Functional Psychiatry in North Carolina: Medication, Deprescribing & Whole-Person Care

Functional Psychiatry and Psychiatric Medications: Why It Doesn't Have to Be Either/Or

Functional psychiatry is about looking at the whole person. But that does not mean avoiding psychiatric medication. In many cases, medication is an important and appropriate part of healing.

There is a growing interest in functional and integrative psychiatry, and for good reason. Many people want to understand why they are experiencing anxiety, depression, difficulty concentrating, insomnia, mood changes, or other psychiatric symptoms.

They may wonder:

• Could nutrition be playing a role?

• Is poor sleep contributing to my symptoms?

• Could a medical condition or hormonal change be affecting my mood?

• Are there medication side effects contributing to how I feel?

• Could deficiencies or other physical health factors be involved?

• Are there lifestyle changes that could support my mental health?

But there is another important question we sometimes overlook: What if medication is actually helping?

Functional psychiatry doesn't mean "anti-medication"

One misconception about functional or holistic psychiatry is that the goal must be to get every patient off psychiatric medication.

That isn't our philosophy.

Mental health is complex. Depression, anxiety, ADHD, bipolar disorder, PTSD, OCD, and other psychiatric conditions can involve biological, psychological, environmental, and social factors. Looking at those factors more broadly does not make psychiatric medication unnecessary.

Sometimes medication is exactly what a person needs.

For some patients, medication can make it possible to sleep, function at work, participate meaningfully in therapy, care for their family, or simply get through the day. For others, medication may be one component of a larger treatment plan that also includes psychotherapy, exercise, nutrition, sleep optimization, stress management, and addressing relevant medical conditions.

There is no prize for suffering without medication.

Taking an antidepressant does not mean you have failed to address the "root cause." Taking ADHD medication does not mean you aren't working on your sleep and lifestyle. Taking a mood stabilizer does not mean other aspects of your health don't matter. Medication and whole-person care can coexist.

The goal isn't "more medication" or "less medication"

A thoughtful psychiatric medication plan should ask: Is this medication helping this particular person?

That question is more useful than automatically assuming that everyone should be taking medication, or that everyone should eventually come off it.

We consider factors such as:

• What symptoms are we treating?

• How much benefit is the medication providing?

• Are there meaningful side effects?

• How long has the person been taking it?

• What happened with previous medication trials?

• Are there medical or nutritional factors worth addressing?

• Are there non-medication treatments that could complement the medication?

• Does the patient want to continue taking it?

• What are the potential benefits and risks of changing the treatment plan?

Psychiatric care should be individualized rather than ideological.

What about patients who want to come off medication?

This is where careful deprescribing becomes particularly important.

Stopping a psychiatric medication is not always as simple as taking a smaller dose for a few weeks and then stopping.

Some people experience withdrawal symptoms when reducing antidepressants, benzodiazepines, gabapentinoids, or sleep medications. Withdrawal can sometimes resemble the return of the condition the medication was originally prescribed to treat, making it difficult to determine what is happening.

The 2024 Maudsley Deprescribing Guidelines specifically address this issue and emphasize individualized, gradual tapering. For antidepressants, the guidelines describe hyperbolic tapering, in which dose reductions become progressively smaller as the dose gets lower. The goal is to adjust the taper based on the person's response rather than following a rigid schedule.

For someone who has been taking a medication for years, a safe taper may take substantially longer than a few weeks. Some people tolerate reductions easily, while others need much smaller reductions and more time between changes. The Maudsley approach emphasizes monitoring symptoms after reductions and adjusting the pace accordingly.

Sometimes the right answer is to stay on medication

This is just as important to say.

If a medication is working well, side effects are acceptable, and the benefits continue to outweigh the risks, there may be no reason to stop it simply because someone has been taking it for a long time.

We don't tell someone with high blood pressure that they have failed because they still need medication.

We don't tell someone with asthma that they should eventually be able to breathe without their inhaler.

Psychiatric medications are more complicated than those examples, and medication decisions always require individualized clinical judgment. But the larger point remains:

Needing medication is not a moral failure.

Some people will eventually taper off medication. Some will need medication intermittently. Some will benefit from long-term treatment.

What does a functional psychiatry evaluation look like?

At our North Carolina virtual psychiatry practice, we take a broad look at the factors that may be affecting mental health while also taking psychiatric symptoms seriously.

Depending on the individual, this may include discussion of:

• Mental health history and previous diagnoses

• Previous medication trials and responses

• Sleep quality and sleep patterns

• Nutrition and dietary patterns

• Exercise and physical activity

• Stress and life circumstances

• Relevant medical conditions

• Hormonal and metabolic factors when clinically appropriate

• Substance and medication use

• Family history

• Therapy and other forms of mental health treatment

• Laboratory testing when medically appropriate

  
  

The purpose isn't to order every possible test or search endlessly for a hidden diagnosis.

The purpose is to understand the person sitting in front of us.

And sometimes that evaluation leads to a medication recommendation.

Sometimes it leads to changing a medication.

Sometimes it leads to a gradual taper.

And sometimes it leads to recognizing that the medication the patient has been taking is actually providing meaningful benefit and should remain part of the treatment plan.

You don't have to choose between "natural" and "medication"

Mental healthcare doesn't have to fit neatly into two opposing camps.

You can care about nutrition and take an antidepressant.

You can prioritize sleep and take ADHD medication.

You can exercise, work on stress management, attend therapy, address medical conditions and take medication.

You can also decide, together with your psychiatric provider, that a medication is no longer necessary and develop a thoughtful plan to taper it.

The goal is not to prescribe as little medication as possible.

The goal is not to prescribe as much as possible.

The goal is to find the treatment approach that makes sense for you.

Functional Psychiatry in North Carolina

Our practice provides virtual psychiatric care for patients located in North Carolina, with an emphasis on thoughtful evaluation, individualized treatment, and whole-person mental healthcare.

We believe psychiatric medication is a tool, not a failure, a shortcut, or a requirement.

For some patients, it may be the most important tool we have.

For others, it may be one piece of a much larger treatment plan.

And when a patient wants to reduce or discontinue a medication, we believe that process deserves the same thoughtfulness and clinical care as starting one.

You don't have to choose between functional psychiatry and evidence-based psychiatric medication. You can have both. To schedule a consultation, you can start with our brief intake form thealchemy-institute.com/intake-form