Building a Foundation: Integrating Healthy Habits and Lifestlye Changes for Mental Health Care

As someone deeply fascinated by the etiology of psychiatric disorders, I find it challenging to admit that there is a single cause for each psychiatric disorder. There are disorders, however, that have more predominant causes such as genetics and the development of schizophrenia. It is more accurate to recognize that multiple factors can contribute to the development of a psychiatric disorder. For instance, one individual might experience depression due to persistent rumination habits, while the other might suffer from depression due to abnormally low levels of Brain-Derived Neurotrophic Factor, or BDNF, in the hippocampus1.

Understanding the etiology of a mental disorder is crucial for guiding effective treatment. However, beyond identifying specific causes, it is essential to ensure that every patient receives fundamental care to address their condition. This includes promoting practices that have been shown to enhance overall well-being, such as maintaining good levels of vitamin D, exercising, and engaging in social activities when possible. There is substantial evidence supporting the positive effects of practices such as diet, exercise, sleep, and socialization on overall wellbeing2,3,4,5.

Before prescribing any kind of medicine or therapy to a patient, clinicians should ensure their patients are meeting a baseline of wellness. The antidepressant itself is rarely enough to treat depression, especially since there is no “miracle” drug on the market. We can go as far as to say that even various therapies should establish this baseline, not just pharmacology. While it seems like common sense that healthy practices- such as a balanced diet, regular exercise, and social engagement- are effective, the reality is that many of us, myself included, struggle to consistently implement them.

To help clarify let’s continue using unipolar depression as an example here. One of the challenges in treating depression is patient compliance. So, you might ask yourself, is it easier to ask someone to take a pill or to change their entire lifestyle and habits? Perhaps the pill. However, we should consider the long-term financial and health benefits of promoting a healthier lifestyle as a first step in treatment. By encouraging an overall healthy routine and diet, we can potentially help people save a lot of money on medicine or intensive therapy. If the approach is successful, it might help prevent relapse rates and the lack of long-term benefits from medications. Since the practice of establishing a baseline of well-being is not very common, we lack data on how many patients would achieve remission solely through lifestyle changes. However, it is safe to assume that everyone, not just patients, would benefit from adopting healthier habits. So why not make sure that those who are struggling physiologically meet that baseline?

Another concern that comes to mind is that when suggesting significant lifestyle changes, can discourage some patients from pursuing treatment altogether.  Many individuals will come to psychiatrists and psychologists to obtain medication as a quick fix for their symptoms. Considering this, the approach suggested in their article will likely lead to lower patient compliance rates. However, it is important to not generalize; some patients are willing to try several different treatment methods before giving up. For those who seem more reluctant to lifestyle changes, it is crucial to address and explore their reluctance. Additionally, you might be asking yourself, aren’t there available therapies such as behavioral activation therapy and motivational interviewing practices that teach how to attain all these healthy habits I have described above? You would be correct. However, while these therapies focus on specific aspects of behavior change- like encouraging fun activities and healthy relationships and increasing motivation- they are often used as separate components of treatment rather than being integrated into a holistic treatment plan. Not all patients are assessed on their lifestyle habits (diet, sleep, social activities); it usually depends on the clinician’s approach, treatment setting, and the specific concerns the patient presents with. I propose a more integrated approach that combines some of these therapeutic elements to establish a wellness baseline for every patient. This approach assures that the clinician addresses the patient’s wellbeing based on physical and psychological factors, rather than just psychological.

We need to focus on creating and sustaining healthy habits. This involves tailoring plans to individual needs, considering physical limitations and scheduling constraints that the individual might have. The challenge lies in finding motivation and maintaining consistency and discipline over time.

What are your thoughts on this?

For a detailed and self-teaching guide on how to do Behavioral Activation Therapy click here.

REFERENCES:

1-       Ferreira Fratelli C, Willatan Siqueira J, Rodrigues Gontijo B, de Lima Santos M, de Souza Silva CM, Rodrigues da Silva IC. BDNF Genetic Variant and Its Genotypic Fluctuation in Major Depressive Disorder. Behav Neurol. 2021 Nov 1;2021:7117613. doi: 10.1155/2021/7117613. PMID: 34760029; PMCID: PMC8575598.

2-       Grajek M, Krupa-Kotara K, Białek-Dratwa A, Sobczyk K, Grot M, Kowalski O, Staśkiewicz W. Nutrition and mental health: A review of current knowledge about the impact of diet on mental health. Front Nutr. 2022 Aug 22;9:943998. doi: 10.3389/fnut.2022.943998. PMID: 36071944; PMCID: PMC9441951.

3-       Scott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev. 2021 Dec;60:101556. doi: 10.1016/j.smrv.2021.101556. Epub 2021 Sep 23. PMID: 34607184; PMCID: PMC8651630.

4-       Mahindru A, Patil P, Agrawal V. Role of Physical Activity on Mental Health and Well-Being: A Review. Cureus. 2023 Jan 7;15(1):e33475. doi: 10.7759/cureus.33475. PMID: 36756008; PMCID: PMC9902068.

5-       Briguglio M, Vitale JA, Galentino R, Banfi G, Zanaboni Dina C, Bona A, Panzica G, Porta M, Dell'Osso B, Glick ID. Healthy Eating, Physical Activity, and Sleep Hygiene (HEPAS) as the Winning Triad for Sustaining Physical and Mental Health in Patients at Risk for or with Neuropsychiatric Disorders: Considerations for Clinical Practice. Neuropsychiatr Dis Treat. 2020 Jan 8;16:55-70. doi: 10.2147/NDT.S229206. PMID: 32021199; PMCID: PMC6955623.