Addressing Lifestyle Factors in Major Depressive Disorder

How can clinicians incorporate lifestyle interventions into major depressive disorder (MDD) treatment alongside pharmacotherapy?

In this video interview, Arwen Podesta, MD, DFAPA, Psych Congress Steering Committee Member, and Mike Asbach, DMSc, PA-C, Co-Chair, Psych Congress PA Institute, discuss the value of a whole-person approach to depression care, emphasizing the role of sleep, exercise, nutrition, and environmental factors in supporting mental health. They explore how lifestyle modifications may influence neuroplasticity and improve patient outcomes, while highlighting the importance of making recommendations affordable and accessible. The experts also discuss how clinicians can move beyond medication management to address broader aspects of patient wellness, even within the constraints of brief psychiatric appointments.

Key Clinical Summary

• MDD management can incorporate lifestyle interventions alongside pharmacotherapy. A whole-person approach considers sleep, exercise, nutrition, and environmental factors in addition to medication management.
• Sleep improvement may support MDD treatment through behavioral changes, sleep hygiene, nutritional supplementation, or other interventions. Lifestyle modifications were also discussed in relation to neuroplasticity and brain functioning.
• Accessible lifestyle interventions are an important consideration in psychiatric practice. Clinicians can help patients identify affordable dietary changes and physical activities that do not require expensive resources, even when appointment time is limited.

Read the transcript

Arwen Podesta, MD, DFAPA: Hi, I'm Dr Arwen Podesta, a psychiatrist in New Orleans, Louisiana. I specialize in integrative medicine and forensic psychiatry, addiction medicine, and adult general psychiatry. I'm excited to be here with my colleague, Mike.

Michael Asbach, DMSc, PA-C: Thanks, Arwen. My name is Mike Asbach. I'm a psych PA. I serve as the associate director of interventional psychiatry at Dent Neurologic Institute up in Buffalo, New York. I also serve as a medical liaison on behalf of the American Academy of PAs to the American Psychiatric Association (APA).

Psych Congress NP Institute (PCNPI): What is a "whole person" approach in integrative psychiatry and how does it influence long-term mental health outcomes?

Podesta: So, Mike, you and I both emphasize a whole person approach, a functional medicine approach, in our treatment with patients in our clinics. How do you see that impacting outcomes in our patients?

Asbach: I think really it comes down to making sure that we're leaving no options on the table. We know that medication can be very effective for patients, but there's so many other things that are part of whole-person mental health care that can be difficult to implement in a short 15-minute med visit.

So, my hope is that if we can help empower clinicians to not only effectively manage medications—which the vast majority of our med visits are that—but also offer opportunities to address the other aspects of health.

Podesta: Yeah, we come from a biopsychosocial training, and yet so frequently we emphasize just that pharmacological intervention when we have so little time. And yet we have so much availability of other tools that we know can modify people's internal systems and their environment that can lead to better wellness.

Asbach: Absolutely, and I think whole person psychiatry does not have to cost more to the patient. It's accessible. If we're encouraging patients to eat better but also helping them do so in a way that's affordable. If we're encouraging patients to be more active but also helping them find ways to do that that don't require expensive gym memberships, that can really allow us to drive better outcomes for these individuals.

Podesta: Absolutely.

PCNPI: How effective are lifestyle interventions in managing major depressive disorder (MDD)?

Asbach: So, Arwen, I'd like to talk about depression specifically. We've talked a lot about lifestyle interventions. Can you talk a little bit about how lifestyle interventions can specifically help in patients that are struggling with depression?

Podesta: Yeah, we both see it in action, right? Like when someone is able to modify their lifestyle in an accommodating and accessible way that works for them with exercise, sleep. dietary changes, maybe some micronutrient changes, removing toxins from the environment removing toxic relationships in the environment. We know that that really connotes better outcomes in general.

One of the things that I think of are some of the studies with major depressive disorder and sleep, for example. By improving sleep, we know very well that those that are struggling with major depression can definitely have some impact. By improving sleep, that might not mean another medicine, but it might mean behavior, lifestyle, sleep hygiene, maybe some nutritional supplementation, maybe some other interventions. So, that is just one element of modifiable changes that can really influence people's outcomes in depression.

Asbach: Absolutely. I think it's so fascinating—our understanding of depression is evolving. I think it's safe to say that we're beyond the point of looking at depression as simply a serotonin deficiency. It's far more complicated than that. One aspect of depression that we know is that it's a state of dysfunctional neuroplasticity. The brain is not synaptically pruning and changing the way that it should. So many of these lifestyle interventions improve neuroplasticity. They can help the brain restore that normal level of functioning and growth.

Podesta: Yeah. improving what we all want. You and I want this for ourselves, for our families, for our friends, for our patients. We all want really enhanced neuroplasticity. We want to maximize the brain power to feel well. So, some of these tools really absolutely do that.

Asbach: That's great.

Michael Asbach, DMSc, PA-C, is a doctorally-trained physician assistant and Associate Medical Director at the DENT Neurologic Institute in Buffalo, New York. He earned his Master’s in Physician Assistant Studies from Daemen University and his Doctor of Medical Science from A.T. Still University. He also holds the Psychiatry Certificate of Added Qualification from the National Commission on Certification of Physician Assistants. Dr Asbach’s work bridges clinical innovation, professional advocacy, and disruption in healthcare, with a focus on advancing psychiatry, elevating the PA profession, and shaping the future of collaborative care. A nationally recognized educator and CME speaker, Dr Asbach specializes in treatment-resistant depression, bipolar disorder, and emerging psychiatric therapies. He holds a faculty appointment with Shenandoah University’s Doctor of Medical Science program, teaches across multiple universities, serves on the Psych Congress Steering Committee, and is a co-chair of the Psych Congress PA Institute annual meeting.

Boarded in Psychiatry, Addiction Medicine, Forensic Psychiatry and Holistic & Integrative Medicine, Arwen Podesta, MD, DFAPA, DFASAM, works in Louisiana, with an office in New Orleans. She authored a book on addiction, HOOKED (see her website, www.podestawellness.com). She was recently awarded the honor of distinguished fellow of the American Psychiatry Association as well as the American Society of Addiction Medicine and is the immediate past President of the Louisiana Psychiatric Medical Association. She consults to the Louisiana governor’s HOPE committee and is a member of the Attorney General’s Opioid Abatement Taskforce. She is a national speaker, she teaches, consults, and is an advocate for integrative best practices for those with addiction and psychiatric needs.