Physical health conditions that can mimic depression

Fatigue, guilt, worthlessness, irritability, insomnia, decreased appetite, loss of interest in regular activities, persistent sadness or low mood are all signs of depression. Some of these signs can also appear when an individual has other health conditions. In such cases, depression may be a symptom and not the underlying illness.

Dr Krishna Prasad, Assistant Professor, Department of Psychiatric Rehabilitation Services, NIMHANS says, “There is a bidirectional relationship between physical illnesses and depression. In other words, signs of depression like getting tired easily, bodily aches and pain can be manifested as physical symptoms and are commonly seen in some deficiencies as well. Sometimes, many physical health conditions like hypothyroidism, anemia and vitamin deficiencies can mimic depression.”

If you are experiencing symptoms of depression, your consulting doctor (general physician or psychiatrist) might want to rule out any physical health problems that may manifest as depression. Research shows that the following conditions can have similar symptoms as that of depression.

• Hypothyroidism (high risk among women in the age group 30-40 years): Underactive thyroid hormone can show signs that include fatigue, weight gain, impaired memory, sleeping excessively, mood swings or sadness.

• Hypoglycemia (mostly in people who have a sedentary lifestyle, poor food habits and a genetic risk) : Low blood sugar can cause fatigue, tierdness, sleepiness and mental confusion.

• Anemia or Iron deficiency (common in women who experience heavy menstrual bleeding, those who have poor intake of iron containing foods or have worm infestations in the gut): The signs include extreme tiredness, loss of weight, difficulty concentrating, and insomnia.

• Vitamin B12 deficiency (usually in those who follow a vegetarian diet) : Deficiency in vitamin B12 can cause tierdness, aches and pains in the body, loss of apetite, mood swings or low mood and irritability.

• Folic acid deficiency (those who don’t consume or have poor intake of fruits and vegetables): Deficiency in folate or folic acid leads to fatigue, excessive sleeping, mood swings and irritability.

• Vitamin D deficiency (commonly seen in elderly and those who are less exposed to sun, or those who have poor dietary habits such as less intake of milk): Symptoms include unexplained fatigue, bodily aches and pains and difficulty thinking clearly.

While evaluating for depression the mental health professional will perform a detailed physical and psychological evaluation. Physical examination includes checking body mass index, pulse, blood pressure, respiratory rate and other body functions. They might recommend that you get a blood test done to rule out any physical illnesses that can present with symptoms of depression. The blood test may include measuring: 

• thyroid hormone and TSH levels in the blood for hypothyroidism or hyperthyroidism

• levels of vitamin B12, folic acid, iron and vitamin D to look out for presence of any nutritional deficiencies

• blood sugar levels for hypoglycemia and diabetes

Many of the conditions listed above are treatable. You may need to consult a general physician or a specialist based on your test results. If you continue to experience symptoms of depression even after being treated for other conditions, you may need to consult a mental health expert.