A couple years ago, I was picking up some extra shifts at a residential school while also working full-time for my family care job. I received a call from one of the instructors. "I've got a 15 year old I'm sending to the clinic for anxiety," he said. "I think he might have an eating disorder." The student showed up shortly thereafter with his instructor who was visibly frustrated. "He's been mopey for a week now. I think he's just trying to get out of PE class. He says he doesn't feel well, and he threw up the last couple of times after eating today." I asked the youth several questions, assessing for possible depression and anxiety.
While he exhibited signs of both of these, I wanted to make sure there was nothing contributing to his depressed mood. I did a full exam and decided to order some blood work. I'm certainly glad I did. His potassium came back high, dangerously so. High postassium can be fatal. We sent him to the ER, where he was then life-flighted to Portland and diagnosed with Addison's disease, a condition in which the body does not make enough of the hormone cortisol.
Fast-forward to just a few weeks ago--a young adult, early 20's, came to me for anxiety. He was shaking and tearful, and terribly thin. He told me that recently he was seen in a mental health crisis center because his partner was concerned about his anxiety--at the crisis center, he was diagnosed with bipolar disorder. However, it just didn't add up to me. Tremors, thin, highly anxious and tearful, fast heart rate--sure, I could diagnose it as anxiety based on that, but I wanted to check his thyroid.
I'm glad I did. His levels were extremely abnormal. He ended up having an autoimmune condition called Grave's Disease, in which the body makes too much thyroid hormone. This can become quite dangerous quite quickly if left untreated.
Now rewind to sixteen years ago. I was doing hot yoga in a tiny little room with several college friends. I was sweaty and very thirsty. I had already done a run that morning, so chalked it up to over-exertion. I started to feel a little dizzy, and then, very anxious. I had to leave the room to get fresh air because I was paniky but didn't know why.
I trugged home through the Colorado snow in our high-altitude Rocky Mountain town and laid down on the floor of my college apartment. I couldn't catch my breath. Something just didn't feel right. I had tunnel vision and felt fearful. I called out to my roommate for help, directing her to call the guy I was dating at the time, a paramedic. He was on-duty just a block down the road. "Tell her to breath into a brown paper bag," he directed my roommate over the phone. "She's having a panic attack." I'd never had on of those before, but she followed his directive. A few moments later, my body became rigid. I seized and became unconscious. My roommate called the paramedic again. This time he showed up with the rest of his ambulance crew and transported me to the hospital. After 9 days inpatient, it was found that very low blood sugar and dangerously low sodium levels likely triggered my initial anixety that the paramedic had presumed was "just a panic attack". Thankfully, after a very scary time in the hospital, I recovered.
Moral of the story: sometimes, it really IS "just anxiety" or "just depression." But sometimes, anxiety or depression may merely be the symptom of something more serious.
I spend a lot of time with my patients in identifying any underlying triggers or causes of anxiety before simply starting them on a medication or supplement/herb. I often screen for nutrient deficiencies, hormonal imbalances, underlying autoimmune or other conditions, etc to rule out and/or treat other causes of anxiety. Also, I take a close look at their diet--are they becoming hypoglycemic or hyperglycemic? Are they drinking too much caffeine?
Taking a deep dive approach may mean checking thyroid, insulin, cortisol, estrogen, testosterone, white blood cell count, hemoglobin and hematocrit, electrolytes, iron, Vitamin D, B6, Alk Phos, Zinc, fasting blood sugar, gluten allergy, and other labs. Sometimes I’ll have my patients keep a sleep, food, exercise journal for a week so we can both be more aware of contributing factors.
Lastly, enough cannot be said for working with a therapist to address the root cause of your symptoms and learn how to cope in a healthy way (or make a change). Combate chronic stress, anxiety, depression, chronic pain, and insomnia with exercise--study after study shows that often, exercise is just as effective (if not more so, and without the side effects) of anti-anxiety meds, pain meds, and anti-depressants. Exercise of any kind, but especially true cardio, increases hormones called endorphins that are the body's own analgesics (pain relievers), anxiolytics (anxiety-busters), and anti-depressants. Yoga has also been found to be highly effective for anxiety, sleep, and depression.
About the author:
Havilah Brodhead, RN, MSN, Clinical Nurse Leader, Family Nurse Practitioner
Havilah lives in Bend, Oregon and owns an Integrative primary care practice for adults and children, called Hearthside Medicine Family Care. She is mother to Ruby (3) and Makaylah (4). She is passionate about equal access to healthcare for all, social justice, and equality. She loves to mountain bike, do yoga, swim, write, care for her patients, take her daughters on adventures, and spend time biking and traveling Oregon with her family.
