Meditation and mindfulness training reduce symptoms of generalized anxiety

Meditation practices are widely employed to reduce anxiety and to maintain optimal psychological and spiritual health. Meditation has been extensively studied as a treatment of anxiety. Beneficial physiological effects of meditation include decreased oxygen consumption, respiratory rate and blood pressure, as well as long-term beneficial changes in brain electrical activity that result in increased calmness. Mindfulness-based stress reduction (MBSR) is an integrative approach pioneered by Kabat-Zinn that has been validated as highly effective for reducing the physical, emotional and mental consequences of chronic stress. MBSR incorporates elements of different Eastern meditation practices and western psychology. Its methods are now widely employed in group therapy in large health-maintenance organizations in the U.S.

Research findings show that the regular practice of mindfulness meditation, in which the individual practices detached self-observation, significantly reduces generalized anxiety and other anxiety symptoms. Almost 100% of individuals who started a 10-week MBSR program successfully completed it, and the majority reported significantly decreased physical and emotional distress, improved quality of life, a greater sense of general well-being, increased optimism and increased feelings of control. Persons diagnosed with Irritable Bowel Syndrome (IBS), a frequent complaint of generalized anxiety, experienced significantly fewer symptoms of both IBS and anxiety when they engaged in two brief (15 min) daily sessions of mindfulness meditation.

You can find out more about meditation, mindfulness training, MBSR and other safe and effective complementary and alternative treatments of anxiety, and learn practical tips for using them in “Anxiety: the Integrative Mental Health Solution,” by James Lake M.D.

Dementia and mild cognitive impairment (MCI): the integrative perspective

Dementia and mild cognitive impairment: overview
Dementia is a chronic condition characterized by severe persisting impairments of short-term and long-term memory and severe deficits in other areas of cognitive functioning such as abstract reasoning, language, impaired capacity to perform routine daily tasks, and loss of ability to recognize familiar objects, places or people. Alzheimer’s disease, the most common form of dementia, is a progressive neurodegenerative disease that accounts for two thirds of all cases of dementia. It has been estimated that roughly one half of all individuals over the age of 85 have Alzheimer’s disease. Genetic risk factors, chronic nutrient deficiencies, toxic injury to the brain, coronary artery disease, chronic stress and prolonged social isolation or restricted intellectual activity increase the risk of developing Alzheimer’s disease. The degenerative changes in the brain that lead to Alzheimer’s disease are related to deposits of an abnormal brain protein called amyloid-beta which sets off wide-spread inflammation and the formation of free radicals that damage or destroy neurons.

Medical causes of dementia include vascular disease that affects the arteries of the brain, Parkinson’s disease, other neurodegenerative disorders, traumatic brain injury (TBI), HIV/AIDS, severe cerebro-vascular accidents (i.e. ‘stroke’), and the cumulative toxic effects of chronic alcohol or substance abuse. Diets high in saturated fats are associated with increased risk of developing Alzheimer’s disease while diets high in fish are associated with relatively reduced risk. Moderate wine consumption (1-2 glasses/day) reduces the risk of Alzheimer’s disease but chronic alcohol abuse probably increases the risk of dementia.
It is important to distinguish the progressive and irreversible changes seen in dementia from the temporary and reversible changes in cognition associated with a state of acute confusion called ‘delirium.’ Serious medical illnesses or acute intoxication with alcohol or drugs often manifest as delirium in which cognitive functioning is grossly impaired. Successful treatment of the underlying cause or causes of delirium restores the brain to its healthy state and cognitive functioning rapidly returns to normal. Anyone who is experiencing rapidly progressing decline in cognitive functioning should be referred urgently to the nearest hospital emergency room or urgent care center to rule out medical causes of these symptoms.

Many individuals experience moderate or severe cognitive impairment as an indirect result of other mental health problems such as severe depressed mood, anxiety, bipolar disorder, psychosis, chronic sleep deprivation, or chronic alcohol or drug abuse. The successful treatment of a mental health problem that is impairing cognitive functioning often results in a return of normal cognitive functioning.

Mild cognitive impairment (MCI) is a less severe form of cognitive impairment that is often temporary but may progress to Alzheimer’s disease or other severe irreversible forms of dementia. MCI sometimes takes place with normal aging, chronic nutritional deficiencies, less severe strokes, thyroid disease, and chronic alcohol or narcotic abuse. Correcting the underlying medical cause or causes of MCI usually results in rapid improvement of symptoms of cognitive impairment.

Limitations of conventional treatments of dementia and mild cognitive impairment
Most currently available pharmacologic treatments of Alzheimer’s disease work by inhibiting the enzyme that breaks down the neurotransmitter acetylcholine, thus increasing available levels of this molecule which plays a critical role in learning and memory. These so-called cholinesterase inhibitors have significant adverse effects, and are only effective against mild or early symptoms of Alzheimer’s disease, but not other forms of dementia. Early promising results of studies on tacrine, the first commercially marketed acetylcholinesterase inhibitor, were offset by findings of significant hepatotoxicity. Second generation acetylcholinesterase inhibitors (donepezil, rivastigmine and galantamine) are no more effective than tacrine but require less frequent dosing and have fewer associated safety issues. Other drug classes that have been investigated for possible cognitive enhancing benefits in dementia include the monoamine oxidase inhibitors (MAOI), estrogen replacement therapy (ie, in cognitively impaired post-menopausal women), naloxone, and various neuropeptides including vasopressin and somatostatin. Most studies on prescription drug treatments of dementia and mild cognitive impairment have yielded equivocal or negative results. Promising novel biomedical treatments of Alzheimer’s disease currently being investigated in clinical trials include a vaccine that may immunize individuals against formation of amyloid beta, secretase inhibitors, anti-inflammatory agents and statins.

Individuals who are severely cognitively impaired frequently experience depressed mood, anxiety and psychotic symptoms. Contemporary biomedical management of such mixed symptom patterns relies on combinations of drugs increasing the risk of adverse effects and toxic interactions. Behavioral disturbances, including agitation and aggressive behavior toward care-givers, are commonly encountered in demented individuals. Even though cholinesterase inhibitors offer only transient improvements in the early stages of dementia, these drugs have become standard-of-care biomedical approach to Alzheimer’s disease and other forms of dementia in Western countries because of consistent findings of reduced agitation. In addition to pharmacological management, behavioral interventions, environmental enrichment and social support mitigate some of the cognitive and behavioral symptoms of dementia.

