Go back

Ruling Out Underlying Health Conditions Before Starting Antidepressants and Ketamine Therapy

Prior to initiating medical treatment for mental health disorders such as depression and anxiety—which may include therapies like oral antidepressants or even ketamine and psychedelic therapy—it is crucial to thoroughly assess and rule out other medical conditions that can mimic or exacerbate symptoms. This step is essential to ensure an accurate diagnosis and effective treatment.

For example, vitamin B12 deficiency can present similarly to major depressive disorder, with symptoms such as fatigue, memory impairment, irritability, and mood changes, commonly associated with depression. Correctly diagnosing and treating vitamin B12 deficiency with supplementation can markedly improve these symptoms and potentially eliminate the need for antidepressants.


Iron deficiency anemia and other forms of anemia (such as vitamin B12 or folate deficiency anemia) can cause symptoms like fatigue, weakness, pallor, and reduced cognitive functioning, all of which can be confused with depression.

Vitamin Deficiencies:

Vitamin B12 deficiency can lead to significant neurological symptoms, including memory problems and mood changes. Vitamin D deficiency has been linked to seasonal affective disorder and other depressive moods.

Thyroid Disorders:

Hypothyroidism can slow down metabolism, leading to fatigue, weight gain, constipation, and depressive symptoms. Hyperthyroidism, though less commonly linked with depression, can cause anxiety, palpitations, and mood instability.

A hypofunctioning thyroid gland may lead to symptoms that mimic major depressive disorder.

Neurological Conditions:

Conditions like Parkinson’s disease and multiple sclerosis may present initially with fatigue and a blunted emotional affect, which can be mistaken for depression.

Endocrine Disorders:

Diabetes can cause fluctuations in blood sugar levels that affect mood and energy levels. Cushing's syndrome involves an overproduction of cortisol, which can lead to symptoms of depression.

Cardiovascular Diseases:

Patients with heart disease may experience limitations in physical activity and lifestyle changes that can lead to depressive symptoms. Assessments typically involve physical exams, ECGs, and other cardiovascular testing to understand the extent of heart health.

Sleep Disorders:

Conditions such as sleep apnea can interrupt sleep, leading to daytime sleepiness and fatigue, which affect mood. Insomnia can prevent adequate rest, contributing to depressive symptoms.

Undiagnosed sleep disorders, such as sleep apnea and insomnia, can lead to fatigue, depressed mood, and heightened irritability.

Substance Abuse and Medication Side Effects:

Alcohol and certain drugs can lead to depressive symptoms either during use or withdrawal. Additionally, medications for high blood pressure, anxiety, and even birth control can have side effects that include depressive symptoms.

Hormonal Imbalances:

Conditions like PCOS or thyroid issues post-pregnancy can disrupt hormonal balance and affect mood. Evaluations might include hormonal blood tests and assessments of symptoms related to menstrual cycles or postpartum conditions.

Identifying any underlying medical conditions ensures a more accurate diagnosis of disorders such as depression and anxiety and aids in selecting the most appropriate and effective treatment strategy. The best place to start is by consulting a primary care provider who can order blood work and the appropriate tests or assessments to accurately rule out any medical causes for symptoms. Once medical causes for mental health conditions are ruled out, a comprehensive approach can enhance treatment strategies, improve outcomes, and prevent unnecessary or less effective treatments.

Keep reading

Disclaimer: All content on this website, including (but not limited to) this statement, news, blog post, article, testimonial, or FAQ is not medical advice and should not be considered as such. This website cannot diagnose or treat any medical condition. Only a licensed medical professional who is familiar with you and your medical history can do that. Therefore, we cannot be responsible or liable for any actions taken by those who access our website or rely on its content. Please refer to the Terms & Conditions for more information.