Table of Contents

• What causes Hashimoto’s depression and anxiety?
• Can you still have depression and anxiety despite treatment with levothyroxine?
• How to manage Hashimoto’s depression and anxiety naturally
• Supplements
• Conclusion

Depression sucks, and unfortunately, it’s more common in Hashimoto’s than in the rest of the population [1]. Even when your thyroid levels seem normal, you may still be prone to depression.

The good news is that there is a lot you can do about it. Here we’ll look at the root causes of depression and anxiety, how they’re linked to Hashimoto’s, and how to improve your mental health naturally. If you choose to take medications, I believe many tips in this article will still be helpful for you.

Medications will not be discussed here, as that is out of my scope as a chiropractor. If you want a well-rounded discussion from a pharmacist, check out Dr. Isabella Wentz’s article on this.

What causes Hashimoto’s depression and anxiety?

Every case is different, but root causes may include stress, lack of energy in the brain, inflammation, gut dysbiosis, unhealthy day/night cycles, and hormones .

A recent systematic review of 17 studies has debunked the myth that low serotonin causes depression [2]. However, other research has so far identified the following contributors to depression. 

Mitochondrial dysfunction

Chronic inflammation can damage your mitochondria, so your brain may struggle with making and balancing neurotransmitters. Also, since thyroid hormones stimulate the mitochondria, low thyroid hormones mean your brain’s metabolism slows down. These can all lead to brain fog, and other cognitive issues, along with depression or anxiety.

Brain cells with damaged mitochondria also can’t produce enough energy and the signals between neurons decreases [3]. This can contribute to fatigue, depression, brain fog, and other symptoms of poor brain function. 

Chronic stress and traumas

The hypothalamus-pituitary-adrenal axis is your stress response axis that increases cortisol. HPA axis dysfunction (also often misnamed “adrenal fatigue”) is common in depression and other mood disorders. 

Chronically high cortisol damages the hippocampus (your brain’s memory center), which affects memory and may be a precursor to depression [4]. 

The incidence of elevated cortisol associated with depression increases with age. Cortisol levels usually decrease with improvement in depression symptoms [4].

Aside from chronic stress, a significant trauma or major life event like a move across the country, a death in the family, a flood or fire damaging your home, or the loss of a loved one can contribute to HPA axis dysfunction. 

Inflammation

Inflammation is a major contributor to depression. Clinical studies show that many depressed patients have high inflammation markers. Researchers believe depression is akin to “sickness behavior.” Sick animals fighting off an infection typically withdraw to protect others from the infection and to focus their energy on recovering [5]. 

Neuroinflammation can also contribute to HPA axis dysfunction, throw off neurotransmitters, and break down neurons [6]. So, if you have days where everything hurts, and you have no motivation and joy, that’s probably inflammation. 

Gut dysbiosis

Increasingly, research has shown there are links between gut microbes and the brain. For example, several studies have found that transferring the stool microbiome from depressed patients into mice causes the mice to develop depressive symptoms [7].

Many autoimmune patients also have gut dysbiosis and leaky gut, which can also contribute to mental health issues [8].

Abnormal circadian rhythm

Circadian rhythm is your day-night cycle that regulates every cell in your body. Abnormal circadian rhythm, such as being a night owl, is associated with mood disorders, including depression [9].

As high as 90% of people experiencing depression report sleep problems [9]. Depressed people also cycle through the sleep stages differently than healthy people  [10]. 

Postpartum and menopausal hormone changes

Postpartum and menopausal women get diagnosed with depression and Hashimoto’s more than any other age groups. This is because fluctuating hormone levels and sleep deprivation can affect your brain significantly.

The worse menopause symptoms you have, the greater your chance of also experiencing depression [11]. However, you can manage these by optimizing your blood sugar and more. To learn more about how to smoothly navigate menopause with Hashimoto’s, check out our Hashimoto’s and menopause article.

Other symptoms, weight gain, and body image issues

Hypothyroidism can add to other symptoms of depression, such as fatigue and low motivation. Weight gain can impact self-esteem and mental health just as much as it can increase the inflammation that contributes to depression.

Can you still have depression and anxiety despite treatment with levothyroxine?

If the other causes of depression in Hashimoto’s discussed above are present, then you can still experience depression despite taking thyroid hormone. Mental health often requires a holistic approach, as it is affected by a combination of biological and sociological factors.

Most people with mental health issues have good days and bad days, even those who are well-managed. If you’re having more good days and fewer bad days, you’re making progress. You may need to take it one day at a time, but it’s about progress not perfection. 

