Is It Really Depression? 7 Conditions That Can Fool You

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Depression is a health threat you don't want to ignore. Growing populations at risk include caregivers looking after frail elders, people with dementia, and people living alone. Yet not all sadness, apathy, low energy, and low mood should be considered depression at work. Sometimes, depressive-type symptoms can flag a different condition.

It's good to know the warning signs of clinical depression -- but if you're worried about someone, also consider whether any of the following situations might apply.

Depression or a Thyroid Condition?

The tiny thyroid gland has a huge role. It regulates metabolism, which means virtually all the chemical reactions in the body, including those involving hormones. If metabolism is out of whack, a person doesn't function right -- or feel right -- usually without realizing why. Resulting symptoms like changes in mood, weight, and energy levels can be mistaken for many other conditions. As many as half of all thyroid disorders are therefore misdiagnosed or undiagnosed.

In a 2004 Spanish study, 34 percent of older adults with hypothyroidism (underactive thyroid) and half of those with hyperthyroidism (overactive thyroid) reported feeling depressive symptoms. Women are at higher risk for thyroid disorders, possibly because they experience more hormonal changes.

What to watch: Other common symptoms of thyroid disorders include weight changes, dry skin, sensitivity to cold, tingling or numbness in the hands and feet, new constipation or loose stools, puffy skin, and bulging eyes. Hypothyroidism sometimes follows childbirth (a period when postpartum depression may also strike).

What to do: Don't ignore depressive symptoms, whether you think you know the cause or not. A thyroid test can measure thyroid function. Hormone treatments are used to restore proper thyroid functioning.

Depression or Drug Side Effects?

When personality and behavioral changes strike in teens or young adults, we're quick to think of drugs. In adults, though, it's often overlooked that prescription drugs can have similar effects. Beta-blockers used to treat hypertension, angina, and other conditions, for example, can cause symptoms that appear to be depression-like, including lack of energy, changes in sleep, lack of sexual interest, and mood changes. Research shows that beta-blockers don't cause depression; rather, they can bring effects that look and feel like it.

Other medications that can sometimes cause depressive symptoms include corticosteroids (for autoimmune diseases), which can alter serotonin levels, and drugs for Parkinson's disease that affect dopamine levels, such as levodopa. Serotonin and dopamine are both linked to mood. Also beware common antianxiety drugs, such as Xanax, Ativan, and Valium.

What to watch: Ask whether the person has recently begun a new prescription or had a dosage change. Abuse of illicit drugs or alcohol can also cause depressive-like effects; be alert to these warning signs of addiction.

What to do: When seeing a doctor about worrisome symptoms, be sure to bring a list of all medications or, better yet, all the medication bottles themselves. A different drug or an adjustment to the dosage may ease the unwanted side effects.

Depression or Sleep Problem?

Say there's no obvious stressor or health symptom -- at least by day -- and yet you feel tired, lethargic, and "off." The problem may be something that's happening at night. Any kind of sleep problem can cause mood and energy problems by day. For example, those who suffer insomnia due to stress, a bladder problem, or caregiving for someone with dementia who doesn't sleep well are at higher risk for depression.

Sleep apnea, a dangerous condition that causes a person to briefly stop breathing during sleep, is often a surprising cause. In sleep apnea, the soft tissues of the throat temporarily close the airway. As many as 80 percent of sufferers go undiagnosed or are treated for the wrong problem.

A 2012 study by the Centers for Disease Control and Prevention of 10,000 adults found that people with sleep apnea have a higher risk of depression. Men, diabetics, and those who are obese are at greater risk of sleep apnea. Other risk factors include a large neck size or being over 40.

What to watch: Someone with sleep apnea usually snores loudly or sounds like he or she is struggling to breathe. A companion may notice actual gaps in breathing. Other symptoms of sleep apnea include restless sleep, plus tiredness and napping during the day.

