User:7mike5000/Depression (differential diagnoses)

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Neuroimaging can be helpful in finding a medical reason for a person's depression.[1]

Depression - is one of the most common of mental health[2][3] and every year the number of new cases in the whole world gets learger..[4][5]In the United States alone depression 17.6 million Americans have depression each year that means 1 out of every 6 people has depression.

Depressed people have more of a chance of getting other disorders and diseases like, Type 2 diabetes, heart disease and they have a higher risk of dying by suicide. Soon depression is expected to be the second leading cause of disability worldwide and the number 1 cause in rich nations, like the United States and Canada.

There are other mental and medical problems that may copy some or all of the symptoms of depression, or a person can have depression and another mental or medical problem which can make it worse.[6][7][8] A medical or mental problem that has the same kind of symptoms as another disorder, and may be the the real problem is called a differential diagnosis.[9]

Many people are told what mental problem they have (diagnosis) by therapists or others with little or no medical training.[10]they say a person has a mental illness like depression without trying to find out what may be casuing it. [11][12][13][14][15][16] Many mental health care workers do not know about the medical illnesses that can cause symptoms of a mental problem.[17]

When a person does not get the right diagnosis of what is causing their depression it can make them much more sick.[18][19]At least 10% of all symptoms of a mental problem may actually be because of a medical problem,[20] and as many as 50% of people diagnosed with a mental illness have a medical problem that the doctors don't know about, which is causing the symptoms or which are making them worse [21][22]

Autoimmune disorders[change | change source]

  • Celiac disease; is when the body is can not handle gluten which is found in foods like, wheat, rye and barley. It can cause mental problems even without causing physical ones.[23]
  • Lupus: Systemic lupus erythematosus (SLE), is a disease that lasts a long time (chronic) that can affect any part of the body.[24]and it can cause or worsen depression.[25]

Bacterial-viral-parasitic infection[change | change source]

MRI brain scan: Neurocysticercosis
  • Lyme disease; is an infection caused by a bacteria. People become infected when they are bitten by a deer tick. Lyme disease can mimic (act like) many other different medical and mental illnesses.[26][27] Lyme disease can be very difficult to diagnose.[28]but it can be treated with antibiotics. If it is not treated in time it can cause severe damage to the brain.[29]
  • Syphilis; is a sexually transmitted disease (STD) if it is not treated in time it can get worse and become neurosyphilis which can harm the brain. Sometimes the only symptoms of syphilis are symptoms that look like they are caused by a mental illness.[30]
  • Neurocysticercosis (NCC): is an infection of the brain or spinal cord caused by the larval stage of the pork tapeworm, Taenia solium. NCC is the most common parasitic worm infestation of the central nervous system worldwide. Humans get cysticercosis when they eat eggs of the pork tapeworm. This can happen when they come into contact with contaminated fecal matter and do not wash their hands well enough, or if they eat food that was contaminated eat undercooked pork.[31] "While cysticercosis is common in Latin America, alot of cases are starting to appear in the United States."[32] "The rate of depression in those with neurocysticercosis is higher than in the general population."[33]
  • Toxoplasmosis; is an infection caused by Toxoplasma gondii a small one-celled animal called a protozoan which is a parasite. Humans can be infected by eating with contaminated hands, or a fetus can become infected while inside the mother's womb if the mother is infected. The main way that humans are infected is contact with the feces of the host species, the domesticated cat, which can happen when cleaning the litter box.[34] Toxoplasma gondii infects about 30% of the world's human population, but most people do not have any major symptoms. Just being exposed to Toxoplasma gondii (seropositivity) without getting the disease Toxoplasmosis can change a person's behavior and can cause depression in some people.[35][36]and causes an increased rate of suicide.[37]
  • West Nile virus (WNV); which can cause encephalitis can also cause depression. People can get WNV by being bitten with an infected mosquito.[38][39]In the United States, WNV infection causes many cases of neurological disease.[40]

Blood disorders[change | change source]

  • Anemia: is a decrease in normal number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood which can be caused by a person not getting enough Vitamin B12.[41]Anemia can cause depression.[42]

Chronic fatigue syndrome[change | change source]