Non-medication treatments of dementia and mild cognitive impairment
The limited effectiveness of available mainstream treatments of dementia and mild cognitive impairment invites serious consideration of non-medication approaches. Natural supplements used to treat mild cognitive impairment or slow the rate of progression of dementia, include certain B vitamins, Ginkgo biloba, idebenone, acetyl-L-carnitine (ALC), huperzine-A and other herbals.
Other alternative approaches that sometimes slow the rate of progression of dementia or decrease the severity of mild cognitive impairment or dementia, include regular exercise, bright light exposure therapy, music, access to ‘wander gardens,’ and a multi-sensory stimulation approach called ‘snoezelen.’ Regular physical activity reduces the risk of developing dementia but does not improve symptoms of cognitive impairment in demented individuals. Using weak electrical current to stimulate the brain may result in temporary improvements in word recall and face recognition in mildly demented individuals.

If you or a loved one are struggling with symptoms of mild cognitive impairment or dementia and taking a medication that isn’t helping, you are experiencing adverse effects, or you simply can’t afford to continue taking a medication that is working, you will benefit from my book Dementia and Mild Cognitive Impairment: The Integrative Mental Health Solution. The book provides practical information about a variety of non-medication approaches that will help you function better such as herbals and other natural supplements, whole body approaches, meditation and mind-body practices, and many others.

Dementia and Mild Cognitive Impairment: The Integrative Mental Health Solution
will help you:
• Understand dementia and mild cognitive impairment better
• Take inventory of your symptoms
• Learn about non-medication treatments of memory loss and other symptoms of cognitive impairment
• Develop a customized treatment plan that is right for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work

Click here to preview or buy my book, Dementia and Mild Cognitive Impairment: The Integrative Mental Health Solution.

Depression: the integrative perspective

Depression: overview
Depressed mood has many psychological and biological causes. Some people are born with genetic factors that significantly increase their risk of developing severe depressed mood. Known medical causes of depression include thyroid disease, heart problems and anemia. When an underlying medical problem is treated depressed mood often gets better. Chronic stress, over-work or sleep deprivation can lead to depressed mood. Some prescription medications can cause or worsen depressed mood including drugs used to control high blood pressure and many others. Symptoms of depressed mood can be mild, moderate or severe depending on how much distress they cause and to what extent they interfere with your ability to function at work, in school or in a relationship.

Some people hear voices or develop delusional beliefs when they are severely depressed. They may not be able to distinguish between reality and fantasy however this does not mean they are ‘crazy.’ Psychotic symptoms generally go away when severe depressed mood improves with treatment. Individuals who experience mood changes that alternate between feelings of depression and euphoria or an irritable mood have bipolar disorder. It is important to understand whether your problem is depression, bipolar disorder or another mental health problem before starting any new treatment because different medications and alternative treatments are used for different mental health problems and taking the wrong treatment can potentially worsen your symptoms.

Limitations of prescription antidepressants
Several independent analyses have concluded that most trials of antidepressants sponsored by pharmaceutical companies fail to show significant response differences between conventional antidepressants and placebos. In United States and West European countries more than two thirds of depressed patients never receive adequate treatment with conventional antidepressants due to inadequate screening by physicians and under-reporting by patients. Over half of all patients who use conventional antidepressants are not treated by psychiatrists and have never been formally diagnosed with depression. Of those who are diagnosed and receive recommended doses of conventional antidepressants, between 40% and 70% fail to respond. The issue of non-response to conventional antidepressants is complicated by reports of overall worsening of depressed mood with long-term treatment. Approximately one half of individuals who fully recover from an episode of severe depressed mood relapse within two years regardless of whether they are taking a conventional antidepressant. Approximately one third of patients who stop taking conventional antidepressants after responding to them subsequently fail to respond to the same antidepressant when it is resumed.

Prescription antidepressants may have limited efficacy because they do not address impairments in neuroplasticity or neurogenesis that may underlie chronic depression. These findings suggest that future antidepressant agents with neurotrophic or neuroprotective effects may be more effective than currently available drugs that target specific neurotransmitters but do not stimulate synaptic growth or reduce nerve cell loss or atrophy believed to be associated with chronic depressed mood. The high cost of prescription drugs has become an important issue for many patients who take antidepressants. In this context it is significant that the cost-effectiveness of more expensive SSRIs and SNRIs is equivalent to that of the older inexpensive tricyclic antidepressants.

Non-medication approaches used to treat depressed mood
The limited effectiveness of available mainstream treatments of depression invites serious consideration of non-medication approaches. Natural supplements used to treat depressed mood include certain vitamins, minerals, herbals, amino acids and essential fatty acids. Depressed individuals may respond better to antidepressant medications when they are combined with certain natural supplements including folate and omega-3 essential fatty acids. St. John’s wort (Hypericum perforatum) is an effective treatment of moderate depressed mood but is much less effective for more severe depressed mood. The omega-3 essential fatty acid called EPA in particular may have beneficial effects against depressed mood when taken alone or in combination with conventional antidepressants. Extensive research has been done on S-adenosyl-methionine (SAMe) for depressed mood and have concluded that SAMe is as effective as prescription antidepressants. 5-HTP is a naturally occurring amino acid found in many foods and is the immediate precursor of serotonin that may be safely combined with prescription antidepressants increasing their effectiveness.

In addition to natural supplements there is considerable evidence for antidepressant effects of regular exercise. Early morning bright light exposure often reduces the severity of depressive mood symptoms. Depressed persons who exercise or use bright light therapy while taking an antidepressant may also improve faster than persons who use either approach alone. Exposure to high-density negative ions may be as effective for depressed mood as early morning bright light exposure. Emerging findings suggest that a specialized biofeedback approach that ‘shapes’ the brain’s electrical activity in the context of a computer game (i.e. EEG biofeedback) may have beneficial antidepressant effects. Other non-medication approaches that have beneficial antidepressant effects include acupuncture, music therapy, meditation, and yoga.

