and adults presenting with mental health problems , such as depression and anxiety . First , can you clarify what lifestyle psychiatry is ?
Joseph : Lifestyle psychiatry is quite a new term that can mean different things to different researchers and different clinical people and academics . But basically , the idea is applying the principles of lifestyle medicine to the treatment of mental health conditions . So , typically , it involves how the traditional health behaviours , like exercise , nutrition and sleeping . relate to people ' s mental health . Lifestyle could also include things like nutrient supplementation , mindfulness , holistic therapy . So , the term can be quite broad , but it usually includes those core health behaviours .
Adrian : So , who ' s using lifestyle psychiatry as a treatment approach ?
Joseph : The acknowledgement that health behaviours affect mental health as much as physical health is quite broad among most clinicians I interact with . Mental health nurses , psychiatrists and psychologists are all quite okay with the idea of things like exercise and nutrition being important for both mental and physical health of people with mental illness . But unfortunately , lifestyle psychiatry , or lifestyle medicine , is not well integrated into mental health services . So , even though clinicians , and even the patients being treated , and their families , acknowledge that these things are important , they ' re not well integrated . The implementation of , I would say ‘ change interventions ’, or lifestyle medicine in actual mental healthcare , is sadly under-utilised at the moment . So , despite all the evidence showing that lifestyle can make a difference , it ' s not widely used in mental health care yet . So , we are always trying to include these physical health practitioners for whatever intervention we ' re trying to increase the use of . We try to include people working in mental healthcare services as members of staff , or at least as points of referral , so that they can deliver a really interesting intervention that gets people going and keeps patients involved , rather than just saying , " Oh , you should be exercising a bit more , or should you be eating a bit better ." If you get these specialists in there – people who are passionate , professional and skilled - as you can imagine , the outcomes are much better .
Adrian : Is there a specific area that you ' ve mainly done your research on ? Is it exercise ? Is it dietary interventions ? Is it nutraceuticals ? What ’ s been your main research focus ?
Joseph : The vast majority of my clinical research has been focused on exercise intervention in two ways . Number one has been setting up exercise staff in mental healthcare units - exercise classes and fitness staff on site for people in mental health rehabilitation . And then number two , setting up exercise referral schemes , basically , where people get referred from the mental health services to their local community leisure centres , where there are fitness staff on hand , but where also mental health champions connected with the services receive those referrals and get people into exercise .
As for number three , what we ' re doing now is the whole program of work on how we can make use of digital technologies to increase the availability of lifestyle interventions in mental healthcare . So we ' re setting up a number of things around smoking cessation , such as online support through apps . We ' re going to be doing some diet and nutrition stuff , and right now we ' re setting up a home fitness program that can be offered through early intervention services for young people . It ' s a live fitness class by a trainer who works within the service dedicated to youth mental health services . And people can just log in from home on a regular basis , do their Zoom fitness session , and do a lifestyle Q & A with their fitness providers over areas of lifestyle , such as what they should be eating , and how they can stay active on a day-to-day basis .
Adrian : I also wanted to talk a bit about some of the work you ' ve done in the area of nutrients . You ' ve written and lead authored some fascinating review papers on nutrients for the treatment of different mental health conditions . Can you tell us a bit about that work ?
Joseph : The body of evidence for nutrient supplementation as an adjunctive treatment for mental illness is something going back just as far as all the exercise and lifestyle medicine therapies really , evolving alongside them . And there are in fact a lot more studies , and RCTs , especially , of nutrient supplementation in mental health , than there are of , say , dietary interventions , which is interesting to observe . And there ' s obviously a whole range of different nutrients that have been tested across the broad spectrum of mental health conditions . So , it ' s a big body of research already .
Adrian : And so , with your paper that you published back in 2019 , what was the strongest body of evidence in terms of nutrients ?
Joseph : Well , omega-3 supplementation is the most widely researched , and it therefore came to the forefront . That review showed the strongest evidence available for using adjunctive omega-3s in the treatment of major depression , I believe , as well apparently as for some other mental health conditions .
But even though there ' s a number of RCTs showing quite positive beneficial effects from omega-3 supplementation , there are also a lot of null trials . And there ' s a lot of misunderstanding , or lack of consensus , on the mechanisms through which omega-3s can help to reduce depression and improve mental health . Some people think it ' s a direct result of the omega-3s themselves acting on the body and the brain . Some people think it could work by reducing inflammation . Omega-3s are known to be able to reduce inflammation all over , like neurophysiological hormonal pathways . It ' s an interesting one . And it could explain why there ' s some variation in the results that we see from studies .
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