If you’re struggling with depression or anxiety, it might not be “just in your head”. Many medical conditions can mimic or trigger mood symptoms—things like thyroid imbalances, hormone changes, nutrient deficiencies, sleep disorders, chronic illness, inflammation, or even side effects from common medications. There are many medical issues that cause depression and anxiety.
In this episode, I’m joined by psychiatrist Dr. Tracey Marks to break down 6 essential medical conditions to check for if you have depression or anxiety. These are often missed for years, and getting proper testing can completely change the course of treatment.
This is the raw transcript of my conversation with Dr. Tracey Marks.
Medical Issues that are Linked to Depression and Anxiety
Emma McAdam (00:00)
Well, Tracey, thank you so much for joining me. I’m so excited to talk with you today.
Tracey Marks (00:03)
I’m excited too. It’s great to collaborate together. Love this.
Emma McAdam (00:07)
Yeah, I love it too. And I wanted to bring you on because there are so many physical medical conditions that can often look like or contribute to mood disorders like depression and anxiety. And I think sometimes people go years without realizing that there’s an underlying biological cause.
Tracey Marks (00:24)
Absolutely. And that’s kind of where psychiatry really comes in, is that overlap between physical and psychiatric manifestations of physical issues. I mean, that’s where our training lies, essentially.
Emma McAdam (00:37)
right.
Yeah, which is why I’m so happy to have you on. You’ve specialized in all of this.
When Thyroid Issues Look Like Depression
Emma:
So, let’s start with like, what are some of the big ones to look for? What are some of the medical conditions that can look like depression or anxiety or contribute to or fuel it?
Tracey Marks (00:54)
Sure. So I think the most common, or at least the most common that I see is thyroid conditions. So either under-acting thyroid or over-acting thyroid. So hypo or hyperthyroidism. And I think it’s probably the most common because it’s more detected. Like you may go to your general doctor and just get a thyroid level checked, whereas some of the other things aren’t necessarily screened for.
Emma McAdam (01:07)
Yeah.
Yeah.
Tracey Marks (01:20)
Yeah, if you have an underactive thyroid, not only will you have other physical issues going on, but it can look like a mild depression. You can get depressive symptoms that don’t respond well enough to your medications. That’s kind of one indicator.
Emma McAdam (01:37)
You know, my dad had that, so he got screened and he had low thyroid, and when they gave him the thyroid medication, what had looked like depression basically went away.
Tracey Marks (01:45)
That’s wonderful. Yeah. I love it when people have a physical condition that gets corrected and then they no longer have mental symptoms. I mean, that’s like, that’s easy.
Emma McAdam (01:55)
Yeah, yeah, and I mean, it’s
like you could go to therapy for five years and it’s not gonna fix the fact that you’re tired and heavy all the time, right? Like your body’s just not working the right way. I think it’s just important to screen for these. I think it’s just important people are aware of them, they have them on their radar, they can check for the signs of them or talk with their doctor about them or run a blood test and then, you know, maybe rule something out.
Tracey Marks (02:01)
That’s right. That’s
Yeah, that’s absolutely true. I don’t know how common this would be, but another source of depressive or anxiety or mental symptoms from a physical issue are things involving your adrenal glands. So whether that be an underactive adrenal gland, which would be called Addison’s disease.
Emma McAdam (02:27)
Mmm.
Tracey Marks (02:33)
or overactive, which would be Cushing syndrome. Now, the thing with these two issues is the physical manifestations are significant enough that it’s almost like you got more going on than depression. This wouldn’t be a hidden cause of depression or anxiety, but where it becomes important is because the physical symptoms can be so significant.
Emma McAdam (02:48)
Okay.
Tracey Marks (02:55)
People can overlook or minimize the psychiatric component or the mood component and not really fully address it because they’re so focused on the physical issues. So.
Emma McAdam (03:00)
⁓ interesting.
Mm-hmm, yeah,
and any physical condition can contribute to anxiety or depression. Like if you have, you know, history of heart attacks, you might feel more anxious or panicky when your heart’s fluttering, or if you’ve had some physical condition that’s impaired your abilities, that might impact your depression,
Tracey Marks (03:22)
That’s right. That’s right. So you can kind of see some of these physical issues as an amplifier of something that’s already there or causing these psychiatric issues, depression and anxiety being the most common symptoms that you could get that could either if you address the physical issue, it can make the mental issues go away completely or kind of the reverse. You could be ignoring, as I was saying, the mental
Emma McAdam (03:44)
Mmm.
Tracey Marks (03:49)
issues because you’re so focused on the physical issues and then you still kind of don’t feel good because you’re not fully addressing the mental symptoms.
Hormonal Issues That Affect Anxiety and Mood Shifts
Emma McAdam (03:56)
Okay, yeah, important, important to look at. Okay, what else?
Tracey Marks (04:00)
Yeah.
So someone with this is still kind of endocrine related. So diabetes, if someone has ⁓ now diabetes doesn’t cause depression, but you can have or notice say with low blood sugars that can trigger mood episodes. could trigger brain fog, like difficulty.
⁓ working, getting your work done, feeling very fatigued, things like that. And sometimes that can be an early sign of glucose instability, if you will. So you may not have ever been diagnosed with diabetes, but some of the first signs of that as your blood sugars are dropping could be, not feeling well mentally.
Emma McAdam (04:36)
Hmm.
Yeah, yeah. Okay. Good to think about like blood sugar dysregulation or instability there. Yeah. Okay.
