Personalized Care for Anxiety, Depression, Chronic Stress, Sleep Disturbances, Brain Fog & Hormone-Related Mood Changes

By Dr. Evelyn Le Ellis, ND, MPH, FAIHM | Prolific Well Integrative Medicine

Your mental health influences how you think, feel, sleep, connect with others, and navigate everyday life.

When your mood, concentration, or sleep begins to change, it can affect nearly every part of your day.

Perhaps you feel anxious without understanding why. You may be experiencing persistent low mood, difficulty concentrating, emotional changes before your period, or brain fog during perimenopause. Maybe you are sleeping eight hours but still waking up exhausted.

These symptoms are real, and they deserve a thoughtful evaluation.

At Prolific Well Integrative Medicine in Olympia, Washington, I provide individualized integrative mental health care for adults experiencing anxiety, depression, chronic stress, sleep disturbances, brain fog, and hormone-related mood concerns.

My approach considers mental health symptoms alongside physical health, hormonal transitions, nutrition, medications, sleep, and lifestyle.

The goal is not to assume every symptom comes from a hormone imbalance or nutritional deficiency. It is to understand what may be contributing to your experience and develop an appropriate, evidence-informed treatment plan.

Schedule a Mental Health & Wellness Consultation

What Is Integrative Mental Health Care?

Integrative mental health care combines established medical and mental health treatments with attention to nutrition, physical activity, sleep, stress management, and other factors that influence well-being.

Mental health symptoms may involve multiple interacting factors, including:

• Personal and family mental health history

• Stressful life experiences

• Sleep disorders or inadequate sleep

• Hormonal transitions

• Thyroid disease and other medical conditions

• Medication or substance effects

• Nutritional deficiencies

• Social and environmental stressors

• Chronic pain or other health conditions

Integrative care does not mean replacing psychotherapy or medication with supplements. It means considering the full clinical picture and selecting treatments according to individual needs and available evidence.

At Prolific Well, I focus on evaluating potential medical contributors, discussing appropriate treatment options, and coordinating with mental health specialists when needed.

Mental Health, Mood & Cognitive Wellness Services

1. Anxiety & Persistent Worry

Anxiety can involve more than feeling nervous.

It may affect sleep, concentration, muscle tension, digestion, and your ability to manage everyday responsibilities.

Common symptoms include:

• Excessive or difficult-to-control worry

• Feeling restless or on edge

• Irritability

• Muscle tension

• Difficulty concentrating

• Sleep disturbances

• Physical symptoms such as a racing heartbeat

What causes anxiety?

Anxiety disorders can involve genetic, psychological, environmental, and physiological factors. Certain medical conditions, medications, and substances may also produce or worsen anxiety symptoms.

A comprehensive assessment may include a symptom history, validated screening questionnaires, medication review, and evaluation for medical conditions when indicated.

Treatment options may include cognitive behavioral therapy (CBT), other evidence-based psychotherapy, prescription medication, lifestyle interventions, and coordinated care.

Nutrition, movement, and stress-management strategies can support treatment but should not automatically replace established therapies.

2. Depression, Low Mood & Emotional Well-Being

Depression is more than an occasional difficult day.

Symptoms may include:

• Persistent sadness or low mood

• Loss of interest or pleasure

• Low motivation

• Changes in sleep or appetite

• Fatigue

• Difficulty concentrating

• Feelings of hopelessness or worthlessness

Depression can affect people of any age and may occur alongside anxiety, chronic medical conditions, or hormonal transitions.

Can physical health conditions contribute to depression?

Yes. Thyroid disorders, certain medications, sleep problems, and other medical conditions may contribute to depressive symptoms or produce overlapping complaints.

However, depression should not automatically be attributed to a hormone imbalance, vitamin deficiency, or inflammation.

At Prolific Well, evaluation includes symptom severity, duration, functional impact, safety assessment, medical history, and current treatment.

Depending on your needs, treatment may involve psychotherapy referral, medication management within my clinical scope, lifestyle support, and collaboration with psychiatry or other clinicians.

Patients with severe depression, bipolar disorder, psychosis, or complex psychiatric needs may require specialist-led care.

3. Chronic Stress & Nervous System Health

Stress is a normal physiological response to challenges.

However, prolonged stress can affect sleep, attention, mood, blood pressure, and health behaviors.

Common concerns include:

• Feeling overwhelmed

• Difficulty relaxing

• Irritability

• Trouble falling or staying asleep

• Difficulty concentrating

• Muscle tension

• Changes in appetite

• Feeling emotionally exhausted

Can chronic stress affect your hormones?

Stress activates interconnected neurological and hormonal systems, including the hypothalamic-pituitary-adrenal (HPA) axis.

Cortisol is one component of this response, but a single cortisol result cannot diagnose chronic stress or explain every stress-related symptom.

