Functional & Integrative Care for Mood, Anxiety & Attention

Learning objectives

• Describe current prevalence, treatment-response, and remission data for depression and anxiety disorders
• Identify physiologic contributors to mood, anxiety, and attention symptoms that symptom-only diagnosis may miss, including inflammatory, metabolic, nutrient, hormonal, microbiome, circadian, and medication-related factors
• Outline a sequenced integrative clinical approach that moves from medication review and laboratory assessment to targeted intervention and safe medication management
• Recognize red flags requiring urgent psychiatric evaluation and define referral thresholds for non-psychiatric clinicians

Learning objectives

• Describe the biological roles of S-adenosylmethionine (SAMe) and methylation in the central nervous system.
• Assess the role of folate, vitamin B12, and vitamin B6 status in one-carbon metabolism and mood regulation.
• Evaluate clinical trial evidence for SAMe and related B vitamins in depression, including monotherapy and adjunctive use.
• Identify appropriate candidates, dosing strategies, and monitoring considerations for SAMe and related B-vitamin supplementation.

Learning objectives

• Recognize prescription and OTC agents with established neuropsychiatric adverse effects, including montelukast, fluoroquinolones, corticosteroids, beta-blockers, isotretinoin, varenicline, and interferon
• Assess cumulative anticholinergic burden and its association with cognitive impairment and long-term dementia risk
• Distinguish medication-induced psychiatric symptoms from primary illness using temporal reasoning and dechallenge logic
• Develop a systematic medication-review protocol to screen for iatrogenic contributors before initiating psychiatric treatment

Clinician tool: medication-review checklist.

Learning objectives

• Interpret fasting glucose, fasting insulin, HOMA-IR, and A1c in patients presenting with mood or anxiety symptoms
• Evaluate hs-CRP, IL-6, and ferritin as inflammatory markers, including ferritin’s dual role as an acute phase reactant and an iron store
• Assess B12, methylmalonic acid, homocysteine, folate, vitamin D, omega-3 index, magnesium, and zinc in relation to neuropsychiatric presentations
• Identify high-prevalence drug-nutrient depletion pairs relevant to psychiatry and recommend evidence-informed monitoring and repletion strategies

Clinician tool: drug-nutrient depletion chart.

Learning objectives

• Describe CYP2D6 and CYP2C19 phenotypes and their documented effects on antidepressant and stimulant exposure
• Apply CPIC guidance to psychotropic selection and dosing decisions
• Evaluate the current evidence base for combinatorial pharmacogenomic panels and their effect on clinical outcomes
• Analyze nutrigenomic variants relevant to mental health, including MTHFR and one-carbon metabolism, and distinguish supported interpretation from commercial overreach
• Counsel patients presenting with direct-to-consumer genomic reports

Learning objectives

• Interpret estradiol, progesterone, and testosterone results in the context of depressive and anxious presentations across the lifespan
• Evaluate thyroid panels beyond TSH and cortisol rhythm testing in patients with mood, anxiety, and cognitive complaints
• Interpret stool testing findings relevant to mental health, including bacterial patterns, calprotectin, sIgA, candida, and parasites
• Evaluate zonulin and other intestinal permeability markers, including their evidentiary limitations

Learning objectives

• Differentiate antidepressant withdrawal from relapse using symptom onset, quality, and receptor-occupancy principles
• Apply hyperbolic tapering to construct a stepwise dose-reduction schedule for an SSRI or SNRI
• Evaluate benzodiazepine and z-drug deprescribing strategies, including microtapering and long-acting substitution, and identify patient factors that modify taper rate
• Formulate an integrative support plan, nutritional and behavioral, to layer onto a taper while monitoring for protracted withdrawal

Clinician tool: taper protocol template.

Anchor evidence: Horowitz MA, Taylor D. Tapering of SSRI treatment to mitigate withdrawal symptoms. Lancet Psychiatry. 2019;6(6):538-546. Horowitz MA, Taylor D. The Maudsley Deprescribing Guidelines. Wiley-Blackwell; 2024.

Learning objectives

• Apply knowledge of anxiety and depression pathophysiology and clinical workup to patient cases
• Analyze laboratory findings across inflammatory, nutrient, hormonal, and microbiome domains to prioritize intervention
• Develop sequenced treatment plans integrating nutrition, targeted supplementation, and pharmacotherapy decisions
• Evaluate monitoring endpoints and treatment response in complex presentations