Integrative Psychiatry

[zenman]

Anyone practice any integrative psych, even if it's prescribing DHA, SAM-e, diet?

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[whopper]

I do so from time to time...

But I try to do so under evidenced-based guidelines.

There is data suggesting that SAM-E is effective as an antidepressant but I'd still rather give an SSRI because there's more data supporting it's use and they're cheaper. 1200 mg of SAM-E could cost a person about $120 a month. That's a heck of a lot more than $4 Citalopram.

That said, if the person also had arthritis or other joint problems, needs augmentation or they want to try a non-prescription medication, I figure why not?

I generally recommend fish oil to all my patients. The data isn't exceptionally strong for it's benefits but there are some in the literature, it's cheap and it's good for your health anyway so I figure why not?

In my parts I've noticed SAD is quite prevalent and I have been recommending light therapy and Vit D3 supplementation if someone has SAD.

 

[nitemagi]

Integrative is such a loose term. What the hell does it mean? Non-medication? Isn't therapy just that? What was formerly called complementary/alternative medicine? Herbal? Acupuncture? Hypnosis?

 

[digitlnoize]

How do you guys feel about Deplin?

 

[notdeadyet]

Integrative is such a loose term. What the hell does it mean? Non-medication? Isn't therapy just that? What was formerly called complementary/alternative medicine? Herbal? Acupuncture? Hypnosis?

I think there's still a distinction made between them.

Complementary Medicine = things like herbs, acupuncture, hypnosis to use in addition to western medicine. Alternative medicine = when you use the above in lieu of western medicine.

Integrative medicine uses the same modalities, but is not limited to physical medicine. It includes spiritual wellness and the rest. I'd be reluctant to consider CAM without spiritual wellness =/= integrative medicine, in my mind.

 

[F0nzie]

Integrative is such a loose term. What the hell does it mean? Non-medication? Isn't therapy just that? What was formerly called complementary/alternative medicine? Herbal? Acupuncture? Hypnosis?

I think it means combining the earth's natural elements such as fire, wind, earth, and water. In addition, one can integrate simple organic elements from the periodic table such as carbon, hydrogen, oxygen and nitrogen. I have all of this in a bottle for $19.95. Supplies are limited.

 

[zenman]

Integrative is such a loose term. What the hell does it mean? Non-medication? Isn't therapy just that? What was formerly called complementary/alternative medicine? Herbal? Acupuncture? Hypnosis?

'It emphasizes principles that may or may not be associated with CAM, such as,

1. The natural healing power of th eorganization
2. Whole person medicine
3. The importance of lifestyle
4. The critical role of the doctor-patient relationship

Integrative psychiatrists have many more options to offer patients than their conventional counterparts. As alternatives to drugs, they can recommend dietary changes, dietary supplements, botanical remedies, exercise, relaxation training, a variety of mind/body therapies, and new forms of psychotherapy that can teach patients to be optimistic and to identify and restructure habitual patterns of thought that lead to negative moods and behaviors."

Integrative Psychiatry by Daniel Monti and Bernard Beitman

 

[nitemagi]

'It emphasizes principles that may or may not be associated with CAM, such as,

1. The natural healing power of th eorganization
2. Whole person medicine
3. The importance of lifestyle
4. The critical role of the doctor-patient relationship

Integrative psychiatrists have many more options to offer patients than their conventional counterparts. As alternatives to drugs, they can recommend dietary changes, dietary supplements, botanical remedies, exercise, relaxation training, a variety of mind/body therapies, and new forms of psychotherapy that can teach patients to be optimistic and to identify and restructure habitual patterns of thought that lead to negative moods and behaviors."

Integrative Psychiatry by Daniel Monti and Bernard Beitman

I consider all of these to be part of medicine.

I don't agree with the "integrative" distinction.

 

[Chimed]

I consider all of these to be part of medicine.

I don't agree with the "integrative" distinction.

Totally agree. I consider these things to be "Stand of Care" and recommend these treatment options to all my patients. For example, I see a lot of ADHD and I always recommend exercise, avoiding artificial food dyes, and Omega-3's. I recommend similar options (depending on the disorder and research) to other disorders including bipolar, depression, and anxiety. I do, however, tell them the evidence and what I know from the literature, which sometimes goes like "although the evidence is not that robust, it (insert recommendation here) has been shown to help some patients and I would therefore recommend this for you to try."