If you are struggling with depression, taking a medication that isn’t helping you feel better, experiencing adverse effects, or you simply can’t afford to continue taking an antidepressant that is helping, you will benefit from my book Depression: The Integrative Mental Health Solution. In the book I provide practical information about a variety of safe, effective and affordable non-medication alternatives that will help you feel and function better such as herbals, vitamins and other natural supplements, whole body approaches, meditation and mind-body practices, and energy therapies.

Depression: The Integrative Mental Health Solution will help you
• Understand depression better
• Take inventory of your symptoms
• Learn about a variety of non-medication approaches for treating depression
• Develop a customized treatment plan that makes sense for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work

Click here to preview or buy my book on Amazon.com

Insomnia: getting better sleep using integrative strategies

Insomnia: overview
Sleep and wakefulness are regulated by many neurotransmitters including the brain’s principle inhibitory neurotransmitter gamma-amino-butyric acid (GABA). Changing brain levels of GABA and other neurotransmitters are believed to be related to normal changes in sleep with healthy aging. What constitutes ‘normal’ sleep varies considerably between different cultures and demographic groups. For example healthy elderly individuals sleep less at night compared to young and middle-aged individuals, and may make up for reduced night-time sleep by spending more time napping during the day.

Chronic insomnia affects at least one third of the world’s population. Insomnia and daytime sleepiness are major public health issues because they result in enormous losses in work productivity and significantly increase the risk of work-place and motor vehicle accidents. Diverse social, cultural, psychological and biological factors affect sleep and most cases of insomnia are caused by multiple factors. Approximately two thirds of individuals treated for any mental health problem complain of chronic insomnia. Individuals who struggle with depression or anxiety or who abuse alcohol or drugs are especially at risk of insomnia. Depending on the particular drug insomnia may be a direct result of substance abuse or a symptom of withdrawal following a prolonged period of abuse.

Insomnia is a core symptom of bipolar mania and post-traumatic stress disorder (PTSD). Insomnia frequently accompanies diverse medical problems such as chronic pain, sleep apnea, diabetes, lung diseases, thyroid disease, dementia and neurological disorders. Sleep apnea is a medical condition in which difficulty breathing when asleep causes frequent waking episodes throughout the night resulting in severe daytime sleepiness. Sleep apnea is associated with a significantly increased risk of depressed mood, overweight and heart disease. Insomnia is a frequently reported adverse effect of many prescription medications. Individuals who do shift-work (i.e. whose work schedule begins late night and continues until early morning) or travel extensively across many time-zones often experience insomnia related to a disturbance in their ‘biological clock.’ Elderly persons who have serious medical or mental health problems are especially at risk of chronic insomnia.

Limitations and safety issues associated with conventional treatments
Prescription sedative-hypnotic medications such as benzodiazepines are used to treat 80 to 90% of all complaints of insomnia in Western countries. This practice has led to over-prescribing or inappropriate prescribing of potentially addictive sedative-hypnotics to millions of individuals. Morning drowsiness, dizziness and headache are common adverse effects of benzodiazepines. Inappropriate long-term use or high doses of benzodiazepines frequently result in confusion, daytime somnolence and short-term memory impairment. Benzodiazepine use in the elderly is especially problematic because of the significantly increased risk of serious fall injuries associated with their use in this population. Many antidepressants including doxepin (Siniquan™), trazodone (Desyrel™), and mirtazapine (Remeron™) are moderately sedating, and their use in the management of insomnia has steadily increased since the mid 1980s. However, research findings suggest that antidepressants used to treat insomnia cause serious adverse effects more often compared to benzodiazepines, including elevated liver enzymes, dry mouth, nausea, weight gain, orthostatic hypotension, daytime sleepiness, and dizziness.

Diphenhydramine, an antihistamine, is frequently prescribed for insomnia because of its sedating side effects. In recent years atypical antipsychotics with sedating side effect profiles have been increasingly used to manage insomnia in the absence of FDA approval for this clinical application, and in spite of the absence of findings from controlled trials supporting the efficacy and safety of these drugs for the treatment of insomnia. Atypical antipsychotic agents frequently prescribed for insomnia include quetiapine (Seroquel™) and olanzapine (Zyprexa™). In many cases the conventional pharmacologic management of insomnia is inappropriate or potentially unsafe because of a non-disclosed history of alcohol abuse or prescription drug dependence, concurrent use of medications that interact with sedative-hypnotics, or the existence of medical conditions that make the use of benzodiazepines unsafe. Meta-analyses of conventional treatment approaches suggest that conventional drugs are probably more effective in the acute management of insomnia, while cognitive-behavioral approaches are more effective over the long term.

Non-medication approaches used to treat insomnia
The limited effectiveness and safety issues associated with available mainstream pharmacologic treatments of insomnia invite serious consideration of non-medication approaches. Simple changes in nutrition can significantly improve the quality of sleep and reduce daytime fatigue. Melatonin is especially effective for management of insomnia caused by disruption of circadian rhythms as in jet lag or shift work. Sustained-release preparations are most effective for increasing the duration of sleep while immediate-release formulations are most effective for individuals who have difficulty falling asleep. Valerian root extract is widely used to self-treat insomnia. A systematic review of placebo-controlled studies of valerian extract for insomnia concluded that 600mg to 900mg taken at bedtime improves the quality of sleep and has few adverse effects. The amino acids L-tryptophan and 5-hydroxytryptophan are sedating at certain doses and are widely used by naturopaths to treat situational insomnia. A special kind of electroencephalographic (EEG) biofeedback that employs alpha-theta training and provide feedback in the form of an individual’s unique “brain music” may be a more effective treatment of situational insomnia than progressive muscle relaxation. Other non-medication approaches to insomnia include taking a sauna or hot bath before bedtime, acupuncture and mind-body therapies.

If you are struggling with insomnia, taking a medication that isn’t helping you sleep better, experiencing adverse effects, or you simply can’t afford to continue taking a prescription sleep aid that is working you will benefit from my book Insomnia: The Integrative Mental Health Solution. In the book I provide practical information about a variety of non-medication alternatives that will help you sleep better such as herbals, vitamins and other natural supplements, whole body approaches, meditation and mind-body practices, and energy therapies.

