Clinician handoff
Anxiety
Designed for a 60-second scan in primary care. Use this to explain why this theory fits, what would weaken it, and which tests are most worth discussing.
Why this still fits
I've been experiencing brain fog with racing heart, derealization, and anxiety symptoms for [DURATION]. My GAD-7 score is [X] and my PHQ-9 score is [Y]. Before accepting an anxiety-only diagnosis, I'd like to rule out POTS, thyroid dysfunction, and other medical mimics.
What would weaken it
- -No threat-state pattern, no rumination, and no link between stress surges and worsening cognitive symptoms.
- -The fog is clearly positional, meal-linked, hormonal, infectious, or injury-linked instead of nervous-system linked.
- -Another cause explains the body story better than anxiety once sleep, thyroid, POTS, and medication effects are compared.
Key points to communicate
- •I want to know whether this is anxiety itself, anxiety amplifying another cause, or a mislabel hiding something else.
- •Please separate panic-like symptoms from POTS, sugar crashes, stimulant effects, and sleep disruption.
- •If anxiety remains likely, I want a treatment plan that targets the cognitive symptoms too, not just reassurance.
Bring this to the visit
- •Recent GAD-7 and PHQ-9 scores
- •A one-week trigger log with sleep, caffeine, posture, meals, and derealization episodes
- •Medication, supplement, and stimulant list including inhalers and energy drinks
- •Any home orthostatic heart-rate readings if position seems to matter
Useful screening structure
- -Use GAD-7 to quantify anxiety severity rather than relying only on a verbal description
- -Add PHQ-9 because depression commonly rides along and worsens the cognitive picture
- -Check orthostatic vitals if palpitations are worse upright and calmer lying down
Tests and measurements to discuss
Orthostatic vitals / Tilt table test
What this helps clarify: Combined HR and BP measurements with position
Range context
Stable BP/HR
How to use the result
Save the result with date and symptoms from the same week.
Thyroid panel (TSH, Free T4, Free T3)
What this helps clarify: This panel helps frame whether the story fits thyroid slowdown, conversion issues, or a closer competitor cause before you default to broad lifestyle explanations.
Range context
Panel context
How to use the result
Ask which thyroid number best fits the way your fog shows up day to day.
GAD-7 (Anxiety)
What this helps clarify: Validated anxiety symptom screener used to support differential assessment in clinical context.
Range context
0-21 score bands
How to use the result
Save the result with date and symptoms from the same week.
PHQ-9
What this helps clarify: Depression screening - overlap with brain fog symptoms
Range context
Score <5
How to use the result
Save the result with date and symptoms from the same week.
ECG if palpitations are abrupt or unexplained
Organic rule-outs still worth naming
- •POTS or another orthostatic syndrome
- •Thyroid disease
- •Hypoglycemia or meal-linked glucose instability
- •Arrhythmia if the palpitations are abrupt, episodic, and not clearly thought-triggered
Questions to ask directly
- •Does this look like primary anxiety, or anxiety amplifying another cause like POTS, thyroid disease, or poor sleep?
- •Would you review my medications and stimulant load for anxiety-like side effects?
- •If anxiety is still likely, what's the first-line treatment plan and what improvement window should I use to judge it fairly?
Functional impact snapshot
- -Can you still hold a conversation, work through email, and remember basic tasks during a flare?
- -Are there position changes, meals, or caffeine use that shift the pattern more than thoughts do?
Escalate instead of self-managing if
- •Sudden-onset confusion, seizures, or focal neurologic symptoms
- •Persistent chest pain, syncope, or obvious cardiac red flags
- •Rapidly worsening function, fever with confusion, or new neurologic deficits
Peer-reviewed references