 

[digitlnoize]

Totally agree. I consider these things to be "Stand of Care" and recommend these treatment options to all my patients. For example, I see a lot of ADHD and I always recommend exercise, avoiding artificial food dyes, and Omega-3's. I recommend similar options (depending on the disorder and research) to other disorders including bipolar, depression, and anxiety. I do, however, tell them the evidence and what I know from the literature, which sometimes goes like "although the evidence is not that robust, it (insert recommendation here) has been shown to help some patients and I would therefore recommend this for you to try."

I spent the last month on an "integrative" or "functional" medicine rotation. Here's what I found:

These are synonyms for "we will diagnose things the 'mainstream' medical community does not recognize." They tend to specialize in the treatment of entities like "Adrenal Fatigue," "Chronic Lyme Disease," "Leaky Gut," "Gluten Sensitivity," and the like. The diseases are typically treated with a variety of supplements (which are "better" than "pharmacologics" because they're natural and "natural things don't have side effects."), dietary changes, lifestyle changes, and sometimes "CAM" treatments like acupuncture, chelation, etc.

A certain subset of patients, many of whom should be outpatient psych patients, actually did fairly well on these treatment plans. I think most of them were mild depression cases, who improved on their own over ~6 months. However, some truly benefited from the dietary changes, and there is some rudimentary evidence for SOME of the treatments (fish oil, vit. d, deplin seems to me to have some good evidence for psych). Adrenal fatigue is an interesting "entity" to me because although a google search for the same reveals MANY doctors bashing it as a fake disease, a literature search reveals a TON of evidence for mild HPA-axis dysfunction in a variety of amotivational states (chronic fatigue, fibromyalgia, etc). I doubt this means you should start chugging "Ashwagandra" or "Rhodeola" to "support your adrenal function" but at the same time, I did see a number of these amotivational patients have improved energy on these regimens. Probably placebo, but hey, they got "better."

Spent a day with a "Chronic Lyme" expert. That was interesting. Many of the people claimed to be hard-working, very functional members of society until they got a tick bite and got "lyme". Then, they became very fatigued, with joint aches, etc, until a >1month course of doxy sometimes in combo with Azithro and/or malaria drugs improved their sx a bit. Many "need" IV abx therapy for many weeks to get "better." Interesting place...

Really, these places are small, niche practices looking to capitalize on a unique market segment who are looking for something other than "traditional" medicine. Many of these people had bad experiences, either with doctors or medication side effects, and were looking for something else.

The biggest danger from these practitioners on our end, is in the tendency I noted to d/c psych meds in otherwise stable patients "because it's bad to be on medicines." They d/c the SSRI, put the patient on about 25 supplements (non-compliance due to complexity is a HUGE issue, IMO), then when the patient returns worse, they tell them that they need to work on their diet (which they charge for with "nutrition counseling", cash only of course), exercise better, and probably do some IgG testing for every food ever until they find one which gives a "mild positive" and tell the patient they have an allergy to Food X which is the TRUE root cause of their depression. Sigh.

Again, many of the patients did improve. Some refused to D/C their psych meds. Most wished me the best of luck in a field "corrupted by big pharma" who just want to "medicate the world" and said I'd have a tough time in psych unless I just wanted to throw meds at people. I said I'd be fine. Hahaha.

In the end, I think that it was a good experience to have, and at least now I know what these people do, and what the "claims" are for many of the more common herbal treatments and weird tests. And if some patients have the money and want to pursue this course of treatment, I'd be game for letting them try it...

 

[nitemagi]

A good example digtl about this artificial distinction IMO between "supplements" and medication. Many people who are more holistically minded recognize that food and medication are on a spectrum, and that "natural" doesn't mean safe, any more than FDA approved does.

 

[digitlnoize]

A good example digtl about this artificial distinction IMO between "supplements" and medication. Many people who are more holistically minded recognize that food and medication are on a spectrum, and that "natural" doesn't mean safe, any more than FDA approved does.

Exactly. I like to use Lithium as an example. As a "natural" substance, these people typically can't make much of an argument against it. Then, if they're EtOH or tobacco users we talk about how EtOH is synthetic and tobacco is "natural". Then we talk about things like lead and other "natural" poisons. By this point (maybe with a few days to think about it), many people come around...

 

[kugel]

I spent the last month on an "integrative" or "functional" medicine rotation.

