Hi Friend,
"Have you considered that you might just be depressed?"
If you live with chronic illness, you have likely heard this phrase from a doctor. And it’s one of the most frustrating things to hear.
Here is the reality: Low mood does not always equal clinical depression.
While living with chronic illness is emotionally heavy, there are distinct physiological mechanisms—chemical reactions in your body—that mimic depression perfectly. When your hormones are off, your inflammation is high, or your adrenals are crashing, your brain physically cannot produce the "happy chemicals" it needs.
Before you accept a psychiatric diagnosis or a new antidepressant, it is vital to rule out the organic causes of low mood.
Here is what you and your doctor need to investigate first.
I always consider these when I see patients, you can book a appointment with me here. Please note I am fully booked until April next year.
1. The Adrenal Crash: Addison’s Disease & Adrenal Insufficiency
This is arguably the most dangerous mimic of depression. Your adrenal glands produce cortisol, the "stress hormone" that keeps you alive.
The Connection: When you have Adrenal Insufficiency (AI) or Addison’s, your cortisol is dangerously low. Symptoms include profound apathy, exhaustion, muscle weakness, and a lack of motivation. This looks exactly like severe depression, but it is actually a metabolic crisis.
Key Symptom: "Air Hunger" (feeling like you can't get a deep breath), craving salt, and low blood pressure.
2. The Inflammation Link: MCAS & "Brain on Fire"
Mast Cell Activation Syndrome doesn't just cause hives; it causes neuro-inflammation.
The Connection: Histamine is a neurotransmitter. When mast cells degranulate in the brain, it creates a "histamine dump." This can lead to sudden onset anxiety, irritability, or a "flat," foggy mood that lifts as soon as the reaction passes.
The Difference: MCAS mood swings are often rapid and cyclical (triggered by food or smells), whereas clinical depression is usually constant.
3. The Hormonal Rollercoaster
Your endocrine system runs the show. If your hormones are unbalanced, your mood doesn't stand a chance.
Thyroid: Hypothyroidism is the classic depression mimic. It slows everything down—your metabolism, your energy, and your brain function.
Sex Hormones: Low testosterone (in men and women), low progesterone, or estrogen dominance can severely impact serotonin production.
If you are worried about these and cant get help, I would be glad to help, book here
📋 The "Rule It Out" Testing Checklist
If you are struggling with low mood, print this list and take it to your next appointment. Ask to run these labs before discussing psychiatric interventions.
✅ To Rule Out Adrenal Issues:
8 AM Cortisol: Must be done first thing in the morning.
ACTH Stimulation Test: The "Gold Standard" to see if your adrenals can respond to stress.
DHEA-S: Often low in adrenal fatigue/insufficiency.
✅ To Rule Out MCAS (Neuro-inflammation):
Serum Tryptase: (Note: A normal tryptase does not rule out MCAS, but a high one confirms it).
24-Hour Urine Methylhistamine: Checks for histamine breakdown over a full day.
Prostaglandin D2 (PGD2): Often elevated in those with "brain fog" and mood issues.
✅ To Rule Out Nutritional & Hormonal Causes:
Full Thyroid Panel: TSH, Free T3, Free T4, and Reverse T3 (don't let them test just TSH!).
Vitamin B12 & Folate: Deficiencies here cause neurological depression.
Vitamin D: Low levels are directly linked to Seasonal Affective Disorder and general low mood.
Ferritin (Iron Storage): You can be anemic without low hemoglobin. Low iron = low oxygen to the brain = depression symptoms.
💡 The Bottom Line
Depression is real, and it deserves treatment. But treating low cortisol or high histamine with an SSRI is like putting a band-aid on a broken leg—it won't fix the root cause.
You know your body best. If your "depression" comes with hives, dizziness, salt cravings, or crashes after eating, keep digging.
Stay strong,
Dr Ahmed
Disclaimer: This newsletter is for educational purposes only. I am a doctor, but not your doctor. Always consult with a medical professional for diagnosis and treatment.
