If you’ve ever been told “it’s just anxiety” — but something inside you knew it was more — you were probably right.
At Fishtown Medicine, we take a step back and ask:
What else could be driving this?
Because anxiety is real — but it’s not always the root cause. Sometimes it’s a signal from deeper systems that need attention.
🧠 Symptoms that look like anxiety, but aren’t always:
Racing heart
Chest tightness
Shakiness or dizziness
Brain fog
Irritability or overwhelm
Trouble falling or staying asleep
Morning dread or mid-day crashes
These can be caused by emotional stress — or by hormones, blood sugar swings, nutrient imbalances, or nervous system dysregulation.
🧪 What we look for beyond mood:
1. Thyroid health
Overactive thyroid (hyperthyroidism or Hashimoto’s flares) can mimic anxiety
Underactive thyroid can create fatigue-driven anxiety or looping thoughts
We check:
TSH, Free T4, Free T3, Reverse T3, and thyroid antibodies
2. Blood sugar and insulin resistance
Crashes in blood sugar (reactive hypoglycemia) can cause panic-like symptoms
Rising insulin levels over time can lead to inflammation, irritability, fatigue
We check:
Fasting insulin, HOMA-IR, glucose curves, A1C, and nutrient response
3. Cortisol and circadian rhythm
High evening cortisol = wired but tired
Flat morning cortisol = dread, overwhelm, no get-up-and-go
Dysregulated rhythm often gets labeled as "generalized anxiety" — when it's hormonal
We may check:
AM cortisol, salivary panels, or symptoms over 24 hours
4. Perimenopause, PCOS, and low testosterone
Estrogen and progesterone imbalances can cause heart racing, insomnia, and mood swings
Low testosterone (in men or women) can present as anxiety, low motivation, or sensory overload
PCOS patients may experience cycles of anxious energy → crash
5. Nutrient deficiencies
Low B12, magnesium, iron, and omega-3s can affect mood and focus
MTHFR-related methylation issues can cause anxiety in response to stress or histamine
🩺 Our approach:
Validate your experience — anxiety is real, whether or not it’s the root
Zoom out before labeling — we don’t treat labs in isolation, and we don’t treat emotions as pathology
Layer in lifestyle, nervous system regulation, nutrition, and clinical testing
Only introduce meds or supplements when the system as a whole makes sense
We believe anxiety is not a diagnosis — it’s a signal. Our job is to decode it.
💡 Bottom line:
Anxiety isn’t always in your head.
Sometimes it’s in your thyroid, your gut, your glucose, or your trauma history.
We look at all of it — not to overcomplicate your care, but to get it right.