my gp insists I have severe depression

[ghostinthecanvas]

and wants me to see a psychiatrist. I am a bit stunned and don't think she is correct. I had been willing to give her original diagnosis a shot and took the citalopram she prescribed. After a couple of months I went back to see her, told her nothing had changed. I was still tired, slept a lot, couldn't concentrate, get the bare minimum done. She changed antidepressants, diagnosed severe depression. Trouble is, I don't feel down, I enjoy things, look forward to seeing friends, have a laugh. Tho I prefer my own company, always have. Everything takes more of an effort than it used to. My brain isn't as sharp as it used to be, I am very slow at doing things. I really feel I am not depressed. Is it possible to be depressed and have absolutely no idea? I feel the gp has 20 years experience that I shouldn't dismiss. I am on thyroxine, level normal. I have had low iron, take daily supplement, level normal. I have endometriosis and am otherwise healthy. I have been tired for 4 years now, gradually getting worse. I would appreciate any advice. Apologies if I have written loads, hope you stuck with it!

You have just described me for the last six years.

Cause was discovered just before Christmas, I have a severe Vitamin D deficiency. Basically I have not been making it for years to be this low (red head who burns in minutes). I'm currently taking 20,000iU of Vitamin D (8 week dose in all) and it's like I've finally woken up, I feel refreshed in the morning, I'm not napping all the time and am enjoying life again.

"Having said that though, it might be worth seeing the psychiatrist, just the once. I got pushed down this route some years ago and it was quite useful to be pronounced mentally sound - stopped the doc in his tracks! Also psychiatrists usually know about the influence of under treated thyroid conditions on mood and motivation."

I have had that experience too. It was helpful.

So much help. I appreciate it. I have felt quietly despairing for a while. It was starting to feel permanent. No light at the end of the tunnel. Even if the diagnosis is CFS, at least I will know. I also feel thyroid may be to blame. I feel more heartened knowing a psychiatrist looks at the whole picture.

I also saw a psychoanalyst for a while a few years ago for panic attacks and general anxiety. I was very open minded to it (my mum was a counsellor and I've always been pro that kind of thing) and found it quite helpful, prepare yourself if you go. I was expecting a nice chat all about me for an hour but found it blindsided me, as it questioned the very foundations of me, and made me uncertain of the things that I deemed good and balanced.

Don't let that stop you going though.

before reading i knew this would be thyroid
ok you need a print out of your results
have you had an antibodies test?
is your tsh below 1 and t4 at the high end of the range?
what is your b12? your ferritin? your vit d?

Just to say you need to keep eating gluten until you get blood test for coeliac disease. I also second getting thyroid tests redone, when first diagnosed I think they are meant to retest after 6 weeks. Low Vit D and Vit B12 may also be contributing. Good luck, hope you feel better soon. I well remember the feeling of constantly being told I was depressed and just knowing there was something else.

I was about to post the same as the above pp, so I second her comment. DO NOT stop eating gluten. I did that and now can't eat it again as it makes me so violently ill, but it means I can't have a coeliac test and so don't get the proper checks that coeliacs should have (it increases the risk of certain cancers). Get the coeliac blood test done first, especially if you have Hashimoto's thyroiditis (the auto-immune type). But to me you sound under-medicated, what dose are you on?

A Psychiatrist will not 'rule out' physical health conditions, they are unable to do that. They will want any required physical investigations to be done / referred to specialists by the GP.
They might be able to reassure you that you are not mentally ill though, and they could communicate that to your GP.
I would go back to the GP though and push for a full range of health tests.
If you were majorly depressed you would know it - you would feel very low in mood and be experiencing high levels of negative thoughts and hopeless feelings (typically).

It seems to me that gp says not thyroid, not low iron, that just leaves depression. It cannot be anything else.
I had such a fight getting thyroxine at all. I remember being told again and again, we need to fix your low iron first. Then I read on here that thyroid the and low iron go together. Vit D, B12 etc never been mentioned. I have a battle plan now. A fluid one! I will go to the psychiatrist, experiment with diet (after test), try the antidepressants. Its been so long, patience now won't do me any harm. I have no faith in the GP. I also have a laparoscopy next month and endo ablation so that will perk me up. Hopefully.

