Continuing Conversations in Lifestyle Psychiatry

SPECIAL REPORT: LIFESTYLE PSYCHIATRY

We are fortunate to be members of a dynamic field of medicine, constantly evolving our understanding of the etiology of symptoms with new evidence-based data. To this end, I suggest that the evidence on the role of lifestyle in preventing, managing, and sometimes reversing not only physical disease but also mental suffering, is compelling. What exciting times to be able to weave together another approach and add to our toolbox of available interventions for our patients.

In this Special Report, we present articles that reflect the broad discipline of lifestyle psychiatry, which encompasses 6 pillars: (1) physical activity and exercise; (2) healthy nutrition; (3) restorative sleep; (4) minimizing the effects of toxic exposures (substances and environment); (5) stress management; and (6) connectedness.¹ These pillars are an expansion and adaptation of the needs of our patients from the field of lifestyle medicine. Although lifestyle medicine stresses that up to 50% of chronic diseases (eg, type 2 diabetes, cardiovascular disease, etc) can often be prevented, treated, and even reversed with lifestyle interventions, lifestyle psychiatry suggests that our patients with depression, psychosis, mania, and cognitive health issues can also be markedly affected by lifestyle.^2,3 Partnering with our patients to implement these behaviors may help them reduce their dose of medication, minimize the metabolic consequences of long-term use, and bidirectionally improve physical ailments.

The importance of lifestyle interventions for health is not a new concept. It is clear to most of us that exercising regularly, eating nutritious food, managing stress, having restorative sleep, minimizing unhealthy substance use, and maintaining positive connectedness to oneself, others, and society constitute a path to well-being. What is new is the availability of evidence to support our adopting these approaches with our patients.

In 2023, the World Federation of Societies for Biological Psychiatry (WFSBP) partnered with the Australasian Society of Lifestyle Medicine Task Force to publish clinical guidelines for the use of lifestyle-based care in major depressive disorder (MDD).⁴ These guidelines were published in the World Journal of Biological Psychiatry, which is not a lifestyle journal, indicating significant movement toward increasing awareness for data in this burgeoning field. The guidelines concluded that “lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with [MDD].”

While giving lectures on this topic to primary care physicians (who often treat half of the patients with depression), clinicians' understanding of how lifestyle could help treat mental illness is limited. I found that psychiatrists were hungry for information and data to benefit their patients. The WFSBP may have put out guidelines, but how many of us have read them? To that end, the American College of Lifestyle Medicine partnered with multiple experts in psychiatry, primary care, and cardiology to develop an expert consensus statement (ECS) on the use of lifestyle interventions in MDD. Through a Delphi method, the group reached a consensus on 71 statements. This ECS is pending publication in early 2026 and hopefully will inform psychiatrists and primary care physicians on the topic. As the field of lifestyle psychiatry evolves and gains wide dissemination of knowledge, 2 textbooks on lifestyle psychiatry and hundreds of peer-reviewed papers are available to guide us.

Our Special Report on lifestyle psychiatry also aligns with the theme of the 2025 American Psychiatric Association Annual Meeting—Lifestyle for Positive Mental and Physical Health—where more than 150 of the general sessions included lifestyle themes.

The Special Report is presented in 2 parts—December 2025 and January 2026. In this issue, we include articles that explore religion and spirituality, green spaces, and lifestyle changes for MDD. Connectedness is foundational to lifestyle psychiatry; it is a construct that includes a connection to ourselves, our community, and the social world at large. Indeed, although much is written about the importance of social connection, I believe there is more to the health of humans vis-à-vis connection.⁵ Our connection to ourselves includes our ability to empathize, show compassion—to self and others—and our relationship to the self. For many of us, healthy aspects of this self-connectedness are necessary to optimize our life journey and allow us the joy of connections with others and society. Data have shown that having a purpose and meaning in life can be protective for our mental health.⁵ Our connectedness to the community includes addressing aspects of social connection and building support and peer relationships meaningful for the individual. Finally, our relationship with religion, spirituality, and nature can be protective lifestyle aspects of connectedness to the world at large. In this issue, we further the conversation around lifestyle psychiatry with a selection of topics useful to our practice.

Dr Merlo is a clinical professor of psychiatry at New York University Grossman School of Medicine and a distinguished fellow of the American Psychiatric Association.

References

1. Merlo G, Porter-Stransky KA, Sugden SG, et al. American Psychiatric Association lifestyle psychiatry presidential workgroup report. Am J Psychiatry. 2025;182(9):885-887.

2. Katz DL, Frates EP, Bonnet JP, et al. Lifestyle as medicine: the case for a true health initiative. Am J Health Promot. 2018;32(6):1452-1458.

3. Merlo G, Vela A. Mental health in lifestyle medicine: a call to action. Am J Lifestyle Med. 2021;16(1):7-20.

4. Marx W, Manger SH, Blencowe M, et al. Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce. World J Biol Psychiatry. 2023;24(5):333-386.

5. Merlo G, Snellman L, Sugden SG. Connectedness: the updated and expanded pillar of lifestyle psychiatry and lifestyle medicine. Am J Lifestyle Med. 2025:15598276251345455.