Abstract: Integrative psychiatry is a holistic approach that utilizes both conventional and complementary therapies. The term holistic implies treating the patient as a whole person, thus in this approach the individual's overall physical, mental, spiritual and emotional wellbeing are taken into consideration. My focus is on what I have found to be both practical and useful in the context of my own practive in clinical psychiatry. This includes the use of nutritional supplements.
While I have a conservative practice in Psychiatry including psychopharmacology and psychodynamic psychotherapy, in my practice I have increasingly found that many patients are using supplements including vitamins and herbs. The use of such products is considered under the domain of Integrative Psychiatry, and in some instances can help. Thus as a psychiatrist I find it my responsibility to have a familiarity with such products.
In this article, I attempt to present information to help make informed decisions. The treatments and supplements including vitamins, and herbs discussed are not exhaustive in scope, but rather focus in on what I have found to be practical, supported by research, and generally accepted by the scientific community as having some potential validity. When I first started medical school about 20 years ago, alternative medicine was accelerating in popularity. Many vitamins and other supplements were entering the market place with various claims, and sometimes at outrageous prices. At that time I was tought that a good, basic multivitamin was a good recommendation, but to suggest more than that might be a waste of money for the patients and even dangerous. The government stepped in to allow the marketing of supplements so long as they did not claim to treat, cure or prevent disease, among other stipulations. Nevertheless, the use and popularity of supplements continued to grow and now is a multibillion dollar industry. With this there has been a growth of interest in supplements and other alternative therapies in the scientific and medical community, and in many ways integrative medicine is becoming mainstream practice. Unfortunately, with money, often comes corruption. Thus there are many companies, that in my opinion market products with proprietary blends of supplements that are very expensive and make no sense, and there are many practitioners that push specialized products which may or may not be backed by scientific evidence, but usually tend to be overpriced. As such there is a lot of mistrust, doctors recommending supplements and alternative therapies may be looked down upon, and the public is confused about what may be good for them.
I feel it important to state that the information provided here is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional or any information contained on or in any product label or packaging. Some information may be accidently incorrect or unintentionally misleading. I do not recommend the use of any of the products and take no responsibility for any consequences. In particular I recommend that supplements if they are taken or other alternatives if chosen, be taken or used with caution because they are not tested for safety or regulated or approved by the FDA like prescription medications, yet they can also have serious side effects, become toxic, cause allergic reactions, cause birth defects, get into breast milk, thin blood-increasing the risk for bleeding especially with surgery, cause sedation and impairment leading to accidents, and interact with other medications and supplements potentially changing their levels in dangerous ways among other potential complications (e.g. lowering the serum levels of birth control pills or changing Coumadin levels). Like medications, several supplements may be dangerous if combined with alcohol. In addition if a supplement or other alternative therapy is self-prescribed, one may mis-diagnose their condition and could be putting themselves in jeopardy of worsening symptoms. Furthermore, even if a supplement seems to be well tolerated, and seems to have a good safety record, complications may arise with high doses or prolonged use. Thus, I believe supplements are best utilized when recommended by a doctor who is familiar with their use and who has diagnosed the condition for which they are intended, and who can monitor for safety and progress.
Anxiety supplements: While several prescription medications are effective, some are very addictive, and many are poorly tolerated, especially in the elderly. Like conventional medications used in psychiatric practice to treat anxiety, supplements may similarly effect neurotransmitter systems including those for serotonin, norepinephrine, dopamine, and GABA. A few I have found useful in treating adults include Ashwagandha, Inositol, Kava, L-Theaninine, and Valerian.
Depression Supplements: Several prescription medications are effective, however they don't always result in the full remission of symptoms and they are often poorly tolerated, especially in the elderly. There is a lot of cross over between anxiety and depression, with many people suffering from both concurrently. Similarly the medications and supplements used in depression also modulates the monoamines, namely serotonin, norepinephrine, and dopamine. A few I have found helpful include Chromium Picolinate, Fish oil, 5-HTP, L-Methlyfolate St. John's Wort, and SAMe.