I do not routinely recommend broad cortisol testing simply because someone feels stressed or exhausted.

Instead, we assess sleep, medical conditions, stressors, mental health symptoms, and daily routines to identify meaningful opportunities for improvement.

Support may include stress-management skills, physical activity, sleep interventions, psychotherapy, and treatment of associated medical or psychiatric conditions.

4. Sleep Disturbances & Insomnia

Sleep plays an important role in emotional regulation, memory, concentration, and metabolic health.

Poor sleep can worsen anxiety, depression, fatigue, and cognitive symptoms.

Sleep concerns may include:

• Difficulty falling asleep

• Waking frequently during the night

• Early morning awakening

• Nonrestorative sleep

• Irregular sleep schedules

• Daytime fatigue or sleepiness

Why am I tired even after sleeping eight hours?

Sleep duration is only one part of sleep health.

Sleep quality, sleep apnea, insomnia, medication effects, depression, and other medical conditions may influence how rested you feel.

Evaluation may include reviewing sleep habits, snoring, breathing symptoms, medications, and mental health concerns.

For chronic insomnia, cognitive behavioral therapy for insomnia (CBT-I) is a recommended first-line treatment.

Sleep hygiene can help establish healthy routines, but it is often insufficient as the only treatment for persistent insomnia.

Medication may be appropriate in selected circumstances after considering benefits and risks.

5. Brain Fog, Memory & Concentration Concerns

Brain fog is a common term used to describe difficulties with mental clarity, attention, processing speed, or memory.

People may describe:

• Forgetting words or appointments

• Difficulty focusing

• Slower thinking

• Trouble completing tasks

• Feeling mentally exhausted

• Difficulty organizing information

What causes brain fog?

Brain fog is a symptom description, not a specific medical diagnosis.

Potential contributors include:

• Inadequate sleep or sleep apnea

• Anxiety or depression

• Medication effects

• Menopause-related symptoms

• Thyroid disorders

• Vitamin B12 deficiency

• Other neurological or medical conditions

A clinical evaluation considers when symptoms began, whether they are progressing, associated symptoms, medications, and functional changes.

Depending on the findings, appropriate laboratory testing, cognitive screening, sleep evaluation, or neurological referral may be recommended.

Persistent or progressive memory loss should not automatically be attributed to stress, aging, or hormones.

Sudden confusion, difficulty speaking, facial drooping, or one-sided weakness requires emergency medical evaluation.

6. Perimenopause, Menopause & Mood Changes

Hormonal transitions can affect mood and sleep.

During perimenopause, fluctuating ovarian hormone activity may occur alongside irregular menstrual cycles, hot flashes, night sweats, and sleep disturbances.

Some women experience:

• Increased irritability

• Anxiety symptoms

• Depressive symptoms

• Sleep disruption

• Difficulty concentrating

• Reduced stress tolerance

• Changes in emotional well-being

Can perimenopause cause anxiety or depression?

Perimenopause is associated with increased vulnerability to depressive symptoms in some women, particularly those with a previous history of depression or significant sleep disturbances.

Hormonal fluctuations may contribute, but they are not the only possible cause.

Treatment depends on the symptoms and diagnosis.

Options may include psychotherapy, antidepressant medication, sleep treatment, management of vasomotor symptoms, and menopausal hormone therapy when appropriate for specific indications.

Hormone therapy should not be presented as a universal treatment for depression or anxiety.

My approach is to consider hormonal transitions without overlooking established mental health conditions or other medical contributors.

7. PMS, PMDD & Premenstrual Mood Symptoms

Some women notice predictable mood changes before menstruation.

Premenstrual syndrome (PMS) may involve:

• Irritability

• Mood changes

• Fatigue

• Sleep disturbances

• Food cravings

• Breast tenderness

• Bloating

Premenstrual dysphoric disorder (PMDD) is a more severe condition involving significant mood symptoms and functional impairment.

How do I know if I have PMDD?

PMDD typically involves symptoms that occur during the late luteal phase, improve shortly after menstruation begins, and are minimal or absent after menstruation.

Prospective daily symptom tracking across at least two menstrual cycles is recommended to confirm the pattern.

Treatment may include selective serotonin reuptake inhibitors (SSRIs), certain hormonal contraceptives, CBT, and other individualized interventions.

Severe premenstrual mood symptoms deserve appropriate evaluation rather than being dismissed as normal hormonal changes.

8. Nutrition & Mental Health

Nutrition supports brain function and overall health.

Adequate intake of essential nutrients is important for normal neurological and physiological processes.

Potential nutritional considerations include:

• Adequate energy intake

• Protein and essential amino acids

• Vitamin B12

• Folate

• Iron when deficiency is present

• Omega-3 fatty acids

• Dietary fiber

• Overall dietary quality

Can nutrition improve depression or anxiety?

