Functional psychiatry
Check the body before blaming the medication.
Functional psychiatry, as practiced here, is a simple discipline: before we conclude that an antidepressant failed, we check whether the body gave it a fair chance. Thyroid, B12, folate, vitamin D, iron, and metabolic markers all shape how you feel and how medications perform. Those labs run through LabCorp, the results are read in the context of your whole picture, and supplements join the plan only where the evidence earns them a place.
PsychMed Care is the medication management practice of Solutions Psychiatry. If you are looking for therapy, or therapy and medication together, the full practice is at psych.us.
The lab panel
Six lines on a lab slip, each there for a reason
Physical drivers can imitate psychiatric symptoms, and they can blunt a medication that should be working. This is the standard panel, ordered when it will change a decision, not as a ritual.
Thyroid
An underactive thyroid wears the costume of depression: low energy, fog, weight creeping up. A medication cannot fix a hormone, so we look before we escalate.
Vitamin B12
Low B12 shows up as fatigue, low mood, and thinking that feels wrapped in cotton. It is common, it is missed constantly, and it is correctable once somebody checks.
Folate
Folate feeds the chemistry your antidepressant depends on. When it runs low, response to medication can stall for a fixable reason, and folate status also informs genetic results.
Vitamin D
Deficiency is widespread and tracks with low mood and flat energy. The level is cheap to learn and changes both supplementation and expectations.
Iron
Low iron stores, even without anemia, can drive fatigue, restlessness, and hair-trigger exhaustion. Ferritin tells the truth that a quick blood count can miss.
Metabolic and inflammatory markers
Blood sugar, lipids, and inflammation markers. Several psychiatric medications move these numbers, so a baseline protects you, and a trend tells us when a medication is costing more than it pays.
Draws happen at a LabCorp near you, wherever you live in the coverage map. Results come back to me, and we read them together at a follow-up: what is frankly abnormal, what is low-normal and worth treating anyway, and what it changes about the prescription. A lab value nobody acts on is trivia. Here it becomes a decision.
The panel is a starting point, not a ceiling. Metabolic monitoring follows its own calendar for patients on medications known to move weight, blood sugar, or lipids: a baseline before the dose settles in, then rechecks on a schedule we set together, so a slow drift gets caught while it is still a conversation rather than a second diagnosis. And when a value comes back off, the response is proportionate: repletion for a deficiency, a referral when the finding belongs to another specialty, or a medication change when the medication is the finding. What never happens is a shrug. Every abnormal result gets a decision attached to it, even when the decision is to watch it together with a date to look again.
Two habits keep this honest. First, we retest what we treat: a B12 we supplemented gets rechecked, a vitamin D we corrected gets a follow-up level, because "probably better" is not a measurement. Second, we do not chase numbers into the ground. A value inside the healthy range that matches how you feel is done, and the panel is not an annuity for the lab. Testing answers questions; when the questions run out, the testing stops.
Supplementation
Supplements, held to a prescription standard
Where the evidence supports it, supplements support the plan. They are chosen the way medications are chosen: for a named reason, at a real dose, checked against everything else you take.
Magnesium glycinate
The calm mineral in its gentlest form, used for sleep quality, muscle tension, and a nervous system that will not downshift at night.
L-theanine
An amino acid from tea, used for focused calm: alertness without the edge, often paired with morning medication rather than against it.
N-acetylcysteine (NAC)
An antioxidant with a real evidence trail in compulsive and habit-driven patterns, dosed deliberately and reviewed like any other agent.
Omega-3s
EPA-weighted fish oil, the supplement with the deepest bench in mood research, chosen at studied doses rather than label decoration.
Low-dose lithium orotate joins the list for some patients, at microdose levels far below prescription lithium, with the same respect for interactions. Every recommendation is dispensed through Fullscript, whose catalog is independently quality-tested, because a supplement industry with no referee is not a place I send patients to guess. What is in the bottle should match what is on the label, every time.
Clear boundaries
What functional does not mean here
Not anti-medication
This is a medication management practice. Functional work makes prescriptions smarter; it does not apologize for them or replace them with powders when a prescription is what you need.
Not a supplement store
Nothing is sold from this page, and no protocol is prescribed because a catalog features it. If a supplement cannot name the symptom, lab, or evidence behind it, it does not join your plan.
Not a fishing expedition
Labs are ordered when the answer would change a decision. Exotic panels, repeated testing without a question behind it, and treating numbers instead of people are all left to other practices.
How the thinking goes on a stuck case: a depression that has outlasted two adequate medication trials is not automatically a third-trial problem. We re-ask the basic questions first. Was the dose ever truly optimized? Is the thyroid quiet? Are B12, folate, vitamin D, and iron where they should be? Is sleep apnea sitting in the room uninvited? Only when the body has been cleared do we call a medication a failure and reach for the genetic report. That sequence, boring as it sounds, is where stalled cases unstick.
Sleep, movement, and light get reviewed in the same spirit, because they are inputs to the same system the medication acts on. A follow-up here can include an honest look at whether your nights are giving the prescription anything to work with, whether movement has quietly left your week, and whether your days include daylight at all. These are not lifestyle lectures and they are never homework you get graded on. They are levers, named plainly, that sometimes move a stubborn case further than the next dose increase would, and they cost nothing but attention.
A word about what happens to results over time. A single panel is a snapshot; the value compounds when snapshots line up into a film. The B12 that was low-normal last spring, repleted over the summer, and rechecked in the fall tells a story neither value tells alone, and it either earns the supplement a permanent place in your plan or retires it with thanks. That is the difference between functional psychiatry as a method and functional psychiatry as a shopping list: everything here is on probation, and only results renew the contract.
GeneSight testing
The genetic lens pairs with the lab lens: one shows how you process medication, the other shows the terrain it works in.
The supplement guide
The supplement evidence guide collects the supplement list and the reasoning standard in one place.
Medication management
Labs and supplements live inside the larger discipline of getting the prescription itself right.
A stuck depression
When labs explain why a depression will not move, the work happens in the conditions we treat every week.
“Your biology is not a footnote to your mental health. It is the terrain the treatment has to cross.”
Labs are part of the first plan, not a last resort. See the full approach