Supplementary Medicines in Psychiatry

Increasingly, questions such as the following arise: Are our psychiatric-psychotherapeutic procedures, as they are commonly characterized as conventional medical approaches (“school medicine”), sufficient for the treatment of our patients within the different levels of acuity of their psychiatric disorders? Can and must we keep up with the times—whether based on our own conviction due to the “current trends” or stimulated by our patients—and apply procedures such as phytopharmaceuticals, acupuncture, or even homeopathy and ayurveda?

The fact is that our field of expertise continues to develop in all directions, including these, and therefore, in my point of view, all potentially promising treatment options should be examined with a critical basic attitude regarding their use for our patients. Thus, the conventional and often even ideologically confrontation of “conventional medicine” and “alternative medicine” seems to be rather pointless. For our patients, we want to take a closer look to all procedures from a medical point of view, and certainly out of scientific curiosity, and also to evaluate their effectiveness, which may be able to increase therapeutic success. These would be those procedures in which there is a great deal of empirical knowledge worldwide and consequently further evidence (i. e., findings according to our scientific thinking). Especially with regard to this last item, alternative medical procedures, even though more and more randomized controlled studies are published, still have a considerable backlog. Therefore, the basic tenor of the current state of knowledge is that none of the treatment procedures that are described and critically discussed in this special issue or elsewhere should be applied primarily as monotherapy. Using these procedures additively and for augmentation of our traditional psychiatric-psychotherapeutical methods individually and in individual cases seems to be useful for gathering initial experiences and planning further randomized controlled studies with larger groups of patients, whether they are inpatient or outpatient or whether they are acutely severe or rather slightly or chronically ill.

Despite all our treatment successes, we should also see that not only patients with physical illness, but also those with mental disorder, have doubts about the long-lasting usefulness of our “traditional medical” methods. Patients are increasingly turning to various “alternatives” and partly rather dubious procedures such as “mental healing”—unfortunately also thanks to the Internet. In view of this, we should be responsible in dealing with these trends and try to integrate into our repertoire well-secured aspects of millennia-old methods from China, India, or even Europe. If we look back only a few decades on the alleged triumphal march of “biological psychiatry,” our field of expertise believed in getting along only with somatotherapeutical or psychopharmacological treatment options. Today, we know that due to increasingly positive experiences treatment components such as change of lifestyle, learning of relaxation techniques (e. g., yoga, sustainable psychoeducation, disorder-specific psychotherapy for learning, and changing of mental strategies) but also phytopharmacological approaches are obtaining approval in addition to classical psychopharmacology.

In this special issue, 2 approaches are presented in more detail and debated in accompanying comments. On the one hand, dietary supplements such as vitamins like vitamin D [1], which are discussed again and again with regard to a reinforcing treatment effect in psychiatric patients, especially depression, but the few randomized controlled trials so far have not provided sufficient evidence, but further efforts should be made. On the other hand, Kampo from traditional Japanese medicine is presented with broad aspects [2]. Kampo formulae consist of plant and animal products and have clear effects on the mental state of many different psychiatric disorders, as shown by the case series and studies high lightened there.

I would like to thank all participating authors of the narrative review articles and comments [3] [4] and hope that the readers of Pharmacopsychiatry will be inspired to become more familiar with the advantages and disadvantages of these methods for practical use in our psychiatric patients.

• References

• 1 Hoffmann K, Emons B, Brunnhuber S, Karaca S, Juckel G. The role of dietary supplements in depression and anxiety – A narrative review. Pharmacopsychiatry 2019; 52: 261-279
• 2 Tatsumi L, Suzuki T, Yamada K, Mimura M, Uchida H. Kampo, A Japanese traditional medicinal system for psychiatric conditions: A narrative review. Pharmacopsychiatry 2019; 52: 251-279
• 3 Tsuboi T. Can Kampo and dietary supplement address unmet need? Early intervention and frailty management in psychiatry. Pharmacopsychiatry 2019; 52: 280-281
• 4 Walach H. Psychiatry is broadening the biological paradigm at last – A commentary on Hoffmann et al. “Dietary Supplements in Psychiatric Treatment – A Narrative Review”. Pharmacopsychiatry 2019; 52: 282-283