Insomnia: The Integrative Mental Health Solution will help you:
• Understand insomnia better
• Take inventory of your symptoms
• Learn about non-medication treatments of insomnia
• Develop a customized treatment plan that is right for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work

Click here to preview or buy my book, Insomnia: The Integrative Mental Health Solution.

Anxiety: integrative approaches

Anxiety: overview
Generalized anxiety is a chronic condition characterized by both psychological or physical symptoms such as feelings of tension, excessive worrying, and heightened arousal that significantly interfere with work, going to school, being in a relationship or functioning in society generally. Symptoms of generalized anxiety often change over time, last for months or longer and are not due to another mental health problem, a medical problem or substance abuse. Many explanations of chronic generalized anxiety have been proposed and the condition is probably related to how the brain responds to chronic stress at the level of neural circuits or neurotransmitters.
Panic attacks are transient episodes of intense anxiety that may be triggered by an unexpected or frightening situation or object, or occur spontaneously. Panic attacks are typically associated with dizziness, perspiration, hyperventilation or shortness of breath, elevated heart rate or palpitations, feelings of intense dread, fear of dying. There is considerable variation in the duration and severity of symptoms that take place during panic attacks. Many individuals who experience panic attacks suffer from significant social and occupational impairment. Biological, social and psychodynamic theories have been advanced in attempts to explain generalized anxiety and panic attacks.

The majority of individuals who suffer from panic attacks eventually develop phobic avoidance of large open spaces (agoraphobia) or avoidance of specific situations or objects they associate with previous panic attacks. Many chronically anxious individuals experience depressed mood, insomnia, panic attacks and other mental health problems. Abnormal heart rhythms, disorders of the thyroid, diabetes and several other medical problems sometimes may cause symptoms that mimic generalized anxiety but which typically resolve when the underlying medical problem responds to treatment. As many as one half of individuals who experience frequent panic attacks become depressed, and 10% eventually attempt suicide.

Limitations of conventional treatments
Established mainstream treatments of anxiety include cognitive-behavioral therapy, supportive psychotherapy, and prescription medications. Double-blind studies have verified the efficacy of sedative-hypnotics (e.g. benzodiazepines) and SSRIs in the short-term treatment of recurring panic attacks and generalized anxiety. Most currently available conventional treatments of anxiety are beneficial but have limited efficacy. Further, individuals who chronically use potent sedative-hypnotics to control intense feelings of generalized anxiety or panic symptoms are at significant risk of drug dependence and withdrawal. This is complicated by the fact that the majority of persons who experience generalized anxiety initially have positive responses to medications but remain symptomatic over the long-term. Finally, many individuals who struggle with chronic anxiety have problems with depressed mood, insomnia and alcohol or drug abuse.

Non-medication treatments of anxiety
The limited effectiveness of available mainstream treatments of bipolar disorder invites serious consideration of non-medication approaches. Natural supplements used to treat generalized anxiety include the kava, the amino acid l-theanine and certain Ayurvdic herbals. Numerous research studies show that 5-hydroxy-tryptophan (5-HTP) has beneficial anti-anxiety effects and may also help prevent panic attacks in some cases. In addition to natural supplements biofeedback, yoga and other mind-body approaches, acupuncture, massage, music, relaxation and micro-current electrical stimulation often reduce symptoms of generalized anxiety. Exercising 20 to 30 minutes daily can significantly lower anxiety level in individuals who have generalized anxiety.

If you are currently struggling with anxiety and taking a medication that isn’t helping, experiencing adverse effects, or you simply can’t afford to continue taking a medication that is working Anxiety: The Integrative Mental Health Solution provides valuable information about non-medication alternatives that will help you feel and function better such as herbals, vitamins and other natural supplements, whole body approaches, meditation and mind-body practices, and energy therapies.

Anxiety: The Integrative Mental Health Solution was written to give you the maximum amount of information in the shortest amount of time. The book will help you:
• Understand anxiety better
• Take inventory of your symptoms
• Identify treatments that make sense for you based on the evidence
• Learn about a range of specific non-medication and integrative approaches for treating anxiety or preventing it from returning
• Develop a customized treatment plan that is right for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work

Click here to preview or buy my book, Anxiety: The Integrative Mental Health Solution.

Psychosis: integrative approaches

Psychosis has many complex causes
Symptoms of psychosis may be temporary or chronic and moderate or severe in their intensity. Schizophrenia and other chronic psychotic disorders are characterized by so-called ‘positive’ and ‘negative’ symptoms. Positive symptoms include auditory hallucinations, paranoia (the belief that someone is following you or trying to harm you), delusional beliefs, and disorganized speech. Negative symptoms include distortions in the perception of reality, extreme apathy, grossly impaired social functioning, and the inappropriate expression of emotions. Individuals develop schizophrenia in stages starting with an early ‘phase’ in which they begin to experience psychotic symptoms but are able to function in day to day activities. The early or ‘prodromal’ of schizophrenia phase soon transitions to an ‘active’ phase in which symptoms of psychosis become more severe often impairing one’s ability to function at work, in school or in society. The initial ‘active’ phase may be followed by a ‘residual’ phase characterized by improved functioning and decreased symptom severity even in the absence of treatment.

Symptoms of schizophrenia usually begin in the second or third decade of life but may occur much later. There is no single explanation of the cause of schizophrenia and other mental health problems in which symptoms of psychosis take place. Strong genetic risk factors have been established in the case of schizophrenia. Other known causes of schizophrenia include exposure to the influenza virus before birth and abnormal fetal brain development. Different medical problems sometimes cause symptoms of psychosis that may be mistaken for schizophrenia but typically resolve with proper treatment. Examples include brain tumors, hyperthyroidism, seizure disorders, Parkinson’s disease, HIV/AIDS and stroke. Psychosis often accompanies Alzheimer’s disease and other forms of dementia. Acute intoxication with methamphetamine, cocaine and other drugs of abuse, high dose steroids and some prescription medications can cause temporary symptoms of psychosis.

