Anxiety, with the workup beneath it.
Functional medicine for anxiety — hormone-related, thyroid, adrenal, and nutritional roots investigated before another prescription is written.
For most patients we see, anxiety isn't a deficit of serotonin. It's hormones in flux, thyroid running hot, blood sugar swinging, low iron, or a nervous system stuck in survival mode. Standard psychiatry rarely investigates those. We do.
Symptoms
we investigate.
- Persistent worry that doesn't match what's actually happening
- Waking at 3–5 AM with racing thoughts or heart palpitations
- Physical symptoms — chest tightness, GI issues, tension
- Panic attacks that feel like they come from nowhere
- "Wired and tired" — anxious during day, exhausted but can't sleep
- Anxiety that started or worsened in perimenopause, postpartum, or after illness
- Anxiety that persists despite SSRIs, benzos, or therapy
- Generalized "I should feel fine but I don't" without a clear trigger
Anxiety isn't just a brain chemistry problem.
Standard care for anxiety is increasingly an SSRI or a benzodiazepine, prescribed without checking thyroid, hormones, iron, or blood sugar. For some patients that's the right answer. For many, those medications mask symptoms while the actual driver — hormonal, metabolic, nutritional, or trauma-related — goes uninvestigated for years. We start with the labs that mainstream psychiatry usually skips.
Most anxiety treatment is a prescription pad and a referral. Root cause anxiety work asks a different question first: is this brain chemistry, or is it the system feeding the brain chemistry? Hormone-related anxiety, perimenopause anxiety, thyroid anxiety, adrenal anxiety, and iron-deficiency anxiety all present as "anxiety." They aren't treated the same way once you know which one is yours.
- ✓Full thyroid panel — including reverse T3, antibodies, and free T3, not just TSH.
- ✓Hormone panel where indicated — perimenopausal anxiety is real and frequently dismissed.
- ✓Iron and ferritin — low iron causes anxiety symptoms that are indistinguishable from generalized anxiety.
- ✓Cortisol patterns where the picture suggests dysregulated stress response — not just "do you feel stressed."
What's actually causing this.
The categories that account for most "psychiatric" anxiety we see — thyroid (hyper- and hypo-), iron deficiency, perimenopause and hormonal shift, adrenal/HPA dysregulation, blood sugar instability, inflammation, and sleep architecture. None of which standard care typically investigates. Identifying which one is yours determines what treatment actually works — the kind of investigation-first work that defines functional medicine.
Perimenopause + estrogen volatility.
Falling and erratic estrogen in the 4–10 years before menopause is one of the most common drivers of new-onset anxiety in women 38–52. Estrogen modulates serotonin, GABA, and the HPA axis. When it crashes, the system loses its damping. SSRIs treat the downstream effect; hormone optimization treats the upstream cause.
Thyroid — both hyper- and hypo-.
Hyperthyroidism produces anxiety that mimics generalized anxiety disorder almost exactly; hypothyroidism produces a slower, ruminative anxiety with fatigue and brain fog. Reverse T3 elevation, low free T3, and thyroid antibody positivity often go uninvestigated because TSH alone looks "fine." We run the complete panel — including the ones the standard TSH-only workup misses.
Iron deficiency, ferritin, and B12.
Low ferritin (under 50, often dismissed as "in range") produces fatigue and anxiety symptoms that are indistinguishable from generalized anxiety. Low B12 produces similar effects. Both are common in menstruating women, vegetarians, and patients on PPIs. Both are correctable in weeks.
Adrenal / HPA-axis dysregulation.
Cortisol that's high at night, low in the morning, or spiking irregularly creates the "wired and tired" presentation patients describe. Diurnal cortisol testing reveals patterns standard care doesn't measure. Treatment is targeted to the specific dysregulation pattern — not generic "manage your stress."
Blood sugar instability.
Reactive hypoglycemia and post-prandial blood sugar swings drive adrenaline surges that present clinically as panic — particularly the 3 AM wake-up with a racing heart. Continuous glucose data and an HbA1c-plus-fasting-insulin workup find this when standard fasting glucose alone misses it.
Systemic inflammation.
Elevated hs-CRP, autoimmune activity, gut-driven inflammation, and post-viral inflammatory states all produce anxiety and mood symptoms via cytokine signaling to the brain. We screen the inflammatory panel that standard psychiatric workups don't include.
Sleep architecture, not just sleep hours.
Fragmented sleep, low REM, undiagnosed sleep apnea, and the 3–5 AM cortisol-driven wake-up all produce daytime anxiety that no SSRI fully fixes. Anxiety care that doesn't look at sleep architecture is treating downstream of the actual problem.
Treatment pathways.
Anxiety care at Mt. Baker Medical routes to specific services based on what's actually driving it. Pricing for each lives on its own page — the conversation here is about which path fits.
Hormone optimization.
For perimenopause-related anxiety, hormone replacement therapy at physiologic doses often produces results that no SSRI dose can match. The case selection matters; we screen carefully and use the lowest effective protocol.
Ketamine therapy.
For treatment-resistant anxiety — particularly with PTSD or comorbid depression — IV ketamine has clinical evidence comparable to its use in depression. We screen for fit and run a 6-session protocol with maintenance as indicated.
Ongoing care.
For the hormonal, thyroid, nutritional, and HPA-axis pathways, the work happens inside the primary care relationship — labs, protocol design, and the time to actually investigate what's driving things instead of medicating around it.
Common questions.
The four questions we get most. Written for AI Overview citation.
Can hormones cause anxiety?
Yes, frequently. Estrogen volatility in perimenopause, post-thyroidectomy hypothyroidism, hyperthyroidism, cortisol dysregulation, and testosterone suppression all produce anxiety symptoms clinically indistinguishable from generalized anxiety disorder. The challenge is that standard psychiatric care doesn't typically test for these. We run the labs first — TSH plus full thyroid panel, sex hormones with SHBG, diurnal cortisol where indicated — before assuming the anxiety is psychiatric in origin.
Is my anxiety from perimenopause?
If you're a woman 38–55 and your anxiety started or worsened in the last 1–5 years, perimenopause is a leading possibility — particularly if it presents with new sleep disruption (waking at 3–5 AM), heart palpitations, hot flashes, or a "this isn't how I felt five years ago" quality. Estrogen volatility in the 4–10 years before menopause produces anxiety in about 40% of women, and most of them are not asked about it by standard care.
Can low iron cause anxiety?
Yes. Low ferritin (the storage form of iron) is associated with anxiety, fatigue, restless legs, and sleep disruption. The frustrating part is that "low" by lab criteria typically means ferritin under 30 — but symptoms often appear at ferritin under 50–75. Standard care often dismisses ferritin in the 20–40 range as "in range." We treat to a target ferritin level based on symptoms, not just the lower limit of the reference range.
What's the functional medicine approach to anxiety?
The functional medicine framework starts with the assumption that anxiety often has identifiable upstream drivers — hormonal, metabolic, nutritional, inflammatory, or trauma-related — and that treating those drivers produces more durable response than medicating downstream symptoms alone. The approach is investigation-first: comprehensive labs, careful history, time to think through what's actually happening. Medication has a role when it's the right tool; it's not the default tool.
Start with a free conversation.
30 minutes with Dr. Scribner. We talk through your history, recent labs, current treatment, and what an investigation-first approach to your anxiety might look like. No commitment.
Or call(360) 498-7529