For decades, psychiatry has focused largely on symptoms and syndromes, with treatment strategies centered on medication and psychotherapy. But a growing body of research is now expanding that perspective, highlighting the role that diet may play in mental health. Across Europe, clinicians and researchers are increasingly asking whether targeted dietary interventions might help patients whose depression, anxiety, or other psychiatric disorders have not responded to conventional care.

This question sits at the heart of nutritional psychiatry, a field that examines how diet, nutrients, and the gut-brain axis influence mood, cognition, and behavior. Once considered fringe, the discipline has gained momentum over the past decade as studies have linked dietary patterns to inflammation, microbiome changes, and brain function. Proponents argue that nutrition represents a low-risk, modifiable factor that could complement existing treatments — particularly for patients described as treatment resistant.

Yet enthusiasm is tempered by debate. While some clinicians are building specialized services around nutritional psychiatry, others caution against overselling diet as a stand-alone solution. The result is a field in rapid evolution, marked by promise, skepticism, and an unresolved question about how nutrition should ultimately be integrated into routine psychiatric care.

From Symptom Management to Root Causes

Psychiatrist Sabrina Garcia, MD, PhD, heads one of Europe’s first outpatient clinics dedicated to nutritional psychiatry and psychosomatics at the Medical University of Graz in Graz, Austria. Similar clinics also exist in Germany and Switzerland, she said. For Garcia, the connection between nutrition and mental health is inseparable from the brain-gut axis — an area she believes is still underappreciated in psychiatric training.

“During my training in psychiatry, I learned a largely symptom-oriented model,” she told Medscape News Europe. “Curing someone was considered unlikely, and care for chronic patients was framed mainly as long-term symptom management. I think we can do more, and I’ve seen it. We’re not using all the tools we could.”

When her department began discussing new clinical priorities 2 years ago, Garcia proposed creating a nutritional psychiatry clinic. “No one knew what it would be about,” she said. “We started from scratch.” What began as a small physician-led service soon expanded into a multidisciplinary team of psychiatrists, psychotherapists, and dietitians.

The clinic primarily receives patients referred by psychiatrists after multiple treatments have failed. “These are patients who have tried several antidepressants and even electroconvulsive therapy,” Garcia said. “When all this fails, patients search for something else.”

Patients undergo blood tests to identify nutrient deficiencies and receive behavioral therapy alongside standard psychiatric care. Medication is prescribed when necessary, but Garcia emphasizes identifying underlying metabolic or nutritional contributors rather than managing symptoms alone. Patients typically remain in care for about a year, the period she says is needed to support sustained behavioral change.

“When patients come to see us, they usually have been nutrient deficient for a long time,” she said. “If deficiencies are really pronounced, then substitution is needed. We look for what is missing and add what’s needed. Often it is vitamin D and the whole range of vitamin Bs,” she said.

Evidence, Enthusiasm, and Caution

Internationally, the scientific case for nutritional psychiatry has been shaped in large part by research led by Felice Jacka, PhD, professor of nutritional psychiatry and founder of the Food & Mood Centre at Deakin University in Australia. Jacka has been involved in multiple studies examining the relationship between diet quality and mental health outcomes.

In 2017, she led a randomized controlled trial designed to directly test whether improving diet could improve mental health. The study found that dietary improvements were associated with a substantial reduction in depressive symptoms. Subsequent work has explored how dietary patterns — such as Mediterranean, fermented, very-low-energy, and polyphenol-rich diets — may influence inflammation, gut microbiota, and brain function.

“Food remains a low-risk, accessible, and modifiable driver of mental health,” Jacka told Medscape News Europe. “With one third of patients experiencing treatment resistance, dietary approaches offer additional, scalable tools.”

Not all experts are convinced that specialist clinics are the right way forward. Ted Dinan, PhD, emeritus professor of psychiatry at University College Cork in Cork, Ireland, said nutritional psychiatry is particularly relevant for mood disorders but should not be viewed as a replacement for established therapies.

“There is increasing evidence that a Mediterranean diet is important in such patients,” he said. “But it is not an alternative to medication or psychotherapy. Appropriate nutrition boosts the effectiveness of these therapies.”

Dinan is skeptical of dedicated nutritional psychiatry clinics, warning that they may foster unrealistic expectations. “Patients assume wrongly that this is an alternative to current therapies, which it is not,” he said. He added that nutrition has so far had limited impact on everyday psychiatric practice, except in managing weight gain associated with antipsychotic use. In the future, he predicts, nutrition will be more fully embedded into standard psychiatric care rather than siloed into specialist services.

Diet, Behavior, and the Broader Clinical Picture

Ulrike Gisch, PhD, professor of nutritional psychology at Justus Liebig University Giessen in Giessen, Germany, agrees that the field must continue to develop, but she stresses the importance of a bidirectional perspective. Nutritional psychiatry, she said, should examine not only how diet influences mental illness but also how psychiatric disorders affect eating behavior.

“Many psychiatric disorders are associated with impaired daily functioning,” she told Medscape News Europe. “This can lead to changes in shopping, cooking, and eating routines. For example, severe anxiety may cause patients to avoid leaving their homes, significantly limiting food availability.”

In her own psychotherapeutic practice, Gisch routinely advises primary care physicians to check for deficiencies such as iron or vitamin D, or for thyroid dysfunction, in patients with depressive symptoms. Nutrition, she said, is a modifiable factor that deserves greater attention across medical, psychotherapeutic, and dietetic settings.

Back in Graz, Garcia sees this broader integration as essential to the field’s future. She hopes nutritional psychiatry will become part of undergraduate and postgraduate medical education across Europe.

“It’s a huge problem that doctors hardly know anything about nutrition, and nothing specific about nutritional psychiatry,” she said. “This is what we want to address in the coming years. We aim to become better doctors for our patients every day.”

Jacka reported receiving industry support for research from Meat & Livestock Australia, Woolworths Group, The a2 Milk Company, Be Fit Food, and Bega Cheese and travel support and speakers’ honoraria from Sanofi-Synthelabo, Janssen-Cilag, Servier, Pfizer, Network Nutrition, Angelini Farmacéutica, Eli Lilly, Metagenics, and The Beauty Chef. She reported being on the scientific advisory board of the Dauten Family Center for Bipolar Treatment Innovation and ZOE Limited. Jacka reported writing two books for commercial publication. Dinan, Garcia, and Gisch reported having no relevant financial relationships.

Sophie Cousins, MIPH, is a global health journalist who has reported from more than 20 countries.