Tracey Marks (04:55)
And then, you know, still kind of living under the hormonal umbrella here would be perimenopause. So anything that changes your hormone levels. Don’t laugh. Have you seen some of those Instagram reels of like, I don’t know how I end up seeing this on my feed, but like guys talking about the horrors of ⁓ surviving perimenopause. Yeah, when I see what they say, I’m like, wow, you know, you’ve lived it. But at any rate, you know, the dropping estrogen levels can certainly affect mood.
Emma McAdam (05:23)
Poor them. I do feel for my husband sometimes.
Mm-hmm. Yeah.
Tracey Marks (05:40)
You get the brain fog again, and you can even get significant, not just low mood, but irritability that can look like, or just, or anger, things like that, that you just don’t feel yourself. And that could be improved by hormonal replacement if you’re a candidate for that.
Emma McAdam (05:42)
Yeah.
Yeah.
Right, right.
Tracey Marks (06:01)
⁓
For women who have it, and I’ll let you finish, but for women who have, who are at the age of going through perimenopause, where you’ve got dropping levels of estrogen and progesterone, which that’s true. That’s true. It doesn’t, this isn’t necessarily, you know, you’re 50 or 60 years old. This could start early with these dropping levels. But, now, then there’s also PMDD.
Emma McAdam (06:12)
Which can start in your 30s. That can start in your 30s.
Tracey Marks (06:27)
a premenstrual dysphoric disorder. So for some women, the hormonal changes that come monthly while you’re still having your periods can significantly impact your mood to where you can not only get depressed or feel depressed, but also the irritability, the lability and things like that.
Emma McAdam (06:30)
yeah.
yeah.
Mm-hmm. There are some, I think it’s important for people to know, like there are some medical treatments for this that can make it just not so hard, including hormone treatments, birth control, and some other approaches that could be helpful.
Tracey Marks (06:57)
Mm Yeah. The recommended treatment for PMDD is either hormones. So like oral contraceptives or low dose antidepressants. So low dose serotonin agents, something like Prozac. The reason I suggest or say Prozac is because the real treatment is intermittent use of the antidepressants. So
Emma McAdam (07:07)
Interesting ⁓
Tracey Marks (07:18)
You know, the symptoms typically onset about two weeks before you have your period. So that’s what you, when you would start the medication. Well, it’s not always easy for people to remember, okay, you got to calendar it, start taking your medicine for two weeks and then stop and all of that. So in patients where I’ve treated them, I’ve generally just suggested just take it every day. And that’s usually easier for them.
Emma McAdam (07:31)
Yeah.
Yeah.
Yeah,
just make a routine of it. Have you seen, I saw some research about vitamin B6 for PMDD. Like it was saying, but it was a small study. It was a small study and it was a one-off study. Have you seen that?
Tracey Marks (07:51)
Yeah,
I haven’t seen that, but you got to be careful with the one-off studies to not generalize too much because they saw this result. So therefore, this is now widely accepted and this is what we’re going to do. It doesn’t always bear out that way.
Emma McAdam (07:54)
Mm-hmm.
Exactly.
Test for Medical Issues That Cause Depression and Anxiety
Emma:
Yeah, for sure, for sure. So we just talked about a couple of hormonal or endocrine issues. How would someone test for these? how would they know if that was impacting their mental health?
Tracey Marks (08:16)
Yeah, so I guess the first way, the first step is how do you even know that you should look for this? And I guess one sign would be if you already have a psychiatric issue, whether it be depression or anxiety and you’re getting treatment for it and you’re not responding well enough to your medications. It’s almost kind of like a treatment resistant picture where nothing seems to be helping enough. That’s a clue to look for something physically contributing to this. Now, you would expect to have some physical symptoms. So you know, that’s another clue is you’ve got this going on. And also your depression just still doesn’t seem to respond. Well, maybe there’s something else. So I always suggest people who have mood issues, whether it be low or high, but particularly a low mood, be screened for thyroid.
Emma McAdam (08:45)
Okay.
Yeah.
Tracey Marks (09:08)
I mean, I think
that just ought to be a given. So if you haven’t had that test, it’s very easy blood tests, then have it done. And for men, you know, I’m talking about hormones or thyroid, I forgot about this one, low testosterone can also look like depression in men. So, you know, the man who’s got not only say low mood or
Emma McAdam (09:21)
yeah. yeah.
Tracey Marks (09:30)
angry, irritable, but also just kind of less vigor, less get up and go, less energy, less sex drive. Having testosterone checked would be the thing to do. And you can start with your primary care, a doctor with these, with these things. ⁓ and then the others that I mentioned, like adrenal dysfunction, all that again, you’re going to have bigger physical problems than just, you know, depression. That’s not going to be the major thing.
Emma McAdam (09:43)
Yeah.
That’s great.
Tracey Marks (09:58)
So chances are you would have had enough physical symptoms that you would see a doctor who would start doing other tests for hormone levels and things like that to see. Because like with adrenal dysfunction, you may have blood pressure issues and things like that.
Emma McAdam (09:58)
Mm-hmm.
Mm-hmm. Yeah. Okay. All right. And anytime we can improve our physical health, that’s going to help support our mental health as well. So, yeah.
Tracey Marks (10:13)
Yeah.
That’s right. That’s right.
The two go hand in hand. They go hand in hand.
Nutrient Deficiencies that are Associated withDepression and Anxiety
Emma McAdam (10:22)
Yeah, cool.
Okay. All right. That’s awesome. Okay. So what about nutrient deficiencies to look for? What do you think about that?
