In the wake of the recent and very public controversy over weight loss supplements, it would be easy to throw the proverbial baby out with the bathwater. Inadequate regulation of supplements has allowed the public to invest considerable money in treatments that may not contain what is stated on the label, can have scant research supporting their use, and in some cases may cause potential harm. Yet, there are supplements that have good evidence of benefit for emotional, cognitive, or other health-related issues, appear to be low risk, and when judiciously used, may be important therapuetic adjuncts for those who have ongoing challenges with mood or other mental health issues.
Woman with vitamins - Horst Petzold, Dreamstime.com
Horst Petzold via Dreamstime.com
Supplements Use is Prevalent
Americans spend nearly $34 billion annually on complementary and alternative (CAM) remedies, with approximately 14.8 billion spend on nonvitamin, nonmineral, natural products such as fish oil, glucosamine, and Echinacea, and roughly $7 billion on vitamin supplements. At present, these expenses are not reimbursed by insurers.
There are many reasons that consumers turn to supplements for mental health issues. For example, up to half of depressed individuals taking antidepressants will fail to achieve complete remission of symptoms; there is no “magic bullet,” conventional or otherwise, that works for everyone or all of the time. Many also desire greater autonomy with regard to their treatment choices, and CAM therapies, because they do not require a medical consultation or prescription, can appeal to this desire. Another oft-cited reason is that consumers feel more comfortable choosing remedies described as “natural;” to many, these appear more benign, health-oriented, and less stigmatizing than taking medication. In addition, many people experience subjective improvements in mood or other issues from supplementation. Relatedly, there are several supplements that have shown evidence of benefit for mood or cognition, as well as for physical health problems that are known to both impact mood and be affected by mood symptoms. These include, but are not limited to, omega-3 fatty acids, l-methylfolate (B9), vitamin B12, and probiotics.
I am health psychologist who treats primarily those presenting with both psychological concerns and chronic medical illnesses. Thus, the majority of those I see report symptoms that have persisted despite trying a number of drug therapies and/or medical procedures. Many of them have tried CAM therapies. Although the availability and quality of the research varies with regard to specific dietary supplements, there are several that can be potentially beneficial as part of a mental health program. Thus, I routinely assess about CAM use in general, including supplements. If it seems warranted, I discuss the potential role or possible liabilities of CAM therapies and recommend that patients bring their medical team into the conversation.
With regard to CAM, dietary supplements, and mental health:
- It is essential for patients to have an open dialog with members of their health care teams, including physicians, mental health providers, and dieticians. This will help providers become more fully aware of what supplements one is already taking, and reduce the risk of adverse drug-supplement interactions and complications during surgery, if applicable.
- Patients will benefit from educating themselves via reputable sources about the potential risks, benefits, and medication interactions relevant to the supplements they are considering taking. Even a supplement considered generally effective or safe may not be appropriate for everyone.
- In my opinion, as providers, we have an obligation to ask about supplement use and be willing to discuss this in a way that is open and non-pathologizing. This stance is far more likely to facilitate communication that is ultimately beneficial to the patient.
- Although no one can know everything about every supplement (far from it, as we still have much to learn about the potential benefits, side effects, and potential for drug interactions for most of these), providers should be willing to learn about those treatments our patients are already using or considering using.
- The research is constantly evolving; thus, it's important to look for the most recent data and also what brands are most reliable/least likely to sell a contaminated product. Consumerlab.com is an independent, unbiased laboratory that summarizes the research on supplements and reviews products. For a small annual fee, anyone can access this data in an easy-to-understand format. Additional resources are below.
Particularly as we move toward greater integration between mental and medical health care, good communication among therapists, psychopharmacologists, primary care providers and others on the team can increase the likelihood that the care we provide is truly helpful. In this way, we can also acknowledge and support our patients as integral partners in the treatment process
In summary, dietary supplement use is prevalent. Providers have a responsibility to ask about supplement use in a way that allows patients to feel safe discussing what they are taking and that acknowledges their desire to have a greater role in their own health care practices. Patients have a duty to educate themselves about the evidence with regard to the risks and benefits of any supplements they are considering, and are encouraged to include their providers in this process.
Finally, as a society, we would be better served by greater oversight with regard to supplement quality and clearer statements regarding their evidence of benefit. Additional research into the potential benefits and risks with regard to supplements is essential to more fully understand potential side effects, interactions with drugs or other supplements, and who is most likely to experience benefit from a particular substance.
For Independent reviews of supplements and relevant research.
Food and Drug Administration’s information on dietary supplements: http://www.fda.gov/Food/DietarySupplements/QADietarySupplements/default.htm
National Center for Complementary and Alternative Medicine
National Institutes of Health, Office of Dietary Supplements Database
Dinan, T. G., Stanton, C., & Cryan, J. F. (2013). Psychobiotics: A Novel Class of Psychotropic. Biological Psychiatry, 2013; 74 (10): 720.
Fluitt, N. (2012). L-Methylfolate: Another weapon against depression. Current Psychiatry, 11(1). Available online: http://www.currentpsychiatry.com/index.php?id=22661&tx_ttnews[tt_news]=176552
Kiecolt-Glaser JK, Belury MA, Andridge R, Marlarkey, W. B., & Glaser, R. (2011). Omega‑3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain, Behavior, and Immunity, 1725-1734.
Nahin, RL, Barnes PM, Stussman BJ, and Bloom B. Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007 [360KB PDF]. National health statistics reports; no 18. Hyattsville, MD: National Center for Health Statistics. 2009.
Owen, C., Rees, A., & Parker, G. (2008). The role of fatty acids in the development and treatment of mood disorders. Current Opinion in Psychiatry, 21, 19-24.
Papakostas GI, Shelton RC, Zajecka JM, Etemad B, Rickels K, & Clain A, et al. (2012). L-methylfolate as adjunctive therapy for SSRI-resistant major depression: results of two randomized, double-blind, parallel-sequential trials. American Journal of Psychiatry. 169(12), 1267-74.
Rondanelli, Mariangela, et al. (2010). "Effect of omega-3 fatty acids supplementation on depressive symptoms and on health-related quality of life in the treatment of elderly women with depression: a double-blind, placebo-controlled, randomized clinical trial." Journal of the American College of Nutrition 29(1), 55-64.
Stanger O, Fowler B, Piertzik K, Huemer M, Haschke-Becher E, Semmler A, Lorenzl S, & Linnebank M (2009). Homocysteine, folate and vitamin B12 in neuropsychiatric diseases: review and treatment recommendations. Expert Rev Neurother, 9(9), 1393-412.
Walker, JG, Batterham, PJ, Mackinnon, AJ, Jorm, AF, Hickie, I, Fenech, M, et al. (2012). Oral folic acid and vitamin B-12 supplementation to prevent cognitive decline in community-dwelling older adults with depressive symptoms—the Beyond Ageing Project: a randomized controlled trial. American Journal of Clinical Nutrition, 95(1), 194-203.
Witte, A.V., Kerti, L., Hermannstädter, H.M., Fiebach, J.B., Schreiber, S.J., Schuchardt, J.P., Hahn, A., & Flöe, A. (2013). Long-Chain Omega-3 Fatty Acids Improve Brain Function and Structure in Older Adults. Cereb Cortex. http://cercor.oxfordjournals.org/content/early/2013/06/23/cercor.bht163.full