Functional Medicine Psychiatry - Addressing the Roots of Brain Symptoms
The Benefits, Risks & How We Can Make it Better
What is Functional Medicine?
“An integrative, biology-based approach that promotes healing and wellness by focusing on the bio-chemically unique aspects of each patient, and then using individually tailored interventions to restore balance. This approach focuses on understanding the fundamental physiological processes, the environmental inputs and the genetic predispositions that influence health and disease. The interventions aim to address the root causes.
In the case of Functional Medicine Psychiatry, such interventions are aimed at promoting healing and wellness for those with brain symptoms such as depression, anxiety, mood swings, fatigue, brain fog, hyperactivity, cognitive impairment, social communication deficits and/or psychosis.
In this Newsletter I’ll discuss:
The advantages and disadvantages of mainstream medicine
Characteristics of many who seek out functional medicine
Benefits of functional medicine
Risks of functional medicine
How these risks can be mitigated by functional medicine physicians and those seeking this type of treatment
Benefits of Mainstream Medicine & Psychiatry
Typically covered by insurance and thus can be less expensive
Usually straightforward: Patient shares concern, answers questions, is examined and given a treatment (or options), which is usually a medication(s) and then takes the medication and hopefully symptoms improve. Very little may be asked of the patient other than to take the medication.
Symptom relief may be more rapid. This is especially important when someone is in a crisis, their symptoms are severely impacting their functioning or are life-threatening or causing irreversible damage.
Treatment interventions have undergone more research. The research, however, typically looks at how a group of people with the same diagnosis respond to the same medication. This doesn’t account for biochemical diversity (we are not all the same), bio-types (one example -there is more than one type of depression), and root causes. This is why many studies into psychiatric medications don’t yield the desired response rates.
Considered the “standard of care” - a legal term that refers to treatments and practices that are accepted by medical experts as the best treatment for a specific disease and are widely used by healthcare professionals.
Disadvantages of Mainstream Medicine & Psychiatry
Though symptoms may improve with psychiatric medication, the root cause is typically not addressed. By root cause, I’m referring to oxidative stress, environmental exposures, sources of inflammation, disruption to the microbiome, nutrient imbalances, trauma, exaggerated or inadequate hormonal stress response, or even autonomic dysfunction. These are all the focus of extensive research; however, much of what is being learned has not yet made its way into medical schools and, thus, mainstream medicine and likely won’t for many years.
Unaddressed root causes of things like depression, anxiety, mood swings, inattention, fatigue, and hyperactivity can show up in other ways:
Other symptoms in other parts of the body
Greater vulnerability to other health conditions, many of which are chronic, such as cardiovascular disease, type 2 diabetes, and autoimmune conditions
Accelerated aging, including cognitive decline.
Side effects from medication:
Bothersome symptoms such as weight gain, fatigue, anxiety, and many others
Another health condition, such as metabolic syndrome in someone on long-term anti-psychotic medications for schizophrenia
Diagnoses can be defining and limiting. They can leave some people to believe that their condition is chronic and incurable or that the prognosis is poor.
Though lifestyle changes may be commented on, there is rarely specific education on how to implement these changes.
Many (not all) with chronic complex illnesses (mast cell activation, mold-related illness, Lyme or co-infections, chronic fatigue, POTS) have felt discounted. Some have even felt traumatized by mainstream medicine. Without an understanding of the underlying factors, mainstream medicine doesn’t have a way to make sense of seemingly unrelated symptoms. Many patients feel that they have been blamed for creating their symptoms. Some are told their symptoms come from psychological issues.
I’m not opposed to mainstream medicine (or psychiatry). I have a primary care physician that I maintain a treatment relationship with. I have, however, relied on her much less in the past 16 years since discovering functional medicine. Still, I never know if I may need help, require an immediate intervention, have an injury, or need a referral to a specialist or surgeon.
It is not necessary to choose between mainstream and functional medicine. These approaches do not need to be in conflict.
Who Finds Their Way to Functional Medicine (Psychiatry)?
People who want to understand why they are having their symptoms.
Often, deeper divers into information find satisfaction in figuring things out.
I would argue that most are undermethylated and are good at detail-oriented thinking. These can be strengths and vulnerabilities.
Those who have not benefited from mainstream approaches. They may have had medication side effects, didn’t benefit from medication, or responded, but then other symptoms they suspected were related started to appear, and they wanted to find a deeper approach with an intention of healing.
Those with complex chronic illnesses who have felt their symptoms were not understood by their doctor or by the multiple specialists they saw.
Most functional medicine doctors find their way into this type of medicine through their own health journey or that of their child’s. In the first blog of my website, I share how I became a holistic (and functional) psychiatrist.
Benefits of Functional Medicine
The focus is on the underlying cause of the symptoms. At its best, it also focuses on the whole person. This is why I prefer Holistic Psychiatry over Functional Medicine Psychiatry.
Addressing the root causes usually helps not only with the primary symptoms.
Other symptoms can improve.
