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Physicians’ use of complementary and alternative medicine
(CAM) treatments in psychiatry range from none at all to
complete immersion. The general goal of most organized efforts
to utilize CAM treatments is to integrate them with the best of
mainstream medicine. Thus, the typical CAM physician is
actually an integrative doctor, one who sees his or her CAM and
orthodox options as a large toolbox from which to choose the
best implements for the task at hand.
The Making of an Integrative Psychiatrist
The making of an integrative practitioner is a different path for
each who travels it. Some doctors have a personal recovery
experience through CAM and excitedly delve into it to bring
similar benefits to their patients. Some grow up in homes where
CAM treatments are used, so find it natural to bring such tools to
their practice. Some come from cultures where CAM is part of
traditional healing methods. Others see a patient or patients
dramatically improve through CAM and investigate further out
of professional curiosity. Some simply see that they are losing
patients to CAM practitioners and feel that learning more of the
subject would be a good business practice.
(CAM) treatments in psychiatry range from none at all to
complete immersion. The general goal of most organized efforts
to utilize CAM treatments is to integrate them with the best of
mainstream medicine. Thus, the typical CAM physician is
actually an integrative doctor, one who sees his or her CAM and
orthodox options as a large toolbox from which to choose the
best implements for the task at hand.
The Making of an Integrative Psychiatrist
The making of an integrative practitioner is a different path for
each who travels it. Some doctors have a personal recovery
experience through CAM and excitedly delve into it to bring
similar benefits to their patients. Some grow up in homes where
CAM treatments are used, so find it natural to bring such tools to
their practice. Some come from cultures where CAM is part of
traditional healing methods. Others see a patient or patients
dramatically improve through CAM and investigate further out
of professional curiosity. Some simply see that they are losing
patients to CAM practitioners and feel that learning more of the
subject would be a good business practice.
Doctors new to the subject typically start by reading articles or
books (such as this one) or attending seminars. They may seek
out professional associates who use CAM and learn from them.
They may stop at booths at medical conferences. If they are
serious, they can join organizations of CAM physicians, such as
the American College for Advancement in Medicine
(www.acam.org), Institute for Functional Medicine
(www.functionalmedicine.org), or the International Society for
Orthomolecular Medicine (www.orthomed.org). They can attend
gatherings such as the 2010 Integrative Mental Health
Conference at the University of Arizona. Also, the newly formed
International Network of Integrative Mental Health
(www.inimh.org) is a global organization to advance an
integrative whole-person approach to mental health through
education, research, networking and advocacy.
Common Concerns
Physicians new to CAM have common concerns. First of all, is it
scientifically based? Hopefully, we have made the case in this
guide that, indeed, much of it is, and the research continues to
grow and appear with regularity in even the most conservative
of medical journals. With internet access to the literature,
finding evidence (or lack of it) of a treatment’s efficacy is not
difficult.
Another concern depends on what others in the profession may
think. Repute is important and can affect patient referrals,
professional advancement, teaching appointments, etc. Doctors
commonly don’t want to appear to their colleagues to be
abandoning their orthodox roots. But part of those roots are the
commitment to use the best science has to offer and primum non
nocere—first, do no harm. Given the rapid advance of research
into CAM treatments, the orthodox paradigm is shifting and,
indeed, in many medical circles, the physician who ignores CAM
may now be considered the less learned.
books (such as this one) or attending seminars. They may seek
out professional associates who use CAM and learn from them.
They may stop at booths at medical conferences. If they are
serious, they can join organizations of CAM physicians, such as
the American College for Advancement in Medicine
(www.acam.org), Institute for Functional Medicine
(www.functionalmedicine.org), or the International Society for
Orthomolecular Medicine (www.orthomed.org). They can attend
gatherings such as the 2010 Integrative Mental Health
Conference at the University of Arizona. Also, the newly formed
International Network of Integrative Mental Health
(www.inimh.org) is a global organization to advance an
integrative whole-person approach to mental health through
education, research, networking and advocacy.
Common Concerns
Physicians new to CAM have common concerns. First of all, is it
scientifically based? Hopefully, we have made the case in this
guide that, indeed, much of it is, and the research continues to
grow and appear with regularity in even the most conservative
of medical journals. With internet access to the literature,
finding evidence (or lack of it) of a treatment’s efficacy is not
difficult.
