A Functional Medicine Approach To Pediatric Mental Health

How can functional medicine be applied to mental health?

Like many things, often there is not one specific cause of mental health symptoms such as anxiety or depression, but a combination of factors that come together. Factors such as genetics, life experiences, and environmental exposures.

For example, a genetic predisposition for lower levels of vitamin D in combination with lack of adequate sunlight and poor intake of vitamin D-rich foods may lead to vitamin D deficiency which can be associated with anxiety, depression, and poor attention.

Detoxification is another good example. A genetic predisposition to slower detoxification in a patient with significant toxic exposures through foods or other sources, who are not supporting natural detoxification through adequate water intake and routine bowel movements, may not be able to keep up with the toxins we are all exposed to a on daily basis. A large toxic burden can overstimulate the nervous system again leading to anxiety, depression, and poor attention.

Gut health is another common contributor to mental health symptoms. The gut-brain connection refers to the bidirectional connection between the gut and the brain. The brain sends messages to the gut and the gut also sends messages to the brain. The gut and the brain are connected in multiple ways through the vagus nerve, the immune system, the endocrine system, and the microbiome. A disruption in gut health through an overgrowth of bacteria or increased intestinal permeability (aka Leaky Gut) can cause or contribute to anxiety, depression, and attention issues.

Common root causes of mental health symptoms include:

• Inflammation
• Nutrient deficiencies such as vitamin D, magnesium, zinc, B vitamins, and omega-3s
• Toxins
• Genetic vulnerabilities
• Food sensitivities
• Gut dysbiosis
• Trauma
• Adverse childhood experiences

You may wonder how a pharmacist became involved in functional medicine, but a functional medicine approach may include medication if it is appropriate. Additionally, pharmacists are often referred to as medication experts, and that typically means we have a healthy respect for both the potential benefits and harms of medications.

Medication use may be appropriate, but my goal as a pharmacist is to make sure we have the right medication at the right dose. I also want to make sure that patients are aware of potential side effects and the risk vs benefits when considering starting a medication. For antidepressants and stimulants commonly used to treat anxiety, depression, and ADHD side effects may include nutrient depletions, changes in the sleep cycle, appetite and weight changes, and withdrawal symptoms when trying to stop the medication.

Pharmacogenomic testing helps to ensure we have the right medication based on a person’s unique DNA. This may help to minimize side effects due to poor metabolism or breakdown of some medications and it may help guide the selection of medication that is most likely to provide benefit. A pharmacogenomic test is a great option for anyone who is taking medication or considering starting medication.

However, I do not recommend medication as a first-line option. Recent reviews of studies assessing the effectiveness of antidepressants used to treat anxiety and depression question their clinical significance. There may be a small benefit compared to a placebo but there is an increased risk of side effects. This may have to do with pharmacogenomics, but also it is likely that there is an underlying cause such as a nutrient deficiency or inflammation that has not been addressed.

For example, vitamin B6 is needed for the body to make serotonin. If the body does not have enough vitamin B6 to make serotonin, it doesn’t matter how much or what type of medication you take you will likely not be able to get into remission if your body does not have the building blocks it needs to make serotonin and the other chemical messengers to regulate mood.