Lifestyle Psychiatry: How Creatine + Exercise Rewires Depressed Brains with Dr. Nicholas Fabiano

Summary

Dr. Nicholas Fabiano, a third-year psychiatry resident at the University of Ottawa with 70,000+ X followers, explains how exercise can match antidepressants for mild-to-moderate depression through muscle-released proteins called myokines that act like "miracle grow for the brain." He introduces the FIT framework (Frequency, Intensity, Type, Time) for systematically discussing exercise with patients, similar to prescribing medication. Creatine supplementation, typically used by athletes, shows promise for mental health when used alongside traditional treatments, but brain benefits may require higher doses (10g+) than the standard 5g used in fitness. Fabiano warns that excessive exercise can become a form of self-harm when used to transfer emotional pain, with red flags including 6+ hours daily and frequent injuries. His vision for psychiatry's future centers on removing the artificial divide between mental and physical health, enabling better collaboration across medical specialties.

Key takeaways:
• Exercise intensity matters more than type for antidepressant effects 
• Creatine costs ~$35 for 90 servings and has favorable risk-benefit ratio 
• Supervised exercise interventions outperform unsupervised due to adherence 
• Future psychiatry requires integrated mind-body treatment approaches
 

Timestamps / Shownotes

[00:00:00] Introduction - Dr. Fabiano's background and training structure in Canada 
[00:04:30] Defining lifestyle psychiatry and the mind-body connection
[00:06:00] Exercise for depression - research evidence and meta-analyses 
[00:09:00] Exercise study design challenges and placebo controls 
[00:11:30] Exercise intensity vs. type - what matters for antidepressant effects 
[00:15:00] The muscle-brain connection - myokines and BDNF explanation 
[00:20:00] Creatine for mental health - from gym supplement to brain fuel 
[00:26:00] Clinical implementation - the FIT framework for prescribing exercise 
[00:33:00] Exercise as self-harm - warning signs and red flags 
[00:40:00] Balancing productivity with self-care during medical training 
[00:42:00] Future of psychiatry - removing mental-physical health divide

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