Omega-3s in Mental Health Care: Part 2

Part 1 reviewed the evidence for omega-3 supplementation in the treatment of depressed mood. This post concisely reviews the evidence for omega-3s in treating schizopohrenia, dementia, ADHD, PTSD and borderline personality disorder.

Omega-3s for symptoms of schizophrenia and other psychotic disorders

Augmentation with the omega-3 fatty acid EPA may be an effective preventive strategy in individuals at high risk for developing schizophrenia or in the early phase of psychotic illness but not as a treatment of established cases of schizophrenia. The neuroprotective role of omega-3s during the early so-called prodromal phase of schizophrenia may be related to general effects on the brain’s antioxidative intracellular defense mechanisms or direct interactions between EPA and the glutamate receptor system. EPA augmentation may be especially appropriate for younger or antipsychotic naïve individuals in the early phase of illness or cases in which metabolic or sexual adverse effects may result in poor medication adherence and symptomatic worsening. Limited findings suggest that a combination of EPA and DHA may reduce the rate of progression to full-blown schizophrenia in high-risk populations including individuals who chronically abuse substances or already have impairments in neuropsychological functioning. In contrast to positive findings of studies on EPA augmentation in the prodromal phase of schizophrenia, a meta-analysis of placebo controlled studies on EPA augmentation on symptom severity in patients with chronic schizophrenia or other psychotic disorders found no evidence for greater benefit of EPA augmentation over antipsychotic medications alone. All studies included in the meta-analysis lasted 12 weeks and used EPA doses between 2 and 3 g per day. Possible explanations of reported negative findings include small study size, absence of clinical efficacy of EPA supplementation in chronic schizophrenia, a “ceiling effect” on response to EPA augmentation associated with concurrent treatment with antipsychotics, combinations of different fatty acids may be more effective than EPA alone, and dietary differences and other socio-demographic factors that may have confounded findings.

DHA supplementation for treatment of cognitive decline and dementia

Systematic reviews and meta-analysis of studies on the effects of omega-3 supplementation on cognitive development, function, and decline throughout the life span concluded that omega-3 supplementation—especially DHA—may significantly improve cognitive development in infants but not in children, adolescents, adults, or the elderly. Omega-3 supplementation was not associated with a reduced rate of cognitive decline in healthy elderly adults or with a slowing in the rate of progression of Alzheimer disease.

Inconclusive evidence for omega-3s in ADHD

Although individual studies on omega-3s in ADHD report positive findings, a systematic review and meta-analysis of placebo-controlled trials on omega-3s in the treatment of ADHD in children and adolescents reported inconclusive findings due to methodological problems including small sample sizes, variability of selection criteria, and type and dosage of supplements and short-term follow-ups.

Recent studies have investigated the role of omega-3s in PTSD. These studies are based on the observation of increased rates of neuronal regeneration in the hippocampus soon following trauma. It is hypothesized that increased neuronal regeneration following trauma may result in more rapid clearance of fear memories and prevent immediate post-trauma memories from becoming long-term memories, reducing the risk of developing PTSD. In fact, animal studies support that omega-3 fatty acids increase hippocampal neurogenesis. Studies done in Japan following the 2011 tsunami investigated the effectiveness of pre-treatment with omega-3s in preventing the development of PTSD following exposure to trauma in first medical responders.

Symptoms of borderline personality disorder may improve with omega-3 supplementation

In a small, 8-week controlled trial (N = 30), women diagnosed with moderately severe borderline personality disorder randomized to ethyl-EPA (1 g per day) versus placebo reported less severe symptoms of aggression and depressed mood compared to the placebo group.

Omega-3s have few mild safety issues

Omega-3 fatty acids are generally well tolerated and pose few safety issues. Transient mild gastrointestinal distress is sometimes reported by patients who take omega-3 fatty acids. There is one case report of possible hypomania induced by omega-3 fatty acids. Rare cases of increased bleeding times have been reported in patients who take aspirin or anticoagulants together with omega-3s.

