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.

Welcome to my blog

This blog reflects my personal and professional commitment to providing reliable information about best evidence in alternative and integrative approaches in mental health care for the treatment of common mental health problems.

Goals of this blog and my website include:

  • Informing patients and medical practitioners about the evidence for non-conventional and integrative approaches in mental health care
  • Encouraging open-minded dialog about evolving understandings and novel approaches in assessment and treatment in mental health care
  • Providing a gateway
    to excellent web-based resources covering the range of biological,
    somatic, mind-body and energy-information therapies in mental health
    care

Announcing a series of e-books on integrative mental healthcare

Other books by Dr. Lake

Mental healthcare is evolving

A growing number of psychiatrists, psychologists, social workers, nurses and other mental health professionals around the world believe that existing conventional treatment approaches such as prescription medications and psychotherapy do not adequately address the mental health needs of people everywhere. There are many reasons for this. First of all, even though prescription medications are often effective and safe, they are not available in many parts of the world and where they are available they are often too expensive for many people to afford. The potential value of prescription medications for people who suffer with mental illness is also limited by the fact that many medications are no more effective than sugar pills and sometimes cause serious adverse effects. The limitations of prescription medications have resulted in renewed interest in complementary and alternative therapies, and efforts by mental health professionals, researchers and our patients to find more effective, safer and more affordable ways to treat many common mental health problems and prevent them from returning.

There is a long historical tradition of uses of so-called complementary and alternative (CAM) therapies in the U.S. and other Western countries in the background of the dominant framework of biomedicine. The rapid growth of CAM is being driven by consumer demands for a wide range of treatment choices, growing dissatisfaction with conventional medical care and increasing openness to new ideas in the leading institutions of Western medicine. Trends that are interfering with the ability of Western medicine to provide adequate health care include restrictions on the kind and quality of treatments available under managed care, private insurance contracts and Medicare; concerns over the efficacy and safety of conventional pharmacological treatments; and the increasing cost of medical care in general.

In the above context it is a significant fact that individuals who use CAM to treat any medical or mental health problem are generally more educated compared to those who use only conventional treatments. Approximately two thirds of all adults in the U.S. use various CAM approaches to treat a medical or mental health problem. Many individuals who see Western-trained physicians also see Chinese medical practitioners, herbalists, homeopathic physicians or energy healers for the same problem but many are also self-treating with herbals, supplements or homeopathic remedies without the advice of a naturopathic physician, conventionally trained M.D. or a mental health professional.

At the same time that patients are demanding more choices in health care, mainstream medicine is becoming more open to change. Courses on complementary and alternative medicine are now offered at most U.S. and European medical schools, and increasing numbers of physicians are becoming certified to practice Chinese medicine, herbal medicine, homeopathy and other established world healing traditions. Approximately one half of U.S. physicians refer patients to acupuncturists, naturopaths, homeopaths, chiropractors and other non-conventionally trained practitioners because they believe these approaches are safe and effective. Together these trends are stimulating evolution of medical care in the U.S. toward an eclectic network of perspectives, skills and services addressing the patient’s body, mind and spirit.

The Increasing uses of CAM in mental health care
Approximately one third of the adult population in the U.S. and Europe use at least one CAM therapy annually. In this context more and more people are using CAM and integrative therapies to treat or self-treat mental health problems. It has been estimated that as many as 10% of U.S. adults take prescription medications for depression, anxiety, schizophrenia and other mental health problems. At the same time approximately 10% of U.S. adults who visited an alternative medical practitioner in the previous year had a psychiatric diagnosis, and half of those had sought care specifically for a mental health problem. It is significant that the majority of individuals who see alternative medical practitioners for a mental health problem are self-referred and do not disclose their use of non-conventional therapies to their family physician, psychiatrist or therapist. Over 50% of individuals diagnosed with an anxiety disorder and 60% of individuals diagnosed with a mood disorder use a CAM therapy while few disclose this information to their family physician or psychiatrist. The majority of individuals who use CAM therapies see a conventionally trained M.D. for the same health problem. Among individuals hospitalized for a severe mental health problem almost two thirds had used a CAM approach within the past year and fully 80% had not disclosed this information to their psychiatrist. Severe depressed mood is the strongest predictor of CAM use in psychiatrically hospitalized individuals. The increasing rate of self-treatment in the context of non-disclosure of CAM use raises significant safety issues because many individuals who use vitamins, herbs or other natural substances also take prescription medications resulting in potentially serious toxic interactions.

Integrative mental healthcare uses approaches from Western biomedicine and CAM
The conventional biomedical model of mental health care widely practiced in the U.S. and many other countries emphasizes the use of potent prescription medications to treat ‘disorders.’ Medications will probably continue to play an important role in mental health care—especially in Western countries and especially for managing symptoms of severe mental health problems such as bipolar disorder, dementia and psychosis—however non-medication treatments will play an increasingly important role in mental healthcare as more research evidence accumulates showing that they are both safe and effective. In contrast to the conventional biomedical model, integrative mental healthcare is concerned with maintaining optimal wellness and managing symptoms of each unique person in the context of their values, preferences and circumstances. Advantages of integrative mental health care over the conventional biomedical model, include:

• improved response to treatment
• reducing the dosage of a prescription medication
• reducing adverse effects of prescription medications
• saving money on treatment costs
• having greater control over your symptoms
• greater emphasis on maintaining wellness
• developing a more personalized plan for treatment and prevention

It is important to point out that integrative mental healthcare does not reject the use of prescription medications, psychotherapy or other mainstream approaches or discount their benefits for mental health problems. Medications and psychotherapy are often beneficial and safe and bring enormous relief to human suffering. As integrative practitioners we often prescribe medications and recommend psychotherapy to our patients but we go beyond this limited model of care. In addition to these conventional biomedical therapies integrative practitioners also recommend a wide range of non-medication treatment approaches such as herbals, vitamins and other natural supplements, whole body approaches such as exercise and massage, changes in the diet, mind-body practices and energy therapies such as acupuncture and healing touch, and many other so-called ‘alternative’ therapies where scientific evidence supports their use. Because integrative mental health care focuses on each person’s unique needs and circumstances, treatment is often highly individualized. This means that there is no single ‘best’ treatment for any particular mental health problem, but each person may have a ‘most appropriate’ treatment plan depending on the particular symptoms they are experiencing in the context of their unique life story, values, preferences and circumstances.

Introducing a series of books on integrative mental healthcare
In an effort to address the limitations of the current model of mental health care, I have written a series of books on integrative mental health care. My chief goal in writing the books was to create a practical and affordable resource on safe and effective non-medication treatments for many common mental health problems. The books in the series provide concise reviews of the evidence for a variety of non-medication approaches used to treat many common mental health problems.
The series covers the following mental health problems:

Alcohol and Drug Abuse
Anxiety
Attention-deficit hyperactivity disorder (ADHD)
Bipolar disorder
Dementia and mild cognitive impairment
Depression
Insomnia
Post-traumatic stress disorder (PTSD)
Psychosis

Click here to learn more about my books and order them.