Dr. Seth Mandel knows a thing or two about treating mental health. As a board-certified psychiatrist with 20 years of clinical experience working with clients spanning the spectrum of mental illness and substance use, he has seen firsthand the impact that proper pharmacological management can have on symptom relief, recovery and quality of life.
But over the last few years, Dr. Mandel, who has worked with many clients at The Dorm as an independent psychiatrist, has started to expand his practice to an exciting new area of research and care: nutritional psychiatry.
“This approach just makes sense.” Dr. Mandel explains, “Instead of exclusively turning to a prescription to combat a mental health diagnosis, nutritional psychiatry also involves looking at a client’s full nutritional makeup to find solutions through supplementation and food. We assess how we can integrate changes to complement medications and bring about positive change for patients.
For the millions of young people facing debilitating diagnoses of depression and anxiety in the United States, nutritional psychiatry offers new hope and a new spectrum of choice in care.
“The reality is, once someone goes on medication for a diagnosis like depression or an anxiety disorder, they very rarely go off”, Dr. Mandel points out, “And all of these medications have side effects, some of which come with their own challenges, like weight gain, sexual dysfunction or insomnia. For most young adults, we have an opportunity to minimize heavy medication use right from the outset. This is why I’m so encouraged about this approach for the clients I work with who tend to fall between the ages of 17 and 35, a time when prescription medication usage can really start to accelerate.”
The last few years have seen a surge in new research and promising studies around the links between dietary change and mental health. Much of this began to emerge with the work of Felice Jacka, whose 2010 Ph.D. study published in The American Journal of Psychiatry found that women on diets that were rich in vegetables, fruit, fish and whole grains were less likely to have depression or anxiety than those who consumed a diet that was high in refined sugars, carbohydrates and processed foods. Today, Jacka heads up the International Society for Nutritional Psychiatric Research (ISNPR), and promising new studies continue to be published, including a randomized controlled trial that has tested dietary improvements as a formal treatment strategy for depression.
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“There is so much exciting research out there right now; the sense is that we are just scratching the surface!”, says Dr. Mandel. “I’m currently undergoing a year-long fellowship on this subject and attending as many lectures as I can so I can bring back the best evidence-based care to clients.”
What this care looks like right now, is a focus on supplements and dietary changes for mood and anxiety disorders. When a new client comes in for a psychiatric assessment, one of the first things Dr. Mandel will do is review their full panel of blood work and, for some clients, genetic testing results.
“I’m looking out for ‘mental health red flags’, like low nutrient levels of B12 or vitamin D (deficiencies in either can cause depression, anxiety, low energy and cognitive impairment),” shares Dr. Mandel, “What many doctors might dismiss as levels in the ‘normal range’, tend to be suboptimal when it comes to the pharmacological spectrum that is conducive to good mental health. Another area I focus on is whether a client may have a MTHFR enzyme genetic variation which can make it more difficult to convert the B-vitamin folate into its usable form l-methylfolate, an amino acid that plays a key role in producing neurotransmitters like serotonin and dopamine.”
While nutritional psychiatry offers so many promising solutions, Dr. Mandel is also careful to stress that it is not for everyone.
“I see nutritional psychiatry as one more great tool and approach to psychiatric care that can help people, not the only right solution. It is certainly not appropriate for every client or every diagnosis. There is still a lot more research to be done on how nutritional psychiatry can help other diagnoses beyond depression and anxiety, like psychotic disorders and bipolar mood disorders. The fact is, for some clients, medication will always need to be part of their treatment plan, and that’s okay, but what works well is when we approach psychiatric treatment in a personalized and collaborative way that explores all the available options”, explains Dr. Mandel.
Regardless, it is important that clients and families know that nutritional psychiatry is a highly systematic and supervised process that involves intermittent testing throughout a multi-month period.
“We work to make sure nutritional levels are where we want to see them and check that the outcome is going in the direction we want,” notes Dr. Mandel, “In particular, this psychiatric approach really works at a place like The Dorm because it is an integrated model with a group of multi-disciplinary therapeutic providers all working together under one roof with the flexibility to work with existing outside providers if that is what is best for the client. When I independently oversee a client’s psychiatric care, The Dorm makes it easy for me to connect directly with the client’s therapists, case manager and nutrition support team to develop a treatment plan. We are all on the same page. We and the client are all set up for success.”
So, what new psychiatric treatment opportunities have Dr. Mandel excited for the future?
“I’m looking forward to continuing to deepen my understanding of what personalized, integrative psychiatry can be and will be,” muses Dr. Mandel, “There is a lot of research right now on the connection between gut health and mental health, for example, that I anticipate will change the way we view mental health and the traditional scope of psychiatry in the years to come. Either way, I feel encouraged by therapeutic platforms like The Dorm that make doing this work possible. Their philosophy has always been to look at the root causes rather than offer quick fixes. They don’t ‘do’ band-aid solutions, they work towards building lives.”