How to manage Hashimoto’s depression and anxiety naturally

Depression and anxiety are multifactorial issues–there is not a single cure for these. However, the more you remove the contributing factors, the more likely it is that you’ll feel better and be able to put it into remission. 

First, work to optimize your thyroid hormones and manage your inflammation. Addressing these will make a world of difference in your mood and motivation. Then, consider the following:

Work with a mental health professional

Find a counselor or psychologist that you resonate with. There are many evidence-based approaches to helping with depression, such as [13]:

• Cognitive behavioral therapy (CBT)
• Interpersonal therapy
• Behavioral therapy
• Mindfulness-based cognitive therapy
• Psychodynamic therapies

It’s important to not ignore the positive impact that talk therapy and other approaches can have on your outlook and perspective of the world. Working with a skilled mental health professional is an essential part of a holistic approach to overcoming depression.

Double down on circadian rhythm and sleep

Many people with depression struggle either with sleeping too much or insomnia, and feel helpless about it. Often, normal modern-day light exposures and activities throw off their circadian rhythms, which adds to this problem. These behaviors inhibit your day-light hormones and neurotransmitters, making it impossible to get restful sleep on a healthy schedule [9].

If you struggle with mood issues, it’s important to double down on sleep hygiene. Consider entraining a healthy circadian rhythm. That means getting some sun exposure for 30 minutes in the morning, and removing all sources of artificial lights a few hours before bed. 

In the winter months, you can use a light therapy box, known as bright light therapy (BLT). After only three weeks, BLT can improve circadian rhythm, sleep quality, and cognitive performance [14].

Red light therapy (LLLT) may also help restore normal circadian rhythm and improve sleep quality. LLLT uses small LED lights on the body to stimulate a physiologic response [15]. I personally use and recommend Joovv for this.

Exercise regularly

Exercise is a powerful way to enhance mood. Except those with severe depression, exercise may work as well as antidepressant medications [16]. However, be careful not to overdo it.

Here at Thyroid Strong, I teach the right way to exercise to balance inflammation and improve mood by working within your physical capacity.

Wherever you are in your exercise capability, you should know that any regular movement will help. Walking just 20-40 minutes a day for 3 times per week can be effective to enhance mood [17].

Whether doing aerobic or non-aerobic exercise, the scientific consensus is that any movement and exercise is more supportive in depression than none [18].

Nature exposure

Nature exposure can help you balance the stress response, improve mood, and increase physical activity [19]. Therefore, regular forest bathing should be an important part of your mental health regimen.

Supplements

Psychobiotics

Psychobiotics are probiotics that support mental health through the gut-brain axis. These help with mood by [20]:

• Balancing the hypothalamic-pituitary-adrenal (HPA) axis
• Modulating immune response
• Regulating inflammation
• Producing neurohormones and neurotransmitters

Omega-3 fatty acids

Omega-3 fatty acids, DHA and EPA, are necessary for healthy brain metabolism and function. Omega-3s support healthy cell membranes and cell signaling between neurons which can balance mood [21]. Omega-3 fatty acids also modulate whole-body inflammation.

Countries in which the population has lower omega-3 fatty acid intake have higher rates of depression [21].

Vitamin D3

Healthy vitamin D3 levels are associated with lower levels of depression. Vitamin D helps balance mood in three ways [22].

• Vitamin D receptors in areas of the brain, such as the prefrontal cortex, regulate mood
• Modulates the immune system 
• Neuroprotective by modulating neuroinflammation

Magnesium

Magnesium is required for healthy nervous system function. Magnesium deficiency can contribute to mood issues and neuronal damage [23].

Magnesium glycinate or magnesium taurate supplementation may promote significant improvements in overall mood [23].

Saffron

Saffron is an herbal supplement that improves resilience to stress and enhances mood. 

In a 2021 study of 56 people, saffron supplementation reduced negative physiologic responses to stress and improved mood. The saffron-treated group also reported improvements in relationships [24].

Conclusion

Depression and anxiety with Hashimoto’s can feel really awful. While you may need to take it one day at a time and be kind to yourself, you can take your mental health into your own hands. The key is to make progress towards putting these into remissions. 

In our Thyroid Strong community, we both commiserate with and keep one another accountable to taking actions – be it exercise, eating right, or taking supplements.

I’ve been there, do not lose hope.

In good health,

Dr Emily Kiberd

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References