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Forum Name: Psychiatric Topics

Question: I Think My Fatigue Has Been Misdiagnosed as Depression


 Kallisti - Sun May 06, 2007 11:28 pm

I am not sure where to put this, I am putting it here because it involves a diagnosis of depression. If it is in the wrong place, I apologize.

History
I am 27, female, currently on no medications. The only surgeries I have ever had were a bar in my right tibia at 21, and a tonsillectomy at 12. My family has no history of depression, but does have a history of thyroid problems.

I have had these symptoms for most all of my life, for this problem I have been consistently diagnosed as having depression, with the exception of a psychiatrist who suggested that I should have my thyroid tested.

Symptoms:
Fatigue/Daytime Drowsiness, persistently dry skin and hair, weight gain in spite of poor appetite, frequent insomnia.

Recent diagnosis and description of problems
For these I have been diagnosed as having depression, as a teenager I was put on a few different anitdepressants - Pamelor, Zoloft, and Paxil. I was also given Elavil for the insomnia. Each of these made the fatigue worse. As they did not help I was taken off the anti-depressants. Later on, I went to a psychiatrist who thought that my problem might have been with my thyroid,

Recently I tried a local doctor's office, and was given a checklist type test for depression. I had two symptoms on the list, fatigue and weight gain, and based on this was diagnosed with depression. I then asked for a lipid panel, and when the results came in was told by the Physicians Assistant that diagnosed depression that my thyroid was normal and was lectured for going off of the antidepressants 10 years ago. I was told by the PA that the only thing my fatigue and weight gain could be is depression, and so did not ask for any other tests.

I do believe, however, that I have been misdiagnosed. The only two symptoms that I have ever displayed (that I know of) are fatigue and weight gain. The anti-depressants I have taken have made these symptoms worse, although I stayed on them for a long period.
If I am being misdiagnosed, I seem to have a little trouble making people listen to me. I would like to try again, however because I believe that those who I have seen thus far have not listened to me (for example the above reference to being lectured for going off the anti-depressants, I was taken off of them by a doctor. I tried to tell the new one that, but was ignored. Also, another example, I am generally ignored when I say that I have exhibited these symptoms for years, the one before this doctor told me repeatedly that I probably had some stress recently that caused depression and these symptoms. Essentially, I think the only thing that they are hearing is 1. I was on anti-depressants, but no longer am. and 2. I exhibit 2 of the symptoms of depression. )

My question
Can a person have depression from very young childhood (I remember having fatigue and insomnia at age 6) with the only symptoms being fatigue and weight gain? And if I am being misdiagnosed, is there anything I can say or do to be taken more seriously?
 Marceline F, RN - Mon May 07, 2007 4:43 pm

User avatar Dear Kallisti,
There are two separate issues at play here. Do you have a thyroid problem as you seem to feel, and do you suffer from depression. These are two distinct disorders that can occur either separately or concurrently. A lipid panel will not reveal problems with your thyroid. The Thyroid panel consists of a T3, T4 and TSH. these are the tests used routinely to rule- in or rule-out a thyroid problem. Depending on the results of these tests there are treatment options.
Clinical depression can hit at any age. While it can be sometimes related to hormonal changes, acute stress, or chronic lifestyle issues, it can also occur in the absence of any traumatic event.
I would hope the questionaire you answered would have included questions about stress in your life, your avaliable support system,and coping mechanisms (whether effective or ineffective).
I will say it is possible for you to develop an acute onset of depression if indeed you have an underlying metabolic disorder that in your perception is being ignored.
Ask your primary MD if he would run Thyroid studies for you, so you can either rule-in or rule-out the thyroid as the source of your problems.
 Debbie Miller, RN - Mon May 07, 2007 5:34 pm

User avatar Hi,
I can certainly understand your frustration here. Depression is an interesting problem because it is both under-diagnosed and over-diagnosed. Many cases are missed because the symptoms can be so similar to many different illnesses. Chronic fatigue, hypothyroidism, other psychiatric disorders such as bipolar I or bipolar II, dysthymia, hormonal problems, other chronic illnesses, infections, etc. can all look like depression. On the other hand, when one cannot determine the cause of the physical symptoms, depression can be a catch-all when nothing else seems to fit. While depression, anxiety, and other disorders are not as common in children, they still are very much present for some people at an early age. Remember we are talking about some chemical imbalances and this could occur at any time.

