Why We Check Your Labs: Blood Work and Mental Health

If you've recently started care with us, you may have noticed that we ordered blood work as part of your initial evaluation. Some patients are surprised by this—after all, you came in for help with anxiety or depression, not a physical health concern. So why are we checking your thyroid, vitamin levels, and other labs?

The answer is simple: your brain is part of your body, and what's happening physically can have profound effects on your mental health. Before we attribute all of your symptoms to a psychiatric condition, we want to make sure we're not missing something medical that could be contributing to how you're feeling.

The Mind-Body Connection Is Real

Mental health doesn't exist in a vacuum. Your mood, energy, focus, and emotional regulation are all influenced by physical factors including hormone levels, nutritional status, inflammation, and organ function. Sometimes what looks like depression or anxiety is actually—or is partly—a medical issue that needs to be addressed.

We've seen patients whose "treatment-resistant depression" resolved after correcting a thyroid problem, or whose severe anxiety improved dramatically after addressing a vitamin B12 deficiency. Getting the full picture through lab work helps us treat you more effectively and avoid unnecessary medications.

What We're Looking For

Here are the most common labs we order and why they matter for mental health:

Thyroid Function (TSH, Free T4, sometimes T3)

Your thyroid is the master regulator of metabolism and energy. Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can cause psychiatric symptoms.

Hypothyroidism can mimic: Depression, fatigue, brain fog, weight gain, low motivation

Hyperthyroidism can mimic: Anxiety, panic attacks, irritability, insomnia, racing thoughts

Even subtle thyroid dysfunction can affect mood and cognition. We want to catch this early because thyroid treatment can make a dramatic difference in how you feel.

Complete Blood Count (CBC)

This basic test looks at your red blood cells, white blood cells, and platelets.

What it reveals: Anemia (low red blood cells) is a common cause of fatigue, difficulty concentrating, and low mood. It can be caused by iron deficiency, B12/folate deficiency, or other conditions. Abnormal white blood cell counts might suggest infection or inflammation affecting your energy and mood.

Comprehensive Metabolic Panel (CMP)

This checks your kidney and liver function, electrolytes, blood sugar, and more.

What it reveals: Kidney or liver problems can affect medication processing and cause fatigue. Blood sugar issues can contribute to mood swings, anxiety, and energy crashes. Electrolyte imbalances can affect cognition and mood.

Vitamin D

Low vitamin D is incredibly common and associated with depression, seasonal affective disorder, and fatigue.

What it reveals: Many people are deficient, especially those who live in northern climates, have darker skin, or spend most of their time indoors. Supplementation is simple and can significantly improve mood in deficient individuals.

Vitamin B12 and Folate

These vitamins are essential for nervous system function and neurotransmitter production.

What it reveals: Deficiencies can cause depression, anxiety, cognitive impairment, and fatigue. B12 deficiency is especially common in vegetarians/vegans, older adults, and people taking certain medications like metformin or PPIs.

Lipid Panel (Cholesterol)

We check this for general health, but also because some psychiatric medications can affect cholesterol levels. Establishing a baseline helps us monitor your health over time.

Hemoglobin A1C (Blood Sugar Control)

This shows your average blood sugar over the past three months.

What it reveals: Diabetes and pre-diabetes are common and can affect mood, energy, and cognitive function. Some psychiatric medications also affect blood sugar, so knowing your baseline is important.

Medication Monitoring Labs

If you're taking psychiatric medications, we'll periodically recheck certain labs to ensure your medications are safe and working properly:

• Lithium: Requires regular monitoring of lithium levels, kidney function, and thyroid function

• Valproate/Depakote: Needs liver function tests and sometimes ammonia levels

• Antipsychotics: We monitor metabolic markers including weight, blood sugar, cholesterol, and sometimes prolactin levels

• Stimulants: May warrant cardiovascular monitoring in some patients

When Should You Get Labs Done?

Initial evaluation: We typically order baseline labs when you first start care to rule out medical causes of psychiatric symptoms.

Before starting certain medications: Some medications require baseline labs to ensure they're safe for you.

Periodic monitoring: If you're on medications that affect metabolism or organ function, we'll recheck labs every 3-12 months depending on the medication and your individual situation.

When symptoms change: If you're not responding to treatment as expected or develop new symptoms, labs can help us understand why.

What If Your Labs Are Abnormal?

If we find something abnormal, we'll discuss it with you and develop a plan. Sometimes this means:

• Adjusting your psychiatric treatment based on new information

• Starting treatment for a medical condition (like thyroid medication)

• Adding supplements to address deficiencies

• Referring you to your primary care provider or a specialist for further evaluation

• Holding off on certain psychiatric medications until the medical issue is addressed

  
  

The goal isn't to medicalize everything or delay your mental health treatment unnecessarily. It's to make sure we're treating the right thing in the right way.

Making Labs Easy

We know getting blood work can be inconvenient. Here are some tips:

• Fasting: Most of our panels require 8-12 hours of fasting (water is fine). Schedule morning appointments when possible.

• Lab locations: We'll provide orders that work with most major lab companies. Choose the location most convenient for you.

• Results: We'll review your results and reach out if anything needs attention. You can also access results through your patient portal.

• Questions: If you see something on your results that concerns you, don't hesitate to reach out. We're happy to explain what everything means.

  
  

The Bottom Line

Blood work isn't about being overly cautious or running up bills. It's about practicing good medicine. Your mental health is connected to your physical health, and we want to see the whole picture before creating your treatment plan.

Think of labs as a way of advocating for yourself—making sure nothing is being missed and that you're getting the most targeted, effective treatment possible. Your wellbeing is worth the small inconvenience of a blood draw.

If you have questions about which labs we've ordered or what your results mean, please bring them to your next appointment. We're here to help you understand every aspect of your care.

This blog post is for informational purposes only and does not constitute medical advice. Lab testing should be individualized based on your specific symptoms, history, and medications.