A story we think about a lot
A new mom came to us with anxiety and insomnia she'd never had before. Her OB had tried one medication, then another. Nothing worked, and each failure made her feel more broken. At her first visit with us we did what we do with everyone: we took the full history, and we ran labs before changing anything. Her thyroid was the problem. It wasn't "true" anxiety or insomnia at all. Treat the thyroid and the symptoms follow.
She isn't rare. She's the reason this is our standard practice.
Why the body gets skipped
Psychiatric symptoms are real regardless of their cause, and in a short appointment the fastest path is to name the symptom and prescribe for it. But anxiety, low mood, brain fog, fatigue and poor sleep are also how the body signals a long list of medical problems. If nobody checks, a woman can spend years on medications for a condition she doesn't have, while the one she does have goes untreated.
Women are especially affected. Thyroid disease is far more common in women, and the postpartum year, perimenopause and heavy periods all raise the odds of exactly the deficiencies that mimic psychiatric illness.
What we commonly check
- Thyroid function. An underactive thyroid can look like depression, fatigue and brain fog. An overactive one can look like anxiety, insomnia and a racing heart. Postpartum thyroid changes are common and often missed.
- Iron and ferritin. Low iron stores, common after childbirth or with heavy periods, cause fatigue, poor concentration, low mood, restless legs and disrupted sleep.
- Vitamin D and B12. Both are linked to mood and energy, and both are frequently low.
- Blood sugar. Swings can feel like anxiety or irritability.
- Hormone levels, when relevant. Especially when symptoms track the cycle or arrive in the forties.
We don't order everything for everyone. We order what your history points to, review the results with you, and only then decide together whether medication, integrative changes, or a referral is the right next step.
What this means for you
If you've been treated for anxiety or depression and never had labs, or if the medications have never quite worked, ask for the full picture. It isn't about avoiding medication. Plenty of our patients take medication and do beautifully. It's about making sure the medication is treating the right thing.
This article is general education, not medical advice. Lab decisions should be made with your own provider based on your history.
Founder of R3 Women's Wellness. Board-certified psychiatric nurse practitioner with an integrative approach to women's mental health. Integrative psychiatry at R3