Complementary Treatments in Psychiatry

TCPR: Dr. Brown, there are many complementary or natural treatments available for our patients. Which treat- ments have you have found particularly helpful in your practice?

Dr. Brown: I would say that number one is breathing—practiced alone or combined with movement and meditation. Many ill- nesses, both medical and psychiatric, are related to the chronic effects of stress. Breathing exercises are a simple way to relieve these tensions, and patients like them because they can feel the effects immediately.

TCPR: Can you give us an example of how we should teach our patients deep breathing exercises?

Dr. Brown: I say something like,“We are going to strengthen your stress response system and activate your recharging system by doing this breathing.Sit with your spine erect and your eyes closed and let’s synchronize our breathing.We are going to breathe in and out through the nose.Take a deep breath in through your nose and let go. Breath in ...2...3...4, breathe out ...2...3...4.”You can do this with a patient for three to five minutes, with the ideal goal of six or less breaths per minute.

TCPR: What should we instruct them to do once they leave our office? How often and when should they practice this type of breathing?

Dr. Brown: In both modern methods and ancient traditions, at least 20 minutes a day produces the best effects.Time of day doesn’t really matter, but I find that if patients don’t do it as soon as they get up, they often don’t do it at all.They can also use this breathing when they are having trouble sleeping. In my experience, some patients may actually be able to taper off sedatives after they start practicing this technique.

TCPR: What natural or herbal medications have you found helpful?

Dr. Brown: I prescribe a fair amount of SAMe, which is helpful for depression (either alone or as an augmenting agent). SAMe also has some evidence for efficacy in treating arthritis, fibromyalgia, and depression in HIV (Di Padova C, Amer Journal of Medicine 1987;83(5A):60–65; Jacobson S et al., Scandinavian Journal of Rheumatology 1991;20(4):294–302; Shippy RA et al., BMC Psychiatry 2004;4:38).

TCPR: How do you instruct patients where to buy SAMe and how to take it?

Dr. Brown: They have to shop wisely.There are a few companies that make it very well—these include Nature Made, Jarrow and Life Extension. Most of these can be bought at mass market outlets. A good starting dose for depression is 400 to 800 mg, depending on the severity of the illness.For example,say a patient is on 225 or 300 mg of Effexor and hates the side effects.We could add 800 mg of SAMe and bring the Effexor down to 75 or 112.5 mg.There are studies indicating that SAMe might be effec- tive for augmentation of antidepressants (Berlanga C et al., Psych Research 1992;44(3):257–262).

TCPR: What are the side effects of SAMe?

Dr. Brown: Mania is the most severe one. In some patients, it can be induced in just one day.The second most common side effect, at dosages around 1,200 mg, is loose stools. Sometimes there is some upper GI upset, but that is uncommon. I typically recommend one big dose in the morning, because it really activates the dopamine system and it can keep people up if they take it at night.

TCPR: What other natural treatments do you favor?

Dr. Brown: I’m a believer in Rhodiola rosea (also known as Golden Root).This plant grows in arctic regions of the world at high altitudes. It has been used in places like Siberia and Mongolia for thousands of years.The Russians have studied this for years and have used it in their space program.They found that it enhances resilience to stress.A Swedish study showed that it is effective in treating patients with mild to moderate depression (Darbinyan V et al., Nordic Journal of Psych 2007;61:343–348).

TCPR: How should we dose Rhodiola rosea?

Dr. Brown: In Georgia and Siberia healthy adults take about 300 mg a day as a tea. For depression, it should be from 350 to700 mg a day.

TCPR: Is it widely available in the U.S.?

Dr. Brown: Yes.You can get it at CVS, but the best brands can be found online or at health food stores. It is very inexpensive too.

TCPR: What are your opinions about St. John’s Wort?

Dr. Brown: I use it occasionally. I look on St. John’s Wort as a mild SSRI that in general will have fewer side effects, but also is not as strong. If you are going to use it for severe depression, it probably is either not going to work alone or you are going to use a huge dose. In Germany, they have done several studies with hundreds of patients showing that it can be quite good for disorders such as chronic fatigue syndrome and fibromyalgia (Muller T et al., Psychosomatic Medicine 2004;66(4):538–547). Even a low dose of St. John’s Wort can be beneficial for that kind of patient.

TCPR: How should we dose St. John’s Wort?

Dr. Brown: For patients with somatic disorders, 600 mg is often enough. But for a patient with depression, I use doses in the range of 1,200 or 1,800 mg a day. Patients taking St. John’s Wort need to watch out for drug interactions and for their skin because it can cause severe sunburn. I don’t use it that often, and I don’t use it alone. I may use it with SAMe or Rhodiola rosea.

TCPR: One of our biggest complaints about psychotropic medications is their sexual side effects. Do any of the herbal treatments help with this?

Dr. Brown: This is a major reason for noncompliance. Rhodiola rosea helps with sexual function. Maca—a tuber that grows in the Andes—enhances sexual function, arousal and desire, which we don’t have any traditional medications for (Gonzales GF et al., Andrologia 2002;34(6):367–372). Another occasionally effective compound is called ArginMax, which contains ginseng and argi- nine (Lebret T et. al., European Urology 2002; 41(6):608–613). It comes in formulas for men and women.

TCPR: Anything else?

Dr. Brown: A significant area that is largely ignored is the effects of DHEA and testosterone on sexual function and depression. There have been a few studies that show DHEA can augment or act as an antidepressant (Bloch M et al., Biological Psych 1999;45(12):1533–1541; Wolkowitz OM et al., Am Journ of Psych 1999;156(4)646–649; Schmidt PJ et al., Arch of Gen Psych 2005;62(2):154–162). Another study has shown that if your free testosterone is in the lowest 20 percent of normal, you havethree times the rate of serious depression (Almeida OP et al., Arch Gen Psych 2008;65(3):283). Low testosterone and DHEA are tied to sexual dysfunction, too, so they really are all interrelated.

TCPR: Thank you, Dr. Brown.

General Psychiatry

KEYWORDS natural_medications