What 2025 Taught Me About the Future of Psychiatry

2025 was a year of immersion. I stepped back from regular publishing—not because I ran out of things to say, but because I needed to go deeper into learning before I could share what I was finding. It was a year that reshaped how I think about psychiatric care, root-cause medicine, and what's possible for our patients.

We're learning to ask why: why the inflammation, why the resistance, why the relapse. That still requires presence. It still requires slowing down. This isn't about abandoning evidence-informed care—it's about expanding it, reaching into the spaces where drugs and devices alone aren't enough. And that expansion is a source of hope—for clinicians who've felt the limits of their training, and for patients who've been told there's nothing left to try.

Two experiences defined that transformation: completing a year-long fellowship and attending a conference that I believe should be required for every psychiatry resident in training.

This past December, I completed the one-year Functional and Integrative Psychiatry Fellowship through Psychiatry Redefined. It was rigorous, clarifying, and deeply practical—offering a structured framework for integrating root-cause approaches into everyday psychiatric practice.

What the fellowship provided wasn't just content. It was a clinical scaffolding: protocols for assessment, a systems-based way of thinking, and a community of like-minded clinicians committed to expanding what psychiatry can offer. It gave me language for what I'd been intuiting and tools for what I'd been attempting piecemeal.

If you're a clinician curious about this path—whether you're in residency, early career, or decades into practice—reach out. I'm happy to share more about my experience.

But one experience in particular accelerated the learning in ways I didn't expect.

In September, I attended the Integrative Medicine for Mental Health (IMMH) 2025 conference in San Diego. Over 1,000 multidisciplinary clinicians gathered around the theme of "The Anthropogenic Drivers of Mental Health"—the ways our modern environment, diet, toxins, and lifestyles are shaping the mental health crisis.

The energy in that room was unmistakable. This wasn't a fringe movement. This was a field in transformation.

What struck me most was how much of the material presented was applied basic science—mitochondrial function, inflammation, the microbiome, environmental toxicology—concepts we learned in medical school, but whose clinical applications in psychiatry have advanced far beyond what our current curricula reflect. These aren't alternative ideas. They're foundational. And the gap between the science and what's being taught is widening.

I walked away convinced: IMMH should be required attendance for psychiatry residents.

Rather than a session-by-session recap, here are the broad themes that will shape my practice going forward.

One of the conference's central messages was this: psychiatric disorders often stem from mitochondrial dysfunction and brain energy deficits—not just neurotransmitter imbalances. As one speaker put it, "The new energy crisis is not outside—it's inside."

This reframes treatment resistance. When SSRIs don't work—and they don't for 45-50% of patients—we may be missing the metabolic picture entirely. The ketogenic diet, long validated for epilepsy, is emerging as a serious therapeutic tool for serious mental illness and brain health optimization. This isn't a fad. It's a paradigm shift.

The gut-brain connection has moved from theory to clinical application. Gut dysbiosis and intestinal barrier dysfunction ("leaky gut") act as upstream drivers of neuroinflammation. When inflammation hijacks tryptophan metabolism through the kynurenine pathway, we get less serotonin and more neurotoxic byproducts.

The field is moving beyond generic probiotics toward strain-specific psychobiotics—targeted interventions with measurable effects on mood and cognition. This has real implications for how we approach treatment-resistant depression, anxiety, and beyond.

Perhaps the most hopeful message came from the work on Alzheimer's prevention and reversal. Precision medicine frameworks are demonstrating that cognitive decline—long considered inevitable—may be preventable and, in some cases, reversible with early, multi-domain intervention.

Biomarkers like pTau217 and imaging tools like arterial spin labeling (ASL) can detect pathology 20 years before symptoms emerge. The shift from hopelessness to proactive brain health has profound implications—not just for dementia care, but for how we think about healthspan, wellness, and prevention across the lifespan.

Mold toxicity. Chronic Lyme and co-infections like Bartonella. Heavy metals. Environmental toxins. These factors are often missed in conventional psychiatric workups—but they may be driving the very symptoms we're trying to treat.

One speaker made the point memorably: if mold toxicity isn't addressed first, the gut won't heal no matter what else you do. The concept of "total load"—the cumulative burden of environmental and infectious stressors—reframes how we think about chronic, complex presentations. Detoxification and environmental assessment belong in psychiatric care.

Dr. Gabor Maté's message resonated throughout the conference: "Don't ask why the addiction—ask why the pain." The mind-body connection isn't a complementary add-on. It's foundational science that mainstream medicine has largely ignored.

In addiction treatment, an integrative approach means looking under the hood—fixing the underlying chemistry so the patient no longer feels they need the substance. And the spiritual dimension isn't an afterthought; it's neurobiologically relevant to recovery, meaning-making, and sustained healing.

A recurring realization throughout the conference: much of this material represents advances in applied basic science—yet it's largely absent from psychiatric education.

And it's not just medical school. Even in my advanced fellowship training in geriatric psychiatry and addiction medicine—subspecialties where metabolic health, brain aging, and root-cause thinking should be central—the paradigm remained constrained to drugs and devices. We learned to prescribe, but not to investigate upstream drivers. We learned to manage symptoms, but rarely to ask why.

Conferences like IMMH fill the gaps our entire training trajectory left open.

But let me be clear: this isn't about abandoning evidence-informed medicine. It's about extending it—adding depth and curiosity where conventional approaches alone aren't making enough impact in our patients' lives. Functional and integrative psychiatry is additive, not replacement. It expands the toolkit without discarding what works.

I'm bringing these approaches into my clinical work—at The Noesis Clinic in my private practice and at Enterhealth in dual-diagnosis addiction treatment. The alignment is clear: metabolic psychiatry, gut health, environmental factors, and root-cause thinking apply across settings. Whether the presenting issue is treatment-resistant depression, cognitive decline, or substance use disorder, the upstream drivers often overlap. An integrative lens doesn't replace what we do; it deepens it.

And through this newsletter, my aim for 2026 is to be in your inbox regularly again—translating this learning into accessible, clinically grounded content. I'm planning deep-dives on metabolic psychiatry, the gut-brain connection, brain health and cognitive prevention, and the intersection of healthspan and mental wellness.

I'll also be exploring cutting-edge interventional neuromodulation—including advanced TMS protocols—as well as the adoption of AI in genomics and how to incorporate biohacking and patient-generated data into clinical decision-making at the point of care.

The mission of Psychiatry 3.0 continues: bridging traditional psychiatry with emerging, evidence-based approaches—without losing the art of understanding at the center. The science is advancing. The training is catching up. And the opportunity to do better for our patients has never been greater.

What topics would you like me to explore? Reply or comment, and let me know. Your input shapes where this goes next.

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