. I got a referral sheet but actually getting that arranged is such a low priority at the moment. Soon, soon, I keep saying…

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