Abstract
Mental health conditions range from mood disturbances like depression and bipolar disorder to anxiety and psychotic disorders, eating disorders, and ADHD. Treatment plans traditionally involve pharmaceutical interventions. However, the emerging concept of lifestyle medicine can be an additive strategy for mental health management. The primary aim of this article is to dive into the use of medication in treating different mental health disorders and also highlight lifestyle changes, such as dietary adjustments and physical activity, as a means to enhance mental well-being, mitigate medication side effects, and address comorbid side effects like diabetes and obesity. The comprehensive approach of lifestyle medicine is presented as a promising complementary option, aiming for better symptom control and improved quality of life alongside medication in managing complex mental health conditions.
Keywords: mental health, lifestyle medicine
“When approaching the treatment of mental health disorders with a holistic perspective, lifestyle medicine emerges as a promising complementary option.”
Introduction
A broad array of mental health conditions spans the landscape of human thought, feelings, and actions. These encompass mood disturbances like depression and bipolar disorder, unsettling anxiety ailments such as generalized anxiety and panic disorders, as well as conditions involving distorted perceptions of reality, such as schizophrenia. Additionally, eating disorders, such as anorexia, and attention-deficit/hyperactivity disorder (ADHD) further diversify this spectrum. Recognizing the individual intricacies within these diverse categories underscores the importance of tailored treatment plans. Traditionally, pharmaceutical approaches have played a central role in addressing these conditions. However, emerging research suggests that embracing lifestyle medicine could present a fresh and effective supplementary strategy in the management of these challenges.
American Journal of Lifestyle Medicine published a paper in Jan–Feb 2022, declaring a call to action mental health in lifestyle medicine. This article continues to recommend continued recognition of the importance of the role of lifestyle medicine in mental health disorders, with a deeper dive into discussing the role pharmacotherapy plays in the treatment while acknowledging the potential role of lifestyle medicine to help address symptoms of mental health disorders and possibly lead to needing less medicine or lower doses of medicine which may help with side effects. Considering that mental illness affects more than 1 in 5 U.S. adults with an estimated 57.8 million adults living with a mental illness, having multiple approaches to treatment may be optimal. 1 In addition, to further implore this need, there is a significant amount of people that have additional comorbidities and these can impact one another, and it is unknown if there is a causal relationship or if the multiple conditions coexist. Regardless of the reasons why, the impact on the person can include emergence of other medical conditions (i.e., weight gain as a side effect can lead to metabolic disorders), polypharmacy, and/or worsening of one or more of the medical conditions. For example, 17.4–22% of deaths in people with either schizophrenia or bipolar disease is caused by cardiovascular disease. 2
Treatment Guidelines
Various medical organizations, including the American Psychiatric Association, have published clinical practice guidelines outlining evidence-based recommendations for each mental health condition. These disorders include anxiety, attention deficit hyperactivity(ADHD), borderline personality, depression, dissociative, eating, obsessive-compulsive, posttraumatic stress, psychosis, schizoaffective, and schizophrenia. 3 Treatment approaches for mental health disorders vary but often involve a combination of medication, psychotherapy, and supportive interventions. The overarching theme is that medication may be necessary because it can help rebalance brain chemistry and alleviate symptoms. Pharmaceutical interventions are recommended to regulate neurotransmitters and improve overall well-being.
Medications
There are many medication classes and even more medications within these classes that treat the various mental health conditions. The medication classes often have multiple indications and are prescribed individually, based on factors such as clinical presentation, response to previous treatment, drug–drug or drug–condition interactions, and adverse effects. Medication classes include serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRIs), benzodiazepines, stimulants, antipsychotics, and mood stabilizers. 4 In addition to these medications, other classes such beta blockers or anticonvulsants may also be used as alternative medications to augment treatment. As with all medications, these medications too have evidence to show their efficacy and safety for use in specific indications. And as with all medications, there are important patient counseling considerations and adverse effects that may impact the place in therapy for people. The adverse profile for many of these medications used for mental health disorders can be lengthy and may limit their use in certain people and/or cause secondary conditions, such as metabolic disorders which then require a further risk/benefit analysis. While complex, medication therapy remains an important component for the management of these conditions in many people.
Lifestyle Medicine
The integration of lifestyle medicine alongside medication in mental health treatment is a topic of increasing importance. One such article by Sarris et al 5 notes the benefits of lifestyle modifications, summarizing that there is a relationship between dietary quality and depression, strong evidence that physical activity and relaxation techniques, especially mindfulness, improves mood, sleep amount/quality and depression risk as well as socialization and mental health have a strong causal link, and there is an association with alcohol/smoking and depressed mood. Another study by Zhao et al 6 found that individuals that exhibit healthy habits, such as proper sleep, exercise that includes aerobic or anaerobic movements, and a nutritious diet such as the whole-foods, plant-based diet, result in the decrease of depressive symptoms.
Within the treatment approach for many of the mental health conditions, the six pillars of lifestyle medicine are included in some capacity. In addition, to serving as a part of the treatment modality for the condition itself, lifestyle medicine can also help mitigate some of the adverse effects of the medications as well as potentially how many medications and what doses of medications are required. Further research is necessary to show exactly what is this impact. In addition to further research to study the impact of lifestyle medicine, finding ways to incorporate discussion about lifestyle medicine with people with mental health conditions is vital.
An approach to enhancing lifestyle interventions may include health coaching to help people gain the confidence and skills to adopt healthy lifestyle choices. 7 Additionally, partnering with local community programs can be beneficial as well. The other articles within this issue further elaborate on the role of health coaching.
Conclusion
When approaching the treatment of mental health disorders with a holistic perspective, lifestyle medicine emerges as a promising complementary option. It extends beyond the conventional use of medications and delves into the nuanced aspects of individuals' lives impacted by these conditions. This approach aims at better symptom control, improved medication adherence, and an overall enhanced quality of life. When dealing with complex conditions like schizophrenia, lifestyle medicine becomes a valuable adjunct by addressing several facets of welfare. This may encompass the incorporation of consistent physical activity, balanced nutrition, healthy sleep habits, and the reduction of substance use. Ultimately, lifestyle medicine promotes a comprehensive state of health, an adjunct to the efficacy of medication in symptom management.
Footnotes
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
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