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Complementary and Integrative Treatments in Psychiatric Practice

Complementary and Integrative Treatments in Psychiatric Practice by Patricia Gerbarg, Philip Muskin, and Richard Brown, eds. Washington, DC: American Psychiatric Association Publishing; 2017. Softcover, 425 pages. ISBN: 978-1-61537-031-3. $65.00.

As more psychiatrists feel limited by the modern psychopharmacological model that predominates current practice, interest in the field of integrative psychiatry has grown significantly. Psychiatry, as a profession, had been slow to begin the transformation to integrative medicine and a more holistic approach. This process is a paradigm shift that moves practitioners from a disease-oriented model to a health-oriented model. For example, five years ago, I reviewed existing conventional psychiatric textbooks and found no discussion of nutrition, micronutrients, or herbal medicine. This textbook, published by the American Psychiatric Association’s publishing arm, supports a practice in which natural modalities such as herbal medicine are acknowledged and more available.

In this text, the editors, all deeply experienced and accomplished, have selected a wide range of professionals to author the 29 chapters. The topics range from specific and quite narrow (Sceletium tortuosum [Aizoaceae] and Bacopa monnieri [Plantaginaceae] for cognitive support) to quite broad (“Complementary and Integrative Medicine in Child and Adolescent Psychiatric Disorders”). The coverage is effectively executed with deep and thorough references included at the end of each chapter.

Herbal medicine is well-represented here. Mark Blumenthal provides introductory comments about plant medicines, and he explores topics such as regulation, research quality, adulterants, analytical testing, and phytoequivalence (the equivalence of a plant-based medicine to a conventional medicine), as they relate to a mental health-oriented practice. Seven chapters go into depth on various herbal remedies. Herbalists may find that the traditional history and application of these plant medicines are replaced with the biochemistry and bench science more comfortable to those in academia.

Many of the authors are researchers who are familiar with the latest science, but less comfortable in the hazy realm of clinical application to practice. In my experience, edited medical textbooks like this tend to fall to one side of the “town/gown” divide; that is, they tend to favor either researchers or clinicians. It is very difficult to serve both sides of that divide well. Some of the chapters in this book found that balance. For example, “Single and Broad-Spectrum Micronutrient Treatments in Psychiatric Practice” by Charles Popper, MD, Bonnie J. Kaplan, PhD, and Julia J. Rucklidge, PhD, presents the existing research quite well and then delves into the actual clinical uses of these tools in solid detail, with step-by-step guidance for application. They even include a discussion of obtaining informed consent. Overall, the text functions best as an introduction and reference for the relevant research on these clinical tools, rather than how they are best applied in practice.

This book may be the ideal gift for a psychiatrist friend who is just beginning to explore these realms, since it offers a worthy introduction to these topics. Well-designed to be widely accepted by practitioners who are unfamiliar with integrative topics, it leads with references and hard science.

Some of the more cutting-edge topics in integrative mental health are not addressed: the microbiome and gut health as they relate to psychiatric symptoms; systemic inflammation and its relationship to chronic psychiatric illness; and psychoactive medicines, such as psilocybin mushrooms, and the research linking them to significant mental health benefits for anxiety, depression, and end-of-life issues. These topics have less direct pathways to clinical application, but the evolving science cannot be denied.

All in all, I found this book well done and quite useful. I have worked in this realm for almost 40 years, and I still found new material to explore and consider. The depth of the research and documentation befits a subspecialty that is moving from infancy into adolescence. This textbook and others like it are sorely needed.

—Scott Shannon, MD
Author, Mental Health for the Whole Child
Fort Collins, Colorado