How to know when anxiety, depression and fatigue are symptoms of physical conditions

I’ve had three children since I launched Parsley Health, a holistic medical practice designed to support the complex health needs of women and families. And whenever I trade stories of raising all my “babies” side by side with other moms, a phrase we often come back to is “it’s a lot.” 

While juggling the responsibilities of school, work, parenthood and life, we often feel fatigued, anxious, foggy or a little down. And it would be convenient to dismiss these feelings as merely the expected side effects of motherhood. 

But as a doctor, I know that’s not true. 

Often, anxiety, depression, fatigue and burnout are symptoms of chronic illnesses that have been misdiagnosed or simply missed by doctors who have not looked closely enough. These are warning signs, your body ringing the alarm bell that something is going on—and if there’s one thing that you need to know, it’s that it’s not all in your head. 

Feeling bad isn’t normal

As women and mothers, we’re too often dismissed when we seek help. Take Sam, a mother of two, who constantly heard from her physicians that her symptoms were “all in her head.” Sam experienced constant fatigue, weight gain, brain fog, and bouts of extreme sadness and depression. 

The last straw was when one of her physicians told her that maybe she was just getting old. At 47, Sam refused to believe it. She knew she had undergone some major stressors—on top of the demands of motherhood—but her intuition kept telling her the doctors were wrong. Feeling this bad couldn’t be normal.  

When Sam came to me at Parsley, I disagreed with her previous doctors. What she was experiencing wasn’t “normal”—not at 47, not at any age. 

It’s crushing at the personal level when doctors brush off symptoms like depression, fatigue and weight gain as something that “just comes with being a mom.” But it also reflects a bigger issue in our culture: 55% of women report feeling dismissed or ignored by their doctor. 

Meghan O’Rourke, the bestselling author of The Invisible Kingdom: Reimagining Chronic Illness, recently mentioned on a panel that when conducting interviews for her book, 90 out of 100 women she spoke with were told they were hypochondriacs—only to be later diagnosed with autoimmune conditions. 

In many cases, physical culprits—ranging from blood sugar disorders and nutrient deficiencies to thyroid imbalances and food allergies—could actually be masquerading as mental health symptoms.

When we understand our health holistically, we unlock new secrets. Looking closer at what is going on within the body, through advanced testing, and looking closer with what is going on in your life via extended one-on-one time with a doctor and health coach is essential to getting to the root cause of health concerns, and resolving them.

Related: Autoimmune disease occurs in way more women than men. Here’s why

Our healthcare system regularly fails women

Unfortunately, our current healthcare system is one that too often cuts visits so short that basic, routine, and preventative tests are barely mentioned—let alone ordered. Our system fails to think outside the prescription-sized box. And when women’s health is corralled into a narrow box of “reproductive health,” it prevents physicians from understanding women as more than our reproductive organs.

Particularly when we become mothers, it can be hard to be seen as a whole human with complex health needs.

Fortunately, Sam’s story doesn’t end with a missed diagnosis. Rather, when Sam came to me, I did what we do at Parsley: ordered essential diagnostic tests to check for one of the many chronic conditions I suspected Sam may have. It turns out, none of the many doctors who dismissed Sam had ever run these tests. 

When the results came back, we learned that Sam had an autoimmune condition called Hashimoto’s thyroiditis. She was not just stressed, not just tired, not just worn out from being a mom; she was one of the 6 in 10 Americans living with a chronic condition. 

We prescribed Sam medication to manage her Hashimoto’s, as well as a prescription to avoid wheat (which can cause flare-ups) and supported her in making other simple changes to her lifestyle and physical health—which in turn, would support her mental health, too. By the end of her first year of care, Sam’s energy had rebounded, her mood had stabilized and she felt better in her body. 

Related: No, your OB-GYN should not be your primary care provider

Start with self-advocacy

Diagnostic tests, like the thyroid panel we ordered for Sam, can catch chronic conditions before symptoms even start to show. Currently, these tests aren’t standard practice for conventional doctors because the time and resources available to them don’t allow for it. 

Which means that the best way to ensure you’re properly tested is to advocate for yourself at the doctor’s. Below, you’ll find a diagnostic test “cheat sheet” listing the tests you need (all covered by basic insurance) that you can bring with you to your next appointment.

And once you’ve eliminated the possibility that a hidden condition might be sabotaging your best efforts to feel good, it’s an amazing opportunity to look closer at how you’re empowered in your everyday life to boost your mental health.

The truth is, 98% of your health happens outside the doctor’s office. When you begin to shift how you spend your time, you can shift how you feel, too. Look at what you eat (food isn’t like medicine—it is medicine), how you move, how long you sleep and your relationship with screens and technology. Check out the chart below for a deeper look at the steps you can take to ensure your physical and mental health on an everyday basis.

As women and mothers, we’re told to put our own oxygen masks on first, but in practice, it can feel like… it’s a lot. But something I share with my patients often is that it is necessary to advocate for yourself and trust your intuition—and know that the only way you can show up for your family, colleagues and friends, is to first show up for yourself. 

This starts by knowing that your symptoms are not all in your head. They can be caused by things going on in your body, too. Take action with the steps below, and if you’re curious about the potential links between your mental health symptoms and what’s going on in your body, take Parsley’s free quiz to analyze your symptoms.

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