The pillars of late-twentieth-century and early-twenty-first-century psychiatric treatment have been psychotropic drugs — substances that alter the functioning of the brain, including antidepressants and mood stabilisers — and various forms of psychotherapy, including cognitive behavioural therapy (CBT) and dialectical behaviour therapy (DBT). Yet, there are definitive indicators that these approaches alone are inadequate. In 2017, the Cambridge University Press published an online article suggesting that medication and psychotherapy avert less than half of the disease burden of mental illness. What if there was another way to mitigate the impacts of these disorders? Research points to a new starting point — what we put on our plates.
The newly-emergent field of nutritional psychiatry is not intended to eradicate the use of existing psychotropic drugs, but to supplement them. These medications themselves are a modern phenomenon — the first successful pharmacological compound for major depression was iproniazid, marketed as an antitubercular substance in 1958 and used by psychiatrists off-label. Nutritional psychiatry is potentially of particular importance to modern medicine, given the comorbidity of mood and eating disorders: data collated for the Australian National Eating Disorders Research and Translation Strategy found that 58% of Eating Disorder patients had comorbid psychiatric diagnoses.
The concept of there being a connection between the gut and the brain is not a new one. The first tentative links between colon and cranium were made as far back as Ancient Greece and the Dong-Jin dynasty, with more concrete evidence emerging in eighteenth-century France. Today, we know that the enteric nervous system consists of over one hundred million nerve cells lining pathways, from oesophagus to rectum. The gut-brain axis comprises bidirectional communication between the enteric and central nervous systems, constituting a direct pathway between gut and brain. The reality of this link has even crept into our vernacular: we’ve all gone with our gut when faced with a particularly obscure multiple-choice question, or experienced butterflies in our stomach opening the ominously innocuous results tab on my.tcd.ie.
Researchers propose that the so-called Mediterranean diet is of particular benefit to mental health. One study notes that, “Such diets are characterised by the high intake of vegetables, fruit, whole grains, nuts, seeds and fish, with limited processed foods”. The benefits of such eating habits are attributed to their association with lower levels of inflammatory markers, while chronic low-grade inflammation has been tied to the onset of de novo depression, schizophrenia, and bipolar disorder. The ongoing challenge for scientists is to identify specific correlations between disease and nutrients. At present, it can only be said that the healthy diet fundamentals touted in SPHE classrooms across the country have validity in the treatment of mental illness, provided that they are packaged in a scientifically-grounded way, rather than the it’s a sin to have a chocolate bar impression that many students depart with.
This is of particular importance to college students, given the notoriously sub-optimal food sources that many of us exist on. That is not to say that procuring such a diet is easy. Safefood, a public body that raises consumer awareness of nutrition in Ireland, estimated in 2023 that a single adult working full-time and earning the National Minimum Wage must spend 14% of their weekly income to purchase a nutritionally adequate food basket. Breads, cereals, fruit, and vegetables — all of the foods that are beneficial to mental health — account for the highest proportion of this cost burden. For many, this is not affordable, nor is the eye-watering cost of private psychology and psychiatry services.
Moreover, the time required to prepare a nutritionally adequate meal is significant. It demands far more mental and physical exertion than tossing something into the microwave, an understandable reflex after coming home from a long shift or a day of panic attacks at the doorway of every classroom.
There is, however, a certain unwillingness within the field of psychiatry to acknowledge the inherent environmental and dietary factors that are leading to the proliferation of mental illness within society today. This is unsurprising given that a study conducted in 2021 found that in 2016, 55.7% of active psychiatrists in the United States received some form of payment from pharmaceutical manufacturers. The very term ‘nutritional psychiatry’ is itself ethically problematic. It endorses the engorging of the field of psychiatry to include dietary recommendations that could be circulated and implemented — at least for milder forms of illness — in low-cost, accessible ways, if only the data was readily provided.
In 2021, The Irish Times published an interview with Dr. Georgia Ede, a psychiatrist pioneering nutrition-based treatment, who observed, “For decades, our treatment paradigm has been the trial-and-error use of psychiatric medications intended to address neurotransmitter imbalances, without seeking to understand what might cause these imbalances in the first place”. This is predictable when one considers the profitable relationship forged between psychiatry and the pharmaceutical industry, as well as the uncanny parallels between psychiatry and capitalism identified by Dr. Richard U’Ren, medicine graduate of McGill and former Stanford Medical Center psychiatry resident, in his 1997 essay, ‘Psychiatry and Capitalism.’
For more severe illnesses, there is the question of how to implement nutrition into existing psychiatry and psychology practices without adding additional costs to patients in the form of dietetics, a service that is already financially inaccessible to many. Additionally, potential discrepancies arise between how these services would be implemented in public versus private care, the former being underfunded and understaffed, the latter liable to commodify these new findings. As of February 2nd, 2025, the HSE’s national waiting list website indicated that there are 547 public patients nationwide awaiting the offer of a psychiatry consultation.
It is unequivocal that diet plays a pivotal role in the management of mental illness. However, how nutrition can cater to specific patients and diseases, as well as how these services can be implemented without necessitating further treatment-restricting costs, remains to be seen.
