Complimentary and Alternative Medicine for Mental Health

CAM therapies have a global reach in mental health care

Posted Jun 21, 2019

Complementary and alternative (CAM) approaches are widely used to treat mental health problems in all age groups and in all world regions. Adults who have a mental health problem are significantly more likely to use CAM therapies compared to the general population (DeJonge et al 2018). Over 138,000 individuals (ages 18 to 100) in 25 countries who participated in 28 surveys administered by the World Health Organization were asked about contact with CAM providers during the previous year (DeJonge et al 2018). Individuals with more severe psychiatric disorders were more likely to see a CAM practitioner for advice and treatment.

For example, 14% of adults with a severe mood disorder; 16% diagnosed with a severe anxiety disorder and over 22% of those diagnosed with a severe behavioral disorder consulted a CAM practitioner. Most adults who have a mental health problem take at least one prescription psychotropic medication while using one or more CAM therapy (Unutzer 2000) and those with more severe symptoms are more likely to combine medications and CAM (Kessler 2001). One-third of individuals who report a history of generalized anxiety, mood swings or psychosis use CAM approaches to treat their symptoms (Unutzer 2000). A national telephone survey of over 3000 women found that over half of women complaining of depressed mood used CAM to treat their symptoms (Wu 2007). Factors associated with higher CAM use by depressed women included being single, working, having self-perceived poor health, preferring more ‘natural’ therapies, and previous disappointing or unpleasant experiences with conventional treatments.

In the U.S., the rate of CAM use to treat mental health concerns is much higher than the global average. The 2007 National Health Interview Survey found that 37% of U.S. adults reported one or more neuropsychiatric symptoms and accounted for $14.8 billion in out-of-pocket expenditures on CAM services or treatments (Purohit 2015). Individuals who reported one or more neuropsychiatric symptoms had a disproportionately higher demand for CAM compared to individuals who reported no mental health problems.  Individuals with moderately severe mental health problems also use CAM modalities and use rates are related to ethnicity and other demographic factors. A data set analyzed from the 2012 National Health Interview Survey (NHIS) found that approximately 40% of U.S. adults across all ethnic groups diagnosed with a moderately severe mental health problem used CAM during the previous 12-month period (Rhee 2017). In contrast, only 32% of adults who reported no mental health problems used CAM. Differences in CAM use by ethnicity ranged from 24% of African-Americans compared to 45% of Asians and almost 50% of other ethnic groups. Being female, younger, having completed college, residing in the Western part of the U.S., being employed, and having functional limitations were predictive of relatively greater CAM use.

Out-of-pocket expenditures on CAM are growing in parallel with increased CAM use. In 2007, the last year for which data are available, $13.9 billion in out-of-pocket expenditures for CAM services in the U.S. were made by roughly 30 million adults ages 18 and older (Davis 2012). Of these, roughly 7 million adults (one-quarter of those surveyed) accounted for 70% of total expenditures.

Children and adolescents also use CAM to treat mental health problems

Large numbers of children and adolescents also use CAM to treat mental health problems. Findings of the 2007 National Health Interview Survey were analyzed for a sample of over 5000 youth aged 7 to 17 who reported attention deficit hyperactivity disorder (ADHD), anxiety or depressed mood in the past 12 months (Kemper 2013). Almost one third who reported a mental health problem used at least one CAM therapy compared to less than 12% of age-matched children and adolescents with no mental health problems. Natural supplements and mind-body approaches were the most widely used CAM therapies. Youth who were more likely to use CAM came from higher socioeconomic backgrounds, had chronic health problems, were taking prescription medications, or could not afford professional counseling services. 

Factors driving widespread CAM use to treat mental health problems and a caveat

Factors driving widespread and increasing use of CAM to treat mental health problems include limited effectiveness of many available medications; concerns over potentially serious safety problems associated with antidepressants, mood stabilizers and antipsychotics such as weight gain, sexual and neurologic adverse effects; limited availability, high cost or limited insurance coverage of many psychotropic medications; and shared concerns over the current model of conventional mental health care in which brief impersonal appointments emphasize ‘medication management’ over wellness and prevention. Although many of these concerns are legitimate reasons to consider using CAM for a mental health problem, they should not be regarded as a wholesale endorsement of CAM. While some CAM treatment approaches have been established by research studies as safe and effective, many CAMs have been found to be ineffective or unsafe.

Bottom line and a caveat

It is important to carefully evaluate the evidence for both safety and efficacy for any new CAM (or conventional) treatment before starting it, ideally in consultation with a qualified CAM practitioner or conventionally trained health care provider who has expertise in the approach you are considering. Not doing so increases the risk of adverse effects and potentially dangerous interactions between an herbal or other natural supplement and a prescription psychotropic medication.

Accumulating evidence supports that combining select CAM and conventional treatments sometimes improves response to treatment. This is the domain of integrative mental health care, a rapidly emerging paradigm in mental health care. I’ve written a series of 10 short books that go over essential concepts in integrative mental health care and provide practical advice on how to approach depression, anxiety, bipolar disorder, PTSD, ADHD and other mental health problems from an integrative perspective.

References

10 short books on integrative mental health care: "The Integrative Mental Health Solution" by J. Lake MD