by Robert Duff
Physical conditions, diseases, and syndromes can also cause symptoms that are remarkably similar to those seen in depression. One of the most common disorders that can mimic depression is hypothyroidism. I have seen this many times in my professional work; people who have things pretty well sorted out, but just cannot shake the icky symptoms of depression that cloud their everyday life. The thyroid is a gland in the body that produces important hormones for regulating normal functioning. When the thyroid gets out of whack, it is really a huge pain in the ass. (There are many different potential causes of thyroid dysfunction, which I will not go into here because it’s not my area of specialty.) Basically, you can have an overactive thyroid, which is called hyperthyroidism, or an underactive thyroid, which is called hypothyroidism. I said the thyroid is a pain in the ass because the symptoms of hyperthyroidism basically look very similar to anxiety and the symptoms of hypothyroidism look very similar to depression. Some of the common symptoms of an underactive thyroid are fatigue, poor concentration, and weight gain with poor appetite. Going back to the diagnostic symptoms of depression, I’m sure you can see how this might get confusing. Luckily, thyroid issues are pretty easy to diagnose. I know that I sound like a broken record, but let’s again utilize our medical doctors for this. Typically if you have questions about your thyroid function, your doc will send you to an endocrinologist who specializes in looking at hormonal functioning in the body. If there is an issue there, they will be able to identify it and suggest possible treatments to help out. In my personal experience, I have had therapy patients resolve most of their depressive symptoms after going on medication to regulate their thyroid functioning. Just like every other physical source of depressive symptoms I mention in this chapter, thyroid issues will not be the golden ticket for everyone. Getting some synthetic thyroid hormone medication will not help you manage your depression if your thyroid is actually functioning normally in the first place. So get a medical workup and continue the diagnostic process of ruling these things out.
Aside from thyroid dysfunction, there are quite a few other disorders that can cause symptoms of depression. Problems with blood sugar, such as diabetes, can have an effect on energy level, motivation, irritability, and all of that good stuff. There are also autoimmune diseases such as Grave’s disease, anemia, lupus (insert House M.D. joke), Celiac disease, and Crohn’s disease, which can contribute to your depressive symptoms. There seems to be some link (that we are still figuring out) between the chronic inflammation that is common in autoimmune disorders and depression, so if you got the short end of the stick with one of these disorders, that is another place to look for the root of your depressive symptomology.
When I was in grade school and we learned all about drugs, I remember them basically being characterized as uppers or downers. Cocaine, meth, and things like that are uppers because they excite your nervous system and get you raging hard. Heroine, benzos, weed, and alcohol are downers because they slow down your central nervous system and get you super chilled. Another name for downers are depressants, because they depress the arousal and stimulation levels within your nervous system. So, if you are regularly deciding to ingest depressants and then get surprised that you are feeling depressed … you’re gonna have a bad time. Seriously though, people often neglect to recognize the impact of the things that you ingest on your mood and physiology.
If you have rampant anxiety, it’s probably a good idea to lay off the coffee. If you are a depressed person, you should probably be careful with the booze. Think of it like a threshold similar to water’s temperature. With water, you reach a certain threshold temperature and you start to boil - that is kind of like anxiety, where you get more and more worked up until you feel downright anxious or even have a panic attack. On the flip side, you also have the freezing point of water, where once you dip below that point things start getting slower and slower until they freeze entirely. That’s like depression. Once you dip below that threshold, you start to feel legitimate depressive symptoms like lethargy, painful feelings of sadness, and a sense of being hopeless. By putting depressants like alcohol into your body, you are basically starting yourself off a few steps closer to that threshold. That means it only takes one or two shitty things to set you off on the path of feeling really lousy and depressed. While you may still be susceptible to depression without the alcohol, you would at least have a little more of a buffer before reaching that threshold. Does this mean that you can’t ever have some alcohol? Of course not. It’s just something to keep in mind. Sometimes having a beer with a friend and talking about life can be really helpful for your mood. Other times, when you have a few drinks, you are basically setting yourself up to feel sad by giving your depression a kickstart.
Know thyself and don’t be stubborn. I know that drugs are fun … that’s the whole point. Just don’t pretend that it doesn’t make a difference. It’s something that personally pisses me off when people with anxiety are like, “Oh, caffeine doesn’t do anything to me. I can drink an espresso and go straight to sleep!” Or when people with depression are like, “Man, I can put down a 6 pack and not feel a thing. That’s definitely not what’s making me feel lazy. I’ve written a whole paper after drinking before!” Gahh! Sorry for getting a little aggro, but it drives me crazy. It’s not like a willpower sort of thing. These substances were designed to directly have an effect on your nervous system. That’s their whole point. You’re lying to yourself if you say that they don’t make a difference. Sure, you can have a tolerance. Bodies are great at habituating to things, but that doesn’t mean the substance suddenly becomes inactive. Again, I’m not saying don’t drink or whatever it is you kids do these days. Shit, I’m sipping a beautiful glass of Basil Hayden’s as I write this. Just like my advice in pretty much every other chapter in this book. Be realistic.
