I remember being in graduate school in the 90s and feeling extremely rundown, depressed, and incredibly anxious. When I would seek out medical attention for the fatigue, I would be told that I have fatigue because I’m carrying some extra weight and because I’m in graduate school. There was no real attempt to try to discern any underlying medical causes. There was no discussion about family history of medical conditions that could significantly contribute to my energy, poor focus, mood, and anxiety..

During my last year of graduate school while I was completing an internship in Salt Lake City, I went to a family practice nurse practitioner who took a serious interest in possible causes for my fatigue. She gathered an extensive family history. She learned that my father had Graves disease, a hyperthyroid condition, and that my mother died from complications of rheumatoid arthritis when I was in kindergarten. She also felt my throat and said that my thyroid appeared enlarged. She ordered bloodwork to see if my thyroid was overstimulated and it came back within the normal range.

After completing my PhD, I continued to struggle with anxiety, depressed mood, and brain fog. I went to see a psychiatrist to talk about a trial of antidepressant medication. Perhaps the demands of graduate school, a failed engagement, and a trip from Buffalo, New York to Salt Lake City and then to West Palm Beach Florida, were just too much for my nervous system and it had crashed. Without asking me anything about chronic health issues in my family history, she prescribed me 20 mg of fluoxetine. If I'm honest, I’ll tell you that it was helpful in that it muted my emotions and allowed me to step back and detach from overwhelming emotions. I could take my worries and set them on the shelf. At the time I was working in an extremely toxic workplace and under chronic stress. About six months later when I left the toxic workplace, I found myself with intensified energy and a sense of giddiness. I decided on my own to wean myself off the medication. I assumed that my brain chemistry had worked itself out, and that outside of a toxic workplace, I could function well enough.Something everyone should know is that there are no protocols to take you off of psychiatric medication. You have to ask your prescriber to advise you how to do it or educate yourself as to the best practices.

Flash forward six years, and I was struggling with fertility issues. I was actually on my way to get the blood work, when I found out that I was pregnant. During my pregnancy I dealt with blood sugar issues, edema, and developed preeclampsia. I spent the last month of my pregnancy in the hospital on bedrest where they monitored my kidney and liver functions. When certain enzymes were elevated, I was given a C-section. The only cure for preeclampsia is delivery of your baby.

About six months after my daughter‘s birth. I struggled with debilitating fatigue and significant hair loss. My mood was a raw nerve, and I found myself prone to unusual outbursts of anger like I had never felt in my life. Following one significant outburst, I was advised by one of my siblings to go to the doctor and to get my thyroid checked. That thyroid issues may be the reason for my symptoms. Remember that I had been in the hospital for a month and under the care of an OBGYN for eight months during my pregnancy and no one had ever checked my thyroid with my family history and the complications of my pregnancy.

When I got to the doctor's office and advised my new PCP that I was not routinely in the habit of throwing chairs off my back deck, (I had found myself in that situation due to deep rage like nothing I had ever felt before in my life), I asked if she could check my thyroid. I told her about my family history and said I wanted to rule it out. She looked at me, surprised, but agreed to do so. This was my first meeting with her. To be fair she hadn’t seen my pre-pregnancy hair, which was something akin to Ruth Buzzi. Losing a third of my hair left me with quite a bit of hair. When the blood work came back, she called me and got me on a dose of levothyroxine as my thyroid stimulating hormone was over 6. The normal range is from .5 to 5.

As I reflect on my past, I can’t help but wonder what could’ve happened to me. I had a good relationship with this family doctor as she often made referrals to my psychology practice. She knew me to be a reasonable and competent person. She had some basis from which to evaluate what I was telling her. I later learned that she also had her own thyroid issues. What if I had a different doctor or stumbled into a psychiatric emergency room seeking help?

I suspect I would have been diagnosed with something like intermittent, explosive disorder, postpartum depression, or bipolar disorder, and placed on powerful unnecessary psychiatric medications. Not really what I would’ve needed and probably damaging and dangerous for me to take. Not to mention the impact on my career as a psychologist.

The truth is that psychiatric diagnoses are largely based on the duration and frequency of a collection of different psychiatric symptoms. For example, you may fit the criteria for bipolar disorder or anxiety disorder, or depssion,, but that tells us nothing about what underlying mechanisms may be driving these issues. I was never taught in my graduate education to do a thorough medical family history to determine whether or not alternative medical conditions could account for someone’s anxiety and depression symptoms.

I was taught in my graduate program in Counseling Psychology at the University of Buffalo, that I should focus on my patient strengths and that psychotherapy was about helping someone learn their way to better coping and improved functioning. I was taught to be skeptical about psychiatric diagnoses as anything more than descriptors of symptoms that cluster together and impact an individuals functioning. I did learn that the determinants of emotional challenges in life are multifaceted and complicated. That understanding context is key to helping your client achieve their behavioral health goals.

Recently, to my great pleasure, I was completing training for my Florida psychology license on medical errors. This was the first time in any professional training that I heard talk of ruling out medical conditions, including thyroid disorder prior to making a psychiatric diagnosis.

Within the past year, I came to learn that my underactive thyroid is due to Hashimoto’s thyroiditis. In the 20 years that I was taking supplemental thyroid hormone, I was never directed to get an antibody test to determine what was causing my underactive thyroid. With this diagnosis I was able to learn about critical lifestyle changes that have had incredible impacts on my mental well being. I learned that gluten mimics your thyroid at a molecular level and increases your thyroid antibodies, which increases your body’s attack on your thyroid gland, further straining it. I am now gluten free and as a result I am brain fog free. I am taking proper nutritional support for my thyroid. I learned that Hashimoto's also affects your liver function and makes it harder for you to break down proteins you need for good energy. I am now taking these proteins directly and my energy is improving. I found a functional medicine primary care provider who specializes in thyroid support and am getting my chronic inflammation identified and treated for the first time in my life..

I can’t help but wonder how my life would have been different if my condition was identified earlier in my life. If you have a history of autoimmune issues in your family history, and you are struggling with anxiety and depression, insist that your medical professional order thyroid antibody tests. If they can’t order it, insist that they refer you to a specialist that can order these tests. Masking your autoimmune symptoms with psychiatric medications allows the damage to your thyroid to continue. The first symptoms of thyroid dysfunction are anxiety, depression, and brain fog. Our current family practice protocols test only thyroid stimulating hormone and thyroid hormone levels. These tests will only detect a thyroid condition AFTER the damage has been done to your thyroid. These tests will not detect Hashimoto's or Grave’s disease antibodies that can be detected prior to thyroid damage. The earlier you identify a thyroid condition, the sooner you can alter your lifestyle to protect your thyroid from further damage.

Thyroid conditions are only one kind of autoimmune issue that impacts our mood and anxiety. It’s critically important that we take charge of our healthcare and insist on getting to the root causes of depression and anxiety rather than throw psychiatric medications at mental health symptoms.

By sharing my own story I hope to inspire others to advocate with their medical providers to get to the root cause of their behavioral health issues, and to earnestly pursue holistic lifestyle changes based upon accurate diagnoses. If your PCP will not work with you, consider transitioning your primary care to a provider specialized in functional medicine. You deserve the opportunity to do a full exploration and examination of health issues that can be affecting your mental health.