Psychotic symptoms associated with schizophrenia and other chronic mental health problems may change over time and wax and wane in severity even in the absence of treatment. According to Western biomedical diagnostic criteria, all ‘phases’ must last for at least 6 months to qualify for a diagnosis of schizophrenia. Schizoaffective disorder is a chronic psychotic disorder in which an individual experiences periods of psychosis that alternate with severe mood swings typical of bipolar disorder. Other psychotic disorders last for a shorter time for example some individuals experience transient symptoms of psychosis that resolve after days or weeks even in the absence of treatment. Individuals who are severely depressed or manic may experience symptoms of psychosis which resolve with treatment. Individuals diagnosed with PTSD or severe personality disorders may also experience transient symptoms of psychosis that resolve with treatment.
Limitations of conventional treatments of psychosis

More recently introduced “atypical” antipsychotics carry a relatively reduced risk of serious adverse effects compared to older antipsychotics, including a reduce risk of permanent neurological syndromes including tardive dyskinesia and tardive dystonia. In spite of the early promise of these so-called ‘atypical’ agents, a meta-analysis concluded that they have only a slight advantage over first generation antipsychotics in both efficacy and frequency of adverse neurological effects. A meta-analysis comparing outcomes of all randomized controlled trials of conventional antipsychotics conducted between 1953 and 2002 concluded that only one atypical agent (clozapine) yielded outcomes that were significantly better than first generation antipsychotics. The same meta-analysis concluded that the antipsychotic efficacy of haloperidol, an important first generation antipsychotic, was superior to all atypical agents. Unfortunately, a 1% risk of a potentially fatal blood disorder (agranulocytosis) with clozapine, generally restricts the use of this medication to patients who are refractory to other antipsychotics.

Limitations and safety issues associated with antipsychotics
Few studies have been done to evaluate the long-term effectiveness of conventional antipsychotic medications in the management of schizophrenia and other chronic psychotic syndromes. At the same time there are increasing safety concerns over the long-term use of antipsychotics. Many atypical agents cause the so-called ‘metabolic syndrome’ including weight gain with a significant associated risk of acquiring non-insulin-dependent diabetes. Other serious medical consequences associated with atypical antipsychotics include hypotension, cardiac arrhythmias, and a potentially fatal condition called Stevens-Johnson syndrome. Because of these serious safety concerns the U.S. Food and Drug Administration (FDA) requires drug companies to issue warnings to physicians and patients about the risk of developing hyperglycemia and diabetes associated with prolonged use of most atypical antipsychotic agents, potentially progressing to diabetic coma and death.

Non-medication approaches used to treat psychosis
The limited effectiveness of available mainstream treatments of psychosis invites serious consideration of non-medication approaches. Natural supplements used to treat psychosis include estrogen, Ginkgo (Ginkgo biloba), Ginseng (Panax quinquefolium), glycine, melatonin, Ayurvedic herbal formulas, and omega-3 essential fatty acids. Eating fish and other foods rich in omega-3 essential fatty acids may be associated with reduced symptom severity in chronic schizophrenics. Glycine is another natural substance that shows promise as a treatment of psychosis. Taking a standardized Ginkgo biloba extract with a conventional antipsychotic may improve negative and positive psychotic symptoms more than antipsychotics alone while reducing the risk of neurological adverse effects. While most natural supplements are safe when used as recommended some herbals may have serious adverse effects when taken at inappropriate high dosages or in combination with certain prescription medications.

Though less effective than prescription antipsychotics and the above natural supplements, acupuncture, animal-assisted therapy, meditation and some mind-body practices may help decrease the severity of psychotic symptoms in some cases. Regular acupuncture treatment using laser light to stimulate specific acupoints may lessen the severity of auditory hallucinations and other positive psychotic symptoms and have efficacy comparable to conventional antipsychotics. Other non-medication approaches that may help individuals struggling with chronic psychosis remain more stable include yoga, and qigong.

If you or a loved one are struggling with symptoms of psychosis, taking a medication that isn’t helping, experiencing adverse effects, or you simply can’t afford to continue taking a prescription medication that is working you will benefit from my book Psychosis: The Integrative Mental Health Solution. In the book I provide practical information about a variety of non-medication alternatives that will help you manage symptoms of psychosis such as herbals, vitamins and other natural supplements, whole body approaches, meditation and mind-body practices, and energy therapies.

Psychosis: The Integrative Mental Health Solution will help you:
• Understand psychosis better
• Take inventory of your symptoms
• Learn about non-medication treatments of psychosis
• Develop a customized treatment plan that is right for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work
Click here to preview or buy my book, Psychosis: The Integrative Mental Health Solution.

Attention-deficit hyperactivity disorder: integrative approaches

Attention-deficit hyperactivity disorder (ADHD) has enormous psychological and social consequences
Approximately one third of the world’s population experiences chronic symptoms of inattention, distractibility, impulsivity or hyperactivity that meet requirements for a diagnosis of attention-deficit hyperactivity disorder. ADHD is the most common mental health problem among young children and may affect as many as 5% of school-aged children. Common symptoms of ADHD include difficulty sustaining attention and carrying out simple tasks at school and at home, intense feelings of restlessness, erratic movements of the legs and hands, and excessive talking that disrupt the normal social or school environment. Some individuals experience mainly inattention and distractibility, others are unable to control impulsive behavior or have difficulty remaining still, and a third group exhibits symptoms of both inattention and impulsivity. Symptoms of ADHD can be mild, moderate or severe in intensity depending on how much distress they cause and to what extent they interfere with your ability to function at work, in school, in a relationship or in society.

Roughly half of individuals diagnosed with ADHD in childhood continue to experience symptoms of inattention or impulsivity into adulthood and throughout life. ADHD has many different causes including genetic factors, trace mineral deficiencies, birth trauma, exposure to environmental toxins alcohol, tobacco or lead during fetal development, and early childhood abuse and neglect. Some cases of ADHD may be caused by an abnormal low level of ‘arousal’ in the frontal cortex, the part of the brain required for normal attention. Neuroimaging studies have shown that the symptoms of ADHD correlate with abnormal patterns of regional brain metabolic and electrical activity. A specialized kind of electroencephalography called QEEG is used to “map” electrical brain activity. A persisting pattern of relative under-arousal in the frontal cortex—the part of the brain that is necessary for sustained attention—is present in 90% of individuals diagnosed with ADHD. Using QEEG analysis to determine the specific pattern of abnormal brain electrical activity associated with ADHD may help guide the selection of the optimal EEG biofeedback training protocol.
Conventional treatments of ADHD and their limitations

Stimulant medications are the principle pharmacological treatments of ADHD in the U.S. and other Western countries. The widespread use of stimulants to treat ADHD has become very controversial because it interferes with normal growth in children, increases the risk of drug abuse and may have long-term toxic effects on brain development. Behavioral modification is a widely used and often effective treatment of ADHD in children aimed at re-enforcing desirable behaviors and eliminating disruptive or inappropriate behaviors.

