Psychiatry Alternatives: Supplements in Integrative Psychiatry

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 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 Mellitox 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 accidentally 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.

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