Introduction: CAMs and the Future of Mental Health Care

November 30, 2016

The articles in part 1 of this Special Report provide concise reviews of important research findings and clinical applications of mindfulness meditation, breath practices, and uses of CAM therapies for perinatal depression.

The professional dialogue on complementary and alternative medicine (CAM) has made little progress after decades of research because no single conceptual framework embraces the diverse understandings of health and illness embodied in the world’s healing traditions. An important practical consequence of this is the absence of consensus on “best practices” in medicine and in mental health care. Clinicians are left with the task of examining the evidence for CAM therapies to judiciously guide patients to modalities that are safe and effective for maintaining emotional and mental well-being or treating specific mental health problems.

CAM therapies are already widely used to treat or self-treat mental health problems. Many of our patients use herbal medicines, essential fatty acids, vitamins, or other natural product supplements-often in the absence of reliable information. Many others are receiving treatment for a mental health problem from acupuncturists, Ayurvedic physicians, massage therapists, and a variety of CAM practitioners. It is significant that many patients who use CAM therapies also take prescription medications for depressed mood, anxiety, bipolar disorder, a substance abuse problem, insomnia, ADHD, or another mental health problem. The majority of individuals who use such integrative approaches do not disclose this information to their mental health care provider, resulting in treatment delays, poor outcomes, and potentially serious safety issues.

-The Premise, Practice, and Promise of Integrative Child and Adolescent Psychiatry

-Evidence-Based Research on the Role of Zinc and Magnesium Deficiencies in Depression

-Mind-Body-Spirit Interventions for Patients With PTSD

-Mini Quiz: Integrative Treatments for PTSD

CAM research findings are leading to many safe, effective, and affordable nonpharmacological approaches for maintaining optimal well-being and treating specific psychiatric disorders. The contributors to this 2-part Special Report represent the vanguard of a movement that is transforming mental health care. They are visionaries who have expertise in a variety of CAM approaches that are being actively investigated in rigorously designed studies and implemented in clinical settings. Collectively, their work is shaping the future of mental health care in the US and globally.

The articles in part 1 of the Special Report provide concise reviews of important research findings and clinical applications of mindfulness meditation, breath practices, and uses of CAM therapies for perinatal depression. The CME article this month is an in-depth review of EEG biofeedback (ie, neurofeedback).

Part 2 of this Special Report will include articles on CAM therapies for children and adolescents with mental health problems, the impact of zinc and magnesium deficiencies on depression, an update on fatty acids and minerals for maintaining well-being and treating psychiatric disorders, and mind-body-spirit medicine for PTSD.

The CAM therapies reviewed in this Special Report do not obviate the need for psychotherapy or medications; rather, they add to the limited armamentarium of biomedical psychiatry and provide mental health providers and patients with a variety of safe, evidence-based treatment choices. In the coming decades, the increased use of evidence-based CAM therapies in mental health care should provide a range of safe and effective treatments for depressed mood, anxiety, ADHD, and other common mental health problems. As adjuncts to conventional psychotherapy or pharmacotherapy, CAM therapies can improve outcomes, enhance our patients’ quality of life, and reduce the high costs associated with mental health care.

As a founding member and former chair of the American Psychiatric Association Caucus on Complementary and Alternative and Integrative Medicine1 and Chair Emeritus of the International Network of Integrative Mental Health,2 my role for many years has been to facilitate rigorous open-minded dialogue and debate on the range of nonpharmacological modalities used in mental health care. Both groups are committed to improving mental health care by advancing an agenda for evidence-based uses of CAM through research, education, and training. I feel strongly that the dialogue on CAM and integrative medicine that is taking place within the American Psychiatric Association, the International Network of Integrative Mental Health, and other organizations will soon extend to the community of practicing psychiatrists. I encourage interested readers to network with one of the above organizations or to participate in a CAM interest group that may already exist in your clinic or hospital. Together our efforts will help shape the future of mental health care in the US and globally.

 

MORE ABOUT THE AUTHOR - James Lake, MD

My sons, my life partner, and my best teacher humble me and inspire me to see more clearly, ask hard questions, and strive to be a better person and physician. I have been blessed with 2 sons, David and Daniel-both already in their 30s-who devote their energy to causes they are passionate about and work diligently to transform their communities and the world into a better, more beautiful, and more interesting place through sustainable energy and agriculture, music, stories, and art. My sons inspire me with their unbridled idealism and boundless energy at a time when it would be all too easy to succumb to cynicism and facile solutions to the complex problems facing this troubled land.

I have been graced with the companionship and love of my soul mate and friend, Nicole, who is a brilliant psychiatrist, intuitive thinker, and gifted artist. Through the images she composes, Nicole reminds me to pay attention to wondrous patterns in the very small that reveal the magic and strange beauty of nature in astonishing new ways.

During residency, I had the good fortune to be mentored by Jim Zarcone, Professor of Psychiatry at Stanford, brilliant scholar and world-class researcher in sleep disorders who had devoted years to the study of Western philosophy before we met when I was rotating through the in-patient wards at the Palo Alto VA. Together we read and debated the works of Wittgenstein, Quine, Frege, Davis, and many others. We read classic philosophical essays examining the functions of language and phenomenology in medicine and especially in psychiatry. The result has been that whenever I think or write about integrative medicine and psychiatry, I feel compelled to “begin” by making my premises explicit and defining a clear framework and method because not doing so would render the work of thinking and writing vague and incomplete.

References:

1. American Psychiatric Association Caucus on Complementary and Alternative and Integrative Medicine. https://intpsychiatry.wildapricot.org/. Accessed October 3, 2016.

2. International Network of Integrative Mental Health. https://inimh.org/. Accessed October 3, 2016.