I listen to a lot of podcasts as a means to feed my hungry multitasking brain. As I’m writing this chapter, some words that I heard from Joe Rogan (yes the comedian that commentates the UFC fights) keep popping into my head. He said, “The people that I know who have the hardest time emotionally are people that don’t work out. And the people that I know that do work out, especially the ones that work out hard, they expel these big giant bursts of energy where your body is like almost dying, you’re heaving, your heart is pounding in your chest, you’re barely able to lift this piece of metal up again, you’re barely able to jump up on this box again, and by putting yourself in that intense form of stress, it makes regular life more peaceful.” Now Joe is on the extreme side of this camp. I’m certainly not practicing what he preaches every day. I do exercise, but I’m not pushing myself to vomit peak every day. Though I can say that the times when I have pushed myself that hard have indeed brought about some very special mental clarity.
The point that I want to make here is that exercise is vitally important when it comes to regulating your mood. It’s almost as important as it is for losing weight. If you’re overweight, the first thing that will be suggested is to start exercising more than you do now. Really, the same thing can go for depression. It’s not that running or lifting weights is going to change the deep down structure of your thoughts and how you interpret the world, but it absolutely will change the way that your emotions hit you. If something negative happens and you are working from a physically lethargic, sedentary baseline, it’s going to feel like an emotional kick in the balls, and your day and/or week will be ruined. If you are taking good care of your body by pushing yourself to exercise regularly, it seems to be that you can build up a bit of a buffer so the same negative event doesn’t hit you as hard, and you are still able to do the things that you want to accomplish. I know this is probably not news for you, but I really want you to take a moment to recognize how awesome this is. There are so many things in depression that are confusing, and it’s so hard to figure out what you could possibly do to make change. It can feel like almost everything is out of your control. This is one thing that you have direct influence over. You
can actually do something that is scientifically proven to have a direct effect on your mood. How badass is that?
Of course, with depression it is not as simple as flipping the switch and turning into a fitness god. The good thing is that you don’t have to. Motivation is definitely at play here. It is MEGA hard to go from feeling like a useless lump to getting off your ass and moving your body a bit. I won’t retread all the things I mentioned in the motivation chapter, but I want to talk about a few things you can do to overcome any roadblocks that stand in the way of your exercising.
First off, you don’t need to start huge. The idea of exercising can be quite imposing, but it doesn’t have to be. It’s not a competition, and no one else gives a shit what you are doing for exercise. Just start at a place that makes sense for you. Maybe that means that you are taking a nice long walk while you listen to your favorite podcasts, albums, or audiobooks a few times per week. Maybe you have a gym membership you can finally put to use. Even if you go to the gym 3 times per week for just 30 minutes, you are still going to have a positive impact on your mental and physical health. I know it feels like people are judging you for not diving in headfirst and going hard on the bench press, screaming with all of your might while you crank out an Olympic feat of strength. They aren’t. Instead of focusing on the end goal, just focus on doing more than you are now.
If there is any way to integrate some pleasure and reward from the exercise, that will help even more! For instance, some people might hate the idea of going for a run around the neighborhood with every fiber of their being. Maybe something like dancing would be less boring. Instead of forcing yourself to run aimlessly around town, try going to a Zumba class and shaking your ass off to the beat of some fun-thumping music. You can likely go to a free beginner’s class at any number of gyms, fitness centers, or dance studios around you.
Maybe you’re not the dancing type? How about an opportunity to beat the crap out of something and get praised for it? There has probably never been a better time to get into martial arts. With the rise in popularity of mixed martial arts, there are more opportunities than ever to try it out. Again, you can try out a sample class at any number of places around you. MMA was my exercise of choice all throughout college.
Each gym certainly has its own personality. Some places you go are full of douchebag meatheads, but other places have a bunch of lovely people like yourself, just trying to get out there and do something vigorous with their bodies. That’s the good thing about free samples; you can try it before you buy it. Group classes like these are great because you can totally lose track of time as you pick up on the excitement and motivation of your fellow ass kickers/shakers. There are any number of cool classes or activities out there. You can hike, kayak, play soccer, pick up free running, hula hoop, soul cycle, or whatever the hell gets you excited. The point is that if you are able to get excited and actually enjoy the activities that you engage in, you are going to train yourself to enjoy being more active in general. Get out there and have some fun, damn it!