Another concern depends on what others in the profession may
think. Repute is important and can affect patient referrals,
professional advancement, teaching appointments, etc. Doctors
commonly don’t want to appear to their colleagues to be
abandoning their orthodox roots. But part of those roots are the
commitment to use the best science has to offer and primum non
nocere—first, do no harm. Given the rapid advance of research
into CAM treatments, the orthodox paradigm is shifting and,
indeed, in many medical circles, the physician who ignores CAM
may now be considered the less learned.
Other issues include the acceptance of CAM treatments as “best
practice” by the local medical society or governing body and
insurance coverage for CAM therapies. These matters, too, are
evolving quickly and are best answered by consultation with
local colleagues, medical organizations, and insurance
representatives.
So what does the practice of a CAM psychiatrist look like? To
provide that insight, we look into the protocols used by Hyla
Cass, M.D. Dr. Cass has published eight books on CAM
treatments, served as Assistant Clinical Professor of Psychiatry,
UCLA School of Medicine from 1979 to 2005, and has made many
media appearances to discuss integrative psychiatric
approaches.
Dr. Hyla Cass on Integrating CAM Treatments
As a conventionally-trained physician with a specialty in
psychiatry, I have incorporated nutrition and other natural
techniques into my practice for more than twenty years.
At the core of this practice is a set of beliefs that have served
my patients well:
− Treat the whole person—mind, body, spirit, and
environment.
− Look for the deepest root problems beneath the symptoms,
which includes using the best that science has to offer.
− Apply a continuum of treatments, always beginning with the
safest, most natural, and most benign.
In the early days of my career, it was my interest in a more
relational, holistic approach, coupled with an appreciation for
the mind-body connection, that led me to psychiatry. During my
residency at Cedars-Sinai/UCLA Medical Center, I eventually
found that the standard “couch and Prozac” combination of
psychoanalytic and pharmacological treatments had their
limitations.
I was drawn to a more personal approach, where therapists
were more directly caring and interactive with their patients. I
practice” by the local medical society or governing body and
insurance coverage for CAM therapies. These matters, too, are
evolving quickly and are best answered by consultation with
local colleagues, medical organizations, and insurance
representatives.
So what does the practice of a CAM psychiatrist look like? To
provide that insight, we look into the protocols used by Hyla
Cass, M.D. Dr. Cass has published eight books on CAM
treatments, served as Assistant Clinical Professor of Psychiatry,
UCLA School of Medicine from 1979 to 2005, and has made many
media appearances to discuss integrative psychiatric
approaches.
Dr. Hyla Cass on Integrating CAM Treatments
As a conventionally-trained physician with a specialty in
psychiatry, I have incorporated nutrition and other natural
techniques into my practice for more than twenty years.
At the core of this practice is a set of beliefs that have served
my patients well:
− Treat the whole person—mind, body, spirit, and
environment.
− Look for the deepest root problems beneath the symptoms,
which includes using the best that science has to offer.
− Apply a continuum of treatments, always beginning with the
safest, most natural, and most benign.
In the early days of my career, it was my interest in a more
relational, holistic approach, coupled with an appreciation for
the mind-body connection, that led me to psychiatry. During my
residency at Cedars-Sinai/UCLA Medical Center, I eventually
found that the standard “couch and Prozac” combination of
psychoanalytic and pharmacological treatments had their
limitations.
I was drawn to a more personal approach, where therapists
were more directly caring and interactive with their patients. I
discovered art therapy with Helen Landgarten, then guided
imagery and other more cutting-edge interactive techniques
such as Voice Dialogue with Hal Stone. Not only did these
methods work more quickly, but they clearly could affect the
body in many ways, from relieving more obvious symptoms to
boosting the immune system.
Then, during my family therapy fellowship, I discovered the
“systems approach,” where the “identified patient” was not
necessarily the true problem! It wasn’t just Johnny who was the
“bad kid” or Jenna who was the depressed adolescent. In fact,
there were secret family issues (Mom’s depression, Dad’s
gambling) that had unbalanced the whole family dynamic, and
the children’s problems were the family’s symptoms. Treatment
would be successful only so far as the underlying issues (i.e., the
parents’ problems) were uncovered and healed.
By the same token, I became aware that the symptoms my
patients reported were just messages that something in their
body systems was awry. They were clues that needed closer
evaluation in order to uncover the real cause. I paid more
attention to the mind-body connection and the doctor-patient
relationship.