What to do: Don't ignore sleep problems, whether you notice them during the day or night. For sleep apnea, treatments include special sleep masks. A 2012 Cleveland Clinic Sleep Disorders Center study found that patients who used them to treat sleep apnea experienced fewer symptoms of depression, even if they didn't follow the treatment exactly as prescribed.

Depression or Dementia?

When a loved one becomes withdrawn and uninterested in activities that once brought pleasure, loved ones are apt to think, "He's depressed" more often than, "He has cognitive impairment." But seeming apathy is a common early sign of dementia, as the person struggling with cognitive changes focuses more thought and energy on everyday behaviors, sometimes to the exclusion of anything else.

Depression and dementia can occur separately, but they're also often found together. The risk of depression is higher in people diagnosed with dementia (of which Alzheimer's disease is the most common cause), though there are other causes.

What to watch: There's a great deal of overlap in dementia and depression symptoms. With both, for example, someone may have trouble concentrating, seem apathetic, show personality changes, or withdraw socially. Other common early warning signs of Alzheimer's include making mistakes with money, having trouble finding the right words, having difficulty with abstract thinking, and being disoriented about time or place. Not everyone with early dementia will have all these signs, but some of them may appear along with the changes in focus and personality that look like depression.

What to do: No single test will distinguish between dementia and depression. A clinical assessment is the best way to diagnose Alzheimer's.

Depression or Burnout?

You can feel emotions like sadness, or feel overwhelmed because you're dealing with chronic stress, without having actual depression, which is a physical disorder. But it's a slippery slope from stress to burnout, and burnout often leads to depression.

What to watch: Ongoing stress (such as the demands of caregiving) is often compared to the proverbial frog in a pot of water on a stove -- the temperature rises so gradually that the frog gets used to it, and by the time he's being boiled away, it's too late. Check in with your stress level to get a sense of how advanced your stress is. One rule of thumb: The longer a stressful situation goes on, the more at risk for burnout you may be.

What to do: Whatever the source of your stress, you've got to look out for Number One even as you struggle with the burden at hand. Among the keys of beating caregiver stress syndrome, for example, are tapping into more practical and emotional support, finding physical outlets for stress, and focusing on self-care as much as possible.

Depression or Traumatic Brain Injury (TBI)?

Traumatic brain injuries (whether caused by falls, sports, accidents, or acts of violence) are commonly known as concussions, and they affect individuals differently. Often they create changes to mood, memory, attentiveness, and energy levels. A sufferer's personality may seem to change, and dramatic mood swings can be mistaken for depression. Making things more complicated, half of those who suffer head trauma will experience clinical depression, according to a 2010 study reported in the Journal of the American Medical Association. So the two conditions can overlap, or one may be mistaken for the other.

What to watch: Usually the cause of a traumatic brain injury is obvious -- but people don't always understand that the associated cognitive and mood effects can persist for several months after the incident. They can include listlessness, anxiety, paranoia, fear, irritability, difficulty beginning or completing tasks, and changes in concentration and attention.

What to do: Encourage someone who hit his or her head in a fall or other accident to get checked out afterward. (See what to tell the doctor when someone with dementia falls).Tell the doctor about ongoing depressive symptoms and encourage the person with the concussion not to be embarrassed or ashamed about sharing these symptoms.

Depression or Grief?

As with stress and burnout, the intense emotional and physical experience of grieving can be profoundly depressing. These very natural emotions aren't usually the same thing as the physical condition doctors call clinical depression, however. Grief and depression can overlap -- or be mistaken for one another.

There is an acute subset of grief, affecting 10 to 20 percent of mourners, known as prolonged grief disorder or complicated grief. (The term prolonged grief disorder was proposed for the 2013 diagnostic manual of mental disorders, DSM-5.) Psychological distress is so intense in these cases as to interfere with everyday functioning. People with this kind of grief are at dramatically increased risk for clinical depression.