Limitations and safety issues associated with conventional treatments
The widespread use of stimulants to treat ADHD has become very controversial because it interferes with normal growth in children, increases the risk of drug abuse and may have long-term toxic effects on brain development. Chronic amphetamine use in childhood is associated with delays in normal development. One-third of all individuals of all ages who take stimulants for ADHD report significant adverse effects including insomnia, decreased appetite, and abdominal pain. And cases of stimulant-induced psychosis have been reported. Stimulants and other conventional treatments of ADHD in adults are probably only half as effective as they are in children. Adverse effects of non-stimulant drugs used to treat ADHD include hypertension, decreased appetite, nausea, fatigue, liver toxicity, insomnia, and seizures. A meta-analysis of 6 controlled trials concluded that stimulant therapy started in childhood reduces the risk of subsequent substance abuse by as much as one-half. In contrast, stimulants started in adolescence or adulthood increase the risk of future substance abuse. Non-stimulant medications and extended-release stimulants are less likely to be abused.

Non-medication treatments of ADHD
The limited effectiveness of available mainstream treatments of ADHD invite serious consideration of non-medication approaches. Natural supplements used to treat ADHD include the herbals Ginkgo biloba, Panax quinquefolius, Pinus pinaster, Bacopa monnieri, as well as omega-3 essential fatty acids, acetyl-l-carnitine, Chinese herbal formulas, multi-nutrient formulas, and the minerals zinc and iron. While most natural supplements are safe when a quality brand is used at the recommended dosage, some herbals or other natural supplements may have serious adverse effects when taken at inappropriate high dosages or in combination with certain prescription medications. In addition to biological treatments such as natural supplements and prescription medications, many non-biological approaches may be beneficial for treating ADHD including EEG biofeedback, exercise, meditation and mindfulness training, Anthroposophic medicine, and ‘green play’ environments.

If you or your child are currently struggling with ADHD and taking a medication that isn’t decreasing your symptoms of ADHD, you are experiencing adverse effects, or you simply can’t afford to continue taking a medication that is working you will benefit from my book Attention-deficit Hyperactivity Disorder (ADHD): The Integrative Mental Health Solution—safe, effective and affordable non-medication treatments of ADHD. In the book I provide practical information about a variety of safe, effective and affordable non-medication alternatives that will help you—or your child—feel and function better such as herbals, vitamins and other natural supplements, whole body approaches, meditation and mind-body practices, and energy therapies.

Attention-deficit Hyperactivity Disorder (ADHD): The Integrative Mental Health Solution will help you
• Understand ADHD better
• Take inventory of your symptoms
• Learn about a variety of non-medication approaches for treating ADHD
• Develop a customized treatment plan that makes sense for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work

Click here to preview or buy my book on Amazon.com

Alcohol and drug abuse: integrative approaches

Overview
Alcohol and nicotine are the most widely abused substances in all countries resulting in untold personal suffering and enormous economic and social costs. A significant percentage of smokers are also alcoholics and also use illegal drugs. Methamphetamine (‘speed’), cocaine and heroin are widely abused in some demographic groups. In recent decades abuse of prescription drugs such as sedative-hypnotics and narcotic pain medications has become a major global health problem. Over-prescribing of sedative-hypnotics and other potentially addictive medications by physicians has resulted in a growing population of individuals who are dependent on sedatives and anti-anxiety medications.Many psychological, social and biological factors determine the risk of developing a substance abuse problem. One current theory relates self-destructive drug seeking behavior to intense feelings of pleasure associated with particular neurotransmitters and brain circuits stimulated by alcohol and drugs.

Craving may be related to rapid decline in brain levels of dopamine and other neurotransmitters resulting in increased drug-seeking behavior. Rapid changes in mood and thinking often accompany intoxication with alcohol and drugs. Physiological symptoms of acute intoxication or withdrawal include sudden changes in blood pressure, breathing and heart rate. Seizures may occur during intoxication or withdrawal from alcohol or drugs. Withdrawal is a syndrome of intense physical discomfort and emotional distress that occurs when the use of alcohol and other substances is abruptly stopped following prolonged heavy use. Individuals who chronically abuse alcohol or other substances are at increased risk for depressed mood, anxiety, memory problems, dementia and insomnia.

Limitations of conventional treatments of alcohol and drug abuse
Controlled studies and patient surveys show that most existing pharmacological and psychosocial treatments of alcohol and drug abuse or dependence have only a moderate success rate in helping individuals to discontinue a substance of abuse or maintain abstinence. By the same token, cognitive-behavioral therapy and psychosocial approaches used in relapse prevention programs are not very effective. One year after discontinuing the use of alcohol or any substance of abuse approximately one third of individuals continue to abuse the same substance at the previous level, one third use the same or another substance but in a more controlled way, and roughly one third remain abstinent. Following the one year mark, abstinence rates continue to decline. Naltrexone and other opiate blockers haven proven ineffective in reducing the rate of heroin addiction. Only one third of recovering alcoholics who attend regular Alcoholics Anonymous meetings remain sober for more than one year. Mainstream approaches that are even less effective include aversion therapy, confrontation, educational films and general psychotherapy.

Non-medication treatments of alcohol and drug abuse
The limited effectiveness of available mainstream treatments of alcohol and drug abuse invites serious consideration of non-medication approaches. Research findings suggest that improved nutrition, certain supplements, herbals and other non-pharmacological therapies are beneficial for reducing craving, diminishing symptoms of withdrawal and reducing relapse risk in alcoholics and narcotics abusers. Most published studies have focused on alcohol abuse. A significant percentage of chronic alcoholics and drug addicts are malnourished and are deficient in thiamin, folate, B-6 and important minerals. Studies suggest that alcoholics who improve their general nutrition maintaining sobriety longer.

