Depression, Thyroid, & Menopause
As an endocrinologist and psychiatrist, I have over 30 years of experience diagnosing and treating many disorders including depression, anxiety, thyroid and adrenal disorders, menopausal and perimenopausal depression, osteoporosis and nutritional imbalances. Psychoneuroendocrinology, also more commonly known as endocrine psychiatry, is the clinical study of hormone fluctuations and their relationship to human behavior and psychiatric illness. This blend of psychiatry and endocrinology gives me a unique insight in the treatment of a variety of disorders. If you are in California and would like a consultation or further information you may contact me. (Due to license laws, I can't consult with out-of-state patients unless they come into California.) My practice is currently located in Northern California, Sonoma County, in Santa Rosa.
What Patients Can Expect
The initial hour of a patient's first session is designated for a complete evaluation of current and past issues as well as reviewing recent laboratory tests and radiological studies. The focus will be on signs and symptoms that relate to the neuroendocrine system. The first session often leads to recommendations for additional neuroendocrine laboratory studies to further evaluate the patient's symptomatology. This is often followed by a second session to initiate discussions and suggestions for treatment using all available modalities.
Thyroid Disorders Sometimes Underlie Other Conditions
Dysfunctions in the thyroid can have a major effect on a person's wellbeing even with a mild or subclinical disorder. Both subclinical hypothyroidism and subclinical hyperthyroidism may not really be "subclinical" in the sense that the effects on the person's health may be profound. A proper endocrine evaluation will assist in determining a possible treatment for an underlying endocrine dysfunction. Consider the following examples:
A woman presents with severe premenstrual symptoms and a thorough evaluation reveals that her problem is related to a thyroid deficiency (or hypothyroidism). Treatment of the hypothyroidism often leads to elimination of the premenstrual symptoms.
A man presents with coronary artery disease and after a thorough evaluation it is revealed that he also has a thyroid deficiency (or hypothyroidism). Treatment of the thyroid deficiency will often normalize his cholesterol and ameliorate his heart disease.
A young woman presents with depression and a thorough evaluation reveals that she has a subclinical or mildly under active thyroid (or hypothyroidism). Treatment of the thyroid disorder often improves her mood.
An older woman presents with atrial fibrillation, an abnormal heart rhythm that can lead to a stroke. Her underlying condition is found to be a subclinical or mildly overactive thyroid (or hyperthyroidism). Treatment of the thyroid excess often leads to normalization of her heart rhythm.
These examples illustrate how the thyroid can affect other organ systems and have a major effect on a person’s wellbeing even with a mild disorder of the thyroid. Therefore, both subclinical hypothyroidism and hyperthyroidism may not be really be “subclinical” in the sense that the effects on the person’s health may be profound. A proper thyroid evaluation will assist in determining a possible underlying endocrine cause of a dysfunction, which, would be treatable.
Clinical Relevance
Many patients, whether medical patients or psychiatric patients, feel they are receiving suboptimal care and feel their hormones are somehow playing a role in their illness, and yet this is commonly ignored in their treatment.
Patients often sense that they have a chemical imbalance. Appropriate endocrine testing can rule out subtle endocrine influences that may play a role in their illness. The mind/body dichotomy is never more apparent than in dealing with illness effecting the brain. Obviously, so called physical illness coexists with psychological illness so frequently that it is the rule rather than the exception. When one has a heart attack it may be initiated by neuroendocrine changes triggered by psychological events originating in our brains and propagated to end organs, including the heart. It is virtually never mind OR body; it almost always is a mind/body event. So ignoring the psychological elements of illness sometimes leads to inadequate medical care. My goal is to integrate the mind/body in a comprehensive approach to the patient's care. Therefore, during an interview we may switch from psychological to physical in a split second with no thought to that shift. After all, our mind/body knows of no such split...read more
