Functional Psychiatry: A Personalized Approach to Mental Health
As a Functional Psychiatrist, I apply fundamental concepts of Functional Medicine to a mental health practice. As opposed to traditional psychiatry, in which symptoms are diagnosed and treated in accordance with standardized classifications, Functional Psychiatry is a systems approach to mental health that honors biochemical individuality.
Robust scientific research has confirmed that biochemical, genetic, and metabolic abnormalities can contribute to the emergence or entrenchment of a mental illness. Treatments are not administered on a “one-size-fits-all” basis but rather in a personalized, scientific manner, informed by the results of objective laboratory testing) that provides a snapshot of individual biochemistry.
My Background and Experience in the Field of Psychiatry
I went to medical school in 1981 as a vegetarian, believing I would pursue a medical career treating patients with brown rice and kale… Nine years later, I completed a fellowship at John Hopkins University School of Medicine in Child and Adolescent Psychiatry and became an expert in psychopharmacology.
Although the health benefits of kale have resurfaced forty years later, I have a deep sense of gratitude and appreciation for my medical and psychiatric education. My training as a psychiatrist provided me with a broad appreciation for the complexity of human behavior, the neurochemistry that drives all thought, feeling, and behavior, and the profound influence of family systems on emotional and mental wellness. Perhaps the most significant aspect of my training was the learning that I pursued about the healing nature of a therapeutic relationship between patient and provider, with the absolute need for purpose and meaning in patients’ lives.
My training also happened to take place during the “Prozac Revolution,” in which dramatic, fundamental changes to the practice of psychiatry began to emerge. These included the advent of direct-to-consumer advertising, managed care, and fifteen-minute medication checks. Together, these changes established “serotonin deficiency” as psychiatry’s new breakthrough paradigm for the understanding, diagnosis, and treatment of depression.
This approach clearly helped to sell medications targeting serotonin, but at the same time it curtailed much needed research, and destroyed attempts to enact models for personalized treatment. One pill meant “one-size-fits-all” treatments to cure all patients with the same diagnosis. Therapeutic standardization and pharmaceuticals became the “new normal” of psychiatry.
The Shortcomings of Modern Psychiatric Prescribing
In lockstep with antidepressants’ rise to popularity in the 1990s, however, came increasingly frequent reports of side effects associated with stopping the very same medications. Trying to wean themselves off antidepressants, patients were reporting symptoms ranging from dizziness, “brain zaps,” and tingling or burning sensations to muscle tremors, anxiety, and insomnia. Sometimes, these symptoms were mild. Other times, they were debilitating.
Yet instead of addressing the problem, psychiatry opted to look the other way. Even as thousands of patients reported the same types of symptoms associated with antidepressant discontinuation, and it became clear that what they were experiencing were symptoms of withdrawal, psychiatry dissembled and rebranded.
Rather than expand research efforts directed at uncovering a solution, psychiatry rebranded what clearly were symptoms of medication withdrawal as the more benign “Antidepressant Discontinuation Syndrome” — a semantic adjustment that did nothing to help the tens of thousands of patients struggling to navigate such withdrawal.
Sadly, most of the burden of discovery regarding effective withdrawal symptom management and safe antidepressant discontinuation has been placed squarely on the shoulders of patients. Individuals seeking to discontinue antidepressants have been generally left to their own devices since the 1990s, essentially ignored by the very doctors that prescribed the antidepressants in the first place.
This is not to say that psychiatry has no suggestions. The literature is actually full of recommendations for antidepressant tapering. The problem is that these recommendations reflect a staggering lack of consensus as to best practices. A cursory dive into the published research literature yields suggestions ranging from four-week tapers, eight-week tapers, percentage dose reductions, and bridging to another antidepressant to adjunctive phototherapy, abrupt discontinuation, and abandonment of discontinuation, recommending that patients continue antidepressants indefinitely.
None of these proposed protocols have been verified by good clinical trials. Instead, these recommendations represent psychiatry’s “best guess” solutions to a growing problem, a riddle that far too many patients are being forced to solve on their own. A riddle that will never be solved until psychiatry can respect and embrace the concept of Biochemical Individuality.
Physicians have been prescribing antidepressants and other medications for mental health conditions for decades without any clear understanding as to how to safely discontinue them. A medication “end game” has in fact never been part of the equation — something most patients do not know when they accept that first prescription. In addition to a stunning ethical failure, this lack of understanding represents a serious void in the current medication treatment model.
The Future of Mental Health Care and Functional Psychiatry
The inadequacies of the mainstream approach ultimately inspired me to pursue a more comprehensive paradigm, one that not only acknowledged the role of biology in mental illness but placed it on equal footing with genetics, nutrition, trauma, lifestyle, and spirituality. This search led me to Functional Psychiatry — an integrated systems approach to mental health.
Functional Psychiatry honors the connections that link mind and body and adheres to a model of personalized medicine based on biochemical individuality. Treatments are developed according to data derived from medical analysis and psychiatric assessment, treatments that address the underlying factors that contribute to pathology. Medications can be part of Functional Psychiatry protocols, but rarely as the sole modality.
A Functional Medicine model prioritizes the repletion of nutritional deficiencies and an understanding of the unique individual.
Over the last decade, scientific research has clearly established a relationship between malnutrition and brain function across every major psychiatric illness. From depression, ADHD, and schizophrenia to eating disorders, anxiety, and suicide prevention, scientific evidence confirms robust associations between discrete nutritional imbalances and the emergence, entrenchment, and symptomatic severity of psychiatric presentations. Mainstream treatment models in psychiatry, however, still fail to recognize nutritional imbalances as being factors in mental illness.
Psychiatry Redefined has established foundational strategies that I have utilized for years to develop personalized treatment plans for the treatment of mental illness from Autism to Alzheimer’s. I have treated thousands of patients with this approach. In a vast majority of cases, addressing biochemistry, genetic makeup, diet, lifestyle, and relevant psychosocial variables yields far better outcomes for patients, and makes the achievement of lasting recovery an attainable goal.
It is my intent that Psychiatry Redefined, and our newsletter Rooted in Healing will spark much-needed conversation regarding modern psychiatric prescribing, illuminate gaps in the mainstream model that leave too many patients rudderless, and drive the actionable change needed to navigate the system of care and truly shift from symptom management to root cause lasting recovery.
Final Word: Carrying On
One of the most rewarding aspects of providing functional and integrative mental health treatment is that it is deeply human. We respect and uplift the patient’s central role in their treatment. The old way—prescribing and telling patients what to do—is replaced by a collaborative model where both patient and provider have an equal voice. Health is a choice, not just a desired outcome. Patients make better choices because they feel more invested in their own treatment, a treatment in which they have a say and that they understand to be highly individualized.
“Perhaps the most significant aspect of my training was the learning that I pursued about the healing nature of a therapeutic relationship between patient and provider, with the absolute need for purpose and meaning in patients’ lives.”
Therapeutic collaborations such as those we aspire to can make a tremendous difference in our patients’ lives. They are not only healing and meaningful for our patients, however. They reward us with a sense of purpose and meaning as well.
In Good Health,
James Greenblatt, MD
Founder, Medical Director, Psychiatry Redefined