Is Addressing Lifestyle in Psychiatry a Professional Obligation?

SPECIAL REPORT: LIFESTYLE PSYCHIATRY

When we consider our medical professionalism obligations, we’re often reminded of the dos and don’ts of medicine: don’t violate professional boundaries, do uphold the Hippocratic oath, do complete your notes on time, do show up to appointments promptly, and so on. We absorb these mandates as part of professionalism as we continue to learn the art and science of psychiatry.

Lifestyle psychiatry—meaning recommending lifestyle interventions for psychiatric disorders and well-being—is now gaining an important place in patient care. Do we have a professional obligation to incorporate lifestyle into our discussions and interventions for patients?¹ Looking back, we can trace many pivotal points in our understanding of psychiatric symptom management. Some of these changes have lasted decades, while others have occurred seemingly overnight. Where do lifestyle interventions for psychiatric disorders fit into this ongoing evolution toward providing hope and relief for our patients? Is there enough evidence? Should we approach the intervention as something we “should,” “could,” or “may” recommend and be helpful to our patients?²

Our current process for evaluating research is guided by the principle that patients “should” adopt our recommendations when supported by robust evidence. As a discipline, we have many ways to formulate our understanding of symptoms, leading to disparate treatment approaches—pharmacotherapy, psychotherapy, somatic treatments, and others. For many patients, we recommend more than 1 treatment modality.

Is there space in our conceptualization to add lifestyle as a major category to our biopsychosocial model—perhaps calling it the biopsychosocial-lifestyle model?³ For those who remain skeptical, I suggest we keep an open mind and focus on the data. In a time when eminent researchers such as Dinan and Cryan are writing in World Psychiatry that gut microbiota may be the missing link in mental health symptoms, we should not only be listening, but listening very carefully.⁴

What does the field of transdiagnostic psychiatry offer regarding the common pathways of disease?⁵ Is there another way to understand illness that includes neuroinflammatory responses as a core component? With our high comorbidity rates, perhaps this is a conversation worth continuing.

Naturally, we will lead with and primarily treat serious mental illness and acute issues using psychopharmacology. But where do we place other available modalities as part of the practice of psychiatry? The lifestyle psychiatry movement offers another approach that may prove valuable for our patients. For example, the evidence is especially strong for the benefits of physical activity in treating depressive disorders. A recent systematic review and network meta-analysis of randomized controlled trials found that physical activity is at least as effective as, and often superior to, selective serotonin reuptake inhibitors for depression.⁶

In this issue, we present the second part of our special report on lifestyle psychiatry, focusing on nutritional interventions, lifestyle guidance for major depressive disorder, and the role of physical activity in schizophrenia.

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. Fagundes CP, Merlo G, Rippe JM. Lifestyle medicine in patient care. In: Merlo G, Harter TD, eds. Medical Professionalism: Theory, Education, and Practice. Oxford University Press; 2025:215-248.

2. 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.

3. Malhi GS, Bell E, Bassett D, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry. 2021;55(1):7-117.

4. Dinan TG, Cryan JF. Gut microbiota: a missing link in psychiatry. World Psychiatry. 2020;19(1):111-112.

5. Fusar-Poli P, Solmi M, Brondino N, et al. Transdiagnostic psychiatry: a systematic review. World Psychiatry. 2019;18(2):192-207.

6. Noetel M, Sanders T, Gallardo-Gómez D, et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2024;384:e075847.