Millions of people are believed to have Chronic Fatigue Syndrome (CFS), but only 50% have gone to a doctor to treat the symptoms of CFS. People who have CFS symptoms also often have an undiagnosed medical or mental disorder such as diabetes, thyroid disease or substance abuse. Early diagnosis and treatment can help cure the symptoms.[43] CFS is often misdiagnosed as depression.[44][45]

Dietary disorders[change | change source]

  • "Fructose malabsorption is when the body cannot digest fructose, a type of sugar. This cause a depressed mood. "Fructose malabsorption should be considered in patients with symptoms of major depression...."[46]

Endocrine system disorders[change | change source]

Problems in the endocrine system can cause many symptoms mental illness; problems in the pituitary, adrenal and thyroid glands have been shown in patients with primary depression.[47]


Adrenal gland[change | change source]

Thyroid and parathyroid glands[change | change source]

Location of the thyroid and parathyroid glands in front of the layrnx.

Pituitary tumors[change | change source]

Tumors of the pituitary gland are common, as many as 25% of people have them.[51] Most tumors are considered to be harmless (benign) however even in benign cases, pituitary tumors can affect thinking, behavior and emotions changes.[52][53] Pituitary microadenomas are smaller than 10 mm in diameter and are generally considered benign, yet the presence of a microadenoma has been positively identified as a risk factor for suicide.[54][55]

"... patients with pituitary disease were misdiagnosed (not given the right diagnosis) and treated for depression and they showed little response to the treatment for depression". This is because in this case the depression was not a "mental illness", it was a symptom of a problem in the pituitary gland. [56]

Pancreas[change | change source]

  • Hypoglycemia: is when the body makes too much insulin and this causes the amount of glucose in the blood to less than the body needs. This may cause a depressed mood.[57]

Neurological[change | change source]

In addition to pituitary tumors, tumors in various locations in the central nervous system may cause depressive symptoms and be misdiagnosed as depression.[58][59]

Post concussion syndrome[change | change source]

Post-concussion syndrome (PCS), is a set of symptoms that a person may experience for weeks, months, or occasionally years after a concussion with a prevalence rate of 38–80% in mild traumatic brain injuries, it may also occur in moderate and severe cases of traumatic brain injury.[60] A diagnosis may be made when symptoms resulting from concussion, depending on criteria, last for more than three to six months after the injury, in which case it is termed persistent postconcussive syndrome (PPCS).[61][62][63][64][65] In a study of the prevalence of post concussion syndrome symptoms in patients with depression utilizing the British Columbia Postconcussion Symptom Inventory: "Approximately 9 out of 10 patients with depression met liberal self-report criteria for a postconcussion syndrome and more than 5 out of 10 met conservative criteria for the diagnosis." These self reported rates were significantly higher than those obtained in a scheduled clinical interview. Normal controls have exhibited symptoms of PCS as well as those seeking psychological services. There is considerable debate over the diagnosis of PCS in part because of the medico-legal and thus monetary ramifications of receiving the diagnosis.[66]

Pseudobulbar affect[change | change source]

Diagnostic differences between PBA and depression

Pseudobulbar affect (PBA) is an affective disinhibition syndrome that is largely unrecognized in clinical settings and thus often untreated due to ignorance of the clinical manifestations of the disorder; it may be misdiagnosed as depression.[67] It often occurs secondary to various neurodegenerative diseases such as amyotrophic lateral sclerosis, and also can result from head trauma. PBA is characterized by involuntary and inappropriate outbursts of laughter and/or crying. PBA has a high prevalence rate with estimates of 1.5 - 2 million cases in the United States alone.[68]

Neurotoxicity[change | change source]

Various compounds have been shown to have neurotoxic effects many of which have been implicated as having a causal relationship in the development of depression.

