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How to Use Herbs, Nutrients, and Yoga in Mental Health

How to Use Herbs, Nutrients, and Yoga in Mental Health Care by Richard P. Brown, Patricia L. Gerbarg, and Philip R. Muskin. New York, NY: W.W. Norton & Co. Inc.; 2009. Hardcover; 441 pages. ISBN: 0393705250. $34.95. Available in ABC’s online store.

Richard Brown is a psychiatrist and psychopharmacologist at Columbia who specializes in integrative therapies. His wife Pat Gerbarg is also a psychiatrist who employs herbs and other integrative modalities in her practice. Among their other books is The Rhodiola Revolution: Transform Your Health with the Herbal Breakthrough of the 21st Century (Rodale Books, 2005), and they have also written a good deal about S-adenosylmethionine (SAMe) and depression. In addition, Drs. Brown and Gerbarg have considerable experience in mind-body medicine. This is apparent in the reviewed book, which explores the subject as it relates to mental health. Dr. Philip Muskin is a geriatric psychiatrist at Columbia and is chair of the American Psychiatric Association’s Council on Psychosomatic Medicine. Thus, these individuals are well qualified to discuss the subject at hand.

This book is a useful source of information for both mental health consumers and professionals and has received high praise from both. Chapters include the following: principles of integrative mental healthcare, mood disorders, anxiety disorders, disorders of cognition and memory, attention-deficit disorder (ADD) and learning disabilities, sexual enhancement and other life stage issues, schizophrenia and other psychotic disorders, medical illnesses, substance abuse, and the use of complementary and alternative medicine (CAM) to counteract medication side effects. The last chapter is a favorite of mine, since it provides an alternative for the often irrational use of more medications to treat medication side effects.

The chapter on mood disorders considers the usual suspects for biologically based treatments including SAMe, St. John’s wort (Hypericum perforatum, Clusiaceae), rhodiola (Rhodiola rosea, Clusiaceae), vitamins, nutrients (such as inositol, 5-HTP [5-hydroxytryptamine], omega-3 fatty acids, N-acetylcysteine), and hormones like dehydroepiandrosterone (DHEA) as well as non-biologic, mind-body practices. The discussions of SAMe and rhodiola are predictably strong, since the authors have published on these agents in the past. Some issues regarding St. John’s wort need some minor additions, however. The Shelton et al (2001) study referred to in the text was actually sponsored by Pfizer and was an out-patient study, rather than in-patient. The authors correctly noted some of the weaknesses of the study but did not mention that St. John’s wort beat placebo on the number of patients who attained remission. Another weakness in this and a later National Institutes of Health study is the fact that the patient population was chronically ill. The duration of the current depressive episode in the Shelton study was 2.3–2.7 years! Experience suggests that these are not the kind of patients you want in a depression trial (unless you want the outcome to be negative).

The authors include a very nice review of omega-3 fatty acids and provide some additional nuggets of their own, such as the importance of using a mixture of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and occasionally going to quite high doses (8-10 g/day). I have found that EPA by itself may induce mania in individuals with bipolar disorder while pure DHA may induce depression, something I’ve never seen in print. One typo is apparent in the Keck et al study, which used 6 g/day rather than 6 mg/day. Also, the prescription version of omega-3 changed names from Omacor to Lovaza in 2007. In the section on 5-HTP, levodopa is mentioned as a decarboxylase inhibitor. It should have been carbidopa.

The herb and nutrients section in the anxiety disorders chapter is much shorter than in the previous chapter (lots of mind-body and life-styles considerations are found here). Most of the “supplement” section deals with adaptogens and the standard herbs historically used for their mild sedative effects. The St. John’s wort product referred to from Nature’s Way (Perika®) is actually the German extract WS® 5570 from Schwabe. Also mentioned in a subsection on gamma-aminobutyric acid (GABA) is an anticonvulsant pharmaceutical called pregabalin. Unlike the name implies, it does not appear to work through GABA and does not have the kind of safety/toxicity profile that would be desirable for the treatment of anxiety disorders.

The chapter on cognitive and memory disorders mostly contains information about supplements. There’s a long section on the use of adaptogens, including Rhodiola rosea, both in research and clinically. There’s a nice introductory summary of how brain functions such as membrane integrity may be involved, as well as some useful summary tables at the end of this chapter.

The chapter on ADD and learning disabilities includes sections on dietary supplements, cognitive activators (mostly herbals; many were covered in the previous chapter), biofeedback, and mind-body treatments.

Chapter 6 deals with life stage issues for women and separate sections for sexual enhancement in women and in men. This chapter is packed with useful and practical information and is complete with informative summary tables at the end. It covers all the things one might expect to see and some that you might not. All in all, it’s quite comprehensive.

The chapter on schizophrenia and other psychotic disorders covers mostly nutritional support to help reduce the effects of medication rather than treatments in and of themselves. As such this is extremely useful information as most people don’t really think in terms of supplements that may be supportive of conventional treatments, rather than as a replacement. Examples are given of ways to reverse some of the cognitive and metabolic side effects from prescription medications.

Supportive treatments during medical illnesses is another practical chapter, which includes information on cancer, cardiovascular disease, chronic fatigue, human immunodeficiency virus (HIV), and irritable bowel syndrome. Chapter 9 deals with substance abuse and mind-body practices as well as herbs and nutrients. Lastly, Chapter 10 deals with the very important (and seldom discussed in detail) use of CAM to counteract the most commonly experienced side effects from a variety of medications. I’m less enthusiastic about the inclusion of information on off-label use of prescription drugs for treating side-effects. I believe that this is what we need to get away from—not explore.

Finally, there is a table in the appendix listing quality herbal and other products with names, prices, and web links.

In summary, this is an excellent reference on the subject that will appeal to CAM consumers and practitioners as well as conventional physicians. All will find a thoughtful review of practical guidelines for the application of CAM treatments for neurology and psychiatry. I give it a thumbs up!

—Jerry Cott, PhD Pharmacologist Silver Spring, MD