Other health conditions may be prevented.
The aging process and cognitive decline can be slowed.
Less need for medications. Exceptions include treating microbial sources of inflammation. I will, for example, prescribe anti-fungal medication to address mold.
There is more focus on empowering patients with information.
People are more engaged in their healing process as lifestyle interventions are given more attention and time than mainstream medicine.
Those with chronic complex illnesses often feel more understood and heard.
Risks or Disadvantages of Functional Medicine
The risks come about when there is not a holistic (whole person) perspective and when assessments and treatment planning are impractical and not decided in collaboration with the patient. In these cases, functional medicine:
Can involve excessive details - excessive lab data, excessive supplements, excessive attention to dietary interventions and environmental exposures and complicated daily routines. This can contribute to stress and rumination.
These excesses can take the attention off the basics of human health - sleep routine, movement, improving diet, and perhaps the most underrated - lowering stress.
Can have some people at odds with their bodies and reinforce thinking that the body is something to be fixed.
Can become addictive. I’ve spoken to a number of people who have spent a tremendous amount of time researching online…. while under the influence of high EMF, stress hormones, and breath holding (which most of us tend to do at the computer and which puts our body into a low-grade fight or flight). Just like a slot machine, sometimes there is an answer that leads to important information, but more often, the stress of the pursuit is becoming an obstacle to healing. I experienced this myself.
Is relatively expensive, and sometimes very expensive, making it inaccessible to most people. Appointments and supplements are often not covered by insurance. Some lab testing is covered. Appointments are longer than in mainstream medicine. More time is spent outside the appointment. Interpreting labs and creating treatment plans takes more time than prescribing medication during an office visit. Many would argue, however, that mainstream medicine’s focus on managing chronic health conditions (rather than promoting healing and wellness) is more expensive over the long term - both in terms of cost and quality of life.
Can lead people to believe that they need to address every underlying factor to heal. This is not the case. Similarly, there are a lot of tools. They don’t all need to be used to bring the body back into balance.
You might notice how aligned each of these risks are with left hemisphere traits - detail-oriented, seeing the body as an object, addictive tendency and all or none thinking.
As patients, I do think that those of us (myself included) who are undermethylated, fit the CAPs profile, and/or have a slow COMT and/or MAOA are especially vulnerable to these risks.
And because most doctors are likely undermethylated and most functional medicine doctors are deep divers (and thus may also fit with the CAPs profile or have a slow COMT or MAOA), they may be more likely to overcomplicate treatment. I’m sure I have been guilty of this.
If functional medicine is not balanced by a right brain perspective, it can easily become stressful. This is the main reason that I attempt to alternate right and left brain topics with these newsletters.
How Can We, As Functional Medicine Physicians, Mitigate the Risks of Functional Medicine?
Think big picture.
Aim to be practical.
Avoid excessive testing. Set priorities and hone in on the most likely factors for which treatment could have the biggest and most immediate impact. I have many people reaching out for consultations or treatment who have known mold toxicity and are still undergoing a lot of testing and treatment for things like SIBO, leaky gut, food sensitivity, and even PANS, PANDAS, Lyme, and co-infections. In my experience, if they have mold that is not being addressed, they’re unlikely to see the benefit from treatment in those other areas.
Communicate pricing with patients before ordering tests.
Seek a collaborative relationship so that we know what testing and treatment is possible from a cost standpoint and can also be implemented.
Listen well and provide education about root causes and priorities.
Spend time exploring barriers to lifestyle change. If lifestyle changes aren’t being addressed, all the supplements in the world aren’t going to move someone toward healing.
Have conversations about how functional medicine (as well as excessive research) can be stressful if not balanced by the right brain approaches (stillness, silence, being in nature, being with people, making time to hear oneself). We can help the person see this is just part of the bigger picture of their life.
What Can Patients Who Use Functional Medicine Do?
Shift into a right-brain perspective - Regularly seek ways to shift from the details to big-picture thinking. Remember, this is about moving the body to balance and supporting healing (and not fixing).
Seek ways to be more embodied and at peace with your body.
Return to the basics of health - the stuff that everyone knows and that doesn’t require deep dives but makes a huge difference - sleep, movement/exercise as tolerated, and a diet that supports your healing. Consider what is getting in the way of your self-care.
Seek out doctors who are practical and don’t do excessive testing or supplements, and who don’t have everyone going through the same program - one that has to be committed upfront.
Seek out doctors who are not authoritarian but instead listen well, provide understandable education, and want to know what makes sense for you.
Tell your doctor if you feel their recommendations are not workable so that together, you can find what is.
Compartmentalize. Put online research into a box that you go to for a visit. Try not to live there. Often, our answers show up when we’re not chasing them down.
And above all else, stay connected to your inner wisdom.
As with all of my lists, this list of lists is not complete. Please feel free to add on, agree, disagree and share your experience.
Until next time,
Courtney
Medical Disclaimer:
This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your own physician for any medical issues that you may be having.
Thank you for writing this article, Dr. Snyder.