Psychiatrist Calls for More CAM (Integrative Care)

The following article was written by the psychiatrist, James S. Gordon on the Psychology Today Blog


We  32Must Consider CAM for Depression by JAMES S. GORDON, M.D.


DR. GORDON is founder and director of The Center for Mind-Body Medicine, Washington, and clinical professor in the departments of psychiatry and family medicine at Georgetown Medical School. He describes this integrative approach to depression in Unstuck: Your Guide to the Seven-Stage Journey Out of Depression(New York: Penguin Press, 2008).

It’s time for psychiatrists to consider seriously an alternative approach to the treatment of depression. By alternative, I don’t mean a fringe technique or a collection of them. I’m suggesting practicing in a way that is in harmony with the biopsychosocial model and backed by sound science as well as common sense.

Why now?

First, the limitations and hazards of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), are increasingly apparent. The latest reviews of unpublished as well as published studies in The New England Journal of Medicine and in the online journal, PLoS Medicine, for example, show that SSRIs are far less effective at relieving symptoms of depression than the earlier studies and meta-analyses indicated.

Meanwhile, questions about efficacy continue to be compounded by the well-documented, short- and long-term side effects and withdrawal symptoms that the drugs produce as well as their potential for precipitating suicidal thoughts and feelings in younger people.

Second, more patients are looking to alternatives for answers. A recent national survey of depressed women by Columbia University researchers indicated that 54% were using complementary or alternative medicine (CAM), including self-care techniques, like dietary supplementation, prayer, meditation, and exercise.

Respondents most often used CAM because they were dissatisfied with the results of conventional approaches and their unpleasant side effects. They also found a greater harmony between CAM techniques and their own worldview-i.e., CAM helped fulfill their desire to participate in their own care. Many of these people prefer to see depression signs and symptoms as a wake-up call rather than the end point of a disease process or as an indication of a biological and psychological imbalance that signals the need for deep change, growth, and healing.

These critical patient concerns lead me to the third reason we psychiatrists should look to alternatives: They are, or can be, as effective in relieving symptoms, reversing biochemical imbalances, and improving mood as they are appealing to patients.

This is not so surprising. Some of these alternative interventions directly address aspects of our biologic functioning that conventional approaches often ignore. For example, diets high in simple sugars and refined carbohydrates may contribute, perhaps through pathways of inflammation, oxidation, and increased insulin resistance, to depression. High consumption of saturated and trans fats may adversely affect brain functioning, possibly by making neuronal membranes rigid and inhibiting neurotransmitter efficacy. Eliminating trans fats and cutting down on proinflammatory omega-6 fats (in red meat) and increasing intake of omega-3 fatty acids that are present in fish oil may make a difference; by itself, supplementation with omega-3s has been demonstrated to improve mood.

Deficiencies of micronutrients-including B12 folic acid, selenium, and chromium-also might contribute to depressive symptoms that can be relieved by supplementation.

Many mind-body techniques such as meditation, guided imagery, journaling, aerobic exercise, and yoga also can easily be included in mainstream psychiatric treatment of depression. Each may have beneficial, direct effects on how we deal with stress and depression. The scientific literature is replete with studies showing that these approaches can decrease cortisol levels, raise endorphin and serotonin levels, make therapeutic changes in functional MRIs, promote neurogenesis in the hippocampus, and, in the case of regular meditation, even increase cortical thickness.

It’s important, though, as we consider these techniques and approaches not to regard them as single, “stand-alone” alternatives. That’s perpetuating a silver bullet model that, though sometimes useful, is limited (e.g., substituting the herb, St. John’s wort for SSRIs). What’s truly alternative, and will, I believe, prove far more effective, is a comprehensive “integrative” approach that may include synergistic combinations of a number of these other techniques and approaches, together with various forms of psychotherapy, individualized for each person and emphasizing that person’s active participation in his or her care.

As we explore the possibilities of this approach, we may find that what we have thought of as alternative becomes the effective, scientifically validated, highly acceptable center of our therapeutic work.


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