What to watch: Everyone grieves differently. But a sign that someone may benefit from additional support is when there's difficulty managing everyday life. Among the other worrisome symptoms of acute grief are emotional numbness, a sense of meaninglessness, difficulty accepting the loss, and suicidal thoughts. Suicidal thoughts, in particular, should be taken seriously and brought to the attention of a clinician. Symptoms may persist a year or more after the loss, or they may not go into full swing until six months after the death.

What to do: A doctor or mental health professional can help advise on treatment for grief-related depressive symptoms. Realize, too, that grief isn't limited to mourning those who have died. Alzheimer's caregivers, in particular, often experience what's called anticipatory grief -- feelings of loss for someone who is still alive. (They don't call Alzheimer's the "long good-bye" for nothing.)

Paula Spencer Scott

Paula Spencer Scott is the author of Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers and much of the Alzheimer's and caregiving content on Caring. See full bio

over 3 years, said...

Daytime is a terrific cure. . .all is worse at night.

almost 4 years, said...

Depression or chronic pain

almost 4 years, said...

Why don't you add Vitamin D deficiency to the list. I have had three friends within six months thinking they had depression only to find out it was lack of Vitamin D.

almost 4 years, said...

Don't forget low vitamin D

about 4 years, said...

I like to add that P.O.T.S a heart condintion, fibrominalgia, and neuropathy can cause pain lack of sleep constant tiredness and therfore lead to it as well. I t is good you brought up different types of grief I would like to add one more type the gief of oneself such as being diagonse with a disease or condition and realizing your never going to be that same person. So it becomes as if the old self is another person you grief over even though it was you (your old self) that you are grieving over the person feels such a disconection from their old self it is as is they are looking at another person. Its like losing a childhood friend and yourself all in one. That kind of greif is terrible too I have seen take a toll on people including myself which now I have done better with if only the others I know could do better as well.

over 4 years, said...

The Brain Injury Association of Virginia, or search: Brain Injury or TBI, See Facebook for support groups. I had an accident with bleeding on the brain on July 30, 2012, a seizure two months later followed by brain surgery. Head concussions are serious.

over 4 years, said...

very well explained article, feeling more enlightened. thanku.

about 5 years, said...

Excellent article. Thank you.

about 5 years, said...

i belive that is what i have,what can i do

about 5 years, said...

Four years ago, 1 year after I had to have my uterus removed, ovaries still in tact though, my skin felt like an alligator's, my hair was listless, no energy, gained 25 lbs. in just 3 months, I was going through 5 surgeries for all different kinds of things, had to find a new GP because my GP of years failed to catch symptoms of a DVT (deep vein thrombosis) in my left leg when I told him about a severe cramp I was having - when I found one - he wants to all of a sudden put me on night-time insulin! My finger-sticks for my mild Type II Diab. weren't even up at over 300 mind you! I said "NO! when they go up to 300+ I'll think about it!" I promptly found a wonderful FEMALE Endocrinologist who took one look at my CBC, complete blood counts, and said "Oh! Your thyroid is slowing, we need to do a complete Thyroid panel on you!" Sure enough, mine went from 4.3 to 6.2 in just 2 weeks. That is actually hereditary from my dad's mother's part of the family I found out from my mother! NORMAL ranges are from 0 - 3.0 NOT from 4.0 to 10 like OLD SCHOOL DRs. used to think. Cleveland Clinic has proven otherwise! AND because I was already on Norvasc 10 mg for mild hereditary Angina (also from my Dad's family -male side) she had to start me out at the lowest dosage and now 3 years later I'm up to 175 mcg - that's micrograms. NOT milligrams. MCG. If they start you out at too high a dose, it can actually send you into A-fib. or Atrial Fibrillation. So make sure you don't have a Thyroid problem first! OH, and one more thing, if you are also having Diabetic symptoms, UNDERSTAND THIS: LOW ACTING THYROID CAN AND USUALLY DOES MAKE YOU (MALE OR FEMALE) INSULIN RESISTANT. So be sure to make your Dr. do a thorough CBC, thyroid panel and possibly refer you to an Endocrinologist.

about 5 years, said...