I carried what I had learned into my new medical practice and
began to explore the influences of nutrition and lifestyle on
health. I observed how imbalance in the body can affect the
mind. The brain, after all, is an organ affected by its internal
physiological environment.
It became obvious to me that psychotherapy is more effective
once the brain is functioning properly. I went on to discover how
many typical psychiatric complaints—anxiety, depression,
premenstrual syndrome (PMS), even schizophrenia—are
frequently related to biochemical imbalances. These can range
from low blood sugar, viral and fungal infections, hormonal
imbalances, allergies, and toxic overload to deficiencies of
specific nutrients.
I am able to diagnose these conditions with the appropriate
laboratory tests that give a scientific basis for treatment
imagery and other more cutting-edge interactive techniques
such as Voice Dialogue with Hal Stone. Not only did these
methods work more quickly, but they clearly could affect the
body in many ways, from relieving more obvious symptoms to
boosting the immune system.
Then, during my family therapy fellowship, I discovered the
“systems approach,” where the “identified patient” was not
necessarily the true problem! It wasn’t just Johnny who was the
“bad kid” or Jenna who was the depressed adolescent. In fact,
there were secret family issues (Mom’s depression, Dad’s
gambling) that had unbalanced the whole family dynamic, and
the children’s problems were the family’s symptoms. Treatment
would be successful only so far as the underlying issues (i.e., the
parents’ problems) were uncovered and healed.
By the same token, I became aware that the symptoms my
patients reported were just messages that something in their
body systems was awry. They were clues that needed closer
evaluation in order to uncover the real cause. I paid more
attention to the mind-body connection and the doctor-patient
relationship.
I carried what I had learned into my new medical practice and
began to explore the influences of nutrition and lifestyle on
health. I observed how imbalance in the body can affect the
mind. The brain, after all, is an organ affected by its internal
physiological environment.
It became obvious to me that psychotherapy is more effective
once the brain is functioning properly. I went on to discover how
many typical psychiatric complaints—anxiety, depression,
premenstrual syndrome (PMS), even schizophrenia—are
frequently related to biochemical imbalances. These can range
from low blood sugar, viral and fungal infections, hormonal
imbalances, allergies, and toxic overload to deficiencies of
specific nutrients.
I am able to diagnose these conditions with the appropriate
laboratory tests that give a scientific basis for treatment
decisions. Then I can often help correct the imbalances with
natural approaches, including the use of well-researched
nutritional supplements. In contrast, conventional physicians
are most likely to prescribe first and test second, if at all, with
problematic results. This approach is often like unplugging the
noisy smoke alarm instead of looking for the fire.
In my move toward “integral” or holistic psychiatry, I found
myself treating a variety of medical conditions, from chronic
fatigue to irritable bowel syndrome. Patients don’t walk into our
offices as disembodied heads. Our bodies do not separate into
specialized compartments for the convenience of cardiologists,
allergists, endocrinologists, or gastroenterologists. You can’t get
to the right diagnosis and treatment without looking at all
systems!
Every symptom reflects an imbalance somewhere in the body’s
systems. Conventional medicine has segmented the body into
the various specialties and often fails to address the reality of
interactive systems.
Holistic or integrative medicine, on the other hand, addresses the
interactive systems of the whole person. The patient is evaluated
in a variety of ways and supplied with specific health
prescriptions—for supplements, foods, exercise, natural
hormones, mind-body techniques, and even prescription drugs
when indicated. Moreover, the individual has to partner with the
doctor in this process, both to carry out the regimen and to give
feedback in order to fine-tune the program.
Compared to drug therapy, natural treatments offer safer,
more user-friendly solutions with far fewer and less harmful side
effects. They work with the body’s chemistry rather than adding
what can be toxic substances to an already impaired body.
A Case in Point
I remember one early patient in particular, a 55-year-old college
teacher named Jean whose story is pretty typical. She was being
treated by her internist for high blood pressure, osteoporosis,
natural approaches, including the use of well-researched
nutritional supplements. In contrast, conventional physicians
are most likely to prescribe first and test second, if at all, with
problematic results. This approach is often like unplugging the
noisy smoke alarm instead of looking for the fire.
In my move toward “integral” or holistic psychiatry, I found
myself treating a variety of medical conditions, from chronic
fatigue to irritable bowel syndrome. Patients don’t walk into our
offices as disembodied heads. Our bodies do not separate into
specialized compartments for the convenience of cardiologists,
allergists, endocrinologists, or gastroenterologists. You can’t get
to the right diagnosis and treatment without looking at all
systems!
