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Complementary medicines in psychiatry: Review of effectiveness and safety

  • Ursula Werneke (a1), Trevor Turner (a2) and Stefan Priebe (a3)

Abstract

Background

The use of complementary medicines in those with mental health problems is well documented. However, their effectiveness is often not established and they may be less harmless than commonly assumed.

Aims

To review the complementary medicines routinely encountered in psychiatric practice, their effectiveness, potential adverse effects and interactions.

Method

Electronic and manual literature search on the effectiveness and safety of psychotropic complementary medicines.

Results

Potentially useful substances include ginkgo and hydergine as cognitive enhancers, passion flower and valerian as sedatives, St John's wort and sadenosylmethionine as antidepressants, and selenium and folate to complement antidepressants. The evidence is less conclusive for the use of omega-3 fatty acids as augmentation treatment in schizophrenia, melatonin for tardive dyskinesia and 18-methoxycoronaridine, an ibogaine derivative, for the treatment of cocaine and heroin addiction.

Conclusions

Systematic clinical trials are needed to test promising substances. Meanwhile, those wishing to take psychotropic complementary medicines require appropriate advice.

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Copyright

Corresponding author

Dr Ursula Werneke, Division of Psychiatry, Homerton University Hospital, East Wing, Homerton Row, London E9 6SR, UK. E-mail: UrsulaWerneke@elcmht.nhs.uk

Footnotes

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Declaration of Interest

None.

Footnotes

References

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Complementary medicines in psychiatry: Review of effectiveness and safety

  • Ursula Werneke (a1), Trevor Turner (a2) and Stefan Priebe (a3)

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Complementary medicines in psychiatry: Review of effectiveness and safety

  • Ursula Werneke (a1), Trevor Turner (a2) and Stefan Priebe (a3)
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eLetters

Incomplete review of complementary medicines

Dr.Zaffar Ul Hassan, Staff Grade Psychiatrist
27 April 2006

I was disappointed to see the narrow concept of complimentary medicine in the paper by Werneke et al (2006), as its contents did not justify the chosen topic and it merely discussed a few herbal remedies. According to the definition by the National Centre for Complementary and Alternative Medicine (2002) complementary medicine is used together with conventional medicine while alternative medicine is used in place of conventional medicine. In the first place the paper failed to explain whether the herbal preparations were used in addition to conventional medicine or on its own.Secondly, the authors also failed to mention other known complementary therapies including the use of yoga, tai chi, relaxation exercises, music,spiritual healing, naturopathy and homeopathy for psychiatric ailments practised in various parts of the world. In this context I would like to point out that there are several papers indicating that acupuncture can also work in relieving depression, anxiety and Seasonal Affective Disorder(SAD). According to the monoamine hypothesis for affective disorders functional impairment of the monoamine systems in CNS is the cause of depression. Pharmacological manipulations of the monoaminergic neuronal system using tricyclics and monoamine oxidase inhibitors produces therapeutic effects. Based on animal experiments, Hans (1986) presented a paper to show that acupuncture or electro acupuncture (EA) is capable of accelerating the synthesis and release of serotonin (5-HT) and norepinepherine (NE) in the CNS. His clinical data indicated that electroacupuncture was at least as effective and with a higher therapeutic index than tricyclic amitriptylinein treating the depressive patients. Another study by Luo et al from the Beijing Institute of Mental Health in 1997 showed that acupuncture was as effective as amitriptyline in the treatment of depression (Kua and Tan -2005). Further studies have shown that different kinds of neuropeptides are released by different frequencies. For example, in EA Low frequency of 2 Hz accelerates the release of enkephalin, beta-endorphin and endomorphin, while high frequency of 100 Hz selectively increases the release of dynorphin. (Han, 2004). ). Practitioners of this art have also used it to relieve headache, insomnia and chronic pain, which may be a contributing factor in depressive illness. Acupuncture has also been used with violent persons and victims of national disasters, chronic fatigue syndrome and insomnia (Ackerman, 1999). In traditional chinese medicine there is also an emphasis on exercise as part of a healthy lifestyle to restore the yin-yang balance. Tai-chi or king-fu is encouraged as a form of exercise during the recuperation phase of physical and mental illness (Kua and Tan,2005).

Declaration of interest

Z.H is the Founder President of the Association for the Promotion of Acupuncture in Pakistan (A.P.A) Regd; taught acupuncture treatment to medical doctors at The Pakistan College of Acupuncture Sciences and was involved in arranging acupuncture seminars and conferences.

References

Ursula Werneke, Trevor Turner, and Stefan Priebe (2006), Complementary medicines in psychiatry: Review of effectiveness and safety,British Journal of Psychiatry 188:109-121

National Centre for Complementary and Alternative Medicine (2002): What is complimentary and Alternative Medicine (CAM) Retrieved on March, 6, 2006 from http://www.nccam.nih.gov/health/whatiscam/

Han JS (1986) Electro acupuncture: an alternative to antidepressants for treating affective disease, International Journal of Neuroscience, March;29: 79-92 Available on PubMed. Accessed on 01/03/2006

Kua, EH and Tan, CH (2005) Traditional Chinese medicine in psychiatric practice in Singapore, International Psychiatry, 7-9 Issue 8, April

Hans, JS (2004) Neuroscience Letters 361: 258-261, Issues 1-3 , 6th.May, Available from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15135942&query_hl=5&itool=pubmed_DocSum(Accessed on 24/04/2006)

Ackerman, John M(1999) Acupuncture in Psychiatry Psychiatr Serv 50: 117 January. Available from American Psychaitric Association’s web page: http://ps.psychiatryonline.org/cgi/content/full/50/1/117
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Conflict of interest: None Declared

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