Integrative and complementary medicine in psychiatry

Public and clinician interest in complementary and alternative medicine (CAM) has grown in recent decades, and has been driven in part by concerns about medication side effects, nonresponse to standard medications, and the high cost of prescription medications. CAM (natural products and therapies) for many people already plays a central role in the treatment of psychiatric disorders. As an area of special interest within psychiatry, the concept of integrative psychiatry (IP) supports the development of a treatment approach that more fully incorporates evidence-based use of medicinal herbs, nutrients, and mind–body practices with pharmacotherapy and psychological therapies

S-Adenosylmethionine (SAMe) for Neuropsychiatric Disorders: A Clinician-Oriented Review of Research.

ObjectiveA systematic review on S-adenosylmethionine (SAMe) for treatment of neuropsychiatric conditions and comorbid medical conditions.Data sourcesSearches were conducted in PubMed, EMBASE, PsycINFO, Cochrane Library, CINAHL, and Google Scholar databases between July 15, 2015, and September 28, 2016, by combining search terms for SAMe (s-adenosyl methionine or s-adenosyl-l-methionine) with terms for relevant disease states (major depressive disorder, MDD, depression, perinatal depression, human immunodeficiency virus, HIV, Parkinson's, Alzheimer's, dementia, anxiety, schizophrenia, psychotic, 22q11.2, substance abuse, fibromyalgia, osteoarthritis, hepatitis, or cirrhosis). Additional studies were identified from prior literature. Ongoing clinical trials were identified through clinical trial registries.Study selectionOf the 174 records retrieved, 21 were excluded, as they were not original investigations. An additional 21 records were excluded for falling outside the scope of this review. Of the 132 studies included in this review, 115 were clinical trials and 17 were preclinical studies.Data extractionA wide range of studies was included in this review to capture information that would be of interest to psychiatrists in clinical practice.ResultsThis review of SAMe in the treatment of major depressive disorder found promising but limited evidence of efficacy and safety to support its use as a monotherapy and as an augmentation for other antidepressants. Additionally, preliminary evidence suggests that SAMe may ameliorate symptoms in certain neurocognitive, substance use, and psychotic disorders and comorbid medical conditions.ConclusionsS-adenosylmethionine holds promise as a treatment for multiple neuropsychiatric conditions, but the body of evidence has limitations. The encouraging findings support further study of SAMe in both psychiatric and comorbid medical illnesses