Every symptom reflects an imbalance somewhere in the body’s
systems. Conventional medicine has segmented the body into
the various specialties and often fails to address the reality of
interactive systems.
Holistic or integrative medicine, on the other hand, addresses the
interactive systems of the whole person. The patient is evaluated
in a variety of ways and supplied with specific health
prescriptions—for supplements, foods, exercise, natural
hormones, mind-body techniques, and even prescription drugs
when indicated. Moreover, the individual has to partner with the
doctor in this process, both to carry out the regimen and to give
feedback in order to fine-tune the program.
Compared to drug therapy, natural treatments offer safer,
more user-friendly solutions with far fewer and less harmful side
effects. They work with the body’s chemistry rather than adding
what can be toxic substances to an already impaired body.
A Case in Point
I remember one early patient in particular, a 55-year-old college
teacher named Jean whose story is pretty typical. She was being
treated by her internist for high blood pressure, osteoporosis,
and heart palpitations. She was referred to me, a psychiatrist,
because of her anxiety, depression, and insomnia. I could find no
obvious psychological explanation for these symptoms, except
maybe for the stress of her physical illness. She was taking an
array of medications, with their attendant side effects. Based on
some simple lab tests and my own clinical experience, I
determined that a likely common cause was a magnesium
deficiency.
After a brief trial on this inexpensive and common mineral,
together with a multivitamin-mineral formula and essential
fatty acids, Jean was able to decrease her medications.
Encouraged by this result, she trusted me enough to eliminate
some foods to which she was allergic, which helped her even
more. In a short time, not only were her anxiety, depression, and
insomnia gone, but she soon was medication-free, depending
instead on a list of supplements (I added a few to those
mentioned here) to restore her normal body chemistry.
Physical Inventory
I typically take a client’s vital signs and ensure they have a
primary-care doctor for major medical issues. I commonly do the
following labs:
− CBC
− Chem-24 panel including cholesterol (HDL, LDL),
triglycerides, magnesium, potassium, ferritin, B-12, folate,
Hgb A1C, homocysteine, C-reactive protein
− (quantitative), fibrinogen, uric acid, 25-OH-vit D, and ANA (if
indicated)
− Thyroid panel (TSH, free T4, free T3)
− If suspect thyroiditis, TPO and anti-thyroglobulin antibodies
− Middle age, peri-menopausal, andropausal: FSH, LH,
pregnenolone, DHEA-S, IGF-1
− If 50+, estradiol, progesterone, testosterone (free, total)
− Male: PSA, DHT
because of her anxiety, depression, and insomnia. I could find no
obvious psychological explanation for these symptoms, except
maybe for the stress of her physical illness. She was taking an
array of medications, with their attendant side effects. Based on
some simple lab tests and my own clinical experience, I
determined that a likely common cause was a magnesium
deficiency.
After a brief trial on this inexpensive and common mineral,
together with a multivitamin-mineral formula and essential
fatty acids, Jean was able to decrease her medications.
Encouraged by this result, she trusted me enough to eliminate
some foods to which she was allergic, which helped her even
more. In a short time, not only were her anxiety, depression, and
insomnia gone, but she soon was medication-free, depending
instead on a list of supplements (I added a few to those
mentioned here) to restore her normal body chemistry.
Physical Inventory
I typically take a client’s vital signs and ensure they have a
primary-care doctor for major medical issues. I commonly do the
following labs:
− CBC
− Chem-24 panel including cholesterol (HDL, LDL),
triglycerides, magnesium, potassium, ferritin, B-12, folate,
Hgb A1C, homocysteine, C-reactive protein
− (quantitative), fibrinogen, uric acid, 25-OH-vit D, and ANA (if
indicated)
− Thyroid panel (TSH, free T4, free T3)
− If suspect thyroiditis, TPO and anti-thyroglobulin antibodies
− Middle age, peri-menopausal, andropausal: FSH, LH,
pregnenolone, DHEA-S, IGF-1
− If 50+, estradiol, progesterone, testosterone (free, total)
− Male: PSA, DHT
Additional Labs
Depending on the patient’s symptoms and information gathered
from interviews and questionnaires, I may order:
− Genova One Test or Organix Test (Genova Diagnostics,
www.integrativepsychiatry.net): This takes the guesswork
out of knowing which nutrients a client needs for optimal
health. The test provides information about oxidative stress
and energy production by looking at potential insufficiencies
of a group of nutrients, including B vitamins, carnitine, NAC
(N-Acetyl-Cysteine), lipoic acid, and CoQ10.
