Now Is the Time for Integrative Psychiatry
A growing interest in integrative medicine is changing the face of psychiatry.
Posted Jun 06, 2018
The sun is setting on the Prozac Revolution and integrative psychiatry is on the rise. It is hard to believe that there was a time in the 1970s when the anti-anxiety drug Valium was the most commonly prescribed medication in the United States. Today, most psychiatric medications have fallen out of the top ten; however, Gabapentin appears on some lists and may be prescribed off-label for anxiety. Although prescription rates of many psychiatric medications continues to trend upward overall, psychiatrists are also beginning to appreciate the role complementary and alternative medicine (CAM) plays in mental health.
We are witnessing a burgeoning 'green psychiatry' movement that consists of health food stores, yoga studios, nutritional awareness, and dietary supplements as patients seek to take hold of their own journey towards wellness. One study suggests that 35% of patients utilize at least one form of CAM (broadly defined) for mental health concerns. Moreover, a recent report offers that the global dietary supplements market value has a projected increase from USD 132.8 billion in 2016 to USD 220.3 billion in 2022.
Mental health professionals frequently brand “treating the whole person” on their website as a top priority – a noble pursuit that not only provides better and more comprehensive patient care, but also likely appeals to a broader patient base.
Despite these trends, within many academic institutions there is broad skepticism about CAM. So, what is integrative medicine anyway and how does it relate to CAM? It is important to note that integrative medicine is not another term for complementary and alternative medicine; although, integrative medicine may certainly encompass specific CAM techniques.
Integrative medicine is a patient-centered model that considers evidence-based pharmaceutical treatments as well as sociocultural factors, nutritional status, mind-body medicine, and preventative medicine in both the eradication of illness and the promotion of long-term wellness. Most importantly, integrative medicine is not a disavowal of standard-of-care treatments, nor is it practicing untethered medicine hinged in pseudoscience. The National Institutes of Health includes guided imagery, diet, and yoga as common complementary health approaches. Prayer, spirituality, and cultural-competence may also support an integrative practice, and has been reported as especially meaningful to patients who identify as minorities. Practicing cultural-competency and encouraging patients to openly share how their spiritual beliefs have supported their health journey will likely strengthen therapeutic alliance, limit patient disengagement, and possibly improve outcomes. Ultimately, integrative psychiatry broadens treatment options beyond the narrow scope of medication management and conventional psychotherapy.
Imagine, a cardiologist would never prescribe a statin drug to a patient with elevated cholesterol and say, “You’re covered, so now you can eat whatever you want.” Similarly, an integrative psychiatrist would approach a depressed patient on Prozac by engaging in a discussion on diet, social support, exercise habits, and what the patient is doing to support his own wellness pursuits in between visits, which is where an equally if not more important component of healing takes place. Furthermore, an integrative psychiatrist or 'green psychiatrist' would not only encourage an anxious patient who reports benefit from acupuncture to continue with treatments if there are no contraindications, but also collaborate with the patient’s acupuncturist to develop a comprehensive treatment plan that may very well include a prescription for Prozac.
There are currently 26 integrative medicine fellowships in the United States including the Academy of Integrative Health and Medicine (AIHM) where I am an integrative medicine fellow. My cohort consists of other healthcare providers in various stages of their career. The multidisciplinary nature of the fellowship serves to encourage collaboration among providers who were trained in vastly different approaches to healing, so that we can work together seamlessly in the best interest of our patients.
Arguably, the most profound barrier to widespread utilization of alternative therapies among medical doctors is the perceived lack of evidence to support their use. While this is a valid concern, some alternative therapies like the utilization of the ancient plant, Ginko biloba, have been vastly studied in the treatment of a number of health concerns. The National Center for Complementary and Alternative Medicine has seen funding increase from 89.2 million in 2001 to 130.5 million in 2017 to support new research studies, which is encouraging. Considering integrative medicine encompasses such a wide range of treatment options, incorporating relatively benign modifications, like 4-7-8 breathing in lieu of a benzodiazepine for the anxious patient, or a diet and exercise regimen for the sedentary patient, may offer benefit to both physical and mental health. The SMILES trial, for example, offers some insight that dietary improvements may support recovery in patients with some forms of depression; albeit, more studies will need to be conducted.
I traveled to San Diego recently for a retreat with other integrative medicine fellows from across the country. On the final day, we stood together in a circle and each tied a small piece of yarn around our wrist as a reminder of the time we had shared together and our dedication to our patients. Glancing across the conference room, I saw a Harvard pharmacist, an internist from the Cleveland Clinic, a private-practice acupuncturist from Seattle, and several other healthcare practitioners interested in providing evidence-based integrative care to patients with the central theme of wellness promotion. It was quite beautiful. Realizing that we can only take care of each other if we take care of ourselves, we reflected on our commitment going forward. I offer a belief that the landscape of psychiatry is evolving for the better. As we gain a deeper understanding of the brain and the biochemical model of mental illness, let’s not forget about the person behind the illness. In wellness and in health, we are just getting started.