There are screenings for depression that suggest even a couple of symptoms can be indicative of depression (you don't necessarily have to be sad or have the classic "look" or the whole list of possible symptoms) and that is probably why they felt this might be the case for you. It is important to get an accurate diagnosis so I would encourage you to get a complete evaluation, including the thyroid function tests and CBC to check for iron levels and other problems. A complete workup with a psychiatrist would probably also be in order so you can be confident about your treatment if antidepressants or other medications are indicated. If you feel your provider is not listening you may want to get another opinion. Take a list of concerns with you in written form to help you remember and state clearly what your problems are. You could even leave a copy for your chart.

Good luck and keep us posted.
 Dr. K. Eisele - Tue May 08, 2007 12:39 am

User avatar Dear Kallisti:

I will loudly second what Debbie and Marceline have said.

I also applaud the psychiatrist who said you could have a thyroid problem, ESPECIALLY since you have a family history of thyroid problems. Hypothyroidism is an illness which mimics the symptoms of depression, and psychiatrists know to ask about the patient's past laboratory work-ups.

I think you need to go back to your primary care doctor and emphasize that there is a family history of thyroid disease. If at all possible, report what that disease is--either HYPO- or HYPER-thyroidism, and what those family members' symptoms were. You may have to do a little bit of research into your family history, but it will serve you well to go in to the doctor 's office well-informed.

The depression issue may get thrown back at you, at which point, I would simply request a thyroid panel and a test for anemia. If they refuse, then you go find another primary care physician. If they agree, then you will have your answer.

My questions for you are these: what will you do if tyou are not anemic and the thyroid panel shows no abnormality? Will you then be able to accept that your problem may indeed be depression?

If you do have depression, there are many explanations as to why the previous antidepressant therapy did not work. Instead of major depression, you could have a more chronic form of depression called dysthymia, which requires a different treatment regimen. The problem could be that the medicines were dosed either too high or too low to start with, which can produce counterintuitive adverse effects. Also, there are many different antidepressants which have different mechanisms of action. Psychiatrists well-trained in psychopharmacology will know which antidepressant would most likely be helpful given your particular symptoms. For example, fatigue and weight gain, if not due to a physical problem, should respond to bupropion (Wellbutrin), which you did not include in your list of antidepressants you've tried.

Pharmacotherapy has come a long way in the last several years. We know much more now about the biochemistry of psychiatric illnesses than we did in the days of the tricyclic antidepressants, such as Pamelor and Elavil.

My recommendation is to have the laboratory work done so physical problems can be ruled out, and if the tests show no abnormality, give psychiatry another chance.

Please do come back and let us know how things turn out.
 Kallisti - Wed May 09, 2007 1:21 pm

Thank you so much for the advice! I've just made an appointment to have a CBC and a thyroid panel done, on June 1st.

The mention of the CBC is something that has made me realize something I should have mentioned. I forgot to say in my original post that when I was born, I was anemic. I was treated for anemia until I was about 5. I've also always been very, very pale. I can't wear liquid cover up or powder because I can not find a shade light enough. I had heard years ago that it couldn't possibly be anemia, because that was "fixed" so long ago, so I never thought to mention it. Could that problem still be there or still be affecting me?

The questionnaire that I filled out was a true or false with 12 questions on it, it had questions about sadness and energy, like "I feel sad all the time" and "I have experienced more than 10 pounds of weight gain this year". Each true answer was one point, 1-4 pts. = Mild depression, 4-8 moderate, 8-12 severe. I scored 2, last year I gained 20 lbs. and the fatigue.

If I didn't have any other abnormalities, and then was diagnosed with depression I would accept it then and wouldn't have a proplem with taking something like Wellbutrin.

I know I sound resistant to the idea of it, but I'm just frustrated. The lipid panel has been the only actual lab test (aside from pre-employment screenings) that I have had since I was about 13. I was initially diagnosed in the school medical office (I went to a boarding school) , without any exclusionary tests, it was just based on the symptoms. Since then, I've heard so many times "Well, because you've already been diagnosed with depression...". It's frustrating, because the initial diagnosis was made in under 10 minutes, I went in, told him my symptoms and he prescribed Pamelor. The idea that I could be diagnosed without ruling anything else out has never sat well with me, know that I know exactly what to ask for I can finally rule anything else out and work on feeling better.
 Debbie Miller, RN - Wed May 09, 2007 1:58 pm

User avatar I understand what you are saying and because of the overlap of symptoms it is important to check all avenues in diagnosing depression. I personally believe everyone should have thyroid testing done at the time of initial evaluation (and probably other routine lab work such as the CBC as well) unless this has already been done as part of a recent physical exam in another setting. It is important to be certain those insidious causes are investigated prior to prescribing antidepressants unless there is a critical need such as with suicide ideation or other harm of self or others.

I am glad you are diligent in getting the care you need. Good luck.

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