− The Genova NutrEval (www.genovadiagnostics.com) or
Metametrix (www.metametrix.com) ION panel
(Individualized Optimum Nutrition) includes the organic
acid urine test and a blood draw. It measures specific plasma
or blood cell levels of vitamins, minerals, amino acids, fatty
acids and toxic minerals such as mercury, lead and cadmium.
− Food Allergy IgG Panel: 90 Foods. This tests for IgG
(immunoglobulin G) antibodies for 90 different foods. IgG
antibodies are indicative of allergic reaction.
− Heavy Metals Testing (mercury, lead, etc.): This can be done
through hair tests and if further investigation is needed,
provocative urine testing can be used (the patient takes a
substance that provokes the heavy metal to leave the body
through the urine) (www.gdx.net, www.doctorsdata.com).
− Urine Neurotransmitter Tests: (NeuroSciences—
www.neurorelief.com, or Sanesco—www.sanesco.net). These
tests require some skill in interpreting since there isn’t a
linear relationship between urine and blood levels. Good
resources for information on nutritional and functional
approaches are the books New Optimum Nutrition for the Mind
by Patrick Holford (go.Amedeo.com/twn) and The UltraMind
Solution (go.Amedeo.com/kwq) by Mark Hyman, M.D.
Depending on the patient’s symptoms and information gathered
from interviews and questionnaires, I may order:
− Genova One Test or Organix Test (Genova Diagnostics,
www.integrativepsychiatry.net): This takes the guesswork
out of knowing which nutrients a client needs for optimal
health. The test provides information about oxidative stress
and energy production by looking at potential insufficiencies
of a group of nutrients, including B vitamins, carnitine, NAC
(N-Acetyl-Cysteine), lipoic acid, and CoQ10.
− The Genova NutrEval (www.genovadiagnostics.com) or
Metametrix (www.metametrix.com) ION panel
(Individualized Optimum Nutrition) includes the organic
acid urine test and a blood draw. It measures specific plasma
or blood cell levels of vitamins, minerals, amino acids, fatty
acids and toxic minerals such as mercury, lead and cadmium.
− Food Allergy IgG Panel: 90 Foods. This tests for IgG
(immunoglobulin G) antibodies for 90 different foods. IgG
antibodies are indicative of allergic reaction.
− Heavy Metals Testing (mercury, lead, etc.): This can be done
through hair tests and if further investigation is needed,
provocative urine testing can be used (the patient takes a
substance that provokes the heavy metal to leave the body
through the urine) (www.gdx.net, www.doctorsdata.com).
− Urine Neurotransmitter Tests: (NeuroSciences—
www.neurorelief.com, or Sanesco—www.sanesco.net). These
tests require some skill in interpreting since there isn’t a
linear relationship between urine and blood levels. Good
resources for information on nutritional and functional
approaches are the books New Optimum Nutrition for the Mind
by Patrick Holford (go.Amedeo.com/twn) and The UltraMind
Solution (go.Amedeo.com/kwq) by Mark Hyman, M.D.
Patient Questionnaires
The importance of patient information cannot be
overemphasized. A few pieces of significant data gleaned from
the patient—that he or she may even consider unimportant—can
make or break a patient’s recovery. Here is a questionnaire my
patients fill out.
If you answer “yes” to any of the following, please provide
details below:
Do you have a history of allergies, asthma, eczema? Are you
taking any medication?
Do you have food cravings? Which foods? Sugar? Carbs?
(Circle here or list below.)
Alcohol use—# of drinks per day _______
Caffeine use—# of cups per day _______
Past or current drug or alcohol use? Current cravings? Provide
details.
Stress inventory:
Please check any current areas of stress in your life:
Parents Children Spouse Work School
Social life Finances Sex
Do you find it hard to relax?
Do your symptoms vary with stress?
Are you a perfectionist?
Depression inventory
Do you feel unfulfilled?
Are you lonely?
Are you sad?
Do you cry often?
Do you find it hard to enjoy anything?
Do you often wish you did not exist?
Do you withdraw socially?
The importance of patient information cannot be
overemphasized. A few pieces of significant data gleaned from
the patient—that he or she may even consider unimportant—can
make or break a patient’s recovery. Here is a questionnaire my
patients fill out.