Tracey Marks (10:28)
Yeah, so the biggest ones that I think about are vitamin B12. Vitamin B12 is one of those things that there’s kind of three. Well, let me just tell you what happens if it’s low. So low vitamin B12 can look like brain fog. Again, going back to that brain fog issue, memory problems, as well as depression, energy problems, like fatigue and things like that.
And to have adequate levels of B12, you need to get enough from your diet. It needs to be adequately absorbed. And you need to have enough stomach chemicals to break it apart from your food to be digested. So people who don’t get enough of it, the typical group of people are vegans and vegetarians, because the biggest sources of it are meat.
Emma McAdam (11:07)
Hmm. Hmm.
yeah.
Tracey Marks (11:17)
⁓ dairy, things like that. So vegans really can easily be deficient in vitamin B12. And then you can just supplement people who’ve had gastric bypass are missing some places where the B12 would be absorbed. And then it also affects stomach acid, which can then affect the absorption. then elderly people are another group of people who can end up with low vitamin B12 just because of age-related
Emma McAdam (11:19)
Yeah.
Interesting.
Tracey Marks (11:43)
digestive issues and not absorbing enough B12. Yeah. So it can be a pretty common cause of dementia in elderly people. Yeah. Mm-hmm. Mm-hmm. So for people who’ve had gastric bypass surgery, usually they will need to get B12 injections because even taking a supplement, could, it’s poorly absorbed. But
Emma McAdam (11:47)
Interesting. Huh. Okay.
Really? Interesting, I did not know that. Huh.
Tristan.
Tracey Marks (12:11)
Yeah, supplementing with B12, easy to do. All right. So that’s B12. Another one is vitamin D. Even though I really don’t think of vitamin D as a nutrient in the sense of something that we consume, because really the biggest source of vitamin D is from the sun and the reaction it makes in your skin. That’s how we produce vitamin D. And
Emma McAdam (12:14)
Okay.
Yeah.
Yeah.
Tracey Marks (12:34)
Many people are deficient because of the darker the skin you have, the less you absorb sunblock blocks it. And then just being inside all the time. And now that, you know, after COVID and stuff, a lot of us working from home don’t get outside that much.
Vitamins that Can Help Depression
Tracey Marks:
So even though there’s not a direct cause, causation connection between vitamin D and depression, there is an association. So it’s more a correlation between low vitamin D levels and depression. There’s enough of a link that if you have depression or if you struggle with a low mood, not necessarily diagnosed with depression, it’s worth having your vitamin D checked.
Emma McAdam (12:59)
Yeah.
Yeah. Yeah. And then if it is low, you can supplement with vitamin D or also increase your sun exposure. And, but don’t overdo it. Don’t overdo it on either cause too much, too much supplements, too much vitamins can also be harmful. Like vitamin D can be difficult to process and remove from your body if you get too much of it.
Tracey Marks (13:26)
That’s right.
Absolutely. It’s one of the fat soluble vitamins. call them. I remember it as DAKE, totally random. But ⁓ D, A, K, and E are all fat soluble. So they get stored in your fat, in your body, which means that you can get too much of it. Whereas something like vitamin C, you can just urinate those out if you end up taking too much of it. But vitamin D is
if you don’t get enough sun exposure, meaning probably daily need of it, supplementing with around 1,000 to 2,000 international units a day is still kind of, I won’t say general recommendation, but generally accepted for someone who’s not even deficient per se as just kind of a maintenance.
Emma McAdam (14:17)
wow.
Tracey Marks (14:18)
But yeah, if you are deficient, which again, a lot of people are, yeah, then that’s usually a prescription level of vitamin D.
Emma McAdam (14:23)
Mm-hmm.
Yeah. Interesting. Interesting. Yeah. So I take 400 I use a day. and like my mood definitely changes in the winter. Like in the summer, I’m outside a lot. In the winter, I’m not so much. And I don’t know. Like I did do the blood test and it was low. Like my vitamin D was clearly low. I was like, all right, I’ll do 400. But now that you’re saying that I’m like, oh, maybe I’ll just do two of those. And it’s also like, it’s a vitamin D supplement that’s paired with, um, K2, I think, or K3. I can’t remember.
Tracey Marks (14:47)
Yeah!
Emma McAdam (14:53)
One of the vitamin Ks supposedly helps with absorption. Yeah, who knows? Yeah.
Tracey Marks (14:57)
Okay, I’m not familiar with that, but yeah, be careful because K is one that’s not, that’s fat soluble. D-A-K-E.
The Role of Supplements in Anxiety and Depression
Emma McAdam (15:02)
Okay, all right. Yeah.
Okay. Yeah. And I think the supplement industry is the Wild West right now. Like everyone is promoting a gazillion supplements from magnesium to omega-3 to like L-theanine. I mean, I just think this, ⁓ so many people are just like jumping on board. My neighbor takes 29 supplements every day. And I’m like, like just because it’s a supplement does not mean it’s always safe. Does not mean it doesn’t impact
Tracey Marks (15:22)
I don’t know.
Emma McAdam (15:28)
Like what do you think? Tell me your take. You’re the psychiatrist here.
Tracey Marks (15:31)
Yeah, so I do think there are some supplements that are beneficial and others that are excessive. And it really just kind of depends on the person. So some of the ones that are more, I don’t even know that I’d say essential, but are generally good and not overhyped would be vitamin D, ⁓ fish oil or Omega-3.
Emma McAdam (15:50)
Mm-hmm.
