Gut Psychosomatics: First Steps — Get Tested Before You Treat

When the stomach or intestines react to stress, it's tempting to reach for a medication right away. But in psychosomatics the order of actions is different. Following the doctor's logic, before treating anything you must understand *what exactly* is disturbing the body's balance — and only then go to a specialist with results in hand.

Why we don't start with medication

Homeostasis is the ability of all body systems to return to balance: blood sugar, blood values, organ function. An irritant — any force, whether biological, chemical, psychological or environmental — can disturb this balance. So the first step is not to silence the symptom but to understand at what level the disruption sits. The doctor warns plainly against grabbing for pills first.

"The main thing in psychosomatics — don't start with medication straight away; you can restore the brain's work and rhythm."

Step one: rule out the psychiatric register

In psychosomatics you first separate out whether a mental disorder lies behind the complaints. Here the word "depression" causes confusion. In everyday use it means fatigue, low mood, feeling down — a "basket" into which people throw all sorts of bad feelings. But for a psychiatrist, depression is a disorder of the F30/F33 register: endogenous, genetically determined, and treated quite differently. So the first move is to set the psychiatric register aside (depressions, schizophrenia and the like), which can itself produce the clinical picture.

Step two: rule out somatic disease

Next you exclude bodily illnesses that secondarily drive the distress. On their own they can knock balance out: the thyroid, the liver, the pancreas and many others. They operate independently, yet they can secondarily generate what a person takes for psychosomatics.

Which examination makes sense

By the doctor's logic, the minimum baseline is tests and a body examination:

• blood test, including enzymes and liver panels (ALT, AST and others);
• urine test and biochemistry — especially liver panels;
• electroencephalogram.

If you want a deeper look at the brain, it only makes sense to use MRI on a 3 Tesla machine. The doctor stresses: CT and the rest, in this context, give no informative basis.

When to see a specialist

It makes sense to go to a specialist *when the results are already in hand*. Otherwise, in the doctor's words, a person simply wastes several visits — throwing away money and time. First the picture, then the conversation about treatment.

Practice: a first-steps checklist

1. Pause and prescribe nothing for yourself — don't start with medication.
2. Separate things out: "depression" as mood/fatigue is a symptom, not a diagnosis; remember a psychiatric register may lie behind complaints.
3. Get baseline tests: blood (enzymes, liver panels — ALT, AST), urine, biochemistry.
4. Do an EEG; if a deeper brain picture is needed — only MRI 3T.
5. Bring the results to a specialist — that way the visit is meaningful.