Natural supplements used to treat alcohol and drug abuse, reduce craving, decrease withdrawal symptoms or reduce the risk of relapse include vitamins, magnesium and zinc, Chinese and Ayurvedic herbal formulas, amino acids and essential fatty acids. Taking certain amino acids including taurine, and L-tryptophan may reduce alcohol craving or consumption and diminish withdrawal symptoms. One study found that taurine in doses up to 3gm/day significantly decreased alcohol withdrawal symptoms in hospitalized alcoholics undergoing acute detoxification. While most natural supplements have few or mild adverse effects when a quality brand is used at recommended dosages some may have serious adverse effects when taken at inappropriate high dosages or in combination with prescription medications.

Other approaches that are sometimes beneficial for treating substance abuse, managing withdrawal or reducing the risk of relapse include acupuncture, EEG biofeedback, meditation, yoga and virtual reality exposure therapy. Virtual environments are being used to stimulate alcohol, nicotine or cocaine craving followed by desensitization using cognitive-behavioral techniques.
If you are struggling with alcohol or drug abuse, taking a medication that isn’t helping you control drug or alcohol use, experiencing adverse effects, or you simply can’t afford to continue taking a prescription medication that is working you will benefit from my book Alcohol and Drug Abuse: The Integrative Mental Health Solution. In the book I provide practical information about a variety of non-medication alternatives that will help you manage symptoms of alcohol or drug abuse such as herbals, vitamins and other natural supplements, whole body approaches, meditation and mind-body practices, and energy therapies.

Alcohol and Drug Abuse: The Integrative Mental Health Solution will help you:
• Understand substance abuse better
• Take inventory of your symptoms
• Learn about non-medication treatments of substance abuse
• Develop a customized treatment plan that is right for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work
Click here to preview or buy my book, Alcohol and Drug Abuse: The Integrative Mental Health Solution.

Post-traumatic Stress Disorder (PTSD): emerging strategies for prevention and treatment

PTSD in overview
PTSD is a severe anxiety disorder that occurs following direct or indirect exposure to trauma. In cases of direct exposure to trauma symptoms of PTSD develop after a potentially life-threatening situation such as a serious injury, physical assault or threat of assault, torture or rape. PTSD may also result from indirect exposure to trauma such as ‘witnessing’ events that threaten the lives of others but do not directly affect the observer, or learning about a life-threatening event (especially one that affected a family member or friend). Symptoms of PTSD may begin within days following exposure to trauma or onset may be ‘delayed’ months or years. Symptoms of psychic numbing typically start immediately following exposure to trauma. Other symptoms that more often emerge in the days and weeks following trauma include repetitive intrusive memories of the traumatic experience (flashbacks), autonomic arousal (perspiration, rapid breathing, elevated heart rate), recurring nightmares, and hyper-vigilance. Traumatized individuals actively avoid situations that remind them of the traumatic event, may have amnesia of the traumatic event, and often experience profound feelings of detachment and loss.

Depressed mood, anxiety, anger, intense shame or guilt feelings, distractibility, irritability, and an exaggerated startle response may continue for years following exposure to trauma. Severely traumatized individuals may experience psychotic symptoms including dissociative symptoms (e.g. difficulty perceiving their body or the environment as ‘real’), and auditory or visual hallucinations. Traumatized individuals may be severely impaired by their symptoms and unable to function at work, in school, in relationships or other social contexts. The majority of individuals diagnosed with PTSD have at least one other serious mental health problem such as generalized anxiety disorder, panic disorder, phobic disorders, major depressive disorder, obsessive-compulsive disorder, anti-social personality disorder, and alcohol or drug abuse. Acute Stress Disorder (ASD) is a less severe variant of PTSD in which all symptoms resolve within one month following exposure to trauma. Roughly one half of individuals who are diagnosed with ASD eventually develop full-blown PTSD.

The enormous personal, social and economic burden of human suffering, treatment costs, disability compensation, and productivity losses related to PTSD are major issues facing American society at this time because of the military conflicts in the Middle East. As many as one half of all persons diagnosed with PTSD who are treated with prescription medications or conventional psychological therapies do not fully respond. PTSD resulting from violent assault, rape or traumatic exposure to combat is often characterized by severe symptoms that are poorly response to treatment.

Conventional treatments of PTSD and their limitations
Conventional pharmacologic and psychological approaches widely used to treat PTSD are based on the assumption that traumatic exposure results in chronic dysregulation in neurophysiology and maladaptive coping with stressful situations. Pharmacological and psychological therapies endorsed by mainstream psychiatry reduce the severity of some PTSD symptoms however most conventional approaches have limited efficacy. In addition to problems associated with limited efficacy many medications cause significant adverse effects resulting in poor adherence or treatment discontinuation. For example the long-term management of PTSD with SSRIs or other conventional drugs frequently results in weight gain, sexual dysfunction and disturbed sleep. The limitations of current mainstream approaches invite open-minded consideration of the range of promising alternative and integrative approaches aimed at preventing PTSD following exposure to trauma and treating chronic PTSD.

Non-medication approaches used to prevent or treat PTSD
The limited effectiveness of available mainstream treatments of PTSD invites serious consideration of non-medication approaches. Natural supplements used to prevent PTSD (i.e. before or after exposure to trauma) or treat chonic PTSD include dehydroepiandrosterone (DHEA), omega-3 essential fatty acids and a proprietary micro-nutrient formula. While most natural supplements are safe when a quality brand is used at the recommended dosage, some herbals and other supplements may have serious adverse effects when taken at inappropriate high dosages or in combination with prescription medications. Other non-medication approaches that can be used to prevent or treat PTSD include massage, dance/movement therapy, yoga, meditation and mindfulness training, virtual reality exposure therapy (VRET) and EEG biofeedback training.

Mindfulness training may reduce symptoms of PTSD when improved attention permits increased control over intrusive thoughts or memories. Patients who engage in a mindfulness practice can be trained to shift attention from remembered fears to present-focused problem solving permitting improved coping. The therapeutic benefits of mantra meditation are believed to be related to the effects of repetitive chanting on reducing the overall level of arousal permitting improved emotional self-regulation. Important advantages of meditation in the treatment of PTSD include ease of training, low cost and practical implementation in group settings.

