A functional medicine approach to mental health

Treating anxiety, depression and other mental health concerns is complex. Mental health issues have many risk factors including: genetics, nutrient status, gut health (GI microbiome), stress levels, trauma, mitochondrial health (energy), childhood attachment issues, hormone health and social connectivity vs isolation. At Tendwell, we aim to assess and address the many factors that perpetuate depression, anxiety and other mood disorders. I have had a passion for working with patients on their mental health for many years. In fact, my first job was at an in-patient acute psychiatric unit at St. Francis Memorial hospital, in San Francisco, CA. I worked there for a couple years while moonlighting at SF General’s Mental Health Rehab Facility. Working in these settings really opened my eyes to the difficulties in providing successful mental health services. I saw a lot of patients with addiction and family trauma–a lot of people who would ping pong in and out of the hospital. I was certainly seeing a part of the population that wasn’t really getting better. This inspired me to develop a focus in prevention. As part of this, I moved into the field of primary care where I treated patients with a multitude of concerns including a lot of mental health issues. I have found that using a multidisciplinary approach with psychiatry, therapy, in a functional medicine framework, is ultimately how patients can feel their best. At Tendwell, we take a holistic approach or a functional medicine approach to diagnosing and treating people with mental health concerns. 

I believe it is the best way to create true health for people.

If you partner with Tendwell to address mental health issues, we will take you on a journey through body systems that might appear at first glance to have nothing to do with mental health. You may ask yourself, “why is she focused on the gut? Who cares about vitamins? Why does she keep talking about mitochondria? Aren’t those the organelles I learned about in 4th grade that make energy for the cell? Do I really need to know about this?” The answer is yes, because everything is connected in a complex interplay within our bodies.

So, why should we focus on a holistic, integrative or functional medicine approach?

Mental health medications have come a long way since they were introduced in the 1950s and 1960’s. The advent of Prozac, FDA approved for the treatment of depression in 1987 and the development of other SSRIs, modern mental health meds have indeed improved many lives. However, they do have a high failure rate. 50% of people will simply not respond to these medications. And 50% of the patients who respond will stop responding after being on the medications for a year. I find these numbers sobering. Also, these medications still have side effects. Some are incompatible with other life goals—including getting pregnant and having a baby. Many of my patients want to come off their anti-depressants for pregnancy. How can we do this safely?

The current standard of psychiatric care recognizes that it is a combination of medication, therapy (most of the studies are on CBT) & exercise that should/could be used in the treatment of anxiety & depression. Let’s take this even further. The DSM-5 categorizes psychiatric diagnoses but doesn’t in fact address root causes. Giving things a label doesn’t help us get into the intricacies of each situation. Depression and anxiety have many causes. These mental health issues can be thought of as analogous to pneumonia. Pneumonia can have many causes: viral, bacterial, fungal…each one in fact results in pneumonia but each one (viral pneumonia, bacterial pneumonia and fungal pneumonia) calls for different treatments based on its root cause. I think this way about depression and anxiety as well. There is no one size fits all approach. This is what a functional medicine approach is all about—rejecting the one-size-fits-all model and creating personalized medicine for each patient.

One functional approach to mental health is to deploy the methods of nutritional medicine. With the rise of metabolic issues, GI issues and hormone concerns, it is important to think deeply about nutrition. Many studies suggest an association between diet and mental health. A 2019 study found that long-term adherence to a “healthy diet” may offer protection against recurrent depressive symptoms. But what is a “healthy diet”? Some basics:

·      Low refined sugar

·      Lots of veggies

·      Some fruit

·      Organic produce

·      High quality proteins

·      Filtered water

To make neurotransmitters you need the right ingredients. You need:

·      B vitamins

·      Zinc

·      Magnesium

·      Amino acids

·      Essential fatty acids–omega 3s

You need key macronutrients as well.

·      Healthy fats: avocados, walnuts, salmon, olive oil

·      Healthy protein: fish, organic grass-fed meats, pasture raised, eggs, non-GMO tofu

If you are interested in addressing mental health issues from the ground up, consider booking a discovery call to find out more about how functional medicine could be right for you.

References:

Sarris J, Logan A, Akbaraly T et al. Nutritional medicine as mainstream in psychiatry. The Lancet Psychiatry. 2015;2(3):271-274. doi:10.1016/s2215-0366(14)00051-0.

Sarris J, Murphy J, Mischoulon D, Papakostas GI, Fava M, Berk M, Ng CH. Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses. Am J Psychiatry. 2016 Jun 1;173(6):575-87. doi: 10.1176/appi.ajp.2016.15091228. Epub 2016 Apr 26. Review. PubMed PMID: 27113121.

Recchia D, Baghdadli A, Lassale C, et al. Associations between long-term adherence to healthy diet and recurrent depressive symptoms in Whitehall II Study.Eur J Nutr. Published online April 13, 2019.

Gangwisch JE, et al. High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative. Am JClin Nutr.2015;102:454–463.

 Martins JG. EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr. 2009 Oct;28(5):525-42.

Swardfager W., et. al. (2013). Zinc in Depression: A Meta-Analysis. Biological Psychiatry. 74(12): 872–878. doi:10.1016/j.biopsych.2013.05.008.