If you answer “yes” to any of the following, please provide
details below:
Do you have a history of allergies, asthma, eczema? Are you
taking any medication?
Do you have food cravings? Which foods? Sugar? Carbs?
(Circle here or list below.)
Alcohol use—# of drinks per day _______
Caffeine use—# of cups per day _______
Past or current drug or alcohol use? Current cravings? Provide
details.
Stress inventory:
Please check any current areas of stress in your life:
Parents Children Spouse Work School
Social life Finances Sex
Do you find it hard to relax?
Do your symptoms vary with stress?
Are you a perfectionist?
Depression inventory
Do you feel unfulfilled?
Are you lonely?
Are you sad?
Do you cry often?
Do you find it hard to enjoy anything?
Do you often wish you did not exist?
Do you withdraw socially?
Cognition inventory
Do you have difficulty concentrating?
Do you get confused at times?
Do you often forget what you are saying in the middle of it?
Are you absent-minded?
Do you get lost easily? Is your mind less clear than it used to
be?
Do you find you are less intelligent than you used to be?
Do you have difficulty making decisions?
Any history of head injury? Loss of consciousness?
Sleep inventory
Trouble falling and/or staying asleep?
Do you wake at night to urinate?
Do your legs jump a lot at night?
Do you snore? If yes:
1) Are you more than 20 lbs. overweight?
2) Do you have periods when you stop breathing briefly
3) Do you have high blood pressure?
Additionally, I use the questionnaires listed on the following five:
Do you have difficulty concentrating?
Do you get confused at times?
Do you often forget what you are saying in the middle of it?
Are you absent-minded?
Do you get lost easily? Is your mind less clear than it used to
be?
Do you find you are less intelligent than you used to be?
Do you have difficulty making decisions?
Any history of head injury? Loss of consciousness?
Sleep inventory
Trouble falling and/or staying asleep?
Do you wake at night to urinate?
Do your legs jump a lot at night?
Do you snore? If yes:
1) Are you more than 20 lbs. overweight?
2) Do you have periods when you stop breathing briefly
3) Do you have high blood pressure?
Additionally, I use the questionnaires listed on the following five:
I also gather information on:
− Height, weight, age
− Major symptoms
− Previous treatments for these and other medical problems
including: medications, surgery, hospitalizations,
psychotherapy, etc.
− Typical daily diet, including snacks
− All current prescriptions, over-the-counter medications, and
supplements
− Mental health history
− Family’s mental health history
− Family’s medical history
− Marital status, including years married and number of
marriages
− Spiritual practices
− Profession and education
The Action Plan
From the patient information, physical assessment, and labs, a
picture begins to emerge. While the client could be primarily
suffering from stress, where lifestyle changes or counseling
would be in order, more often I find physical issues—commonly a
number of them—impacting behavior, emotions, and cognitive
function.
Frequent issues that appear include:
− Nutrient deficiency such as B vitamins, minerals, amino
acids
− Neurotransmitter depletion: can be due to genetics, poor
diet or malabsorption due to gut disturbance (e.g., leaky gut
inflammation, food allergy), among other factors
− Height, weight, age
− Major symptoms
− Previous treatments for these and other medical problems
including: medications, surgery, hospitalizations,
psychotherapy, etc.
− Typical daily diet, including snacks
− All current prescriptions, over-the-counter medications, and
supplements
− Mental health history
− Family’s mental health history
− Family’s medical history
− Marital status, including years married and number of
marriages
− Spiritual practices
− Profession and education
The Action Plan
From the patient information, physical assessment, and labs, a
picture begins to emerge. While the client could be primarily
suffering from stress, where lifestyle changes or counseling
would be in order, more often I find physical issues—commonly a
number of them—impacting behavior, emotions, and cognitive
function.
Frequent issues that appear include:
− Nutrient deficiency such as B vitamins, minerals, amino
acids
− Neurotransmitter depletion: can be due to genetics, poor
diet or malabsorption due to gut disturbance (e.g., leaky gut
inflammation, food allergy), among other factors
− Impaired methylation (most often genetic and treatable with
specific B vitamins)
− Essential fatty acid deficiency
− Blood sugar imbalance
− Brain inflammation due to food allergy (e.g., gluten, dairy),
heavy metals, infection, toxic exposure
− Hormone imbalance—e.g., thyroid, adrenal, estrogen,
progesterone, testosterone
− Traumatic brain injury
From this we can formulate an action plan:
− Follow-up medical evaluation as needed, such as a referral to
a specialist for serious endocrine disorders, a sleep study for
a heavy snorer (sleep apnea, most often due to metabolic
syndrome), or further labs for a client with markers of
gluten sensitivity (not necessarily full-blown celiac disease).