I am on minimum thyroxine dose.

I know we don't know your medical history and can only bandy about conditions but something might jump out at you!

I have no idea of your weight or smoking etc but unrefreshed sleep and daytime tiredness despite a good sleep routine etc can be an obstructive sleep apnea syndrome. Hve a look and see what you think.

Missed that tho no faith in gp, I will go in with a list from here.

I haven't smoked for 14 years, weigh 8 and 1/2 stone. 5ft 4inches. 48 years old.

selks

the psych will ensure that everything is considered and not just - looks like depression
if it was me I'd see a diff GP or maybe the same one and chat it through
the psychiatrist won't blindly push for depression

Minimum varies, so what dose is it? You can start as I did on 25mg, but the current recommendations are that in under 50s with no heart issues there is no benefit in starting a dose any lower than 100mg. So your GP may have started you on 100mg? Or much lower. My TSH was creeping up so I was put up to 50mg but I still feel ghastly and think I need at least 100mg. Your TSH should be around 1.

Remember that not everyone feels better on thyroxine only treatment. Others do much better on natural dessicated thyroid like Armour. If your job is particularly stressful I would bet my first born that you have high cortisol levels and adrenal fatigue. TSH alone is not a good indication of thyroid function.

My thyroxine is 50mg.
Going to chat with same gp. My tiredness started 2 years into my job. I think that is definitely a factor.

ask for your tsh and t4. bet your tsh is right at the top end of 'normal'.

you could also consider increasing your meds yourself. plenty of advice no doubt on the thyroid forums. i did that, couldnt be arsed with gp keeping me undermedicated.

read up about it first, obvs!

I've felt like that twice. First time was before being diagnosed with coeliac disease. The second time was vitamin D and iron deficiency. I was utterly exhausted and could barely stay awake in the day.

If you know you're not depressed, the GP should be looking at your general health for other explanations. I would get a second and third opinion. I saw about nine GP's before the coeliac diagnosis.

Get a second opinion. But not from the internet.

I know a GP who was feeling a bit the same. It took him a while to come round to the conclusion that he was depressed, and had been so for 10 years.

Ukip I have explored the possibility of depression. I am down that I am in this cycle of tiredness and lack of concentration but I honestly feel that I enjoy life as much as I can. I am not irritable or tearful, my own self is quite happy. When gp first said depression I was ok with exploring the idea. She seems closed to any other ideas, hasn't looked at anything else. I came here just to be sure that I wasn't kidding myself. I absolutely am going back to see her. I am keeping an open mind, given gps certainty. There are suggestions on here I would not have thought about and tests I would not have known to ask for. I will keep everyone that is interested updated.

I have endo, and when it's bad I am so fatigued I feel exactly as you describe, all month. It could be the endometriosis, it absolutely does cause this sort of fatigue. Since being on a hormone treatment I feel almost normal again.

It's also worth remembering that some auto immune disorders have depression as a symptom. Coeliac and thyroid problems both do.

If you are on 50mcg thyroxine, it is highly likely, in fact almost definite, that you are not on enough to relieve your symptoms and keep you well. As others have said, for a healthy person under 50, there is nothing to be lost by starting on 100mcg and there is published, peer reviewed research to confirm this. I started on 75mcg and felt the benefits from the very first dose.

I still believe this is thyroid related and I would be very careful about going down the CFS route. The NHS quite happily diagnosed me with CFS when in fact I had very low ferritin and vitamin D levels, low vitamin B12 and folate and my thyroid was failing. It took me nine years to get treatment for my thyroid and I have gone from an obese woman who could barely get up and down the stairs to a merely slightly overweight woman who cycled into work this morning!

The ThyroidUK forum at www.healthunlocked.com is very sensible and also very used to the under-medicated turning up and asking questions.