Sarah came to our practice for anxiety that was getting so intense she could barely get through a work meeting without a panic attack.
Between the heart racing, sleepless nights, jitters, and relentless self-critical thoughts, she was struggling to get through each day.
She was worried about losing her job and terrified that the anxiety would never get better. So, she decided to make an appointment and work with our team.
By the time Sarah came to us, she needed some rapid relief, and was interested in medication support but wanted to know what else she could do in terms of nutrition, gut health, sleep optimization, and mind-body practices.
She knew that meds could help but wanted to keep them to a minimum by working on a plan to work on all of those different areas.
So Here’s What We Did
The first step was a baseline set of rating scales to quantify her anxiety levels. This allows us to also track the effectiveness of treatment over time, as we do the scales before each follow-up visit.
Sarah also had an Oura ring, so we used that to track her HRV (heart rate variability, which is a marker of stress) and sleep quality and see how those changed once she started treatment.
Then, we did a comprehensive set of blood tests to ensure there weren’t any nutritional deficiencies or medical issues (for example, thyroid imbalances) that could contribute to her symptoms of anxiety.
It turned out she was pretty iron deficient, so we came up with a plan to address it with supplements and diet.
Iron deficiency is associated with depression, anxiety, and sleep issues. Iron is necessary for the production of neurotransmitters like dopamine, serotonin, and norepinephrine.
Then, we looked at medication options to provide symptomatic relief. SSRIs (selective serotonin reuptake inhibitors) are the first-line recommended medications for anxiety.
We started a low dose of an SSRI and carefully increased it to a dose that worked well for her.
Anytime we start a medication, we have an end-date in mind and continually re-evaluate the dose, side effects, and how long it’s necessary to stay on it.
Within a week, she was already feeling a lot better.
At that point, she was ready to introduce mind-body tools to regulate the nervous system.
We have a whole toolbox of options, and she responded really well to a yogic breathing practice called alternate nostril breathing.
Just a few minutes a day is shown to reduce stress and anxiety levels, and the best part is that it’s free with no side effects.
Next, we worked on nutrition, starting with a mindful eating practice. Food provides the building blocks for the body to produce the neurotransmitters required for mood, energy, and focus.
We figured out that Sarah wasn’t getting enough fiber, and that blood sugar fluctuations had a direct impact on her anxiety levels.
She also recognized how regular cardiovascular exercise had a positive impact on her mood and added it back into her routine.
Working on those aspects had a huge impact on how she felt.
Sleep is vital to treating anxiety, because poor sleep causes more anxiety, and vice versa. By addressing the iron deficiency and unhelpful behaviors that were making her sleep worse, Sarah was able to get deeper, more restful sleep. We also worked on stress dreams and nightmares that were associated with anxiety.
All along the way, we worked on cognitive tools and self-compassion practices to address the self-critical patterns that were feeding her anxiety.
We met every 2 weeks to keep up the momentum and check in on her progress. Her scores on the anxiety scale were steadily decreasing and the heart racing, jitters, and negative self-talk were becoming less intense.
By the 12-week mark, Sarah was feeling like herself again and thriving at work. We started meeting once a month after that.
Anxiety was no longer ruling her life and she felt empowered to continue using the tools we’d introduced along the way.
After a year, she tapered off the SSRI and is doing great. Now, she checks in every few months for a “tune-up.”
There’s no one-size-fits all approach to anxiety, but it’s helpful to have a process to address the different pieces of the puzzle.
If you’re struggling with anxiety, have hope that relief is available.
If you’re in California and looking for this kind of approach, schedule a call to see how we can help.
To your wellbeing,
Dr. Nishi
Nishi Bhopal MD
Founder, Pacific Integrative Psychiatry