− Lifestyle changes including living arrangements, job
situation, marital counseling, and removing sources of
stress.
− Exercise recommendations as needed.
− Hormonal treatments as indicated by lab results
− Supplements—amino acids, vitamins, minerals, fatty acids,
and more—to restore normal body chemistry as indicated by
lab results.
− Herbal treatments and other natural or safe approaches to
reduce symptoms.
− Relaxation techniques including yoga and meditation.
− Dietary changes to reduce or eliminate junk foods,
incorporate healthy foods, and remove offending foods,
particularly those found on food allergy panels.
− Medication as needed, including avoiding an abrupt
withdrawal from current medications. As symptoms
specific B vitamins)
− Essential fatty acid deficiency
− Blood sugar imbalance
− Brain inflammation due to food allergy (e.g., gluten, dairy),
heavy metals, infection, toxic exposure
− Hormone imbalance—e.g., thyroid, adrenal, estrogen,
progesterone, testosterone
− Traumatic brain injury
From this we can formulate an action plan:
− Follow-up medical evaluation as needed, such as a referral to
a specialist for serious endocrine disorders, a sleep study for
a heavy snorer (sleep apnea, most often due to metabolic
syndrome), or further labs for a client with markers of
gluten sensitivity (not necessarily full-blown celiac disease).
− Lifestyle changes including living arrangements, job
situation, marital counseling, and removing sources of
stress.
− Exercise recommendations as needed.
− Hormonal treatments as indicated by lab results
− Supplements—amino acids, vitamins, minerals, fatty acids,
and more—to restore normal body chemistry as indicated by
lab results.
− Herbal treatments and other natural or safe approaches to
reduce symptoms.
− Relaxation techniques including yoga and meditation.
− Dietary changes to reduce or eliminate junk foods,
incorporate healthy foods, and remove offending foods,
particularly those found on food allergy panels.
− Medication as needed, including avoiding an abrupt
withdrawal from current medications. As symptoms
improve, a slow titration down from current meds may be in
order.
As brain chemistry begins to normalize through proper
nutrient and endocrine balance, patients usually begin to feel
better. By re-evaluating the patient’s progress at regular
intervals, we adjust the plan as needed to keep him or her on a
path to recovery and greater wellness.
Summary
Though learning the arts of integrative psychiatry takes some
time and effort, the rewards are worth it. Instead of maintaining
patients on a steady dose of medication, monitoring them for
inevitable side effects and adjusting meds when things go awry,
you start thinking in terms of recovery. Lots of my clients simply
recover from their underlying bodily issues and get well. In fact,
in many cultures worldwide, psychotic and other psychiatric
conditions are regularly treated by family and community
support, without the recurrence that we in the West assume is
inevitable. Another large percentage improves markedly. Even
those who remain symptomatic can often be helped with
treatments such as herbs, supplements, or lifestyle changes that
bring relief—regardless of the cause—without the downsides of
meds.
That means greater wellness for my patients and happier lives
for them and their families. That is a gratifying result for any
physician.
order.
As brain chemistry begins to normalize through proper
nutrient and endocrine balance, patients usually begin to feel
better. By re-evaluating the patient’s progress at regular
intervals, we adjust the plan as needed to keep him or her on a
path to recovery and greater wellness.
Summary
Though learning the arts of integrative psychiatry takes some
time and effort, the rewards are worth it. Instead of maintaining
patients on a steady dose of medication, monitoring them for
inevitable side effects and adjusting meds when things go awry,
you start thinking in terms of recovery. Lots of my clients simply
recover from their underlying bodily issues and get well. In fact,
in many cultures worldwide, psychotic and other psychiatric
conditions are regularly treated by family and community
support, without the recurrence that we in the West assume is
inevitable. Another large percentage improves markedly. Even
those who remain symptomatic can often be helped with
treatments such as herbs, supplements, or lifestyle changes that
bring relief—regardless of the cause—without the downsides of
meds.
That means greater wellness for my patients and happier lives
for them and their families. That is a gratifying result for any
physician.
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