Functional medicine is an interdisciplinary field that uses established quantitative analysis methods to assess relationships between nutritional status, neurotransmitters, endocrine and immune function, and psychological symptoms. Functional tests used to evaluate mental health problems include urinary assays of neurotransmitters and their metabolites and serum assays of cholesterol, triglycerides, vitamins, minerals, amino acids and their metabolites, hormones, fatty acids, molecules that cause inflammation (e.g. interleukin-6 [IL-6], IL-8, and IL-1b), and immunologic factors.
Until now researchers have failed to identify correlations between specific biomarkers and specific psychiatric disorders, thus findings of functional assessment seldom translate into specific treatment recommendations that yield improved outcomes. For example, although low serum folate levels have been causatively linked to depressed mood, research findings are inconsistent, and this apparent relationship may be due to chance, bias, confounding, or reverse causality.
Preliminary findings suggest that total cholesterol and triglyceride levels may be inversely correlated with the severity of depressed mood. Depressed patients who attempt suicide frequently have abnormal low serum total cholesterol and triglyceride levels, which may provide useful clinical markers for suicide risk. Depressed individuals who are not suicidal tend to have cholesterol levels in the vicinity of 180 mg/dL while severely depressed suicidal patients tend to have significantly lower serum total cholesterol levels in the vicinity of 150 mg/dL. On the basis of these findings, it is prudent to check cholesterol levels of severely depressed patients, make appropriate dietary recommendations, and address issues related to the use of cholesterol-lowering medications.
In contrast to abnormal low cholesterol in severe depressed patients, elevated serum cholesterol may be a highly sensitive marker for various anxiety disorders, including generalized anxiety disorder, panic disorder, and possibly also obsessive-compulsive disorder (OCD). Amelioration of anxiety symptoms in response to prescription anti-anxiety medications is often associated with a reduction of total serum cholesterol to normal levels. The findings of a large observational study showed that abnormal low serum levels of certain B vitamins (thiamin, B6, and niacin) and vitamins C and E are associated with an increased risk of generalized anxiety. Assessment of vitamin deficiency states is important when working with patients who do not take supplements or who are at risk of one or more vitamin deficiency syndromes because of chronic malnutrition or a medical problem that interferes with normal absorption or metabolism.
I would like to invite readers interested in learning more about functional medicine approaches for evaluating and treating mental health problems to go to my 10 e-books on integrative mental healthcare.
The Integrative Mental Health Solution; a series of 10 e-books on non-pharmacologic treatments of mental health problems, by James Lake MD