What Tests can be Used to Rule Out Physical Causes of Moods?
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Q:  What Tests can be Used to Rule Out Physical Causes of Moods?

I was recently diagnosed with bipolar disorder and I do believe the diagnosis is correct, but my doctor ran some blood  tests to rule out physical causes of my moods. I forgot to ask what he was looking for.  What do doctors generally look for with "oh you have mood symptoms" blood tests.  Several websites/books tell us that doctors do this to rule out other illnesses  that can cause depression, but I'm not sure what they are. I'm thinking thyroid  function, but is there anything else? I know the right blood tests can probably  tell doctors a fair amount of information about a person's health, but is that really all that was needed?  I'm  curious because I've never seen a full explanation of what I've only read as "physical illnesses that can cause bipolar (or just  depression) like symptoms" means although I think I recall reading  "thyroid disorders and other", but what is other? I'd never be able  to enter the  medical profession, but I like reading about this kind of stuff. It's  fun.


PS. I fear the list might be a bit long.


Dear Kathryn --
Good question.  The list of standard things to test for is actually very short.  It includes thyroid.  After that, there is a question of how many haystacks to turn over, looking for a needle.  For example, sometimes people have bipolar-like symptoms after a stroke, or a head injury.  But we don't routinely do a brain CT scan, or an MRI, every time someone presents with bipolar symptoms.  Unless they are over 40 or so.  A new-onset bipolar disorder, over age 40, is actually pretty unusual and might in some cases be worth a search for some underlying basis of the late onset.

Again, in general, the only standard, widely accepted blood test, diagnostically, is thyroid. The idea, of course, is to make sure that what looks like bipolar disorder is not hypothyroidism (or in some cases, particularly if someone shows up looking manic, but not exactly manic, hyperthyroidism).

However, there are other reasons to get a blood test at a first visit.  Most of the treatments we might consider have the potential to cause dangerous physiologic changes, so we need to know, before treatment starts, exactly where we are starting from.  For example, lithium can interfere with kidney function, so it is routine to check kidney function at some point.  But since lithium treatment requires numerous blood tests, I think it is within standard of care to delay the first blood tests until after a trial of low-does lithium, as long as the person is young and physically healthy as far as she/he knows.  But some doctors would get a "baseline" for kidney function before starting with him in all cases.

Likewise, the whole family of "atypical antipsychotics", which we use as mood stabilizers, (sometimes in very low doses) can cause increases in blood glucose, progressing even to diabetes.  They can also cause increases in cholesterol.  So we need to know where glucose and cholesterol levels are before we start, or very near starting (some of those changes can take a while, but some of them can be quick).

In general, I try to limit laboratory testing: it can be expensive, it can turn up unanticipated abnormal values that are sometimes just a statistical fluke, and some involve at least scheduling hardship if not physical discomfort for my patients.  So I'm a little less likely to order "baseline" labs until I know what I'm going to use them for, compared to some of my colleagues, I think. But other doctors, particularly in busy clinics were they can't think through the details every time, might order a whole panel of baseline tests for everyone.  That is not outside standard of care either.

Finally, there are other needles (in haystacks) out there that a few doctors might think are worth checking at the outset: vitamin D, B12, calcium, (all of these are blood tests).  That is not an official list.  Oh, and some doctors might even want a urine sample, and in which to look for marijuana and other substances of abuse. I think talking to patients is a better way to get that information, but I will miss substance use problems in some people here and there (on the other hand, it does not subject people to the indignity of a urine drug screen either; a trade-off).

Thanks for your question.

Dr. Phelps

Published October, 2009


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