ct-scans-1-1526905-639x427Just as some medical doctors aren’t in tune with the importance of recommending psychotherapeutic evaluations, some psychotherapists aren’t aware of the importance of recommending medical evaluations.

Sadly, I would say this is often the case. Illnesses that should be treated medically can sometimes masquerade as emotional problems.

For example, a condition such as mitral- valve prolapse (a common disorder where the valve between the heart’s heart’s left upper chamber and the left lower chamber doesn’t doesn’t close properly) can cause symptoms of anxiety, including heart palpitations.

Hypothyroidism (an under-active thyroid gland) can cause depression and irritability, and there are numerous other medical conditions that can cause psychological symptoms. There is a link between bipolar disorder and diabetes. Is this a case of chicken or egg first? Researchers say that those with bipolar disorder are at risk of developing diabetes and other metabolic issues.  But the research isn’t complete.

Thoughtful observation has led me to feel that blood-sugar and/or insulin swings might mimic bipolar disorder and/or contribute to it. In a case I’m familiar with, once the issue of blood sugar abnormalities was addressed, it appears that bipolar symptoms dissipated.

Another area of medical importance to mental health is sleep. Sleep disorders co-occur with many mental illnesses. I do know that everyone benefits from a good night’s sleep and in some cases sleep issues can be addressed with simple changes to sleep schedule, mattress, and light.

Of course, sometimes medication is indicated. Medications themselves can cause psychological symptoms, including medications given to alleviate psychological problems.

It is important that the psychotherapist you choose to hire works well with your psychiatrist or other medical doctor, if you have one. Your psychotherapist is the caregiver who will spend the most time getting to know you. He or she will be able to advocate for you and even ask your other doctor to prescribe appropriate medications if he agrees that you need them.

For this reason, if medication is determined to be necessary, it is important that your therapist be someone with an up-to-date knowledge of medications—–he doesn’t have to be a doctor, but he should keep abreast of the latest drug therapies, something many counselors, especially those who work in addiction therapy, do.

In an ideal world, anxiety disorders would respond to deep breathing, guided visualizations, and simple behavioral modification; indeed, whenever possible, I try these methods alongside proven techniques.

I believe that prayerful meditation can offer serious benefits as well, for those who want to try it. (Obviously, this is part of my personal, heartfelt beliefs.)

But anxiety, depression, and other disorders can cause such extreme suffering that almost every minute of a person’s life can seem unbearable. Sometimes, treating and relieving the symptoms medically is the first step. Then therapy can begin. In psychotherapy, the judicious use of medication can help a patient who is comfortable with the idea of taking medication, make gains so that he or she is not distracted by painful symptoms.

I recommend that all evaluations that lead to diagnoses of mental illness be coupled with a complete medical exam, which also covers diet, sleep, and so on.

Based on a subchapter in our guide to therapy, including excerpts from Therapy Revolution: Find Help, Get Better, and Move On


Richard Zwolinski, LMHC, CASAC & C.R. Zwolinski

Richard Zwolinski, LMHC, CASAC is the author of Therapy Revolution: Find Help, Get Better, and Move On Without Wasting Time or Money and is licensed in addiction and psychotherapy with over 25 years experience as well as a consultant to organizations and companies in the fields of mental health and addiction. He is the executive director of an outpatient behavioral health program. Learn more about Richard here.

No comments yet... View Comments / Leave a Comment



APA Reference
& C.R. Zwolinski, R. (2015). . Psych Central. Retrieved on September 22, 2020, from


Last updated: 13 Aug 2015
Statement of review: Psych Central does not review the content that appears in our blog network ( prior to publication. All opinions expressed herein are exclusively those of the author alone, and do not reflect the views of the editorial staff or management of Psych Central. Published on All rights reserved.