Tracey Marks (15:53)
because we typically don’t get enough of that in our diets, particularly in the Western diet. Curcumin is one of the ones that I like, which is an anti-inflammatory because inflammation is the biggest evil of all. I mean, so some of the physical issues and things that can cause that can also cause psychiatric manifestations.
Emma McAdam (16:05)
Yeah.
Hahaha. Yeah.
Tracey Marks (16:18)
Some of the basis of that is inflammation. But turmeric is the root. I guess it’s a vegetable root substance. And curcumin is the, I guess, kind of the chemical that comes out of that. So it’s really turmeric. ⁓ And I think magnesium is also good for a lot of different.
Emma McAdam (16:21)
Mm-hmm.
Okay.
Mm-hmm.
Tracey Marks (16:43)
⁓ reasons. It’s also very helpful in the whole cycle of neuroplasticity and all of that is kind of like one of those essential elements that’s a part of all of that. But it’s also relaxing. and not everyone gets enough of it in their diet.
Emma McAdam (16:54)
Yeah.
Mm-hmm.
Tracey Marks (16:59)
It’s not that hard to get enough of it in your diet, but still it’s one of those that could be a good supplement. I don’t know that I’d necessarily say essential, but I mean, you could, you could stack this stuff up and end up with a handful of stuff you’re taking every day. And not to mention it can get really expensive.
Emma McAdam (17:07)
Yeah.
That’s right. Yeah. And too much of any of these can have side effects. When I was pregnant, I was having all these leg cramps, all these leg cramps. And I like went to my doctor and I was like, Hey, I wonder if this is magnesium related. He’s like, probably not. You just need to stretch more. And I was like, but is it safe for me to take magnesium? And he’s like, yeah, up to 400 or whatever. And I took, um, 200 milligrams and my leg cramps went away. I was able to sleep through the night without leg cramps. It was clearly like directly correlated for me. And.
Tracey Marks (17:28)
You
Nice.
Emma McAdam (17:40)
My sleep is improved, but I don’t take the full even 400 on magnesium. Let’s see. I take magnesium and vitamin D and that’s about it. But now that you’ve said that, maybe I’ll try curcumin as well. I should be doing omegas. have some, I just always forget to take them. I like to keep them refrigerated and then I forget to take them.
Tracey Marks (17:57)
I
I know, I forget to, I’ve ran out and I hadn’t gotten any more lately, but yeah, I take vitamin D, I take the curcumin. And you another one that I take, which is not necessarily huge for people, is CoQ10. ⁓ So CoQ10 is one of those enzymes that’s involved in certain metabolic processes, but it could get depleted in people who take statins. So.
Emma McAdam (18:11)
yeah, print of that.
Okay.
Tracey Marks (18:22)
If you, you know, if you have high cholesterol and you take a statin drug for that, you could end up with low CoQ10 levels. And so that was kind of how I started thinking about and recommending it to my own patients who were on the statins, because a manifestation of that is a lot of fatigue and just like feeling draggy and whatnot. And they were on statins when they when they supplement with the CoQ10 that it just perked them up.
Emma McAdam (18:29)
Interesting
Mm-hmm.
Interesting, interesting. You know, I was researching a video on choline and I saw something that said that for some people going on statins actually can help with depression. Like, and it was like a meta-analysis, like it was a decent meta-analysis.
Tracey Marks (19:05)
Okay. Yeah, you know, that vaguely sounds familiar to me. There’s so much stuff out there, but that vaguely sounds familiar to me. There is.
Emma McAdam (19:09)
Yeah, there’s so much stuff out there and it’s complex.
It’s complex too. Like there’s a lot of moving parts, right? A lot of moving parts. Yeah.
Tracey Marks (19:16)
There is a lot of moving parts,
which is why it’s great that we have so much more access now to research studies and stuff, but you know, it’s a double edged sword because then what do you do with the information? How do you know how to apply it? Yeah.
Emma McAdam (19:26)
That’s right.
That’s right. Yeah.
And in general, supplements are poorly researched because there’s so many different variations of each supplement and they’re not funded by like a medication company and they aren’t regulated in purity and quality. So when people consider supplements, they need to really take what they’re being told with a grain of salt, talk with their doctor and be kind of cautious. I would say err on the side of caution, not just like, it’s a supplement. I can take it if I want to. Like these things, if they have enough ability to impact us positively, they also have the ability to impact other organs or systems in our body in another way that we maybe
to wear off. ⁓
Tracey Marks (19:59)
Right, exactly. Yeah,
All of these things can have side effects, if you will, because just because it’s natural doesn’t mean that it can’t do harm, you know.
Emma McAdam (20:03)
Yeah.
That’s correct. Yeah,
like lead is natural and it’s very poisonous. Like arsenic, snake poison, snake venom, they’re all natural. Just because something’s natural does not mean it’s safe. That’s correct. Yeah.
Tracey Marks (20:10)
Hahaha!
That’s right. That’s right.
I use a site called ⁓ Consumer Lab. ⁓ It is a paid subscription, but I use it to check. They do independent lab testing. Now there may be some other companies that do that where you can get the information for free, but that’s one way to check the source of your supplements. So this company will test things and then give you a report and rank them based on
Emma McAdam (20:23)
Hmm.
Okay.
Tracey Marks (20:43)
Do they contain what they say they’re supposed to contain? Do they have additives? The purity as well as the strength, like all of that. And so I would recommend if you are someone who likes taking supplements that you have your brand checked and preferably by an independent source like that.
Ashwagandha Support for Cortisol and Anxiety
Emma McAdam (20:52)
Yeah.