Cigarette smoking[change | change source]

There has been research which suggests a correlation between cigarette smoking and depression. The results of one recent study suggest that smoking cigarettes may have a direct causal effect on the development of depression.[69] There have been various studies done showing a positive link between smoking, suicidal ideation and suicide attempts.[70][71]

In a study conducted among nurses, those smoking between 1-24 cigarettes per day had twice the suicide risk; 25 cigarettes or more, 4 times the suicide risk, than those who had never smoked.[72][73] In a study of 300,000 male U.S. Army soldiers, a definitive link between suicide and smoking was observed with those smoking over a pack a day having twice the suicide rate of non-smokers.[74]

Link Between Smoking Depression and Suicide

"Current daily smoking, but not past smoking, predicted the subsequent occurrence of suicidal thoughts or attempt."[75]

"It would seem unwise, nevertheless, to rule out the possibility that smoking might be among the antecedent factors associated with the development of depression."[76]

"Abstinence from cigarettes for prolonged periods may be associated with a decrease in depressive symptomatology."[77]

"The stress induction model of smoking suggests, however, that smoking causes stress and concomitant negative affect."[78]

Medication[change | change source]

Various medications have been suspected of a having a causal relation in the development of depression; this has been classified as "organic mood syndrome". Some classes of medication such as those used to treat hypertension, have been recognized for decades as having a definitive relationship with the development of depression.[79]

Monitoring of those taking medications which have shown a relationship with depression is often indicated, as well as the necessity of factoring in the use of such medications in the diagnostic process.[80]

  • Topical Tretinoin (Retin-A); derived from Vitamin A and used for various medical conditions such as in topical solutions used to treat acne vulgaris. Although applied externally to the skin, it may enter the bloodstream and cross the blood brain barrier where it may have neurotoxic effects.[81]
  • Interferons; proteins produced by the human body, three types have been identified alpha, beta and gamma. Synthetic versions are utilized in various medications used to treat different medical conditions such as the use of interferon-alpha in cancer treatment and hepatitis C treatment. All three classes of interferons may cause depression and suicidal ideation.[82]

Chronic Exposure to Organophosphates[change | change source]

The neurophsychiatric effects of chronic organophosphate exposure include mood disorders, suicidal thinking and behaviour, cognitive impairment and chronic fatigue.[83]

Neuropsychiatric[change | change source]

Bipolar disorder[change | change source]

  • Bipolar disorder is frequently misdiagnosed as major depression, and is thus treated with antidepressants alone which is not only not efficacious it is often contraindicated as it may exacerbate hypomania, mania, or cycling between moods.[84][85] There is ongoing debate about whether this should be classified as a separate disorder because individuals diagnosed with major depression often experience some hypomanic symptoms, indicating a continuum between the two.[86]

Nutritional deficiencies[change | change source]

Nutrition plays a key role in every facet of maintaining proper physical and psychological wellbeing. Insufficient or inadeqaute nutrition can have a profound effect on mental health. The emerging field of Nutritional Neuroscience explores the various connections between diet, neurological functioning and mental health.

  • Vitamin B6:pyridoxal phosphate (PLP) the active form of B6 is a cofactor in the dopamine serotonin pathway, a deficiency in Vitamin B6 may cause depressive symptoms.[87]
  • Folate (vitamin B9) - [[Vitamin B12|Vitamin BTemplate:Ssub]] cobalamin : Low blood plasma and particularly red cell folate and diminished levels of Vitamin BTemplate:Ssub have been found in patients with depressive disorders. "[W]e suggest that oral doses of both folic acid (800 µg/(mcg) daily) and vitamin B12 (1 mg daily) should be tried to improve treatment outcome in depression."[88][89]

Sleep disorders[change | change source]

  • Insomnia: Not being able fall asleep is often a symptom of depression, it can also be the trigger for getting a depressive disorder.[93][94] It can be transient, acute or chronic. It can be a primary disorder or a co-morbid one.
  • Restless legs syndrome:(RLS), also known as Wittmaack-Ekbom's syndrome, is characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can also affect the arms or torso, and even phantom limbs.[95] Restless Leg syndrome has been associated with Major depressive disorder. "Adjusted odds ratio for diagnosis of major depressive disorder... suggested a strong association between restless legs syndrome and major depressive disorder and/or panic disorder."[96]
  • Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. Each episode, called an apnea, lasts long enough for one or more breaths to be missed; such episodes occur repeatedly throughout the sleep cycle. Undiagnosed sleep apnea may cause or contribute to the severity of depression.[97]
  • Circadian rhythm sleep disorders, of which too few clinicians are aware, often go untreated or are treated inappropriately, as when misdiagnosed as either primary insomnia or as a psychiatric condition.[98]

See also[change | change source]

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