Herbal, Nutritional Therapies Can Play Supportive Role in Practice

TUCSON, ARIZ. – Complementary herbal and nutritional therapies can play an important role in an integrated psychiatric practice, Dr. Iris R. Bell said at a psychopharmacology conference sponsored by the University of Arizona.

Disputes remain about the lack of randomized trials supporting the use of complementary and alternative medicine (CAM). But evidence continues to mount about the benefits of CAM therapy that is individualized to a patient's specific needs and preferences.

The use of broad-based nutritional supplements has been reported to ameliorate psychiatric symptoms such as mood swings, depression, and aggression in a variety of patients, including young criminal offenders. The mechanisms by which these changes occur are not established. But the supplements may provide the nutritional support needed to improve brain chemistry and promote better use of traditional medications, said Dr. Bell, a professor at the university and director of research for its integrative medicine program.

Activated forms of pyridoxine, niacin, iron, and tetrahydrobiopterin are cofactors for the enzymes tyrosine hydroxylase and tryptophan 5-hydroxylase, which participate in brain biosynthesis of catecholamines and serotonin. It has been shown that patients with the melancholic form of depression have low levels of folate and respond poorly to fluoxetine, in part because they don't have adequate neurotransmitters to use it, she said.

Studies of high-dose antioxidant supplements by themselves, such as vitamin E alone in Parkinson's disease, may have failed because the vitamin needs other components of its biochemical network, such as vitamin C and other nutrients, to regenerate antioxidant forms from prooxidant forms of the vitamin, Dr. Bell said. Folate, B₁₂, and B₆ vitamin supplements are now being used together as a low-risk strategy to lower homocysteine levels in Alzheimer's patients. Studies suggest that elevated homocysteine is an independent risk factor for Alzheimer's disease and a variety of vascular diseases. “We may have a more preventive role to play than we thought,” she said.

Ginkgo biloba has produced mixed results in patients with dementia and should be used with caution in those patients on concomitant warfarin or other anticoagulant agents, Dr. Bell said.

Small controlled studies have shown that kava kava can reduce anxiety over a 4-week period, but Dr. Bell said she is uncomfortable recommending its because of the potential for serious liver damage from the forms available in Western countries.

The folk remedy passion flower has been helpful in generalized anxiety and when used in combination with clonidine to reduce mental symptoms in opiate addicts. “It might provide an added benefit to get them through acute withdrawal, but it's not a long-term solution,” Dr. Bell said.

TUCSON, ARIZ. – Complementary herbal and nutritional therapies can play an important role in an integrated psychiatric practice, Dr. Iris R. Bell said at a psychopharmacology conference sponsored by the University of Arizona.

Disputes remain about the lack of randomized trials supporting the use of complementary and alternative medicine (CAM). But evidence continues to mount about the benefits of CAM therapy that is individualized to a patient's specific needs and preferences.

The use of broad-based nutritional supplements has been reported to ameliorate psychiatric symptoms such as mood swings, depression, and aggression in a variety of patients, including young criminal offenders. The mechanisms by which these changes occur are not established. But the supplements may provide the nutritional support needed to improve brain chemistry and promote better use of traditional medications, said Dr. Bell, a professor at the university and director of research for its integrative medicine program.

Activated forms of pyridoxine, niacin, iron, and tetrahydrobiopterin are cofactors for the enzymes tyrosine hydroxylase and tryptophan 5-hydroxylase, which participate in brain biosynthesis of catecholamines and serotonin. It has been shown that patients with the melancholic form of depression have low levels of folate and respond poorly to fluoxetine, in part because they don't have adequate neurotransmitters to use it, she said.

Studies of high-dose antioxidant supplements by themselves, such as vitamin E alone in Parkinson's disease, may have failed because the vitamin needs other components of its biochemical network, such as vitamin C and other nutrients, to regenerate antioxidant forms from prooxidant forms of the vitamin, Dr. Bell said. Folate, B₁₂, and B₆ vitamin supplements are now being used together as a low-risk strategy to lower homocysteine levels in Alzheimer's patients. Studies suggest that elevated homocysteine is an independent risk factor for Alzheimer's disease and a variety of vascular diseases. “We may have a more preventive role to play than we thought,” she said.

Ginkgo biloba has produced mixed results in patients with dementia and should be used with caution in those patients on concomitant warfarin or other anticoagulant agents, Dr. Bell said.

Small controlled studies have shown that kava kava can reduce anxiety over a 4-week period, but Dr. Bell said she is uncomfortable recommending its because of the potential for serious liver damage from the forms available in Western countries.

The folk remedy passion flower has been helpful in generalized anxiety and when used in combination with clonidine to reduce mental symptoms in opiate addicts. “It might provide an added benefit to get them through acute withdrawal, but it's not a long-term solution,” Dr. Bell said.

TUCSON, ARIZ. – Complementary herbal and nutritional therapies can play an important role in an integrated psychiatric practice, Dr. Iris R. Bell said at a psychopharmacology conference sponsored by the University of Arizona.

Disputes remain about the lack of randomized trials supporting the use of complementary and alternative medicine (CAM). But evidence continues to mount about the benefits of CAM therapy that is individualized to a patient's specific needs and preferences.

The use of broad-based nutritional supplements has been reported to ameliorate psychiatric symptoms such as mood swings, depression, and aggression in a variety of patients, including young criminal offenders. The mechanisms by which these changes occur are not established. But the supplements may provide the nutritional support needed to improve brain chemistry and promote better use of traditional medications, said Dr. Bell, a professor at the university and director of research for its integrative medicine program.

Activated forms of pyridoxine, niacin, iron, and tetrahydrobiopterin are cofactors for the enzymes tyrosine hydroxylase and tryptophan 5-hydroxylase, which participate in brain biosynthesis of catecholamines and serotonin. It has been shown that patients with the melancholic form of depression have low levels of folate and respond poorly to fluoxetine, in part because they don't have adequate neurotransmitters to use it, she said.

Studies of high-dose antioxidant supplements by themselves, such as vitamin E alone in Parkinson's disease, may have failed because the vitamin needs other components of its biochemical network, such as vitamin C and other nutrients, to regenerate antioxidant forms from prooxidant forms of the vitamin, Dr. Bell said. Folate, B₁₂, and B₆ vitamin supplements are now being used together as a low-risk strategy to lower homocysteine levels in Alzheimer's patients. Studies suggest that elevated homocysteine is an independent risk factor for Alzheimer's disease and a variety of vascular diseases. “We may have a more preventive role to play than we thought,” she said.

Ginkgo biloba has produced mixed results in patients with dementia and should be used with caution in those patients on concomitant warfarin or other anticoagulant agents, Dr. Bell said.

Small controlled studies have shown that kava kava can reduce anxiety over a 4-week period, but Dr. Bell said she is uncomfortable recommending its because of the potential for serious liver damage from the forms available in Western countries.

The folk remedy passion flower has been helpful in generalized anxiety and when used in combination with clonidine to reduce mental symptoms in opiate addicts. “It might provide an added benefit to get them through acute withdrawal, but it's not a long-term solution,” Dr. Bell said.