Sometimes, we actually have legitimate excuses for not exercising. Physical disabilities, illnesses, and all of that other fun stuff can really limit your ability to do all of those things that I talked about before. While that definitely sucks, there are things you can do about it. If you have physical limitations like arthritis, asthma, etc. that inhibit your ability to participate in high impact activities, you might have a look at swimming or underwater exercise. It’s not just for old people (though it’s GREAT for old people). While it is low impact, swimming is still a great source of cardiovascular exercise, which makes it a perfect candidate for improving your mood. If you are thinking about attending a fitness class and are afraid that it might be too intense for you, simply take a minute to talk to the instructor before the class starts. They will let you know the best ways that you can participate in the class given your limitations and will mostly likely be super excited to have the challenge of trying to adapt the class to fit all different ability and activity levels. Have you ever seen wheelchair basketball or wheelchair Zumba? It’s freakin’ awesome. There is almost always a way for you to get out there and spike your heart rate a few times per week while having fun with it. If you need to do it a different way, that is okay. Don’t be afraid to ask for help or options. They are out there. And remember… no one gives a shit about what you are doing because they are just trying to focus on not keeling over and dying themselves.
The final thing that I want to mention about exercise is it’s a great way to meet new people and maybe even make friends. The topic of making friends as an adult is something that has come up many times with patients of mine. How the hell are you supposed to just go and make friends when you don’t have school or something like that to make the process automatic? Well, exercise classes are a great place to do that when you don’t want to find people at work or at the bar. There are so many good things about this. Not only are friends great because they are extending your personal network of support and allies, but these people that you will likely run into at these sorts of activities are probably going to be interested in bettering themselves as well. That means you’re on the same quest and can help one another to be more motivated to follow through with your goals. The buddy system works!
Of course no chapter on physical contributors to depression would be complete without addressing diet a little bit. I am not a dietician. Therefore, I am not going to pretend like I know the exact diet that you should be following. It is important that you are eating well, though.
As you know, it doesn’t take much to throw you off your game when you are depressed. Anything that we can do to minimize your chances of feeling like shit is a good thing. That means that you want to make sure that your diet is providing you with enough readily available energy to take action when you are able to capture some elusive motivation. Inadequate nutrition can also contribute to feelings of lethargy and fatigue. If these are issues for you, check in with your doctor. You will want to make sure that allergies or sensitivities are not keeping your body in a constant state of drain. In my opinion, you don’t need to jump the gun and dive into paleo or some other bullshit fad diet. Just try to become more aware of the ways in which your dietary choices impact your physical and emotional state.
If you are quite overweight, you don’t need me to tell you that losing some weight can help. Gaining weight can be a symptom and a contributor to depression. By that I mean you can put on weight due to your feelings of sadness and gaining weight can also make those feelings of sadness worse. It’s probably an all-around good idea to shed some of that gained weight. Along with exercise, the right diet can really help out with that. If you have the means to do so, go see a dietician and have them do the hard work for you. They can analyze your current eating behaviors and suggest some changes that may have a significant impact on your mood and energy level.
Sleep is the last thing that I want to talk about in this chapter. Sleep is an interesting one because, much like weight gain, it can be both a symptom and a cause. Hypersomnia (sleeping too much) or insomnia (trouble falling asleep) are both symptoms of a major depressive episode. Not getting enough sleep can also be something that throws your body off and causes you to feel out of sorts. It can sometimes be disruptive enough of your mood on its own that you start to feel depressed from not sleeping well. As with everything else, I will encourage you to check in with your doctor if you are having consistent issues with sleep. They might make you do some tests to make sure there isn’t something like sleep apnea or some other sleeping disorder going on that’s to blame for your poor sleep. Beyond that, there are a few tips I can share for helping you to be a better sleeper, which can in turn help regulate your mood and get you to wake up on the right side of the bed every once in a while.
The practices and habits that help to promote good sleep are collectively referred to as sleep hygiene. There are a few sleep hygiene basics that you should probably have in your back pocket. Hopefull
y I’ve gotten across already that your brain is pretty powerful. It has this amazing ability to learn new things and make associations that can sometimes help us and sometimes hinder us. Take a moment to think of the things that you do in bed. Ideally there are only two things that you should be doing in bed. One of them is sleeping. What else do you do? Do you find yourself using your laptop in bed to complete work? Check your email? Do you watch your favorite shows in bed? Each of these things could potentially be wrecking your sleep. It comes down to association.
You ever hear the story of Pavlov’s dogs? Basically, this dude wanted to mess with some dogs, so he started ringing a bell every time he presented them with delicious food. Over time, he noticed that the dogs would salivate at the sound of the bell even when there wasn’t actually food present. It’s the same reason that your pets come running like a bat out of hell when you open up a bag of chips for yourself. They think that it is a treat for them. They made the association between the sound of crinkling and the receiving of delicious treats. So when you continually pair the location of your bed with the process of doing work, or the entertainment of watching television, you weaken the association that your brain has between bed and sleep. Also GET YOUR DAMN PHONE OUT OF THE BEDROOM. If your tiny little bright white screen is the last thing that you look at before you go to sleep and the first thing that you look at when you wake up… you’re doing it wrong. They still make alarm clocks that are only meant to serve as alarm clocks… I suggest you use that instead.