I am SO impressed to read that someone who chose this rotation came away with both skepticism and an open mind still intact.

I would love to have this kind of critical thinking taught to med students before they start the memorization marathon.
Present them with 20-30 medical "facts" from textbooks from within the last 20 yrs, half found to be "true" and half found to be completely "false." Then show them how each was questioned, how it was tested, and how it was proved to be true or false. Then present them with another medical concept and ask the students to come up with ways to test it. Then present the next set of tests of that concept that did occur, and ask them to draw conclusions and come up with the next set of tests, then present them with the next set of info, and so on. Then do that same process for another 20-30 concepts (half true, half false).
Look at that!! That's the same way we use case studies to teach how to use H&P info and diagnostic tests to develop a differential and treatment plan! We're just using it to teach how to evaluate the science behind the medicine.
If it took 3 days at the beginning of 4 years of med school, that's 3/1460 = 0.2% Would you give up 0.2% of med school days to learn critical thinking before you learn the anatomy and physiology, and so many of the things that will turn out to be obsolete by the time you graduate residency.

And before graduating, teach them how to read journal articles with that same skepticism and open-mindedness:
"Do the conclusions flow from the data using those methods?"
"What other conclusions could you draw from this data?"
"What other factors could be causing this?"
"If I told you that I don't believe this, how would you go about testing it?"
"Regardless of the p-value, does this MEAN anything?" (statistical vs clinical significance)

 

[zenman]

Exactly. I like to use Lithium as an example. As a "natural" substance, these people typically can't make much of an argument against it. Then, if they're EtOH or tobacco users we talk about how EtOH is synthetic and tobacco is "natural". Then we talk about things like lead and other "natural" poisons. By this point (maybe with a few days to think about it), many people come around...

I like to ask the diehard "natural" folks if they would agree to wipe their butts with "natural" poison ivy.

 

[zenman]

I spent the last month on an "integrative" or "functional" medicine rotation. Here's what I found:

..

These guys routinely order labs for vitamins, folic acid, D, B, mag, etc

 

[sunlioness]

I like to ask the diehard "natural" folks if they would agree to wipe their butts with "natural" poison ivy.

My father allegedly did that by accident once on a roadtrip. From what I understand, the results were not pretty.

 

[thoffen]

This is a great thread. My limited experience overall is that there are a subset of patients who are simply biased against a traditional approach such that they'll want alternative therapies regardless of what you tell them. I'd like to think the future of medicine is integrative, utilizing the best evidence possible to find the best fit for an individual. However, it seems like practitioners of "integrative" medicine and the patients that flock to them are just as separatist as their counterparts.

 

[sunlioness]

I went to one of the integrative presentations at APA last week. I really liked the first half when they were talking about vitamins and nutrition. I felt the evidence was well-presented and that I learned something. But I didn't much care for the second half. Probably because it started with a guided meditation and for some reason, I just really don't like those. And then they were talking about EFT and did an EFT demo. And it just seems so hokey to me. I'm not sure what I think of the so called energy therapies. I mean, it's not that I think it categorically doesn't work or can't work . . . I guess I just haven't been too impressed by the kinds of people who seem to gravitate toward them. And maybe their tendency to disparage and poo-poo more traditional psychiatry is part of that impression.

 

[digitlnoize]

These guys routinely order labs for vitamins, folic acid, D, B, mag, etc

These are some of the more reputable labs they order. They have to use special labs to run most of their tests because LabCorp and everyone else won't ("can't") run them.

What bothered me more was when they'd run labs then diagnose normal values as abnormal. For example, a CBC with an MCV within 2-3 points of the upper limit would be cause enough for them to tell the patient they need B12. They were also huge fans of transdermal hormones, playing strange games with TSH, and overall micromanaging of ANY perceived abnormality that MIGHT be used to fit the customer's (and I use CUSTOMER on purpose) symptoms.

The genius part of the whole thing was that they sold all the supplements in house. So they're charging ~$200-300/hour, plus making a boatload off the supplements. They get visits from supplement reps the way the rest of us get hounded by drug reps. All that being said, they only saw maybe, 6 patients per day if they were lucky.

This is a great thread. My limited experience overall is that there are a subset of patients who are simply biased against a traditional approach such that they'll want alternative therapies regardless of what you tell them. I'd like to think the future of medicine is integrative, utilizing the best evidence possible to find the best fit for an individual. However, it seems like practitioners of "integrative" medicine and the patients that flock to them are just as separatist as their counterparts.

