A recent 8-week double-blind, randomized, placebo-controlled trial investigated whether oral creatine monohydrate (5g/day) could enhance the effects of cognitive-behavioral therapy (CBT) in treating major depressive disorder (MDD)—especially in under-resourced areas where access to treatment is limited.
🔬 Why Does This Matter? While CBT is a gold-standard therapy for depression, many patients do not achieve full remission. This study explored whether creatine—widely used for muscle and brain energy metabolism—could provide an extra boost to treatment.
🧠 Key Findings: ✅ Participants receiving creatine + CBT had greater reductions in depression symptoms (measured by the Hamilton Depression Rating Scale) compared to those receiving placebo + CBT ✅ Reported improvements in mood, energy levels, and cognitive function ✅ Creatine was well-tolerated, with no significant safety concerns ✅ CBT was delivered once weekly by trained therapists
⚠️ Study Limitations: 🔹 Small sample size—larger studies are needed to confirm these findings 🔹 Short trial duration—long-term effects are still unknown 🔹 Study population—results may not generalize to all individuals with MDD
💡 What’s Next? If larger studies confirm these results, creatine could become an accessible, affordable adjunct to therapy, particularly in communities with limited mental health resources.
What do you think? Could a common fitness supplement help improve mental health? Let’s discuss! ⬇️
Exercise is a powerful, evidence-based strategy for managing ADHD symptoms. Research shows that regular physical activity can boost dopamine and norepinephrine levels, improving attention, executive function, and emotional regulation.
1. Aerobic Exercise Programs
Aerobic activities are particularly effective for ADHD because they increase heart rate and stimulate brain chemicals associated with focus and mood.
Example:
Program: Preparing for 5K race
Duration: 3 times per week, 30–45 minutes per session
Benefits: Gradual progression helps build consistency, while running boosts executive functioning and decreases hyperactivity.
2. High-Intensity Interval Training (HIIT)
HIIT involves alternating short bursts of intense activity with periods of rest or lower-intensity activity. It’s time-efficient and highly engaging, which suits individuals with ADHD.
Example:
Program: 20-Minute HIIT Circuit (e.g., 30 seconds of jumping jacks, 15 seconds rest; repeat with squats, burpees, and mountain climbers)
Frequency: 3–4 times per week
Benefits: Improves impulse control and mood regulation through quick transitions and intense focus.
3. Martial Arts Training
Martial arts like karate, taekwondo, or judo combine physical activity with discipline and mindfulness, making them highly effective for ADHD.
Example:
Program: Weekly martial arts classes for 60 minutes
Key Features: Incorporates structure, focus on breathwork, and sequential movements that require attention.
Benefits: Enhances self-control, confidence, and attention.
4. Yoga for ADHD
Yoga combines movement with mindfulness, helping individuals develop better body awareness and emotional regulation.
Example:
Program: 20–30-minute yoga sessions using ADHD-focused videos (e.g., Cosmic Kids Yoga for children or Yoga with Adriene for adults).
Frequency: Daily or 3–5 times per week
Benefits: Reduces stress, improves attention span, and strengthens mind-body connection.
5. Structured Strength Training
Strength training involves repetitive, organized routines that build physical strength while requiring focus.
Example:
Program: 3-day split routine (e.g., arms, legs, core) at home or in the gym, using weights or resistance bands.
Benefits: Boosts discipline and executive functioning, while offering visible progress over time.
6. Nature-Based Activities
Activities like hiking, biking, or kayaking combine exercise with the calming effects of nature, reducing overstimulation.
Example:
Program: 60-minute nature walk or bike ride in a local park 2–3 times per week.
Benefits: Improves mood, reduces hyperactivity, and promotes relaxation.
How to Get Started
Start small: Begin with 10–15 minutes and gradually increase duration.
Make it fun: Choose activities you enjoy to sustain motivation.
Set a schedule: Consistency is key. Aim for at least 150 minutes of moderate-intensity exercise per week.
Monitor progress: Track improvements in focus, mood, or energy levels to stay motivated.
Over the past several years, a growing body of research has highlighted the role of inflammation in the development and progression of psychiatric disorders. A key biomarker frequently used in these studies is C-reactive protein (CRP), which can be measured through a simple blood test. For precise results, it’s important to order the ultra-sensitive CRP test when conducting this in a lab setting.
Recent findings from JAMA Psychiatry have revealed varying mental health trajectories for individuals with low-grade inflammation throughout childhood. Persistently elevated CRP levels, particularly peaking around age 9, were linked to an increased risk of developing psychosis, severe depression, and insulin resistance in adolescence and early adulthood.
This research suggests that a simple blood test could potentially identify children at higher risk for serious mental illnesses and cardiometabolic issues later in life, offering a window for early intervention.
The big question remains: how should we address this low-grade inflammation? My first recommendation is to focus on lifestyle modifications, particularly dietary changes that reduce inflammation, such as adopting a Mediterranean diet. Additionally, I believe chronic stress is a major contributor to inflammation. In modern American society, stress reduction is often overlooked, but finding effective ways to manage stress is crucial to mitigating long-term health risks.
Omega-3 fatty acids are reported to help with several physical and mental health conditions.
They are termed essential because they cannot be produced by the body and must come from the diet.
In fact, I use 1000 mg of omega-3 fish oil daily as part of my own supplement routine.
