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.
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:
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
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