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Now a 26-year-old college student working on earning her master’s degree in social work, Emily remembers her parents commenting constantly on her “moodiness” as a teenager. Emily began experiencing extreme mood swings around the time she entered high school. One week she would feel euphoric and invincible. The next week she would feel so depressed she could barely get out of bed. Sometimes her parents would joke about how she was such a “typical moody teenager.” Other times, they would tell her to stop behaving like a “brat.”
Emily’s wildly fluctuating moods worsened during her senior year in high school. During one of her “down” phases, Emily tried to commit suicide by taking a whole bottle of ibuprofen. After getting her stomach pumped at the hospital, Emily talked to a mental health counselor who diagnosed her with depression.
A doctor prescribed an antidepressant for Emily’s depression. Privately, the doctor (her family’s primary care physician) told Emily’s parents that once she graduated high school and entered college, her mood swings would disappear. The doctor also suggested Emily consider taking birth control pills to help balance her hormones.
The combination of antidepressants and birth control pills did nothing to treat Emily’s mood swings. Her “up” moods only intensified. As a freshman in college, she applied for dozens of credit cards and quickly maxed them out. She developed a reputation for jumping from one boyfriend to another, claiming they always “dumped” her because they were envious of her “spectacular ideas.” She stopped taking antidepressants. Her grades suffered so much that she lost her financial aid grant.
Emily’s parents contacted the police when they didn’t hear from her for a couple of weeks. Soon after reporting Emily missing, her parents received a call from the police saying Emily had been found standing on a street corner during a snowstorm. She had been wearing only shorts and a tank top and was shouting to passersby that she had been told by the President of the United States they should prepare for a coming “invasion” of extraterrestrials who want to “control our thoughts.”
Emily was taken to the psychiatric ward of the local hospital. After talking to her parents and gathering information about her past, a psychiatrist diagnosed Emily with bipolar disorder.
How Common is a Depression Misdiagnosis?
The Diagnostic and Statistical Manual for Mental Disorders (DSM-V) lists criteria that must be met before diagnosing clinical depression. Criteria must also include the person experiencing at least five of these symptoms for at least two consecutive weeks:
- Eating more or less than usual–gaining a lot of weight or losing weight (>5%body weight) in a short time frame
- Insomnia or sleeping too much, sometimes 16 hours at a time
- Lack of energy, always feeling too tired to do anything
- Frequent stomachaches, digestive complaints
- Any physical symptom that has no physical basis or does not respond to usual treatments
- Extreme disinterest in things that were once enjoyable
- Self-isolation
- Memory difficulties and the inability to make simple decisions
- Neglecting personal hygiene, especially when a person was once particular about their appearance
- Thinking of suicide with an emphasis on how family and friends would react if the suicide was completed
- Crying for seemingly no reason other than a feeling of emptiness, sadness, and meaninglessness
- Feeling guilty, anxious, nervous, or panicky for no reason
Unfortunately, Emily’s primary care physician was not qualified to provide a psychiatric diagnosis. In fact, misdiagnosis of depression is a leading cause of mental health crises. One study found that out of every 100 people diagnosed with depression by their physician, only about four actually had depression following re-evaluation by a psychiatrist.
Why is Depression Misdiagnosed So Frequently?
Emily was misdiagnosed because her doctor was not a mental health professional. Although primary care physicians have rudimentary knowledge of mental illnesses and can prescribe medications, they should never be relied on for a definitive diagnosis of depression.
Depression is one of many symptoms seen in more complex mental illnesses. Attention-deficit hyperactivity disorder (ADHD) can easily be misdiagnosed as depression because of symptom overlap. Like individuals with depression, teenagers and young adults with ADHD have difficulty concentrating and remembering, experience overwhelming fatigue and apathy, and report feeling worthless and guilty for no particular reason.
People with schizoaffective disorder, bipolar disorder, and PTSD have symptoms of depression that can often be missed by primary care physicians. Unless the person is actively hallucinating or having delusions that they verbalize, a physician could misdiagnose a more serious mental illness for depression.
Medical Conditions that Mimic Depression
Hypothyroidism
When the thyroid gland does not produce enough triiodothyronine and thyroxine (hormones made only by the thyroid gland), symptoms of hypothyroidism may emerge. Resembling classic signs of depression, hypothyroidism causes a person to feel weak and tired all the time, have problems thinking clearly, and lack motivation to do anything except stay in bed. Although someone with hypothyroidism may feel depressed, the cause of their “depression” is not psychological but physical. Antidepressants will not treat hypothyroidism.
Fibromyalgia
Thought to be a systemic inflammation of the nervous system, fibromyalgia symptoms include fatigue, appetite loss, headache, body pain, and brain fog. While antidepressants seem to help some people with fibromyalgia feel better, treatment programs for fibromyalgia involve more than just taking one medication.
Problems with Misdiagnosed Depression
Whether a person is misdiagnosed with depression and actually suffers from a purely physical disease or that person has depression but is misdiagnosed with a non-psychological disorder, the misdiagnosis could have long-term, detrimental effects.
Being prescribed incorrect medication is perhaps the worst consequence of misdiagnosed depression. People with hypothyroidism who receive antidepressants instead of thyroid hormone replacement drugs could eventually experience life-threatening symptoms. Alternately, people with depression who are misdiagnosed with hypothyroidism and are prescribed hormone replacement medications may suffer a psychiatric crisis and need hospitalization due to suicidal thoughts.
Should You Get a Second Opinion to Avoid Misdiagnosed Depression?
To accurately diagnose persistent depressive disorder, primary care physicians should order a series of tests before referring someone to a psychologist or psychiatrist for a final diagnosis. Physical examinations to rule out medical causes of depression involve assessments of the endocrine and neurological systems. In addition to blood tests for detecting thyroid disease, Cushing’s disease and nutritional deficiencies, doctors should also take a deep dive into a person’s medical history. Past head traumas, “silent” strokes, or severe anemia can cause symptoms of depression. In addition, Prednisone and other corticosteroid medications are known to cause depression-like symptoms such as fatigue, mood swings, body aches, and weakness.
Learn More About a Diagnosis of Depression
FHE provides mental health rehab programs to treat depression, anxiety disorders, schizophrenia, and other mental illnesses. If you have been diagnosed with depression, know that we are here to help you get the professional treatment you need. Call today to talk to a caring staff member about getting real relief for symptoms of depression.