How Do Omega-3s Work:
Omega-3’s coat neurons, increase cell membrane fluidity, have neuroprotective properties, and the most well-established mechanism is an anti-inflammatory action. They directly affect arachidonic acid metabolism because they displace arachidonic acid from membranes and compete with it for the enzyme that catalyzes the biosynthesis of thromboxanes, prostaglandins, and leukotrienes involved in the inflammatory process thus reducing the formation of these products.
Indications For Omega-3 Use In Psychiatry:
In mental health the most well-established use of Omega-3s is for the treatment of depression. It’s been looked at as a primary treatment as well as augmentation. The results aren’t that great when Omega-3s are used as stand-alone therapy. As augmentation they have an effect size of 0.5 to 0.6.
Given our previous talks about inflammation and depression, people with high inflammatory biomarkers may respond better to Omega-3 treatment.
Omega-3s And Schizophrenia:
Maybe the most interesting data comes from studies of Omega-3 use in schizophrenia. It seems to work best when started early in the illness when the first signs or symptoms appear. There also seems to be a reduction in white matter changes on imaging studies.
This raised the important question; can we prevent schizophrenia?
Vienna Study:
There was a study published in nature communications that looked at outcomes in the prevention of psychotic disorders in Vienna.
They started with 12-week trial with omega-3s which proved to reduce the risk of progression to a psychotic disorder in young people with subthreshold psychotic states for a 12-month period compared to placebo.
They then completed a long term follow up of the study to show that brief intervention with Omega-3s reduced the risk of progression to a psychotic disorder and psychiatric morbidity.
A year after the Omega-3 treatment only 5% converted to schizophrenia, compared to 28% in the control arm. Seven years later the rates of conversion to schizophrenia were 10% Vs 40% with most of the patients being retained in the study.
Side Effects of Using Omega-3:
There are very few risks to adding omega-3 fatty acids to existing psychiatric treatments. Fish burps are a common occurrence and can be mitigated with enteric coated capsules or refrigerating the capsules. Omega-3 can increase bleeding time and require careful monitoring if the person is scheduled for surgery or taking anticoagulants. Keeping doses at 1000 mg/day is advised for this population.
Sources of Omega-3:
You can use a supplement, or you can consume fish like salmon, herring, or anchovies two times per week to get an adequate dose.
Ensuring the EPA to DHA ratio is 2:1 (EPA: DHA) or pure EPA is essential when selecting a product. Consumerlabs.com to help ensure the purity and potency of the product is accurate.
The cost of adding an Omega-3 supplement to your treatment is $8 to $30 per month depending on the specific product.
There is very little downside to increasing your consumption of Omega-3 fatty acids either from whole food sources or as a high-quality supplement.
I will talk about sedative and hypnotic medications in future videos, but I want to start a discussion on sleep with sleep hygiene. I recommend all my patients start here and follow this process at least 90% of the time prior to talking about medication. I find most patients are not doing these things and if they are it’s not consistent enough to see a noticeable improvement.
Stick to a routine by waking up at approximately the same time each day. Do this for seven days, and do not alter the time on weekends. This will help you gradually set your internal clock. You have more control over your wake times than your sleep time as you may not feel tired. Try to avoid taking a nap during the day even on nights where you do not get much sleep.
Avoid all caffeine after 12 PM, the effects of caffeine are long lasting and can interrupt sleep. If you can completely stop caffeine that would be best, but at the very least minimize consumption before 12 PM.
Try to exercise daily (seven days per week), preferably early in the day and not too close to bedtime. Start with 15 minutes per day and gradually work your way up. A combination of resistance training and cardiovascular training is best.
Stop doing active mental work at least one hour before bed.
Avoid watching TV, using a phone, laptop, or tablet before bed. The blue light from screens has been shown to worsen sleep. The bed should be used for sleep and sex only.
Create a bedtime ritual to follow every night before bed, warm bath, mindfulness exercise, gratitude journal, reading, or listening to music.
Do not use alcohol as a way to promote sleep. Alcohol negatively impacts sleep architecture and the sleep you do get will be unsatisfying.
The bedroom should be dark, quiet, and the temperature should be cool but not cold around 65 degrees is ideal. Consider blackout curtains, a fan to cool the room, and ear plugs to facilitate these conditions.
Restrict Food and drink 2-3 hours prior to bedtime. This will reduce the chances of sleep being interrupted to use the bathroom.
If you have any pain, take appropriate pain medications prior to bed.
In this video I focus the discussion on the exercise/physical activity portion of lifestyle medicine for psychiatry. Exercise is an underrated and underutilized tool for fighting depression. It can have a profound impact on mood, and helps people learn to be more resilient.
Key Findings Include:
For resistance training, higher intensity and shorter duration provides improvement in mood symptoms
For aerobic exercise, durations of 45-60 minutes appear to provide the most improvement in mood symptoms. Longer and shorter durations showed less benefit.
Keep it simple and just get started. There are a million different programs, and you can easily find yourself worrying to much about getting all the information and not enough time worrying about exercising.
The simplest way to start is with a daily walking routine. Spend six months consistently walking for 45-60 minutes. That’s it, no special equipment or significant out of pocket expenses required.
A walking routine will set the foundation for adding additional forms of exercise including resistance training
My clinical experience indicates that most psychiatric disorders would benefit from the use of lifestyle medicine. As a member of the American College of Lifestyle Medicine, I’ve used lifestyle interventions to treat many of my patients. It’s an underutilized and undervalued part of health care in general and these are my thoughts about why that is the case.
