Find The Missing Puzzle Pieces: How Anemia and Hypothyroidism Contributed to My Depression

One thing that gave me hope while dealing with depression was knowing that if I get better, there is a better life waiting for me. Despite my best efforts, I kept cycling between recovery and relapse. Finally, I understood I had to be on medication or therapy or under monitoring forever. I wondered if depression was a psychiatric issue tied to my brain, a biochemical imbalance in my hormones, or a philosophical struggle of the mind. I couldn’t figure out which it was. It turns out it’s a combination of all three.

Accidents aren’t random; they occur when a series of events align perfectly. For a collision to occur, one vehicle must leave at a specific moment, while another departs from a different point at the right speed and direction. A difference of even a millisecond or microsecond could prevent it. Similarly, diseases rarely have a single cause. There are always contributing factors—genetics, environment, lifestyle, and timing—all shaping the outcome. Understanding these connections helps in understanding the disease and how to deal with it.

When I was diagnosed, I believed it was a total psychiatric issue that my mental health couldn’t handle due to limited life struggles. When a major event struck, my brain couldn’t cope, and I assumed the cause was straightforward. I attributed my depression entirely to life events.

Today, I’ll explain how I ignored another contributing factor that caused me additional suffering. On my first visit, the psychiatrist gave me a list of investigations to rule out any pathological causes that could exacerbate the psychiatric symptoms. Believing I was physically healthy—I could handle 24-hour shifts and ate reasonably well—I ignored the investigations entirely. Looking back, that was a critical mistake.

At my next visit, when he inquired about the tests, I falsely said they were normal. I was a physician, so he believed me, and I took advantage of his belief, which cost me a lot.

Life went on, and I was on medication. One winter day, after climbing stairs, I felt breathless and thought it was work anxiety, so I ignored it. But at night, in a quiet room, I heard my wheezing breath; I knew it was asthma. The next day, I went to a physician who did a spirometry and X-ray, diagnosed me with asthma, and prescribed medicine. Looking back, I had anxiety episodes with severe breathlessness and wheezing but labeled myself as anxious, so I never considered other reasons. During the next anxiety attack with breathlessness, I didn’t know how to differentiate, so I took an inhaler, which helped me breathe better.

Second thing that happened when we were trekking in Vietnam was that I started having palpitations. So I sat down, and my heart was beating so fast, like it was about to give up. I was about to faint when a girl said, “You look so pale.” I checked my hemoglobin, and it was seven. I was diagnosed with severe anemia and started treatment. As my anemia improved, along with the psychiatric medicine, I started to feel more energetic; I guess it was a combined effect.

The third instance occurred this year in Jharkhand. I’m doing well now on one medication. It was too cold, but it was abnormally cold for me; my friends wore two layers, and I wore four. I used two blankets and still felt cold.Cold intolerance is a prominent symptom of hypothyroidism, so I got my thyroid checked and was diagnosed with hypothyroidism and started on medication.

I have read that hypothyroidism can cause depression, anaemia can cause palpitations and anxiety, and asthma causes breathlessness. It’s a vicious cycle, where brain, blood, and heart are parts of one body and work in harmony. So when dysfunction occurs, it’s like the chicken-or-egg dilemma.

It took me two years to diagnose my other contributing factors, which could have been identified at the first visit if I followed medical advice. I regret not investigating during the first visit; my suffering might have been less and shorter since recovery from anemia and hypothyroidism was significant.

I learned the hard way not to ignore psychiatrist instructions. I once thought psychiatry required minimal investigation. But conversations with Dr. Sagar and Dr. Mauni made me realize its deep connection to every body system—nervous, digestive, reproductive, and endocrine, They’re critical for brain specialists and clinical management.

Here are examples of investigations and their importance:

- Hemoglobin to assess anemia

- Thyroid function can affect mental health. Hypothyroidism can mimic depression and hyperthyroidism can mimic anxiety.

- LFTs to assess organ damage after alcohol use

- TDM monitoring for lithium, valproate, and carbamazepine

- MRI and CT in dementia, chronic schizophrenia, and brief psychotic episodes, tumours, stroke, and volume occupying lesions

- EEG - Reasons for Epilepsy

- BMI, waist-hip ratio, and lipid monitoring are used to track antipsychotic side effects.

- Genetic testing for allergies, multiple comorbidities, lack of improvement on multiple medication trials, and side effects from low medication doses.

Try the following activity:

Take out your depression on paper with a pen.

Write down everything that could be causing it.

What are the psychological factors?

What are contributing causes?

What are the pathological causes?

What are the recent and remote causes?

Which is the weakest link that I can attack next?

Try working on it today.

I’ve learned to separate illness from identity—to see disease as something external, not a defining trait. I no longer say 'I am depressed'; I say 'I have depression.' I learned to express my disease on paper, dissect it, and identify every cause. I work on them one by one, starting with the weakest link. This way, I wasn’t shooting in the dark; I was aiming at one enemy. That way, fighting depression became possible.

PS- The weakest link concept in depression refers to the idea that a person’s mental health is only as strong as its most vulnerable factor. Depression doesn’t stem from a single cause; rather, it results from an interplay of biological, psychological, and environmental influences. However, within this web of causes, there is usually one dominant weak link—something that, if addressed, could significantly improve overall well-being