Yeah. Hmm. my gosh. I could talk with you about supplements for an hour. Like I would love to pick your brain about supplements for a whole hour. Let me just ask you about two more. How about Ashwagandha? What do you think about Ashwagandha?
Tracey Marks (21:14)
Yeah, ashwagandha. So I think it can have specific purposes and specific benefits. So I actually have recommended it to some patients. What it does is it lowers cortisol, which if you are someone who is sensitive to, say, high cortisol levels, particularly in the mornings, that’s when we get the spike, the cortisol spike, that then can lead to anxiety and panic. ⁓ Ashwagandha can be useful for that.
Emma McAdam (21:25)
Yeah.
Yeah.
Tracey Marks (21:42)
So I have recommended it to some patients who have anxiety, particularly morning anxiety and use it to to modify that.
Emma McAdam (21:42)
Yeah.
Interesting. yeah. So I was working with, uh, like a woman’s health doctor and we, yeah, I don’t even need to go into this, but I’ve not been sleeping well and especially badly the week before my period. we’re like, all right, let’s try progesterone. We added in a little progesterone, added in a little estrogen. That didn’t help that much, maybe a little bit. And then her next thing was like, well, like, let’s see, like it might be cordial. Cause I do, I, I am like anxious at night. I’m anxious in the morning.
And She suggested one supplement that had ashwagandha, L-theanine, and magnesium. And I did the research. I was like, the research is decent on ashwagandha. I haven’t started it yet, but I’m like, I might try that for a bit.
Tracey Marks (22:29)
Mm-hmm.
Yeah, it is ⁓ decent on ashwagandha and particularly, you know, it’s affecting the cortisol. So if you’re not someone who’s, let’s just say, whose anxiety is driven by or, you know, amplified by cortisol levels, then it may not help you. You know, but it’s worth a try if, you know, you kind of have that pattern of being really revved up in the mornings and even in the evenings to see if it helps.
Emma McAdam (22:57)
Yeah. Interesting. Okay. I could just, I would love to ask you about all the supplements because I think it’s just such a hot topic, but let’s move on. Let’s move on.
Sleep Disorders’ Role in Depression
Emma McAdam
Let’s talk about another category of health issues that a lot of people don’t think about, but I just brought up, which is sleep. ⁓ I saw one study, it was a little bit older, but it said they were treating people who had depression and sleep disorders. And when they were able to treat the sleep disorder, 87 % of those people saw their depression symptoms resolved.
Tracey Marks (23:00)
Yeah.
Yes.
Emma McAdam (23:26)
Like, gone.
Tracey Marks (23:27)
Yes, yes, it is real. Chronic sleep deprivation is a real source or cause or trigger, whatever you want to call it, for depression. It just really is. And one of the main mechanisms is inflammation. Now, sleep deprivation causes inflammation in your body. Inflammation in your body is bad. It, it…
Emma McAdam (23:39)
Yeah.
Interesting.
Yeah.
Tracey Marks (23:50)
It wreaks havoc on a lot of systems, let’s just say, inflammation in the brain can look like depression and anxiety. I think I’ve always been a big sleep person, not only talking about it, which not everyone wants to listen, sleep can be a boring topic. Because we just take it for granted. And I think it ends up being one of those things that
you sleep when everything else is done for the day, you don’t have anything else to do. So, okay, it’s time to go to bed. I’ve always felt like it’s the last priority. Absolutely. And just like your phone will freak out on you if you don’t keep it charged and tuned up, will just, you know, it won’t work if you don’t charge it. Our brains and bodies are the same way. There’s a lot of things that happen during sleep. It’s not just resting muscles.
Emma McAdam (24:18)
It’s like their last priority.
Tracey Marks (24:38)
in the brain, you know, there’s, you know, kind of think of it like a warehouse in the evening, where there’s things are getting filed away, and there’s lots of work going on to prepare for the next day. Your memories get consolidated, like all of that stuff. But I think the preparation for sleep needs to start in the morning, because what you do all day long affects how well you’ll be able to sleep at night. So planning for sleep is kind of like that first step, and many people don’t plan for sleep.
Emma McAdam (24:49)
Yeah.
Mm. Mm.
Tracey Marks (25:07)
I’ll ask almost every patient, so how’s your sleep? It depends. It shouldn’t depend. There should be a time you plan to go to sleep and then you work the rest of your day around your sleep schedule.
Emma McAdam (25:19)
I do this. I love sleep, but I don’t- I do it poorly. I sleep very well the first part of the night. I fall asleep so easily, but I do not sleep well the second half of the night. But I do. I’m like, gotta get to bed by nine or I’ll be dead tomorrow. And there is that aspect of like sleep anxiety. So some people within insomnia, like they do get so anxious about sleep that they can overdo it. And we could talk about that another day. But sleep is so, so essential. And I love what you’re saying about like, you got to plan this in the morning because when you get morning-
Tracey Marks (25:20)
You
Yes.
Mm-hmm.
Emma McAdam (25:45)
sunlight exposure, that tells your body to start that circadian rhythm of like increasing your activity levels during the day and then preparing you to release melatonin at night. So like even just the simplest action of like getting morning sunlight or morning, like if you don’t have sun where you live, if you live, I mean like even as it’s dark here, it’s like getting ⁓ light therapy can also be really helpful to to manage that.
Tracey Marks (26:08)
yeah.
Yeah, because you’re absolutely right. Your clock resets every day. And so, yeah, you want to pull it forward as much as you can. So morning sunlight is what helps reset that for the rest of the day, which is why, you know, there’s a whole debate about daylight savings time. Now, daylight savings helps us have more sunlight in the evening so we can go to, you know, evening soccer, soccer games. But
Emma McAdam (26:13)
Yeah.