Agreed. If there is good evidence for a certain therapy, I'm totally game to use it. I don't care if it's a vitamin, diet, exercise, drug, or whatever. My problem what these guys are using to constitute "good evidence." Since there are few to zero large clinical trials of these things, "evidence" consists of "my buddy told me" or "this guy in germany has had good results with this" or "a couple of tiny clinical trials" or "some studies in animals". I would actually LOVE to see larger scale clinical trials of some of the more popular of these claims, mostly so we'd know if they actually worked or not. As I said earlier with the "adrenal fatigue" crowd, there does seem to be solid evidence for mild hypo function of the HPA axis in chronic fatigue, but very little evidence for what (if anything) ashwagandra or rhodeola may do to improve this state.

My favorite story comes from the days when I was working in an ER as a pre-med. This hispanic family came in with a little kid who'd gotten cut. They had cracked an egg, and put the shell (yolk side in) on the wound. It was said to have healing properties. I did some digging, and sure enough, found one very, very small study showing that, indeed, the proteins found on the inside of an egg shell did promote wound healing and had anti-inflammatory properties. Wasn't a clinical trial, just a biochemical analysis, but it was interesting nonetheless. Does that mean I'm going to rx egg shell to my patients instead of sutures? Hell no. But I do think the area deserves more study. We may be surprised by what we'd find.

 

[zenman]

I went to one of the integrative presentations at APA last week. I really liked the first half when they were talking about vitamins and nutrition. I felt the evidence was well-presented and that I learned something. But I didn't much care for the second half. Probably because it started with a guided meditation and for some reason, I just really don't like those. And then they were talking about EFT and did an EFT demo. And it just seems so hokey to me. I'm not sure what I think of the so called energy therapies. I mean, it's not that I think it categorically doesn't work or can't work . . . I guess I just haven't been too impressed by the kinds of people who seem to gravitate toward them. And maybe their tendency to disparage and poo-poo more traditional psychiatry is part of that impression.

Well, I'll go out on a limb here! I used to have friends...well still do...who I thought were way out there in lulu land. They used to talk about spirit guides standing behind them helping them when they did massage. Then, one day when I was manager of a Level I in Mississippi, a black lady came in complaining that her pastor had "tossed the bones" on her. Instantly, I was "told" what to do and I did a "ceremony" with a BP cuff around her body and told her that her pastor would never be able to hurt her again. Then the resident came in to help her out.

I was gradually pulled into studying shamanism with a medical anthropologist/psychologist guy and have studied with Q'ero Indians and Shipibo shamans in Peru. Guided meditation is tame compared to what I've been exposed to and I'm still on no meds, lol! There's been quite a few scientists and physicians who have had their world rocked. I've been paralyzed for over an hour in the Amazon and couldn't even wiggle my eyebrows while a spirit ran around inside my body. I wasn't scared, just observing the experience like a detached observer.

There's a lot of "techniques" that I can used in psych and I can gear it to different people. If someone wants a full blown ceremony complete with drums, rattles and fire I can do it. Or, with a more Western-minded person sitting in my office, I may have an image and bring it up such as, "I'm having an image of you with your feet stuck in cement. Does this mean anything to you?"

Quite a few people around me have commented about owls, which is one of my spirit animals. One professional mental health person said an owl flew at her twice when she was working on me.

And from an Ayahuasca vision in Pucallpa, Peru I got some nice insight:

"The side of the Jaguar appeared directly in front of my face. I went inside him but was afraid and came back out. He appeared again and I stepped inside him. My body boundaries completely dissolved and for a brief moment I was afraid. Then I saw through the eyes of the Jaguar that I was one with everything...the trees, water, sky, plants, and the earth. There was no me separate from nature. I also realized that in order to help others heal I must be able to step inside them."

What were you saying about guided meditation? Check out Jon Kabat-Zinn at University of MassMedical Center

But I'm with you. Some people need meds and that's fine. Others have yet to find what the heck is going on. Those are my favorite patients. I still remember some Vietnam vets when I was training, and my instructors reminding me to use EBM only when I would kid around about other modalities. I'm thinking to myself..."It's 40 years later and EBM hasn't helped." I'd have loved to have these guys in a ceremony. It's a pisser when you can't stop flying to Vietnam (real pisser to get screwed up on the flight over), or not be able to sleep today because your firebase was attacked 30 something nights in a row, or knowing exactly when a part of your soul left your body and has yet to return.