Insomnia Supplements: Insomnia is often associated with an underlying illness, often depression or an anxiety disorder. It is sometimes a feature of mania in bipolar disorder, and can also be associated with sleep apnea and the restless leg syndrome. Thus as with other problems addressed in this article, medical attention should be sought for proper diagnosis and treatment. For insomnia several prescription medications are effective, however they are often addictive and they are often poorly tolerated, especially in the elderly. Here are some possible alternatives for adults. Like conventional medications used in psychiatric practice to treat insomnia, supplements may similarly effect neurotransmitter systems including those for serotonin and GABA. Often medications and supplements used to treat anxiety also help with insomnia. There are several formulations that mix several supplements together used for both anxiety and insomnia, however the scientific basis of this is often lacking, and this presents a higher risk of side effects. Melatonin has unique qualities in this class of supplements. It can be especially beneficial in disorders of circadian rhythm. It may be used together with supplements like Ashwagandha, Chamomille, Kava, L-Theanine, and Valerian , or by itself. L-Tryptophan can also be effective, and is also sometimes combined with the other supplements listed.
Cognitive Supplements: Cognitive problems need medical evaluation to determine their underlying cause. If several conditions are not diagnosed, there can be irreversible decline where this at one time may have been prevented. Alzheimer's disease is the most common cause of dementia, and while there are only a handful of conventional medical treatments available, they have some efficacy and new treatments are being developed. There are several complementary and alternative treatments which have been studied, but their effects are also limited. In my practice I recommend these complementary and alternative treatments only to augment standard medical treatments when there is an actual diagnosis unless a patient is absolutely unable to tolerated the standard treatments. In cases of mild cognitive decline which may not actually be associated with a dementia, complementary and alternative medicines may play a preventative role. Like conventional medications used in psychiatric practice to treat cognitive disorders, supplements may similarly effect neurotransmitter systems including those for Acetylcholine and Glutamate. Some supplements that may be considered are Acetyl-L-Carnitine, Methylcobalamin, especially in combination with L-Methylfolate and N-Aceyl-Cysteine, CDP-Choline, Curcumin, Fish oil, Ginkgo Biloba, Huperzine-A, and Phosphatidylserine.
Other Conditions: While the use of supplements has been suggested for several other psychiatric conditions, in my opinion there is limited evidence or justification for this at the current time. In any case such therapies should never be used as a first line treatment in serious conditions involving severe impairment, psychosis, mania, or suicidal thinking.
In summary, there are many choices to offer to folks to make informed decisions about what type of treatments they want for various psychiatric conditions. It is my opinion that in current times it is the responsibility of psychiatrists including myself to be able to discuss with our patients not only conventional treatments, but also complementary and alternative treatments, their risks, along with the potential benefits and risks of no treatment at all. Supplements are increasingly playing an important role in this process. This article names a few common uses of supplements in anxiety, depression, insomnia and cognitive disorders.
My website Psychiatry Alternatives at www.psychiatryalternatives.com elaborates on mechanisms of action, safety, and dosing of the supplements mentioned in this article. In addition on the website I attempt to keep up to date and offer contemporary references in this rapidly evolving field of Integrative Psychiatry.
Dr. Robert Homer left his career as a research scientist based on a decision to pursue a clinical career in medicine and psychiatry. He holds a Bachelor's degree in Physics from Brandeis University, graduating Cum Laude, with Honors in Physics. He earned both his Master's Degree in Electrical Engineering, and Ph.D. in Physics from the University of Miami. His medical doctorate was awarded by the Eastern Virginia Medical School. He received his specialty training in psychiatry at Beth Israel Medical Center in New York City. He is a Diplomate in the specialty of Psychiatry with the American Board of Psychiatry and Neurology and a Diplomate in Addiction Medicine with the American Board of Addiction Medicine. He received a Certification in Psychodynamic Psychotherapy from the New York Medical College, and is designated as a Master Psychopharmacologist with Distinction by the Neuroscience Education Institute. He is a member of the American Psychiatric Association and the American Association of Clinical Psychopharmacology.
Practice website http://Homer.MD