Yeah.
Yeah.
Tracey Marks (26:34)
But it’s more important for us to have sunlight in the morning, not wake up in the dark. Yeah.
Emma McAdam (26:38)
That’s how I feel. That’s
how I feel. don’t like, I’m, my body just literally never adjusts to daylight saving. Like it just doesn’t work. I have like such a weird circadian rhythms. So I’ll went too long. just wake up at four and then all summer long I wake up at five. It’s cool. Whatever. Like it’s terrible actually sometimes, but, ⁓ I have to.
Tracey Marks (26:49)
You
9 o’clock bedtime. That’s impressive. Even I don’t get that. ⁓
Emma McAdam (27:00)
I have to, right? Because I wake up at four. If I don’t go to bed by nine and I always wake up at four. I could go to bed, like New Year’s Eve, I went to bed at 12:30, woke up at four, doesn’t matter. I could go to bed at 11 PM, and wake up at four. I’m not setting an alarm here, just in case anyone’s wondering. My body is like, hey, hey, you want to be awake right now, let’s go. You can either lay in bed and be wide awake or you can get up. Your pick.
Tracey Marks (27:03)
⁓ okay.
⁓ yeah, yeah.
Mm-hmm. Mm-hmm.
Okay.
The body doesn’t forget.
It’s like this is the schedule. You can go along with it or not.
Emma McAdam (27:28)
Yeah. Yeah. Yeah, I have
like a really funny, a really weird, like I’m an incurable morning person and it’s not by choice. Like I just, that’s how my system is. It’s not terrible. I get a lot of stuff done. That’s the only way, it’s the only way I’m able to do the channel while I have four kids is just like.
Tracey Marks (27:41)
Yeah, I’ll bet I’ll bet I kind of I might try that. Go ahead.
Emma McAdam (27:52)
I get stuff done in the morning before they’re up, I work a couple hours during the day and that’s it. So, yeah.
The Connection Between Sleep Apnea and Depression
Emma McAdam
So, do you want to rattle off a couple of sleep disorders that people might not have on their radar or like any treatments?
Tracey Marks (27:56)
Oh boy. Yeah, yeah. All right.
Yeah, probably the biggest one or the most common one, impactful one, is sleep apnea. ⁓ sleep apnea is a big deal. It causes other medical issues as well, but it can also be a source of depression through the mechanisms of decreased oxygen.
Emma McAdam (28:14)
Mm.
Tracey Marks (28:29)
supply to your brain and all of that. So it’s not like sleep apnea biochemically causes depression per se, although maybe that’s not what people are thinking. But I’m just saying there’s a big association between sleep apnea and depression as well as other medical issues. Some clues that you could have that is being chronically tired all day despite getting enough hours of sleep, waking up with a headache or having someone
Emma McAdam (28:42)
Mm.
Tracey Marks (28:54)
tell you, a bed partner tells you that you sound like you stop breathing or during the night or you sound like you’re choking, things like that. There’s home tests that you can get to check for this. So it’s not as hard these days to have this diagnosed as opposed to having to go do some sleep study in a hospital kind of thing. That’s probably the biggest one. But then, you you mentioned your legs, but like restless legs is something that
Emma McAdam (29:03)
Mm-hmm.
Tracey Marks (29:19)
could be a nutrient deficiency or caused by that that could then be reversed and you don’t have the problem, but could also then just kind of keep you awake by no fault of your own. Those are probably the biggest two that kind of come to mind as far as things that impair your sleep that then can cause psychiatric issues.
Emma McAdam (29:38)
Yeah. Okay. Great. Yeah. And there are a lot of good options to get better sleep, including like sleep hygiene. CBT-I is like 70 to 80 % effective at helping people with insomnia. And then there’s some other psychological approaches involving like dropping the struggle with sleep. and this is something I have been considering, if people really just struggle and struggle to sleep or they feel really tired or they’re falling asleep when they sit down, you might want to consider getting a sleep study.
Like, let’s see if you’ve got some kind of sleep disorder where your sleep cycles are off or doing something funny like that.
Tracey Marks (30:04)
Mm-hmm.
Yeah,
absolutely. And then one more thing about the sleep, going back to you waking up at 4am no matter what time you go to bed, your circadian rhythm, your body clock is super important for your overall health. And when you get dysynchrony, like your body clock is off, it also affects your body rhythms and your physical condition. Like there’s a lot that goes into our body clock that’s not just sleep.
You know, it’s temperature regulation, it’s energy management, like all of that. Yeah.
Emma McAdam (30:36)
Yeah.
Hunger, like one of the biggest
indicators of overeating is being tired because you’re growing, your hunger hormones get dysregulated when you don’t sleep, right?
Tracey Marks (30:47)
That’s right. That’s right. So one more intervention for this whole sleep thing. We talked about morning light, then there’s blocking an evening light. So devices, even like our lights in the house can ⁓ decrease melatonin release. Melatonin being the hormone that says, oops, it’s nighttime, time for your body to get to go to bed. So I wear blue light blocking glasses. I’ve been wearing those for years now, at least 10.
Emma McAdam (30:56)
yeah, yeah.
Tracey Marks (31:14)
where you wear them two hours before you plan to go to bed or want to go to bed. And it blocks the signals that are saying it’s still light outside and it makes your eyes believe or your brain believe it’s dark outside. So we need to start producing melatonin soon.
