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Ask the Mental Health Expert Archives 2001-2004

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Symptoms of Depression

Q. I suffer from depression, and I know that a lack of appetite is a symptom of it. But there have been times when I have had a total lack of appetite and hardly ever eat breakfast or lunch. My husband makes me eat if he's around. Even if I am physically hungry, I just don't feel like eating. I usually skip breakfast and lunch. I might snack on some pretzels, since they are low-fat. I do have a problem with my weight. I am about thirty pounds overweight but I'm not obsessed with it. It bothers me just a little. So is it just from the depression? Or something more?

A. I can't tell you what is causing your lack of appetite, since that would require a complete medical and psychiatric evaluation--which, if you haven't already obtained these, I would strongly advise. The first question is, could there be a medical problem that could account for such profound loss of appetite, in the presence of excessive weight? One candidate might be hypothyroidism (low thyroid function). Other common symptoms of hypothyroidism include decreased energy, constipation, dry/coarse skin, intolerance of the cold, and hoarseness.

In some cases, hypothyroidism may cause--or be accompanied by--clinically significant depression. It is sometimes hard to tease out what's doing what. But individuals who are depressed because of low thyroid function usually don't improve until their thyroid balance has been restored. On the other hand, all the symptoms you describe are fully consistent with major depression.

If you are not currently seeing a psychiatrist for this, I would strongly consider doing so, perhaps in consultation with your primary care doctor. If you are seeing a psychiatrist--or being treated by your PCP--it is possible that your depression has not been fully or adequately treated, and that a consultative second opinion may be useful. Getting your thyroid checked is obviously also important.

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September 2001

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