Dietary quality is associated with mental health outcomes, and some dietary interventions may offer benefits as part of comprehensive care.

However, nutrition alone is not a reliable substitute for evidence-based treatment of a diagnosed mental health disorder.

Testing for nutritional deficiencies may be appropriate when supported by symptoms, medical history, dietary patterns, or other findings.

I do not recommend large supplement protocols without a clear indication, particularly when products may interact with psychiatric medications.

9. Medication & Supplement Evaluation

Medication review is an important part of integrative mental health care.

Some medications and supplements can affect:

• Sleep

• Mood

• Anxiety

• Attention

• Energy

• Appetite

• Cognitive function

At Prolific Well, I review current prescriptions, over-the-counter medications, supplements, and relevant substance use.

This may help identify adverse effects, interactions, or opportunities to improve treatment.

Should I stop antidepressants if I want a more natural approach?

No medication should be stopped abruptly without guidance from the prescribing clinician.

Some antidepressants can cause discontinuation symptoms, and stopping treatment may increase the risk of relapse.

When medication adjustments are appropriate, they should be individualized and medically supervised.

10. Integrative Mental Health Support & Coordinated Care

Mental health care often works best when clinicians collaborate.

Depending on your needs, I may recommend or coordinate care with:

• Licensed mental health counselors

• Psychologists

• Psychiatrists

• Sleep medicine specialists

• Neurologists

• Other appropriate healthcare professionals

My role includes identifying relevant medical contributors, supporting general health, discussing treatment options within my scope, and helping patients access appropriate specialty services.

Prolific Well is not an emergency psychiatric service or a replacement for specialist treatment of severe psychiatric illness.

What Tests May Be Appropriate for Mood, Fatigue or Brain Fog?

Testing should be guided by your history and examination.

AssessmentWhen it may be usefulPHQ-9Screening and monitoring depressive symptomsGAD-7Screening and monitoring anxiety symptomsComplete blood countAssessing anemia or other blood abnormalities when indicatedTSH and selected thyroid testsEvaluating possible thyroid diseaseVitamin B12Assessing suspected deficiency or neurological symptomsIron studiesEvaluating suspected iron deficiencyMetabolic panelAssessing selected metabolic or organ-function concernsSleep studyEvaluating suspected sleep apnea or other sleep disordersCognitive screeningAssessing persistent or progressive cognitive concerns

Hormone testing may be appropriate for specific endocrine questions, but extensive hormone panels are not routinely necessary to evaluate anxiety or depression.

The goal is to choose tests that can meaningfully guide care.

Why I Take a Whole-Person Approach to Mental Health

In my practice, I often see how physical and emotional health influence one another.

A patient may come in describing fatigue, brain fog, poor sleep, or irritability.

Sometimes the main concern is a mental health condition that deserves direct treatment.

Other times, sleep disruption, medication effects, thyroid disease, hormonal transitions, or nutritional problems may also be contributing.

I believe it is important to look at the whole picture without overlooking the diagnosis in front of us.

I also recognize that many patients are looking for options beyond simply adding another medication.

That is a reasonable conversation to have.

But the answer is not always a supplement, a hormone test, or a special diet.

Sometimes psychotherapy is the most important next step. Sometimes medication is appropriate. Sometimes improving sleep or treating a medical condition makes a meaningful difference.

Often, the best plan combines several approaches.

My philosophy is to help you understand your symptoms, make informed decisions, and develop a realistic plan that supports your mental and physical well-being.

What to Expect at Your Mental Health & Cognitive Wellness Consultation

Step 1: Comprehensive Health & Symptom Review

We discuss your symptoms, medical history, sleep, medications, nutrition, hormonal changes, stressors, and previous treatments.

Step 2: Clinical Assessment

Depending on your concerns, I may use validated screening tools and recommend appropriate laboratory testing or additional medical evaluation.

Step 3: Personalized Treatment Planning

Your plan may include:

• Nutrition and lifestyle recommendations

• Sleep-focused interventions

• Stress-management strategies

• Medication review or management when appropriate

• Evaluation of hormonal or medical contributors

• Psychotherapy referral

• Specialist coordination

Step 4: Follow-Up & Monitoring

We monitor symptoms, treatment response, medication tolerance, functional improvements, and whether additional support is needed.

Mental health treatment is not always linear. The plan may change as your needs evolve.

Mental Health & Cognitive Wellness Care in Olympia, Tumwater, Lacey & the South Sound

Prolific Well Integrative Medicine provides integrative mental health and cognitive wellness consultations in Olympia, Washington.

I serve patients from Olympia, Tumwater, Lacey, Tenino, Shelton, Centralia, Chehalis, McCleary, Elma, Aberdeen, and surrounding South Sound communities.

