Why I Ask My Therapy Clients About Their Bloodwork
A man comes to see me for depression. Therapy is helping, but only a bit. He tells me he gets enough sleep, but he still wakes up exhausted. He works hard despite feeling foggy, flat, and dragging himself through the day. He starts to wonder whether something is wrong with him, and whether therapy can actually help. So I ask a question you would not expect from a psychologist: “When was your last physical, and what did the labs show?”
Most of my field describes itself as biopsychosocial. In practice, many of us focus on the psychological and the social and quietly dismiss the bio. I try not to. The brain is an organ, one of the most metabolically active, and it depends on the same systems as everything else in your body: hormones, blood sugar, nutrients, immune function, etc.
There is a growing conversation in mental health about metabolism as a driver of mental illness, and while the evidence is still coming in, we can already say with confidence that bodies and minds are intimately connected.
Here is what an ordinary blood panel can tell us. An underactive thyroid can look exactly like depression: fatigue, low mood, slowed thinking. An overactive one can look like anxiety or panic. Blood sugar matters too. A 2021 study in the American Journal of Psychiatry found that insulin resistance roughly doubled the odds of developing major depression years later, and the atypical pattern of depression it comes with (more sleep, more appetite, less energy) is one I see in my office regularly. Inflammation is part of the picture as well. Roughly a quarter of people with depression show elevated inflammatory markers, and research suggests those are often the people who respond poorly to a first antidepressant. Low iron produces the fatigue and brain fog that get mistaken for depression, especially in women. Low vitamin D or B12 are also worth checking.
None of these findings mean depression is entirely biological. But they could be the missing piece of the puzzle that explains what you are going through.
As a psychologist, I do not order labs, diagnose medical conditions, or tell anyone what to take. What I do is ask whether these things have been checked. When a client brings in bloodwork, I read it alongside their physician's interpretation and bring it into how we understand what is happening. When something looks worth a medical conversation, I say so and refer. The man I described earlier had a thyroid issue that was contributing to his depression. His physician treated it, and then therapy finally had room to work.
If you have been in therapy that helps but eventually stops working, it may be worth looking at the whole picture. So bring your labs to session; let’s review them together.
