Can Physical Health Problems Mimic Anxiety or ADHD?

Feeling low, wired or unable to focus does not always start in the mind. Sometimes it starts in the thyroid, in a vitamin level, in sleep, or in a medication. A thorough psychiatric evaluation therefore looks at the body as well as the story. This guide explains what the research says, without telling you to diagnose yourself.

Why does a psychiatric evaluation ask about physical health?

The American Psychiatric Association says a mental health diagnosis typically involves a full health evaluation, which can include a physical exam and sometimes blood work or neurological tests, because some conditions mimic medical problems (APA (opens in a new tab)). The National Institute of Mental Health notes that certain medications and medical conditions, such as viruses or thyroid disorders, can cause the same symptoms as depression (NIMH (opens in a new tab)). MedlinePlus adds that medical tests may be done to rule out other conditions (MedlinePlus (opens in a new tab)).

That is one of the three lenses in Better Place Now’s approach. The “body” lens looks at sleep, lab work, nutrition, medical history and every medication already in the picture. You can read more about the framework in what integrative psychiatry is.

Thyroid problems and mood

NIMH lists hypothyroidism among the chronic diseases linked with depression. The link runs both ways, and depression together with a chronic illness tends to produce more severe symptoms of both (NIMH (opens in a new tab)). A blood test can check thyroid function, which is one reason lab work is part of a careful evaluation.

Vitamin B12 deficiency

The National Heart, Lung, and Blood Institute explains that untreated vitamin B12 deficiency can cause confusion, forgetfulness and mood changes such as depression or irritability (NHLBI (opens in a new tab)). MedlinePlus describes irritability, reduced concentration and confusion with prolonged deficiency, and psychosis in severe cases (MedlinePlus (opens in a new tab)). If you suspect a deficiency, ask for a blood test rather than guessing with supplements.

Sleep apnea, insomnia and poor sleep

A meta-analysis of 73 articles found depressive symptoms in about 35% and anxious symptoms in about 32% of people with obstructive sleep apnea. This is an association, and the authors suggest it runs both ways (Garbarino et al., 2020 (opens in a new tab)). Insomnia also matters. A meta-analysis of 13 longitudinal studies found that insomnia predicted later depression (odds ratio 2.83) and anxiety (odds ratio 3.23) (Hertenstein et al., 2019 (opens in a new tab)).

For general guidance, the CDC says adults aged 18 to 60 need seven or more hours of sleep, and that adequate sleep can reduce stress and improve mood (CDC (opens in a new tab)). If snoring, gasping at night or daytime exhaustion is part of the picture, tell your clinician. Treating sleep can change how everything else feels.

Conditions that overlap with ADHD

MedlinePlus explains that there is no single test for ADHD, and that clinicians must rule out other conditions such as anxiety or depression (MedlinePlus (opens in a new tab)). Poor sleep and anxiety can also cause trouble focusing. That is why an ADHD evaluation asks about sleep, mood, anxiety and health before settling on an answer. See ADHD evaluation by telehealth in Arizona for how it works.

What to bring to the visit

• Every medication and supplement, with doses. Include over-the-counter products.
• Recent lab results, if you have them, and the name of your primary care clinician.
• Sleep notes: bedtime, wake time, snoring, night-time waking, how rested you feel.
• Symptoms with dates, including anything that changed around the same time.
• Questions. For example, “Could anything physical be contributing to this?”

For what happens in a full first hour, see what to expect at your first psychiatry visit. If you are ready to talk it through, you can request an appointment.