Clinicians Digest Mar/Apr 2008 - Page 3


Belfort, a research scientist in developmental genetics and bioinformatics with the Wadsworth Center of the New York State Health Department, writes that she had four years of psychotherapy for her mild depression, dealing with her father's suicide and other issues. Three years after therapy successfully ended, she lapsed into a worse depression. She saw a psychiatrist, but despite different combinations and doses of antidepressants, her depression deepened into psychosis. She later had shock therapy, was better for a while, and then suffered three more relapses. Finally, her psychiatrist ordered a blood work-up, and discovered she suffered from hyperparathyroidism, a condition that affects about 100,000 Americans annually. Hyperparathyroidism is only one of several thyroid or adrenal disorders linked to depression. After two surgeries to control her hyperparathyroidism, Belfort has gone three years without another significant depressive episode and is cautiously optimistic.

How can therapists who treat moderate to severely depressed clients know when to think beyond psychosocial events and serotonin? In his 2000 book, The Antidepressant Survival Guide, psychiatrist Robert Hedaya, professor of psychiatry at Georgetown University, presents separate checklists to help determine whether a depression might be caused by malfunctioning thyroid or adrenal glands. Among the dozens of possible indicators: weak muscles (especially in the upper arms and thighs), unexplained weight fluctuation, dry skin, hair loss, swelling in the hands or feet, puffiness below the eyes, irregular menstrual periods, a craving for salty foods, excessive tiredness, dizziness or light-headedness when standing, an increased tendency to bruise, or darkening of the skin around elbows, knuckles, palms, knees, or nipples.

Not all therapists pay sufficient attention to possible biological causes of depression. Belfort's article serves as a reminder that therapists should make sure that they refer to psychiatrists who consider thyroid and adrenal problems before handing out an antidepressant prescription. The simple blood tests may head off months of anguish and deterioration.

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