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Complementary Medicine and Natural Medications
Overview
Complementary and alternative medical (CAM) therapies constitute a diverse spectrum of practices and beliefs in current medical practice. The National Institutes of Health has defined CAM as “healthcare practices outside the realm of conventional medicine, which are yet to be validated using scientific methods.” The term natural medications refers to medications derived from natural products that are not approved by the U.S. Food and Drug Administration (FDA) for their proposed indication. Natural medications under the category of CAM may include hormones, vitamins, plants, herbs, fatty acids, amino acid derivatives, and homeopathic preparations, among others. Although natural medications have been used for thousands of years, their use in the United States has increased dramatically over the past two decades. The consultation psychiatrist must therefore be informed about these medications to provide comprehensive patient care. This chapter provides an overview of the use of natural medications in psychiatry. Issues pertaining to general safety and effectiveness are discussed first, followed by a more specific look at some of the remedies used for mood disorders, anxiety and sleep disorders, menstrual disorders, and dementia. The final section is devoted to a description of two non-medication alternative therapies: acupuncture and hypnosis.
Efficacy and Safety
Despite the increase in both government and industry sponsorship of clinical research involving natural medications, data regarding efficacy and safety are still limited. Moreover, the safety and efficacy of combining natural medications with more conventional medications remains unclear. This situation is very important to the consultation psychiatrist because of the prevalence of polypharmacy often seen in inpatient medical settings. It is also noteworthy that patients frequently do not disclose use of CAM therapies to their physician, thereby making it essential to ask patients specific questions about use of prescribed and over-the-counter medications. Finally, preparations of natural medications often vary in purity, quality, potency, efficacy, and side effects. The remainder of this chapter outlines what is currently known in this regard for a few such natural medications.
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