This Month in Psychopharmacology

Highlights from 2024 NEI Synapse: We Didn’t Write the Rx: A Guide to the Pros and Cons of Complementary and Alternative Medicine

2023 NEI Congress Session Highlight

Highlights from 2024 NEI Synapse: We Didn’t Write the Rx: A Guide to the Pros and Cons of Complementary and Alternative Medicine
Sunday, April 21, 2024

Complementary health approaches are commonly used by patients seeking relief for psychiatric symptoms. Dietary supplements and mind-body practices are the most popular options due to a combination of factors such as cost and perceived safety. From the healthcare provider’s perspective, the safety of complementary health approaches is paramount. Dietary supplements do not have to prove they meet the safety requirements of the U.S. Food and Drug Administration (FDA), nor do they have to prove the accuracy of the claims they make in their labels. Due to this minimal regulation, herbal and dietary supplements may have varying degrees of active ingredients that may leave symptoms undertreated if used as alternatives to psychotropic medications. Additionally, there is a potential for pharmacological interactions with psychotropic (and other) medications.

Dr. Thomas Schwartz tackled this important topic in an enlightening presentation about the research supporting the use of various dietary supplements and mind-body practices in psychiatry. In the case of dietary supplements, omega-3 fatty acids and St. John’s wort have the strongest research evidence supporting their use as treatments for major depressive disorder (MDD). Omega-3 supplements can be recommended as adjunctive treatment for MDD. Formulations that have higher EPA (eicosapentaenoic acid) versus DHA (docosahexaenoic acid) concentrations seem to be more efficacious. Likewise, high-dose (at least 2000 mg/day) versus low-dose (less than 2000 mg/day) supplementation appears to be favorable. Omega-3 supplements are generally safe but can increase bleeding tendency. On the other hand, St. John’s wort can be recommended as monotherapy for mild-to-moderate MDD. There is no consensus about appropriate dosage, but clinical trials report divided doses of 500 to 1,800 mg/day. Although, St. John’s wort is generally safe, it has the potential for quite a few pharmacological interactions and must be used carefully to avoid unnecessary side effects. In addition to these supplements, Dr. Schwartz reviewed the evidence for probiotics, zinc, methylfolate, n-acetylcysteine, saffron, curcumin, lavender, and ashwagandha for MDD, schizophrenia, and generalized anxiety disorder. In the case of mind-body practices, mindfulness-based meditation practices have relatively strong research supporting their use, particularly for depression, anxiety, and insomnia. Dr. Schwartz reviewed this research along with other evidence for the use of yoga, relaxation techniques, and music therapy for MDD, anxiety disorders, and negative symptoms of schizophrenia.

Any providers choosing to advise patients on complementary health approaches must take care to consider the same decision points they do when recommending conventional treatments: Is it safe? Does it work? If so, how? Does it interact with any medications or other supplements? Does it have side effects? To help address these questions, Dr. Schwartz’ presentation provided valuable background about complementary health approaches, as well as the purported mechanisms of actions and research supporting the use of various complementary treatments.


Thomas L. Schwartz, MD. We Didn’t Write the Rx: A Guide to the Pros and Cons of Complementary and Alternative Medicine. Presented April 21 at 2024 NEI Synapse, Las Vegas, NV.

To Learn More: The recording of these presentations, as well as all of the other presentations from the 2024 NEI Synapse, will be available as Encore Presentations for NEI Members.


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