If you are struggling with post-traumatic stress disorder (PTSD) and taking a medication that isn’t decreasing your symptoms, you are experiencing adverse effects, or you simply can’t afford to continue taking a medication that is working you may benefit from my book Post-traumatic stress disorder: The Integrative Mental Health Solution—safe, effective and affordable non-medication treatments of PTSD. In the book I provide practical information about a variety of safe, effective and affordable non-medication alternatives that will help you feel and function better such as herbals, vitamins and other natural supplements, whole body approaches, meditation and mind-body practices, and energy therapies.

Post-traumatic stress disorder (PTSD): The Integrative Mental Health Solution will help you
• Understand PTSD better
• Take inventory of your symptoms
• Learn about a variety of non-medication approaches for preventing or treating PTSD
• Develop a customized treatment plan that makes sense for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work

Click here to preview or buy my book on Amazon.com

Bipolar disorder: managing your symptoms from an integrative perspective

Bipolar disorder in overview
Approximately 1% of the adult population experiences persisting mood swings and fulfills criteria for the diagnosis of bipolar disorder. Bipolar disorder is a heritable mental illness. First-degree relatives of Bipolar individuals are much more likely to develop the disorder than the population at large. Bipolar illness in one identical twin corresponds to a 70% risk that the other twin will also have the disorder. This risk is estimated at 15% in non-identical twins. Recurrent episodes of mania are often associated with progressive deterioration in social and occupational functioning, and often lead to job loss and divorce. Approximately two thirds of individuals diagnosed with bipolar disorder are unemployed, although most have attended college. One fourth of Bipolar I patients attempt suicide, and 15% eventually succeed.

A diagnosis of bipolar disorder is made after an individual experiences at least one episode of mania. Mania is a symptom pattern that lasts several days or longer and consists of emotional, behavioral or cognitive symptoms including rapid speech, racing thoughts, euphoric or irritable mood, agitation, inflated self-esteem, distractibility, excessive or inappropriate involvement in pleasurable activities and diminished need for sleep. Symptoms of psychosis such as hearing voices, paranoia or delusional beliefs, may occur during episodes of severe mania or depression. A manic episode causes significant impairment in one’s ability to work, go to school or be in a relationship. In contrast ‘hypomania’ is a milder form of mania characterized by less severe symptoms that is shorter in duration. The majority of individuals diagnosed with bipolar disorder experience episodes of depressed mood more often than mania or hypomania.

Many individuals diagnosed with bipolar disorder also have problems with alcohol or drug abuse, which they may use to ‘self-medicate’ mood swings. Chronic alcohol or drug abuse can also cause erratic changes in mood that resemble the mood swings seen in bipolar disorder. Medical problems that can cause mood swings similar to the symptoms of bipolar disorder include thyroid disease, multiple sclerosis, and strokes affecting certain brain regions.

Limitations of conventional treatments
Prescription medications used to treat bipolar disorder include so-called ‘mood stabilizers’ such as lithium carbonate and divalproex; antidepressants; antipsychotics; and sedative-hypnotics. Unfortunately, currently available prescription medications used to treat both the depressive and manic phases of bipolar disorder have only limited effectiveness. This is due in part to a high rate of non-compliance with conventional pharmacological treatments among many bipolar patients, and due in part to limited efficacy of medications themselves. It is estimated that less than one third of all individuals who meet criteria for bipolar disorder receive any treatment for manic or depressive symptoms during the active phase of their illness. Because less severe symptoms of mania (i.e. ‘hypomania’) often go unreported, and because many symptoms of hypomania resemble agitation or anxiety, there is on-going debate over the rate of occurrence of bipolar disorder compared to major depressive disorder. Only half of currently available prescription medications used to treat bipolar mood symptoms are based on strong research evidence of efficacy. Fewer than half of individuals who take conventional maintenance treatments for bipolar disorder following an initial manic episode experience sustained control of their symptoms. Further, the relapse rate among bipolar patients who adhere to lithium carbonate or other conventional mood stabilizers is also very high at approximately 40%. Finally, the use of prescription antidepressants does not reduce the frequency of depressive symptoms in bipolar patients over the long term nor does it lead to increased time spent in remission.

As many as one half of patients who are treated for Bipolar disorder fail to adhere to their recommended regimens of conventional mood stabilizers, often because of adverse effects. Bipolar patients who discontinue lithium carbonate or other conventional mood stabilizers are almost certain to relapse. There is evidence that discontinuation of lithium carbonate, and other prescription medications, is associated with reduced efficacy if these medications are resumed in the future. A review of 7 studies (4 of which were randomized) involving 358 patients concluded that adding an antidepressant to lithium therapy does not substantially increase protection against bipolar depressive recurrences.

Non-medication treatments of bipolar disorder
The limited effectiveness of available mainstream treatments of bipolar disorder invite serious consideration of non-medication approaches. Natural supplements used to treat bipolar disorder include omega-3 fatty acids, magnesium, N-acetyl-cysteine, micronutrient formulas and Chinese herbal formulas. Some natural supplements may be safely combined with prescription medications increasing their efficacy. Most natural supplements are safe when a quality brand is used at the recommended dosage however some herbals and other natural supplements can have serious adverse effects especially when taken at inappropriate high dosages or in combination with prescription medications or other supplements. Non-biological approaches such as mindfulness-based cognitive therapy and yoga may help individuals improve their capacity for emotional self-regulation thus reducing the severity of mood swings.

If you are currently struggling with bipolar disorder and taking a medication that isn’t helping you control your mood swings, you are experiencing adverse effects, or you simply can’t afford to continue taking a medication that is working, you will benefit from my book Bipolar Disorder: The Integrative Mental Health Solution. The book provides practical information about a variety of non-medication approaches that will help you feel and function better such as herbals and other natural supplements, whole body approaches, meditation and mind-body practices, and many others.

Bipolar Disorder: The Integrative Mental Health Solution will help you:
• Understand bipolar disorder better
• Take inventory of your symptoms
• Learn about non-medication treatments of bipolar disorder
• Develop a customized treatment plan that is right for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work

Click here to preview or buy my book, Bipolar disorder: The Integrative Mental Health Solution.