Complementary and alternative medicine in psychiatry.

CPD Online – Complementary and alternative medicine in psychiatry 1 CPD Online take-home notes The world of complementary alternative medicines Whereas conventional medicine is predominantly disease-oriented, complementary alternative medicine (CAM) is symptom-orientated. CAMs include pharmacological, physical and psychological options. Most treatments applicable to mental health aim at reducing stress, anxiety, agitation, low mood and sleep disturbance. The evidence base for many treatments is extremely limited, but individual patients may still derive benefit. Although all of these treatments are all very gentle and can enhance well-being, vulnerable people may experience a deterioration of their mental health problems. Herbal remedies and supplements For most pharmacological CAMs used for psychiatric problems, the evidence remains limited. The best evidence exists for the use of St John's wort in the treatment of depression. Its effectiveness has been confirmed in several meta-analyses. S-adeneosylmethionine (SAMe) is also effective in the treatment of depression but trials in this area tend to be small and short-term. Its use remains expensive. Omega-3 fatty acids may be of some value as adjunct treatment of uni-or bipolar depression but not as a mood stabiliser on their own. This requires confirmation in larger trials. The evidence for remedies targeting the GABA system including valerian for insomnia remains inconclusive. Kava has been shown to be effective as treatment against anxiety but its use cannot be recommended due to concerns about liver toxicity. Pharmacological CAM options for psychosis, tardive dyskinesia or dementia remain extremely limited. Safety aspects of CAMs Contrary to the commonly held belief that pharmacological CAMs are natural and hence harmless they may be associated with significant health risks. Some remedies are associated with substantial adverse effects, others with significant drug interactions. Not all drug interactions indentified in vitro or in animal experiment may be clinically significant.