In-person and telehealth appointments are available when clinically appropriate.

Prolific Well Integrative Medicine
1820 Black Lake Boulevard SW, Suite 101C
Olympia, WA 98512

Phone: (360) 339-6169

Schedule a Mental Health & Wellness Consultation

Frequently Asked Questions About Integrative Mental Health

Where can I find integrative mental health care in Olympia, WA?

Dr. Evelyn Le Ellis, ND, MPH, FAIHM, provides integrative primary care evaluations for mood, sleep, stress, and cognitive concerns at Prolific Well Integrative Medicine in Olympia, Washington.

Can a naturopathic doctor help with anxiety and depression?

A Washington-licensed naturopathic physician can evaluate medical contributors, provide appropriate care within their scope, and coordinate psychotherapy or psychiatric services. Treatment depends on the severity and nature of the condition.

Can hormone imbalances cause anxiety?

Certain hormonal changes and endocrine disorders can contribute to anxiety-like symptoms. However, anxiety is not always caused by hormones, and appropriate mental health assessment remains important.

Why is my anxiety worse during perimenopause?

Hormonal fluctuations, sleep disturbances, vasomotor symptoms, previous mental health history, and life stressors may contribute to increased anxiety symptoms during perimenopause.

Can menopause cause brain fog?

Some women report changes in concentration and memory during the menopausal transition. Sleep disruption, mood symptoms, medications, and other medical conditions may also contribute.

What is the difference between PMS and PMDD?

PMS involves recurring physical or emotional symptoms before menstruation. PMDD involves more severe mood symptoms that significantly interfere with daily functioning and follow a characteristic menstrual-cycle pattern.

Can poor sleep cause anxiety or depression?

Sleep disturbances and mood disorders can influence one another. Persistent insomnia deserves appropriate evaluation and treatment.

What vitamins should I take for brain fog?

There is no universal vitamin treatment for brain fog. Supplementation is most appropriate when a deficiency or another specific clinical indication is identified.

Can thyroid problems affect mental health?

Yes. Thyroid disorders may cause or contribute to changes in mood, energy, concentration, and sleep. Thyroid testing is appropriate when clinical findings suggest thyroid disease.

Can nutrition improve mental health?

Nutrition can support general brain and metabolic health and may complement mental health treatment. It should not replace psychotherapy or medication when those treatments are indicated.

Do I need hormone testing for anxiety or depression?

Not routinely. Hormone testing should be guided by specific symptoms, menstrual history, age, medical conditions, and clinical findings.

Do you prescribe mental health medications?

Medication evaluation and prescribing may be available within the scope of Washington naturopathic practice and the individual clinician's training. Some psychiatric conditions and medications require specialist management.

Does insurance cover integrative mental health consultations?

Coverage depends on the insurance plan, network, diagnosis, medical necessity, and services provided. Psychotherapy and specialty mental health services may have separate coverage requirements.

When should I seek urgent mental health care?

Seek immediate help for suicidal thoughts with imminent danger, inability to stay safe, severe confusion, psychosis with safety concerns, or other psychiatric emergencies.

In the United States, call or text 988 for the Suicide & Crisis Lifeline. Call 911 for immediate danger or a medical emergency.

About Dr. Evelyn Le Ellis, ND, MPH, FAIHM

I am a Washington-licensed naturopathic physician and founder of Prolific Well Integrative Medicine in Olympia, Washington.

My education includes a Doctor of Naturopathic Medicine from Bastyr University, a Master of Public Health from the University of Washington, and a Bachelor of Science in Biochemistry from Baylor University. I am also a Fellow of the Academy of Integrative Health and Medicine.

My clinical interests include integrative primary care, mental well-being, hormone and thyroid health, metabolic medicine, digestive health, preventive care, and longevity.

I believe patients deserve compassionate, evidence-informed healthcare that considers both their physical and emotional health.

Meet Dr. Evelyn Le Ellis

Take the Next Step Toward Better Mental & Cognitive Well-Being

You do not have to navigate persistent mood changes, stress, poor sleep, or brain fog without a clear plan.

Whether your concerns involve anxiety, depression, hormonal transitions, concentration, or overall emotional well-being, a comprehensive medical evaluation can help identify appropriate next steps.

At Prolific Well Integrative Medicine, I focus on understanding your symptoms, identifying relevant medical contributors, and developing an individualized plan that supports your health and daily functioning.

Schedule Your Mental Health, Mood & Cognitive Wellness Consultation

Medical disclaimer: This page provides general educational information and does not replace individualized medical or psychiatric care. Prolific Well Integrative Medicine is not a crisis response service. For immediate danger, call 911. For mental health or suicide-related crisis support in the United States, call or text 988.