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Why It Is Important To Be Cleared Medically Before Seeking Anxiety Treatment

We Must Rule Out Medical Causes Of Symptoms

We always recommend that our patients be seen by a primary care doctor and be cleared medically prior to seeking psychiatric treatment to rule out any non-psychiatric causes of their symptoms.

It is imperative to be medically cleared before seeking treatment for anxiety, as research has demonstrated that up to half of individuals experiencing mental health issues have underlying medical conditions that may be causing or exacerbating their psychiatric state. Examples of such conditions include hyperthyroidism, hypoglycemia, calcium and magnesium deficiencies, allergies to particular food additives, and more.


Schedule  A Thorough Physical Exam

In order to rule out any medical conditions, it is recommended to have a complete physical examination and blood tests before attempting to tackle the issue with cognitive behavioral interventions. Although the above medical conditions may contribute to anxiety or panic in only a small number of cases, it is important to always rule out these potential causes. However, oftentimes, when these conditions are remedied the anxiety is no longer a concern.


Conditions Which Might Be A Cause Of Psychiatric Symptoms

Other conditions that might be a cause of panic attacks or generalized anxiety include

Hyperventilation syndrome, which is rapid shallow breathing at the level of your chest. This can sometimes lead to excessive lowering of carbon dioxide in your bloodstream, and can produce lightheadedness and dizziness feelings, shortness of breath, trembling and/ or tingling in your hands feet or lips. These symptoms, in turn, may be perceived as dangerous and may stimulate a bona fide panic attack.

Hypoglycemia can cause blood sugar levels to fall too low causing people to experience a variety of symptoms. The symptoms can include anxiety, shakiness, weakness, dizziness and disorientation can be similar to a panic reaction. Hypoglycemia can cause panic attacks or more often, result in an aggravation of panic reactions.

Hyperthyroidism and the excessive secretion of the thyroid hormone can lead to rapid heartbeat (heart palpitations) sweating and generalized anxiety.  

Mitral valve prolapse is typically a harmless condition that results in heart palpitations. Caused by a slight defect in the valve separating the upper and lower chambers on the left side of your heart. It results in a heart rhythm disturbance that can be disconcerting enough to cause some people to panic, However, it is not dangerous and is not a cause of heart attacks. For reasons that are unclear, mitral valve prolapse occurs more frequently in people with panic disorder than in the population at large

Premenstrual syndrome (PMS) has been known to cause anxiety and panic reactions. So, it is important for women to observe whether their panic reactions or generalized anxiety is worse around the time just before their period. If so, treating your PMS may be sufficient to alleviate your symptoms of anxiety or panic. Treatment usually involves improvements in diet and exercise, taking supplements such as vitamin B6, and in some cases taking oral progesterone.

Consult With Your Doctor Before Addressing These On Your Own

It is recommended that you consult with your primary care physician instead of attempting to address these issues on your own, as any changes should be considered in the context of your overall physical and mental health treatment plan. This is important to ensure that you receive safe and effective care and treatment.

Inner ear disturbances can result in panic attacks for a small portion of the population. This is usually associated with a disturbance in balance caused by swelling of the inner ear due to infection, allergy, Meniere’s syndrome or other problems.  If dizziness, lightheadedness, or unsteadiness are a prominent part of your anxiety and panic, you may want to consult with an Otolaryngologist, a medical specialist who treats conditions related to the ear, nose, and throat.

Other medical conditions which can cause anxiety or panic include:

  • Withdrawal from alcohol, sedatives, or tranquilizers
  • Parathyroid disease
  • Complex partial seizures
  • Primary or Essential hypertension
  • Deficiencies of magnesium, calcium, niacin, potassium, or vitamin B12
  • Post-concussion syndrome
  • Acute reaction to cocaine, amphetamines, caffeine, Aspartame or other stimulants
  • Congestive heart failure
  • Cardiac arrhythmias
  • Emphysema
  • Pulmonary Embolism
  • Cushing syndrome
  • Environmental toxins such as food additives, pesticides, carbon dioxide, mercury, and carbon hydrocarbons

In summary, it is essential to be cleared medically and have your doctor give you a thorough physical examination including blood tests before attempting behavioral or psychological strategies. It is important to rule out and address any medical conditions that could be causing or aggravating your anxiety, panic, or other psychiatric symptoms.

Once cleared you are ready for treatment. Schedule a free consultation to see if therapy with us is right for you.



Bourne, E. J. (2000). The anxiety & phobia workbook (3rd ed.). New Harbinger Publications.

Hall RC, Gardner ER, Stickney SK, LeCann AF, Popkin MK. Physical illness manifesting as psychiatric disease. II. Analysis of a state hospital inpatient population. Arch Gen Psychiatry 1980;37(9):989–95. [PubMed] []