Sometimes I am so depressed it seems overwhelming. I had suspected it could be burnout from my job and after reading this article I am even more convinced that is what it my mom and brother both suffer from hyperthyroidism and it was helpful to keep that in mind as well.

about 5 years, said...

You left out a very important physical condition, one which occurred to both my father and me: bleeding ulcers. Because there's usually no pain, you don't know that anything is wrong until you don't have enough energy to even lift your head off the pillow - and by then, the situation has become life threatening. If you notice a person sleeping or lying down much more than usual, please consider this problem, and go to the doctor. It took a lot of blood to save my life and the life of my father. Don't let it get that far.

about 5 years, said...

have all these symptoms but have been told I have M.E. im going to request another thyroid test.

about 5 years, said...

We are adapted to fast life style which leads us to depressive.

over 5 years, said...

For sure! I watch people TEXTING, and yapping on cellphones, and because I am a longtime meditation practitioner, I smile as I ponder: how these folks may not in fact be all that busy .. they are just uneasy at the prospect of being alone with themselves! That is an acquired trait, and 'civilised' high tech doodads can often take us away form our calm center, where we find comfort, and wisdom. I am not saying a cellphone is not a blessing in an emergency, but simply that it is so easy to make these things more important than they actually ought to be. Meditation also develops in a person, the talent for 'noticing'. In Zen is it called mindfulness. So, when I entered Mary's apartment, or visited with Joe, I would watch my dear senior charges, and then say to myself, "Hmm, that's not like him/her to do that.." And the fact that I knew them both so well, and was so acquainted with their habits, made me soon become aware that things were changing in terms of their behavior and coping skills. Moreover, that it was time to seek professional intervention, family help, or a Doctor's advice. I do believe this kind of awareness is an extremely valuable trait to hone, on all fronts!

over 5 years, said...

Besides the reasons mentioned in the article I think that Longevity and modern ways of city-life also play a role for causing depression.We have become dependent on various types of gadgets that in turn have caused to reduce our body-movement.We also have disattached from 'nature' depriving ourselves of self-healing powers

over 5 years, said...

Indeed. My neighbor Shirl from the local senior center does pottery and makes some terrific things. That gives her real joy, and she sells her pieces regularly, which creates a little income! But she used an expression one day when we were talking about 'beating the blue days'. She said, "Well, lemme say this...I have developed what I call a NOSTALGIA FOR THE FUTURE.." What a wonderful point of view! By the way she also takes a therapeutic strength multivitamin, expressly formulated for the needs of older people. Eating light and healthy throughout the day keeps her blood sugar stable and her energy level where it ought to be, to cope with that full dance card of hers. Combined with, her Tai Chi classes, a great attitude, and ceramics have kept this lady, 85 and still spry..on the high road!

over 5 years, said...

Honestly, I am too busy to be "depressed"! If something has gone "wrong", the do something about it. Moping won't help. The various causes leading to such a state, I know nothing about, not part of my world, fortunately. If it's in the mind, get the mind busy & stay in that lane. You or nobody can bring back that which is/has past, move on, new horizons, new aspects get away from whatever is upsetting!

over 5 years, said...

Good to know all options to consider when you are suffering w/what you know isn't "just the blues".

over 5 years, said...

One very helpful and positive way to deter depression I have found is to go to the gym on a regular basis.This really works.It gives you a time every day to look forward to.And the results are so beneficial.You will feel better and certainly look better.You will have more confidence.Good health is the one thing money can,t buy.Your view of life will change immediately.You will be more social and more aware of what is going on.You will just feel better about life.Your body will be stronger and less susceptible to injuries.It is never to late to start.I have found this to be true because it happened to me. Please go to "YOUTUBE" and view "Al Wheeler workout" I am now 79 and feel like a very young man.Give it a try..Al W.