What to do when conventional treatment options fail, either because they do not work or because adverse effects are unacceptable, remains a hot topic in psychiatry. The answer is not simple, but contrary to their patients, very few clinicians would venture into the field of complementary alternative medicine. Admittedly, the evidence, with a few notable exceptions, is either non-existent or inconclusive. Patients, possibly less concerned with evidence, may find the conclusion that ‘more research is needed’ unhelpful. They want help here and now and may turn to alternative sources when disillusioned with conventional practice. In these days it is straightforward, just log on to the internet and a world of therapeutic promise, justified or unjustified, unfolds.
To keep up with the plethora of complementary alternative treatments is by no means an easy task for the busy clinician. This is where the book How to Use Herbs, Nutrients and Yoga in Mental Health Care comes in. Thoughtfully written, with an introductory chapter on medico-legal issues, the book systematically outlines step-by-step complementary alternative treatment approaches to common mental health problems ranging from depression and anxiety to substance misuse and side-effect management. Very helpfully, each chapter starts with an outline and ends with a tabulated summary of treatment options.
For me, the great strength of this book resides in the combination of underlying psychopharmacological principles with epidemiological evidence. For instance, it makes sense to understand somatic aspects of anxiety not only as hyperactivation of the sympathetic nervous system but also as a lack of parasympathetic compensation; this is where relaxation strategies and yoga come into play. Nowadays, it is obviously impossible for any book to keep pace with the emerging evidence both on effectiveness and safety. Thus, clinicians wanting to practise in this area are advised always to check the latest evidence. This inevitable disadvantage is offset by the commitment to practical relevance and the thought-provoking case presentations. Some examples may be controversial, though. For instance, many clinicians would not feel comfortable recommending pheromones, chemical signalling substances, to increase sexual attraction. But it is relevant to the problems patients may wish to address even if clinicians do not. As William Osler famously said, ‘It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has’.
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