And like you, I'm interested in nutrition and some supplements, especially after my PCP found my Vit D was half what it should be.

 

[sunlioness]

You know, I really have no problem with traditional shamanic methods of healing. I don't know a lot about it, don't particularly want it done to me, but I'm willing to believe they have merit. I don't think believing in spirit guides or totem animals or different planes of existence that you can travel to in trance states is any wackier than someone believing Jesus died for their sins. I do believe that the world is wider and more magical than many are willing to accept.

What I do have a problem with is performing shamanic/traditional/energy healings and calling it psychiatry. I didn't learn how to do soul retrieval in residency and it wasn't on my board exams. Now, I'm sure there are mental health professionals who have studied these methods in depth and are perhaps qualified to hang shingles as traditional healers. But doing it within the context of a psychiatric practice really muddies things, I think.

 

[zenman]

You know, I really have no problem with traditional shamanic methods of healing. I don't know a lot about it, don't particularly want it done to me, but I'm willing to believe they have merit. I don't think believing in spirit guides or totem animals or different planes of existence that you can travel to in trance states is any wackier than someone believing Jesus died for their sins. I do believe that the world is wider and more magical than many are willing to accept.

Now don't play the religious card, lol. Religion is a belief system. Shamanism is an experiential path.

What I do have a problem with is performing shamanic/traditional/energy healings and calling it psychiatry. I didn't learn how to do soul retrieval in residency and it wasn't on my board exams. Now, I'm sure there are mental health professionals who have studied these methods in depth and are perhaps qualified to hang shingles as traditional healers. But doing it within the context of a psychiatric practice really muddies things, I think.

I don't think there's a problem if you're trained in both and you're clear that you offer one or the other or a combo. We have strict ethics and can't do any work on anyone without their permission. I don't even work on my wife or friends without their permission.

 

[sunlioness]

Well, I think it's difficult to divorce the practices from the belief systems that gave rise to them. I know there's some resentment in indigenous communities toward "plastic shamans" and people who learned techniques in weekend workshops rather than growing up in the culture. But a discussion of cultural appropriation is really beyond the scope of these boards, I think.

We can agree to disagree, but there's still something about offering psychiatry and shamanism in combo that doesn't sit right with me. I think to do so implies, in a sense, that one system explicitly endorses the other. I don't think that's true from either side. And it's not just shamanism I'd say that about. I'd feel weird about a psychiatrist who initiated as a mambo or houngan running a mental health clinic/botanica, too.

Well, it's bed time for me. Hope you have a good night.

 

[splik]

my favorite was a talk i went to on spirit release therapy (the speaker was a psychiatrist). my friend asked during the Q&A 'how do you release spirits' and the psychiatrist said 'psychotherapy with spirits is much easier than with humans. you just reason with them they'd be better off if they left and they listen.' all with a straight face... i had to bite my lip to stop myself from laughing!

 

[splik]

what i take issue with is these psychics who charge for a missed appointment. surely they would have known and could have booked in another patient/client?

 

[sunlioness]

I met a psychiatrist once who asserted that many, if not most, cases of bipolar disorder were actually cases of spirit possession.

 

[zenman]

my favorite was a talk i went to on spirit release therapy (the speaker was a psychiatrist). my friend asked during the Q&A 'how do you release spirits' and the psychiatrist said 'psychotherapy with spirits is much easier than with humans. you just reason with them they'd be better off if they left and they listen.' all with a straight face... i had to bite my lip to stop myself from laughing!

You didn't ask him to demonstrate? You got to do that.

 

[zenman]

I met a psychiatrist once who asserted that many, if not most, cases of bipolar disorder were actually cases of spirit possession.

Same here. Did he have cases that improved? What if he does? What then?

 

[Ceke2002]

Most wished me the best of luck in a field "corrupted by big pharma" who just want to "medicate the world" and said I'd have a tough time in psych unless I just wanted to throw meds at people. I said I'd be fine. Hahaha.

