The Traditional Medical Model of Mental Health Disorders
Mental health care today often begins with a checklist of symptoms and ends with a recommendation for psychotherapy, a prescription or both. This approach, while evidence-based, isn’t focused on looking at a person holistically. When a person reports feeling depressed, helpless, hopeless, poor appetite and having low energy, they may be given a diagnosis or label like Major Depressive Disorder. The resulting diagnosis helps determine which treatments might address the reported problem. This is exemplary of the reductionist approach characterizing the traditional medical model of mental health disorders.
Traditionally, depression has been viewed through a “molecule deficiency” lens, suggesting it’s primarily due to a lack of serotonin or dopamine production in the brain. However, this approach is reductive in the sense that it overlooks other neurobiological, behavioral, psychological, and lifestyle factors contributing to mental health. While selective serotonin reuptake inhibitors (SSRIs) and other medications might alleviate some symptoms for some individuals, the other drivers of mental health dysfunction can be overlooked.
The commonly used medical model boils down to a simple formula: syndrome = biological cause + symptoms. The medical model is beneficial as it allows healthcare professionals to have a common language that helps them identify which disorders may benefit from specific treatments. However, humans are complex, and symptoms are not just chemical imbalances. Symptoms are influenced by a wide range of sources, including lifestyle factors like stress, diet, metabolism, and genetics. By only considering the traditional medical model of mental health disorders, there is a higher risk of missing contributing factors.
The conversation on mental health has recently shifted from a singular focus on diagnosis and specific treatment to a more holistic approach. Recent discussions highlight how stress, trauma, idleness, and loneliness significantly impact total well-being and contribute to mental health disorders. When one of these emotional and physical responses begins to present, other responses are soon to follow.
Lifestyle medicine further emphasizes metabolism, avoidance of harmful substances, exercise, nutrition, sleep, purposeful action, and relationships as critical components of a more holistic treatment plan to address mental health disorders and support total wellness.
The Role of Metabolism and Mitochondria
Mitochondria are often called the powerhouses of our cells and help regulate neurotransmitter production, stress response, and hormone synthesis. Brain activity is fueled by our metabolism, which requires energy and metabolic resources to create new neural connections. This begs the question: if our metabolic system is insufficient, how does that affect our brains?
Mitochondria play a significant role in releasing neurotransmitters, managing inflammation, and synthesizing vital hormones like cortisol, estrogen, and testosterone. Dysregulation of these hormones can often be traced back to mitochondrial dysfunction.
Metabolic psychiatry is a new, science-backed approach to viewing mental disorders through the lens of metabolic and mitochondrial health. Metabolism, metabolic regulation, and mitochondrial health are all involved in the critical processes of converting energy from one form (e.g., food) into a form usable by our cells (e.g., adenosine triphosphate, ATP), as well as how we use this energy. Our metabolism is fueled by what we eat and the energy we burn. Mitochondria play a huge role in running our metabolism, and every system of our body cannot function without them!
What can we possibly do to impact metabolism and mitochondrial health? For most people, the best way to have a positive impact on these systems is to optimize the 6 pillars of lifestyle medicine (https://twapsychiatry.com/blog/f/mental-health-awareness-into-action). This ensures that everything is balanced and that the brain has what it needs for healthy functioning.
The 6 Pillars
Lifestyle medicine’s six pillars—nutrition, exercise, stress management, sleep, social connection/purpose, and avoiding harmful substances—are crucial for enhancing mitochondrial health and our mental well-being. While it seems that the American population has become less healthy over time, our stress levels and mental health, in general, also seem to be getting worse. One expert says that this problem is so obvious that “it’s not just staring us in the face, it’s slapping us” – Dr. Chris Palmer.
Nutrition
Ultra-processed foods and food additives can negatively affect mental health, while a diet rich in whole foods supports metabolic health. Intermittent fasting and ketogenic diets can enhance mitophagy (the process of clearing damaged mitochondria) and improve gut health.
Research indicates that the average American has at least one vitamin deficiency. Yet, it seems like we’re only just starting to talk about this mineral and vitamin deficiency issue. Among the most common deficiencies are B12, folate (B9), and iron, which are nutrients essential for healthy mitochondrial function. Vitamin B12, for instance, is vital for brain function. A deficiency of B12 is associated with higher rates of fatigue, depression, and even symptoms of psychosis. Oral contraceptives, metformin, menstruation, and vegan/vegetarian diets can increase the risk of B vitamin deficiencies.
Iron deficiency is particularly prevalent (especially in 40% of American women!) and can contribute to mental health issues. Iron deficiencies lead to fatigue, anemia, weakened bones, bodily tissues, hair loss, and weight gain due to mitochondrial disruption. Folate (vitamin B9) is used in the body to make new red blood cells. A lack of folate can manifest as fatigue, depression, and even a decrease in cognitive function.
Exercise
There is a higher density of mitochondria in muscle tissue from people who exercise. More mitochondria mean more capacity to produce energy, hormones, and neurotransmitters. In essence, when we exercise, we can help treat mental health conditions such as depression, anxiety, and insomnia. Exercise releases dopamine and serotonin, which can improve mood and reduce anxiety.
Stress
Not all stress is bad! (https://twapsychiatry.com/blog/f/happy-national-stress-awareness-month)
When our stress levels become unmanageable, we increase our risk of developing metabolic disorders, cardiovascular problems, and other serious health concerns that can impact longevity. When metabolic processes are disrupted by repeated exposure to stress, this can lead to metabolic dysfunction, including elevated cholesterol, diabetes, and weight gain.
Sleep
Sleep is the grand regulator for our minds and bodies. Poor sleep can deplete mitochondrial energy and dysregulate the production of neurotransmitters. Insomnia impairs brain network repair and neuroplasticity, a process by which neurons break down or form new connections. These factors can increase the chance of experiencing memory loss, depression, anxiety, and even schizophrenia.
Social Connectedness and Purpose
Life is not to be lived alone! Staying social has been proven to improve longevity and our cognition as we age. Isolation reinforces symptoms related to anxiety and depression. The lack of connection to others can even slow down the production of mitochondria. It is important to form new relationships and continue strengthening the ones we already have. Finding your village helps reinforce healthy habits, positive behaviors, promotes physical activity, and keeps stress levels at manageable levels. Similarly, those without strong social connections can reap benefits from staying engaged in activities with meaning and purpose. Whether volunteering or working at a job they love, this aspect of lifestyle can bring meaning, identity, and validation.
Substance Use
Stimulants, alcohol, high doses of nicotine, and other recreational substances can damage mitochondria. High consumption of alcohol has been shown to harm many bodily systems, such as our digestion, disrupting the sleep cycle, and even contributing to deficiencies in thiamine, folate, and B12.
Reframing Mental Illness: Looking for Root Causes
When looking at mental illness through the lens of metabolism, mitochondria, and lifestyle, it can be surprising to discover underlying causes or contributors to mental health symptoms and disorders. Mental health disorders do not have to be seen as a life sentence. It is essential that health professionals stop zooming in on only symptoms, but view the entire picture.
To find out more about metabolic psychiatry, book a consultation with one of our clinicians at TWA Psychiatry today!
Resource:
Podcast https://www.youtube.com/watch?v=hCyvqRq5YmM
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Written by Cana Cravens, Eliza Montufar, and Demian Obregon, MD.
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