Emma McAdam (31:28)
Yeah.
interesting, interesting. And I saw a video of yours about how that can also be sometimes a helpful treatment for bipolar disorder as well.
Tracey Marks (31:37)
Yes, that’s right. It can be. There’s dark therapy, as you know, it’s called dark therapy. With bipolar disorder, people intrinsically have sleep disturbances, like bipolar disorder is pretty complex. But there’s a lot of other body systems that are affected by it sleep and you’re in your circadian rhythm being one of those. So
Emma McAdam (31:49)
Yeah.
Tracey Marks (32:00)
keeping things regulated so that you get darkness when you’re supposed to have darkness to help you get on a regular schedule and a regular sleep schedule is really important with bipolar disorder.
Medication Effects On Depression and Anxiety
Emma McAdam (32:12)
Okay, that’s important, it’s really good to know. Okay, let’s talk about another thing people often don’t think about is how their medication might have side effects that impact their mood. Is this common? What do you see?
Tracey Marks (32:24)
Yeah, yeah, it is pretty common. one that people probably don’t think about that much would be some cardiac or heart medications like beta blockers. A beta blocker would be like metoprolol or perpanolol even, but that you could be prescribed to control your blood pressure that can also cause depression as a side effect of it.
you know, things like steroids, if you got put on prednisone, because let’s say you got a bee sting or you know, something happened and you needed to take prednisone. High doses of cortisol or having high levels of cortisol in your body can not only cause the depression that we mentioned, but some people can get we call it steroid psychosis, where you can have like manic type symptoms or kind of become
essentially just become psychotic, like lose track of what’s real and what’s not real. That would be a more extreme case. And we would tend to see that more with someone maybe in the hospital getting IV steroids. yeah, even the oral steroids can impact your mood negatively. And then you’ve got things like overstimulating medications could be something like decongestants.
Emma McAdam (33:16)
Whew. Yeah.
Mm-hmm.
Tracey Marks (33:34)
and they’re stimulating, which could cause anxiety.
Emma McAdam (33:37)
Mm-hmm.
pseudophedrine. That one can make people feel more anxious, right?
Tracey Marks (33:37)
huh. Yeah.
Absolutely. Yeah. I mean, and that’s, you know, Sudafed is the brand name. I don’t know how it is in Utah, but here, you know, it’s behind the counter. you’ve got to use your ID to get it. Why? Because yeah, people get it, crush it and snort it to, turn it into an illicit substance. But yeah, it’s a stimulant, essentially.
Emma McAdam (33:56)
Yeah.
Tracey Marks (33:59)
So any kind of other stimulating medications, that’s kind of more the common one, but inhalers that you could use for asthma or something could also be stimulating and then cause anxiety for you. And these drugs that can get you ramped up and cause anxiety, they may not necessarily cause panic attacks. So go, now I’ve got anxiety, but they could keep you from sleeping.
Emma McAdam (34:10)
yeah.
Tracey Marks (34:24)
So that could be a different manifestation of the increase in the stimulating effect is now you have trouble falling asleep or staying asleep. So you can fall asleep because you’re just exhausted. But, you know, four hours later, now you’re waking up.
Emma McAdam (34:40)
Yeah, I hear that. And I think it’s important to say that this doesn’t mean you shouldn’t follow your doctor’s orders, you shouldn’t use your prescriptions, you should definitely just be aware that medications can contribute to this multifactorial experience of anxiety or depressive disorders. Depression and anxiety are not a single illness, they are this complex web of what’s going on with your body. And so be like in
Tracey Marks (34:40)
Hmm, Emma.
Emma McAdam (35:06)
communication with your doctor, your psychiatrist as you talk about your mental health and your physical health and the medications you’re on. I certainly don’t want anyone to take away from this, oh I’m gonna take all these supplements and I’m gonna turn off all my meds or stop taking all my meds. I was like no no no please don’t do that, right?
Tracey Marks (35:21)
Absolutely.
Yeah, that’s a really good point is that it is complicated. there’s a lot of moving parts and things that go together. And this is where having a physician or a clinician say, take a look at the big picture. Now, some people will say, well, my doctor doesn’t care. He’s just doesn’t, listen to me. This is where you can help by giving your doctor more information.
you know, trying to pull them in with you, because you are aware that there’s other factors at play here. So, you know, I’m feeling low, and I’ve never been diagnosed with depression before. I don’t know what’s wrong with me. Could, Doctor, could it be something I’m taking? Like, that’s a reasonable question to ask of your doctor. You don’t have to be afraid that going to offend the doctor, if you do offend them, then that’s their problem. But you know,
Emma McAdam (35:44)
Mm-hmm.
Yeah.
Yeah.
Tracey Marks (36:11)
We know now, we clinicians know that there’s so much information online. It’s part of our job to help patients sort through what’s accurate, what applies to them, and what doesn’t apply to them. And I love it when patients come to me with information that I could either correct or validate for them. having your own information about what’s going on with you,
Emma McAdam (36:27)
Yeah. Yeah.
Tracey Marks (36:33)
Every time you go see another doctor, you want to give them all of the medicines that you’re taking so that they can take that into account.
Medical Conditions that Impact Depression and Anxiety
Emma McAdam (36:39)
That’s really important. That’s really important. Okay, so we’ve talked about hormonal stuff, sleep, supplements. We’ve talked about medication side effects. Can you just rattle off some other illnesses or conditions people might have that might impact their mood, their anxiety or depression?
