Treatment-resistant depression. ADHD. Generalized anxiety disorder. Memory lapses. Mood disorder. What do all of these mental health problems have in common?
Despite being very different, all of these issues can have biological contributing factors and sometimes, even biological causes. This is why mental health should not be treated in isolation, this means that the body and lifestyle habits can have an immense impact on mental well-being. Mental health treatments can fail when the root issue of a problem isn’t addressed. In real life, you cannot cure the mental effects of a biological thyroid or respiratory issue with talk therapy. Psychiatric overshadowing occurs where physical causes are overlooked because a psychiatric label has been applied. In short, biological or physical roots can be ignored in caring for people with a psychiatric diagnosis. Some clinicians call these “medical mimics.” As humans, our bodies and brains are remarkably complex, and the body and brain exist in constant cross talk. The body and brain affect one another in many ways that are still being explored. Physical illnesses can regularly resemble mental health conditions. Responsible mental-wellness treatment requires ruling out any underlying biological factors before committing to purely psychiatric diagnosis.
The Body’s Messengers
The endocrine system, a complex network of glands and organs throughout the body, secretes hormones directly into the bloodstream to coordinate critical body functions like metabolism, growth, sleep, and reproduction. This intricate system directly influences mental health because endocrinal chemical messengers cross the blood-brain barrier and regulate the messengers that are used within the nervous system, called neurotransmitters, alter brain structure, and regulate emotional resilience. When the glands release too much or too little of these chemical signals, the resulting imbalance frequently shows up as psychiatric symptoms.
This is especially true of the thyroid, a small, butterfly-shaped gland located at the lower front part of the neck. Low thyroid hormone levels (hypothyroidism) slow the activity of the central nervous system, causing lethargy, weight gain, and low mood. Hypothyroidism can look very similar to depression, but it has a completely different cause and requires a different treatment response. Excess thyroid hormone (hyperthyroidism) can produce an elevated heart rate, tremors, and stress responses that mirror generalized anxiety or panic disorder.
Some clues to consider to help differentiate between mental and physical root causes can include:
- Unexplained weight changes
- Temperature intolerance
- Thinning hair
- Changes in heart rated
If any of these symptoms exist alongside signs of depression or anxiety, mental health providers should consider whether physical, hormonal factors might be to blame.
The Sleep Bandit
Consider an adult who is struggling at work, unable to focus, constantly fatigued, and feeling emotionally flat. A strictly psychological diagnosis would likely include adult ADHD and persistent depressive disorder, diagnoses that are usually treated with prescription medication and talk therapy. But it’s also possible that these symptoms could be the result of obstructive sleep apnea (OSA).
In OSA, the muscles in the back of the throat temporarily relax and collapse during sleep, physically blocking the upper airway. These repetitive intervals without oxygen stress the body and the brain, even when someone isn’t aware that it’s happening. This interrupted sleep pattern can lead to executive dysfunction, difficulty concentrating, and restlessness—symptoms that sound a lot like ADHD. However, ADHD and OSA require vastly different treatment plans, and treating someone with sleep apnea for ADHD isn’t going to solve their problem. Overlapping symptoms, like those in ADHD and OSD, are one of the reasons that finding a well-trained and qualified mental health professional is so vital for the journey to true mental health. Psychiatrists are medical doctors with specialization in mental health. Dr. Marie Bosch’s extensive training and practice supports her skill and expertise. She understands the roots of both of these issues, allowing her to provide an accurate diagnosis and an effective treatment plan.
Nutrition Matters
Nutritional deficiencies can also cause cognitive disturbances. Many times, mental health symptoms of nutrient deficiencies will manifest before the physical symptoms do.
Vitamin B12, for example, is necessary for the manufacture of dopamine, serotonin, and norepinephrine. These neurotransmitters are vital for many foundational brain processes including executive functioning, emotional stability, and stress responses. Without enough vitamin B12 in the body, people can experience severe memory lapses, irritability, and depressive episodes. Despite the symptoms being psychological, the cause of the problem is biological—and it’s easily treatable. For deficiencies like this, simple nutritional replacement can restore cognitive clarity without a need for long-term psychotropic medication.
Other B vitamins, vitamin D, iron, and folate also contribute to important brain processes. When these nutrients are lacking, mental health symptoms may include delusions, hallucinations, depression, and other profound disturbances. Clearly, nutritional causes must be considered when evaluating psychological issues.
What Should You Do?
When you’re struggling with mental health, it can be incredibly difficult to figure out the best path forward. Psychiatrists Matcheri Keshaven and Yoshio Kaneko suggest asking these questions to explore what factors might be contributing to your mental health struggles:
- Is the psychiatric symptom(s) showing up in an unusual manner?
- Is a medical condition or substance use related to the mental health problem in time?
- Are the psychiatric symptoms better explained by a psychiatric disorder?
- Is the mental health problem a direct consequence of a medical illness or substance use?
The truth is that symptoms are signals, not final diagnoses. Not all providers (or internet searches) can address the true root issues of mental health. If you feel stuck in your mental health journey, Dr. Bosch has the training, compassion, and experience to find the root cause of your symptoms and provide a path toward genuine healing.
Sources:
Bathla, M., Singh, M., & Relan, P. (2016). Prevalence of anxiety and depressive symptoms among patients with hypothyroidism. Indian Journal of Endocrinology and Metabolism, 20(4), 468–474. https://doi.org/10.4103/2230-8210.183476 Cited by: 177
Blesch, L., & Breese McCoy, S. J. (2013). Obstructive Sleep Apnea Mimics Attention Deficit Disorder. Journal of Attention Disorders, 20(1), 41–42. https://doi.org/10.1177/1087054713479664 Cited by: 23
11 Keshavan MS, Kaneko Y. Secondary psychoses: an update. World Psychiatry. 2013;12(1):4-15. DOI: 10.1002/wps.20001. PubMed PMID: 23471787.
McKee, J., & Brahm, N. (2016). Medical mimics: Differential diagnostic considerations for psychiatric symptoms. Mental Health Clinician, 6(6), 289–296. https://doi.org/10.9740/mhc.2016.11.289 Cited by: 45
Welch, K. A., & Carson, A. J. (2018). When psychiatric symptoms reflect medical conditions. Clinical Medicine, 18(1), 80–87. https://doi.org/10.7861/clinmedicine.18-1-80 Cited by: 28
