Integrative Psychiatry

An approach that emphasizes individualized care, safety,
and the use of interventions supported by clinical trial data.
Individualized Care
Safety as a priority
Evidence-Based Care

Combining conventional medications with select botanicals and vitamins, prioritizing evidence-based use, safety, and individualized care.

The integrative psychiatry approach to the use of medication, botanicals, and vitamins involves combining conventional psychopharmacologic treatments with evidence-based complementary interventions, such as select botanicals and nutraceuticals, to optimize outcomes and address unmet clinical needs in psychiatric care. This approach emphasizes individualized care, safety, and the use of interventions supported by clinical trial data.
 
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Pharmaceuticals (e.g., antidepressants, antipsychotics, mood stabilizers) remain the first-line treatments for most moderate to severe psychiatric disorders. Integrative psychiatry may incorporate botanicals such as St. John’s wort for mild to moderate major depressive disorder, saffron and curcumin for depressive symptoms, and ginkgo biloba as adjunctive therapy in schizophrenia, though concerns about standardization, safety, and publication bias persist. The American College of Physicians does not currently recommend St. John’s wort, omega-3 fatty acids, or SAMe as initial monotherapy or adjuncts due to insufficient or inconclusive evidence and lack of FDA regulation, and highlights the need for caution regarding content and potency variability in these supplements.[1]
 
Vitamins and nutraceuticals, including omega-3 fatty acids, folate, S-adenosylmethionine (SAMe), and N-acetylcysteine, have shown promise as adjuncts to standard medications, with some evidence supporting their use to enhance response or reduce side effects, particularly in depression and bipolar disorder.[2-6] However, robust, safety-conscious studies are needed before routine clinical application. Integrative psychiatry also considers dietary modification and lifestyle interventions, such as exercise and mindfulness, as part of a comprehensive treatment plan.[7-9]

In summary, integrative psychiatry judiciously combines conventional medications with select botanicals and vitamins, prioritizing evidence-based use, safety, and individualized care, while recognizing the limitations and regulatory gaps in the current evidence base.[1-6][9-11]  While not a robust amount of evidence in support of vitamins and botanicals is available, it is worth noting that there are many “high yield” protocols that include vitamins and botanicals that have limited or anecdotal evidence showing benefit while also demonstrating low to no risk, such as DHA for depression.

References

  1. Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians.
    Qaseem A, Owens DK, Etxeandia-Ikobaltzeta I, et al.
    Annals of Internal Medicine. 2023;176(2):239-252. doi:10.7326/M22-2056.
    Leading Journal

  2. Adjuvant Use of Nutritional and Herbal Medicines With Antidepressants, Mood Stabilizers and Benzodiazepines.
    Sarris J, Kavanagh DJ, Byrne G.
    Journal of Psychiatric Research. 2010;44(1):32-41. doi:10.1016/j.jpsychires.2009.06.003.

  3. Mood Disorders and Complementary and Alternative Medicine: A Literature Review.
    Qureshi NA, Al-Bedah AM.
    Neuropsychiatric Disease and Treatment. 2013;9:639-58. doi:10.2147/NDT.S43419.

  4. Complementary and Alternative Medicine (CAM): Considerations for the Treatment of Major Depressive Disorder.
    Freeman MP.
    The Journal of Clinical Psychiatry. 2009;70 Suppl 5:4-6. doi:10.4088/JCP.8157su1c.01.

  5. Nutritional Psychiatry: From Concept to the Clinic.
    Sarris J.
    Drugs. 2019;79(9):929-934. doi:10.1007/s40265-019-01134-9.
    Leading Journal

  6. Augmenting Clinical Interventions in Psychiatric Disorders: Systematic Review and Update on Nutrition.
    Offor SJ, Orish CN, Frazzoli C, Orisakwe OE.
    Frontiers in Psychiatry. 2021;12:565583. doi:10.3389/fpsyt.2021.565583.

  7. Nutritional Psychiatry: The Present State of the Evidence.
    Marx W, Moseley G, Berk M, Jacka F.
    The Proceedings of the Nutrition Society. 2017;76(4):427-436. doi:10.1017/S0029665117002026.

  8. Nutrition and Immunology in Mental Health: Precision Medicine and Integrative Approaches to Address Unmet Clinical Needs in Psychiatric Treatments.
    Chang JP, Su KP.
    Brain, Behavior, and Immunity. 2020;85:1-3. doi:10.1016/j.bbi.2019.09.022.
    Leading Journal

  9. Integrative Medicine for Treating Depression: An Update on the Latest Evidence.
    Luberto CM, White C, Sears RW, Cotton S.
    Current Psychiatry Reports. 2013;15(9):391. doi:10.1007/s11920-013-0391-2.
    Leading Journal

  10. Plant-Based Medicines (Phytoceuticals) in the Treatment of Psychiatric Disorders: A Meta-Review of Meta-Analyses of Randomized Controlled Trials.
    Sarris J, Marx W, Ashton MM, et al.
    Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2021;66(10):849-862. doi:10.1177/0706743720979917.

  11. Herbal Medicines in the Treatment of Psychiatric Disorders: 10-Year Updated Review.
    Sarris J.
    Phytotherapy Research : PTR. 2018;32(7):1147-1162. doi:10.1002/ptr.6055.
    Leading Journal

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