Is a Hidden Medical Condition Causing Your Anxiety?

Contributor: Robert Cain, MD

When anxiety surfaces for the first time in adulthood, an underlying medical problem may be the cause. A visit with your doctor to explore this possibility can help to uncover the reason for your newly anxious feelings.

Anxiety: A widespread problem

Anxiety disorders are the most common psychiatric problem, affecting over 20 million U.S. adults and children every year.

Because the physical symptoms often overshadow the psychological, and because medical conditions and anxiety often coexist, establishing a diagnosis can be difficult.

Your doctor may suspect an underlying medical condition if your exam and history reveal clues such as:

• You haven’t suffered from anxiety in the past
• No one in your family has had an anxiety/other mood disorder
• You’ve experienced no recent major life changes
• The anxiety came on recently and rapidly, versus gradually
• You seem less alert
• Your symptoms fluctuate a lot
• You’ve experienced disorientation or memory loss
• You’ve recently changed medications
• Your physical exam or vital signs are suddenly abnormal
• You can’t provide a clear history of your condition
• Anxiety surfaces later in life (anxiety disorders usually begin in childhood or early adulthood)
• You have multiple medical conditions

Possible medical reasons for anxiety

A useful mnemonic device, “THINC MED,” developed by Georgetown University psychiatrist Robert Hedeya, MD, helps doctors determine potential medical causes of anxiety:

T (tumors): Brain tumors cause a wide range of psychological symptoms, including anxiety, personality changes and hallucinations, along with physical symptoms. Adrenal gland tumors (pheochromocytomas) produce excess adrenaline, which can trigger anxiety, along with headache.

H (hormones): Thyroid problems are among the most common medical causes of anxiety, either because the gland is overactive (hyperthyroidism) or underactive (hypothyroidism). Parathyroid and adrenal gland conditions can trigger anxiety, too. (Other symptoms: restlessness, sleep problems, tremors, heat intolerance and weight loss.) The female hormone estrogen can also prompt anxiety when the menstrual cycle fluctuates and during menopause.

I (infectious diseases): Lyme disease from tick bite infections can trigger anxiety and other psychological symptoms. Untreated Strep infections can cause the neurological tics sometimes seen with anxiety disorders. Guillain-Barre syndrome, a rare neurological disorder that can follow a viral infection, may trigger anxiety as well (along with progressive weakness, difficulty breathing and altered sensation).

N (nutrition): The symptoms of vitamin deficiency/overload, malabsorption and poor nutrition can mimic emotional disorders. For example, anxiety may be the first symptom of B12 deficiency. (Gastric bypass surgery and disorders of gut absorption increase this risk.)

C (central nervous system): Head trauma, even when mild, can trigger anxiety and other psychological symptoms. Anxiety is also seen with chronic or progressive neurological conditions, such as Alzheimer’s, myasthenia gravis and Guillain-Barre.

M (miscellaneous): Any chronic disease or chronic pain condition can elicit anxiety as the illness progresses and impairs function. Unusual conditions, such as Wilson’s disease (a genetic disorder of copper metabolism) and porphyria (a disorder of blood metabolism), can cause anxiety and other psychological symptoms. Anxiety is also associated with food allergies; rheumatologic disorders like lupus; other connective tissue and inflammatory conditions; and fibromyalgia.

E (electrolyte abnormalities and environmental toxins): Many medical therapies can disturb your electrolytes, leading to anxiety. Anxiety and restlessness can also develop after long-term exposure to organophosphate insecticides.

D (drugs): Many over-the-counter and prescription drugs, herbal supplements, homeopathic remedies and food additives (particularly MSG) can cause anxiety. Excess caffeine can make many adults and children anxious — so be wary of “energy drinks” and “boosters.” Misuse of/withdrawal from alcohol and cocaine or other stimulants can provoke anxiety as well.

The bottom line

Because anxiety is linked to so many medical conditions, it’s important to have your primary care doctor evaluate it when it’s a new symptom for you.

It’s also worth a visit to your doctor if you have been diagnosed with an anxiety disorder but suspect an underlying medical cause.

Your doctor will work in partnership with you to uncover the cause and, ultimately, arrive at the best treatment for you.