Functional psychiatry asks a different first question. Instead of only “which diagnosis fits these symptoms?”, it also asks “what is driving these symptoms in this particular person?” It treats anxiety, depression, fatigue, brain fog and poor focus as signals that something in the body, the environment or daily life may be out of balance, and it looks for those drivers before, or alongside, adding treatments.
Same symptom, different root cause
Consider three people who all describe low mood, low energy and trouble concentrating:
- Person A has heavy periods and a ferritin level that turns out to be very low. Iron deficiency can cause fatigue, poor concentration and low mood.
- Person B sleeps five hours a night, drinks four coffees a day and two glasses of wine most evenings, and has been under intense pressure at work for a year.
- Person C has an underactive thyroid that has never been tested.
All three might receive the same diagnosis and the same first-line prescription. A functional approach would also correct the iron, treat the sleep and stress pattern, and refer the thyroid finding for treatment. Each of those changes targets something that a medication alone would not.
The root causes we look for
Nutrient deficiencies
Low iron, vitamin B12, folate and vitamin D are common and can produce fatigue, low mood, poor focus and, in some cases, anxiety. Omega-3 intake and magnesium also matter. See nutritional psychiatry and vitamin D and depression.
Thyroid and hormonal changes
An underactive thyroid can cause depression-like symptoms; an overactive thyroid can look like anxiety or panic. Postpartum shifts, perimenopause and other hormonal changes also affect mood and sleep. See thyroid and mental health.
Blood sugar regulation
Irregular meals and rapid swings in blood sugar can cause irritability, shakiness, anxiety-like symptoms and afternoon crashes. Insulin resistance is also associated with depression.
Inflammation and immune activation
Some people with depression have raised inflammatory markers, and certain illnesses and infections can affect mood and cognition. In children, sudden onset of obsessive-compulsive symptoms after an infection raises the question of PANS / PANDAS. See inflammation and depression.
Gut health
The gut and brain communicate through the vagus nerve, immune signals and gut-derived compounds. Digestive problems are common in people with anxiety and depression. See the gut-brain connection.
Sleep and circadian rhythm
Chronic short sleep, irregular sleep timing and untreated sleep disorders such as sleep apnea can drive daytime mood, anxiety and attention problems. See sleep and insomnia.
Stress physiology
Long-term stress changes cortisol rhythms, sleep, appetite and the nervous system’s baseline. See cortisol, stress and anxiety and why burnout is not just being tired.
Medications and substances
Some medications can affect mood, sleep or energy as a side effect, and caffeine, alcohol, cannabis and nicotine all influence anxiety and sleep. A careful review often reveals easy wins.
Environment and lifestyle
Low daylight in Pacific Northwest winters, sedentary routines, social isolation, heavy screen use and exposures such as mold in a damp home can all play a part. See screen dependency.
How functional psychiatry uses testing
Testing is a tool, not the goal. We order labs when the result would change what we do. A typical first panel for persistent fatigue and low mood might include a complete blood count, ferritin, vitamin B12, folate, vitamin D, thyroid tests, fasting glucose or HbA1c, and markers of inflammation. Other tests are added only when your history points to them. We avoid large, expensive panels ordered by default, because they often produce borderline results that lead to more testing without better care. See functional lab testing for mental health.
What treatment looks like
Once likely drivers are identified, the plan addresses them directly, for example by correcting a deficiency, stabilizing blood sugar with regular meals, treating insomnia, building stress-regulation skills, adjusting a medication with side effects, or referring a medical finding to the right specialist. Psychotherapy remains part of most plans, because how we think, cope and relate to others is also a root cause in its own right. When medication is the right tool, it is included; see psychiatric medication management.
An example of the process
Here is how a root-cause assessment might unfold for a composite patient, a 34-year-old professional with two years of low mood, afternoon crashes and broken sleep who has tried two antidepressants with partial benefit:
- History. Symptoms began after the birth of her second child. She skips breakfast, relies on coffee until mid-afternoon, and wakes at 3 a.m. most nights. Periods have been heavy since the birth.
- Targeted labs. Ferritin is low, vitamin D is low, and thyroid tests suggest a mildly underactive thyroid.
- Plan. Iron and vitamin D are repleted, the thyroid result is shared with her primary care provider, meals are restructured around protein in the morning and afternoon, caffeine is moved earlier, and she starts a structured approach for insomnia alongside weekly therapy focused on postpartum adjustment. Her current antidepressant is continued and reviewed.
- Follow-up. Over the following months, energy and sleep improve first, then mood. Labs are re-checked only where the result guides the next step.
Not every case resolves this neatly, and many people have several smaller contributors rather than one large one. The point is that each part of the plan has a reason.
Questions to bring to your first visit
- When did my symptoms start, and what changed in my life or health around that time?
- Have my iron, vitamin B12, folate, vitamin D and thyroid ever been checked?
- Could any of my current medications or supplements be contributing?
- How are my sleep, caffeine, alcohol and meal patterns affecting how I feel?
- How will we know if the plan is working, and when will we review it?
What functional psychiatry is not
- It is not anti-medication. Medication can be essential, and we never ask patients to stop a prescription on their own.
- It is not a guarantee of a single hidden cause. Most people have several contributing factors, and some symptoms are mainly psychological or situational.
- It is not a substitute for crisis care. If you are thinking about harming yourself, call or text 988 or call 911.
- It is not a reason to over-test. More data is not always better data.
Functional, integrative and holistic psychiatry
These approaches overlap. Functional psychiatry focuses on physiological drivers; integrative psychiatry focuses on combining conventional and complementary treatments; holistic psychiatry focuses on the whole person and their life context. At Sphosh Health we use all three, so that nothing important is missed and nothing unnecessary is added.
Who benefits most from a root-cause approach
- People whose symptoms have only partly responded to therapy or medication.
- People with physical symptoms such as fatigue, digestive problems, pain or hormonal changes alongside mood or anxiety.
- People who developed symptoms after a clear trigger, such as an illness, pregnancy, a move or a long period of stress.
- Parents seeking a thorough assessment for a child whose behavior, mood or attention changed suddenly.
Getting started
Most patients begin with our Biopsych Assessment, a comprehensive intake that covers your history, symptoms, sleep, nutrition, medications and goals, with labs recommended where they would change the plan. Care is led by Dr. Koichi Tanji, ND, LMHC. We see patients in person in Bellevue and by secure telehealth across Washington, and we are in-network with Premera, Regence, BlueCross BlueShield, Aetna, Cigna and Kaiser PPO. Book online or call (425) 278-6166.