The amino acid L-theanine has beneficial effects for generalized anxiety

L-theanine increases brain levels of several neurotransmitters

The amino acid l-theanine found in green tea is widely used in China, Japan, and other Asian countries to treat anxiety and depressed mood. Animal studies confirm that l-theanine increases brain levels of serotonin, dopamine, and gamma-amino-butyric acid (GABA) (an important inhibitory neurotransmitter) and may have general neuroprotective effects.

L-theanine reduces anxiety by increasing alpha brain wave activity

Anxiety-reducing effects of l-theanine are believed to be mediated by enhanced alpha brain wave activity in the occipital and parietal regions that are dose dependent and similar to EEG changes observed during meditation. Calming effects may last 8 to 10 hours and are usually experienced within 30 minutes following ingestion of l-theanine at doses between 50 and 200 mg.

Promising research findings need to be confirmed

However, findings of clinical research studies on l-theanine in anxiety are inconsistent. In one small placebo-controlled study (16 patients), healthy adult volunteers randomized to the prescription medication alprazolam (1 mg) versus l-theanine (200 mg) or placebo experienced equivalent and non-significant anxiety reducing effects during an experimentally induced anxiety state. In another small placebo-controlled study (12 patients), individuals taking l-theanine experienced relatively greater reduction in acute stress response as measured by changes in heart-rate variability (HRV) and salivary immunoglobulins (s-IgA) compared to the placebo group. These findings suggest that stress-reducing effects of l-theanine may be mediated by inhibition of cortical neuron excitation. In a crossover study, healthy adults were randomized to l-theanine (250 mg) alone or in combination with caffeine (150 mg). Compared to the l-theanine–only group, the combination group experienced improved visual information processing, reduced mental fatigue, faster reaction time and faster working memory, generally increased alertness, and fewer headaches. Moderately severe anxiety symptoms may respond to l-theanine taken at a dose of 200 mg twice daily however more severe anxiety may require doses up to 600 to 800 mg per day divided into 200-mg increments every 3 to 4 hours. ​Large well designed placebo-controlled studies on l-theanine are needed before more definitive comments can be made about its anti-anxiety benefits.

No safety problems

l-Theanine is generally well tolerated, and there are no published reports of serious adverse side effects or interactions with other natural products or conventional prescription medications

Widespread Use of Complementary and Alternative Medicine

In the North America, Europe, and other industrialized world regions, an increasing percentage of the population is using complementary, alternative, and integrative approaches to treat or selftreat medical and mental health problems. A large patient survey (N = 7,503) found that females, college graduates, and persons who believed that they received poor health care were more likely to use CAM, and only one-half of individuals who used CAM notified their health care providers. The majority of CAM users are well educated, committed to personal growth, satisfied with the conventional care provided by their physician or other health care provider, and use both prescription medications and CAM approaches for the same problem. An increasing number of medical schools, nursing schools, and psychology graduate programs offer courses on CAM. Symposia on CAM modalities are included in the annual meetings of the American Medical Association (AMA), the American Psychiatric Association (APA), and other professional medical associations. Approximately half of US physicians—and the majority of European physicians—believe that acupuncture, chiropractic, and homeopathy are valid therapeutic modalities and refer patients to practitioners of these therapies. Increasing numbers of primary care physicians are becoming certified to practice massage, acupuncture, herbal medicine, homeopathy, and other nonallopathic modalities.

Widespread Use of Alternative Therapies for Mental Health Problems

Persons diagnosed with a major psychiatric disorder are significantly more likely to use CAM treatments than the general population, and the majority of people who use CAM to self-treat a mental health problem take prescription medications concurrently. Almost one-half of persons diagnosed with major depressive disorder or panic disorder use at least one CAM treatment, compared to less than one-third of the general adult population. Roughly two-thirds of severely depressed or anxious persons who use CAM therapies consult with a mental health professional and 90 percent of the time this is a psychiatrist. The majority of persons who use CAM therapies for a mental health problem do not disclose this to their mental health care provider. This trend is alarming in view of potentially serious safety problems that can result when combining certain herbals or other natural products with pharmaceuticals. More than one-half of persons who self-treat severe depression or anxiety using CAM while concurrently taking a pharmaceutical believe that CAM treatments and conventional medications are equally efficacious.

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.