Caucus to Advise APA On Nontraditional Treatments

Complementary and alternative approaches to treating mental illness, including yoga, TaiChi, and homeopathy, among many others, are here to stay, and many patients are using them—whether psychiatrists know it or not.

So says psychiatrist James Lake, M.D., chair of APA's new Caucus on Complementary, Alternative, and Integrative Approaches in Mental Health Care.

Lake told Psychiatric News that the caucus, which first met formally at the 2004 annual meeting in New York, is the result of the shared interests and efforts of psychiatrists committed to working within APA to establish expert resources on complex clinical and research issues pertaining to uses of the wide range of complementary, alternative, and integrative approaches in mental health care.

Caucus members will advise APA committees, including the Committee on Research on New Treatments, on significant emerging research findings or safety considerations pertaining to complementary, alternative, and integrative treatments.

Nonconventional treatments include exercise, dietary supplements, Western herbs, Yoga, Taichi and other mind-body practices, traditional Chinese medicine, Ayurveda, orthomolecular approaches, massage therapy, guided imagery, prayer and other spiritual practices, and homeopathy.

“Many psychiatrists have interests outside of conventional psychopharmacology,” Lake said. “While we acknowledge the usefulness of conventional treatments in psychiatry, it is also important to consider alternative and integrative approaches. The reasons for doing so are compelling in view of recent [Food and Drug Administration] disclosures about safety and limited efficacy of many mainstream pharmacological treatments.

“We believe it is important to add to the armamentarium of conventional pharmacological treatments and to educate psychiatrists and mental health professionals about a range of evidence-based complementary, alternative, and integrative approaches,” he said.

Lake added that the formation of the caucus is a step toward APA's acknowledgement of an important fact: patients are using complementary and alternative treatments at increasing rates.

“Surveys suggest that two-thirds of patients who are treated for major depressive disorder and anxiety disorders already self-treat with a range of alternative approaches and typically do not disclose this to their psychiatrist or primary care physician, resulting in significant potential safety issues,” Lake said.

At last year's annual meeting, three broad goals for the caucus were outlined: educating APA members, nonmember psychiatrists, and nonmedically trained mental health professionals about safe, evidence-based uses of complementary and alternative treatments in mental health care; conducting a survey of APA member and nonmember psychiatrists in order to characterize and quantify their beliefs and practices regarding uses of complementary and alternative treatments; and establishing a research agenda prioritizing complementary or alternative modalities of great interest to psychiatrists that may hold promise as treatments of psychiatric disorders.

Darrel Regier, M.D., M.P.H., director of the American Psychiatric Institute for Research and Education, noted that the caucus provides an opportunity for clinicians and researchers within APA to focus on what the evidence is for various alternative and complementary treatments in psychiatry.

“The use of these treatments is very widespread, so the question is not whether the American public is using them or not,” Regier said.“ The question is, what advice psychiatrists can give to their patients about these treatments.”

Information about the new caucus, including a questionnaire and registration form, is posted online at<APACAM.org>.▪