Tracey Marks (36:56)
Sure. So there’s the category of autoimmune disorders, things like Sjogren’s syndrome. I don’t know why that’s the first thing that comes to my mind. But lupus, that’s more common than Sjogren’s. Lupus, there’s such an entity called lupus cerebritis, where you’ve got inflammation in your brain because of the lupus. Other things like Lyme disease,
Even COVID, had its own impact on your mental health for some people, not everyone. Chronic pain conditions. So fibromyalgia, there’s an association with or kind of ⁓ an overlap between the physical aspects of fibromyalgia and the mental aspects of fibromyalgia. Turns out, you know, one of the medications that’s used for that
Emma McAdam (37:20)
Yeah.
Right?
Tracey Marks (37:39)
is Cymbalta, which is an antidepressant. No surprise that helps with fibromyalgia, but also it’s an antidepressant, help with mood and anxiety. So all this to say that there is such a connection between body and mind and brain that the significance here is that we need to take all of this under consideration when
Emma McAdam (37:44)
Yeah.
Yeah.
Tracey Marks (38:03)
assessing what’s really going on. And we don’t want to ignore the possibility of having something physical going on when you’re experiencing something mental. But you also if you have something physical going on like lupus or, or just, chronic gastrointestinal distress that and now you’re having, you know, chest pain or something, you want to recognize that some of these physical illnesses can also have mental manifestations that often need to be addressed separately. Sometimes just fixing the physical cause can then clear up what’s going on mentally. But sometimes you need both treatments. You need to address both. So someone say with lupus may also be put on an antidepressant because treating the lupus doesn’t necessarily erase or make their depression go away. They need both treatments.
Get Help for Medical Issues that Affect Depression and Anxiety
Emma McAdam (38:43)
Yeah. Right, right, absolutely. And I think that’s my biggest takeaway is just like when we’re looking at mental health, we can’t just think, you just have to meditate hard enough to make this all go away. Like that’s not how this is. Like this is our mind and our body and our social experiences and our soul, like all interacting in a complex and beautiful way. And let’s just chip away at these little parts that might be contributing to the difficulties we’re having. ⁓ And then of course, as always.
Tracey Marks (39:20)
That’s right.
Emma McAdam (39:23)
talk with your doctor. Hopefully a supportive doctor will listen to you.
Tracey Marks (39:26)
people with mental health issues can end up getting bad medical care from the perspective of well, whatever you’re experiencing, it’s mental, you know, so now I have stomach issues.
Emma McAdam (39:37)
Yeah, it’s just, it’s all in your
head. Mm-hmm.
Tracey Marks (39:39)
It’s all in your head. ⁓ You know,
just go talk to your psychiatrist, but and not fully explore, could there be a physical issue? so another message or another takeaway here is advocating for yourself and by recognizing, yes, there are physical things that physical conditions that can have mental manifestations.
Emma McAdam (39:48)
yep.
Tracey Marks (40:01)
And we always need to rule out something else physical going on when you do have something mental that pops up and clues that you need to dig further is sudden onset of something or symptoms that just don’t resolve even if you have addressed it from a mental standpoint, either be it because of therapy or medication, it’s just not getting better. Let’s look deeper and see if there’s something physical.
Emma McAdam (40:25)
Yes. I love that. I love that. And I will give two examples. I heard this one lady, she was talking to Mel Robbins, who I respect and admire, but she was talking to Mel Robbins. said, I just started having, I’ve started having panic attacks for the first time in my life. And she was 45 or 50. And Mel Robbins was like, here, let me give you some, some tips and some good ideas. And they were psychological treatments, which is fine. That’s great. and if someone’s having panic attacks for the first time in their life, like, let’s see, is this connected? And she was middle aged. It’s like, is this connected to, to perimenopause?
Like, is this connected to something else going on biologically? It’s like, if symptoms showing up out of the blue or like you change a medication and then the symptom shows up, like that’s a good indicator. Like, let’s look and see what’s going on. ⁓ Here’s a way more extreme example. This is like the most bizarre example I’ve ever read in the news. But this lady in Australia was like in her mid 40s, had never had a depressive episode in her life. Gets super depressed.
Tracey Marks (41:05)
Mm-hmm.
Emma McAdam (41:20)
beyond depressed, depressed, like way depressed. They tried therapy, they tried antidepressants, nothing’s helping. I don’t know why the doctors went this direction, but they did a brain scan and they saw like a spot on her brain. And then they went in and did exploratory surgery and they found a parasite in her brain. Yeah.
was a parasite, but like there was something biological going on making her brain unhappy and that was contributing to her depressive symptoms. Now I do not think the majority of people with depression have a brain parasite. Like this is incredibly rare, but when the symptoms come out of the blue, should be asking some questions on a medical side.
Tracey Marks (41:52)
Absolutely. If symptoms that come up out of the blue, even if it is mental symptoms like depression or anxiety, the first place you should go should not be a psychiatrist. The first place to go is your primary care doctor. Then if it looks like you’re in the clear, like they can’t find any physical reason for this, then that’s when you look at mental having this be a psychiatric issue.
Tracey’s transformation journal, SHINE
Emma:
Do you want to tell us about your journal?
Tracey:
Sure. This is my transformation journal. This structured journaling system helps you integrate self-reflection, mindful practice, and neuroscience-based insights into everyday life. Comment end
Emma McAdam (42:14)
Yeah, for sure. Awesome. Thank you so much. Really, really appreciate your time. Thanks for taking the time to share your expertise with my audience.
Tracey Marks (42:18)
Sure. Absolutely.
Thanks for having me. I enjoyed this. All right. Yes, let’s.
Emma McAdam (42:23)
Yeah, let’s do it again sometime.
