by Ginny Graves, Vogue
Prozac (Paxil, Wellbutrin, Celexa, Effexor) Nation, take note: Some doctors now warn that our national epidemic of lackluster mood-10 percent of women in their 20s and 30s and 23 percent in midlife take antidepressants-may be driven partly by an underrecognized and somewhat controversial health issue: subclinical hypothyroidism, a less intense version of full-blown low thyroid that can cause depression-like symptoms.
When researchers from Boston University recently reviewed the literature on low-grade thyroid problems and mood, they found that treating the condition, which affects about 8 percent of women overall (and as many as 15 percent of older women), revived those who were downcast, possibly because thyroid hormone affects parts of the brain that help regulate mood.
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Psych meds are undoubtedly helpful for those who are truly depressed. "But you certainly don't want to take them when you actually have a hormonal problem," says Russell Joffe, M.D., a psychiatrist and lead author of the study. For one thing, the medication probably won't work; in addition, antidepressants can have side effects, like weight gain, reduced sex drive, and insomnia.
As important, overlooking a thyroid issue has hazards of its own, particularly in women who are trying to get pregnant. A sluggish thyroid function has been linked to higher rates of infertility, miscarriage, and preterm delivery, as well as developmental problems in children born to moms with the condition.
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Thankfully, the deficiency of thyroid hormone is easily treated with synthetic hormones. And the benefits, doctors say, can be quick and dramatic. To detect a thyroid problem, doctors test your level of thyroid-stimulating hormone (best to have it tested on multiple occasions because levels can fluctuate). High levels are suspect. But the line between normal TSH levels and abnormal is unclear at best, contentious at worst. "Many of us are starting to believe that what's 'normal' may be highly individual," says Joffe. "Some women with elevated TSH levels may have symptoms, while others may be just fine." As a result, whether you get treated or not can depend as much on your doctor's point of view as on your TSH levels and symptoms.
A growing chorus of M.D.s, however, is trying to provide some clarity and pushing for more widespread testing and treatment. They believe that any woman who is thinking about getting pregnant should have her TSH tested, since symptoms of a languid thyroid can be subtle and pregnancy can mask them. Weight gain, fatigue, intolerance to cold, poor memory, dry skin, and brittle nails and hair all can be caused by a slowing thyroid. High cholesterol is another red flag because low thyroid function may put you at increased risk of lipid problems and heart disease. In addition, some doctors say, anyone with mood issues who's considering antidepressants, or who's already taking mood meds that don't seem to be working, should ask for a thyroid test.
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If your numbers are in the subclinical range (see chart, above), ask your doctor about a trial of thyroid hormone. The medication is far more benign than antidepressants, says Thomas Geracioti, M.D., a professor of psychiatry at the University of Cincinnati College of Medicine. "There's a lot to gain and almost nothing to lose."
by Ginny Graves, Vogue