As a patient I've personally found that the majority of 'Big Pharma conspiracy, you don't need to be on medication' type practitioners come across as being far more interested in pushing their own private agenda than they are in actually providing proper treatment. Same with patient advocates, who advocate in the extreme that absolutely no one should be place on an involuntary treatment order, ever, regardless of the danger they might present to themselves or others (because clearly even the most far end of the Schizophrenia spectrum can be managed with kisses and huggle f*cks ). This sort of extreme black and white, 'it's us against them' type of thinking and practice bothers me immensely from the point of view that I've actually seen it result in death.

And you sound like you'll do just fine in Psych, you seem to have a good, balanced attitude towards stuff.

*goes back to lurking and reading*

 

[Cinclus]

As a patient I've personally found that the majority of 'Big Pharma conspiracy, you don't need to be on medication' type practitioners come across as being far more interested in pushing their own private agenda than they are in actually providing proper treatment. Same with patient advocates, who advocate in the extreme that absolutely no one should be place on an involuntary treatment order, ever, regardless of the danger they might present to themselves or others (because clearly even the most far end of the Schizophrenia spectrum can be managed with kisses and huggle f*cks ). This sort of extreme black and white, 'it's us against them' type of thinking and practice bothers me immensely from the point of view that I've actually seen it result in death.

And you sound like you'll do just fine in Psych, you seem to have a good, balanced attitude towards stuff.

*goes back to lurking and reading*

I just died laughing.

 

[whopper]

I like to ask the diehard "natural" folks if they would agree to wipe their butts with "natural" poison ivy.

I wish I could find the video for this.

Dennis Miller, when he had his HBO show (that I thought was his prime), mentioned something to the effect that

-If it comes down to me having to use chemotherapy to treat cancer that I hope to God never get or sticking my penis into a beehive, I'm going to go with the chemo.-

I know it really doesn't come down to that, but I thought it was funny. My own opinion is so long as there's evidence to back it up that is scientific, consider it, whether or not it's fish oil, SAM-E, what have you, but the strength of the evidence, along with the risk/benefits, price, and patient preference will determine how high or low it will end up on the decision algorithm.

E.g. fish oil is cheap, it has plenty of health benefits aside from treating mental health problems, it's risk for problems is low, and it can augment existing psychiatric treatments, so I'm going to place it pretty high up as an augmentation treatment. I'm not going to place it high on the list as a primary treatment.

 

[Ceke2002]

Zenman - If you're interested in the practices of Shamanism, you might like to take a look at shadow work, if you're not already familiar with it.

Relevant linkage...

http://hawkscry.org/2009/09/discovering-shadow/
http://www.drjontry.com/workshops/shadow.htm
http://www.markwalstrom.com/articles/shadow-work.html
http://www.soulfulliving.com/july02features.htm
http://webspace.webring.com/people/pw/wiccantwinpaths/shadow-work/summarypage.htm
http://missworld.tumblr.com/post/4470842842/the-shadow-within

Integral Recovery - 3-2-1 Shadow work

John Dupuy describes of the process of shadow work, a core part of integral life practice

http://www.youtube.com/watch?v=YeK4AYG5Kqs

Wiccan/Neopagan aspects of shadow work (I'd also recommend checking out her other videos such as 'seven days of shadow work' and 'shadow work and self improvement'.

http://www.youtube.com/watch?v=OvHzUgNSF3E

A more New Age approach to working with shadow

http://www.youtube.com/watch?v=C6wDHBt7r5U

Romancing the shadow (shadow work with Connie Zieg)

Connie Zweig, Ph.D., is a Jungian psychotherapist who specializes in shadow-work, as well as creative and spiritual issues.

http://www.youtube.com/watch?v=av_ndaeG-1c

edited to add: I don't want to stick my nose into this thread too much, being that I'm not a healthcare professional, but if you're interested in discussing anything further, at least from the point of view of shadow work in Wiccan practice, feel free to shoot me a pm.

 

[Leo Aquarius]

What a weird-ass thread this has become.

 

[zenman]

Zenman - If you're interested in the practices of Shamanism, you might like to take a look at shadow work, if you're not already familiar with it.

Familiar with it thanks, but will check out some of these links.

 

[zenman]

What a weird-ass thread this has become.

 

[loveoforganic]

Came across a NP (non-psych) recently, big on the gamut of (her own) supplements. Had a pt who presented with mild depression (along with a couple non-psych complaints), took a serum serotonin and recommended 5-HTP and st. john's wort. Yeah... how about just an SSRI? Or a CBT referral? But the pt would have to go to elsewhere for those rather than your own nutrient depot...