Your thyroid is a small butterfly-shaped gland at the front of the throat that produces and sends hormones into the bloodstream. These hormones regulate many important processes such as metabolism, body temperature, energy levels and other vital functions in the body. The presence of a thyroid disorder can affect your weight, body temperature and moods. In fact, the thyroid plays such an important role in mental health that many people tend to seek psychotherapy for their symptoms of depression or anxiety prior to realizing they have a thyroid condition.

It’s not uncommon to have a client enter my practice with what we soon find out is a thyroid condition, which has been masquerading as anxiety or depression. As a mental health professional I prioritize ruling out any medical conditions before diagnosing an individual with a mental health diagnosis. In this article we will explore two of the most common thyroid conditions that result in unbalanced hormone levels: hypothyroidism and hyperthyroidism. Both conditions have well-documented associations with anxiety and depression.

Hyperthyroidism

Hyperthyroidism is when an overactive thyroid produces too many hormones. Symptoms include:
- Anxiety or panic attacks
- Tension in the body
- Insomnia
- Elevated heart rate / high blood pressure
- Mood swings and irritability

Hyperthyroidism tends to keep an individual’s nervous system in high alert: it makes sense this person may assume they have an anxiety disorder and seek psychotherapy. A study estimates that up to 60 percent of people with hyperthyroidism also have clinical anxiety!


Hypothyroidism

Hypothyroidism is when a thyroid gland is “sluggish” or underactive, not producing enough hormones. Symptoms include:
- Loss of appetite
- Difficulty concentrating or memory loss
- Reduced motivation
- Fatigued
- Bloating or weight gain

Hypothyroidism tends to keep an individual’s nervous system shut down, which explains its striking similarities to the symptoms of major depressive disorder.

As you can see, the overlap of symptoms in thyroid conditions and clinical anxiety and depression can result in misdiagnosis. As a clinician it is my goal to arrive at the root cause of my client’s presenting symptoms. To receive the best treatment available I encourage clients to complete routine blood work and follow ups with doctors and seek appropriate medical testing when necessary. If you’re reading this and struggling with confusing symptoms it’s important to advocate for your own health so you can identify and treat health conditions early. At an appointment, your doctor may do a blood panel to specifically test your T3 and T4 levels as well as an ultrasound of your thyroid to see if there are any nodules, and if it shows inflammation or overactivity.

It’s important to consider recent research that suggests individuals who do not have a history of thyroid disease can develop hypothyroidism when taking antidepressants. Recent research suggests that certain classes of antidepressants (tricyclic antidepressants, SSRIs and non-SSRIs) can interfere with thyroid hormone synthesis and iodine utilization. Individuals taking non-SSRIs may be at risk for either hypothyroidism or hyperthyroidism. Whether you have a thyroid condition or not, those who take antidepressants usually need to regularly monitor their thyroid function. If you have any concern, follow up with your prescriber and do not stop taking any medication unless your doctor tells you to do so.

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246784/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144691/
https://www.hindawi.com/journals/jtr/2012/590648/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978977/
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2679767?_ga=2.115206660.2000789584.1667694440-74168533.1667596873
Bou Khalil R, Richa S. Thyroid adverse effect of psychotropic drugs: a review. Clin Neuropharm. 2001;34(6):248-255
Shelton RC, Winn S, Ekhatore N, et al. The effects of antidepressants on the thyroid axis in depression. Biol Psychiatry. 1993;33(2):120-126

Erica Basso is a Licensed Marriage & Family Therapist practicing statewide in California. She helps guide women in overcoming anxiety, perfectionism, and imposter syndrome. To learn more about working with her, visit www.ericabassotherapy.com.