While behavioral and pharmacological therapies are the current standard of care for treatment of psychiatric disorders, many individuals request information about non pharmacological options that can be utilized alone or in combination with their psychiatric prescriptions in treating various conditions. These questions are certainly appropriate because of the complexity of our biological makeup, our environment (natural and social), our personal history and the interaction between all of them.
The following is provided as a brief review of complementary and alternative medicine (CAM) approaches that show promise and are worthy of consideration and conversation with your healthcare provider. It is important to note that some of these methods are not currently at a level of effectiveness or sufficient study to be considered scientifically validated. In other words the jury is still out on many of them, but the data is building about the potential efficacy of these interventions. The scientific community (see bottom of this page) is beginning to recommend the implementation of many of these promising treatments in the practice of medicine.
The following suggestions may in some cases be integrated with prescription medication but ONLY with the approval of your doctor. If your doctor is unaware of your use of CAM treatments you could place yourself or your child at risk for negative interactions. Please be certain to share any CAM treatment you are considering with your prescribing doctor BEFORE you begin.
Please undertake any treatment described below only under the guidance of a qualified and experienced health professional. The first step is getting a comprehensive sampling of blood, urine, and in some cases hair or stool to accurately explore for chemical imbalances. One laboratory that is well regarded is Direct Healthcare Access II Laboratory in Mount Prospect, IL..
Every intervention discussed could cause side effects, but they are usually far below the level of side effects of synthetically derived prescription psychiatric medications. Careful monitoring should occur for the duration of any treatment. It is important to note that these treatments are often not covered by insurance because they generally lack sufficient scientific evidence at this time. The treatments described can therefore be expensive and or difficult to implement.
Chronic systemic inflammation (SI) is the result of release of pro-inflammatory cytokines from immune-related cells and the chronic activation of the innate immune system. It can contribute to the development or progression of a variety of conditions including psychiatric disorders. The Journal of the American Medical Association of Family Physicians has stated that: Depression is associated with systemic inflammation. With the role of inflammation in mind a review of dietary strategies to reduce inflammation suggests experimentation with elimination of certain foods to include: synthetic food additives, sensitizing food allergens, sugar, dairy (casein free) and wheat (gluten free). Some diets suggest a significant restriction in certain food groups. One anti-inflammatory diet that seems to hold promise is the Ketogenic diet. However, research has confirmed that no one diet is appropriate for everyone! Elimination diets or highly specialized testing of RNA are needed to determine which diet is right for each individual. We are all like our fingerprints, unique!
The Ketogenic Diet has been used in treatment-resistant epilepsy since the 1920s with significant success and it has positive outcomes in a variety of other neurological conditions including ASD and ADHD. The Ketogenic Diet replaces high carbohydrate consumption with high fat consumption, including dietary supplementation using healthy fatty acids such as omega-3, omega-6 and omega-9, while minimizing carbohydrate intake. Keto also suggests increases in amino acids and natural metabolites.
It is also very important to note that improvements in mood and behavior have been achieved with an increase in fatty acids and amino acid supplementation when used with and or without other dietary changes.
An example of an essential mineral needed by the body/brain is Zinc. Zinc plays an important role in nerve transmission and is necessary for cellular metabolism. A lack of zinc has been implicated in impaired cell function and protein synthesis during brain development. Just one cup of garbanzo beans provides nearly a quarter of your daily zinc needs. Nuts are also rich in zinc: (pecans, almonds, walnuts, peanuts and hazelnuts) are all great choices. (See supplementation for additional sources of Zinc).
It is highly recommended that dietary changes be discussed with your physician, or under his or her direction, with a Registered Dietitian or Nutritionist. With this said, organic foods are generally recommended by these professionals due to reduced exposure to environmental toxins.
Unfortunately while children with neurodevelopmental disorders may be at high risk for vitamin and mineral deficiencies they are also often the most difficult individuals to intervene with. This is due to reduced appetite and or unwillingness and inability to experiment with new foods. This behavior can result in low levels of many vitamins and minerals that are essential for optimal neural functioning.
One example of a chemical everyone needs is choline. Choline is one of the most important chemicals in the brain. It is necessary for the development and maintenance of many of the brain’s neurotransmitters. Good dietary sources of choline include eggs, meat, poultry, fish, cruciferous vegetables, peanuts, and dairy products.
A number of herbal remedies may also be worth experimentation. These include: Rhodiola Rosea aka Golden Root, Arctic Root (for attention, anxiety and mood), Ginkgo Biloba (attention, memory, fluid reasoning and executive function), and Melatonin (sleep).
One 2008 randomized clinical trial showed that Magnesium (Mg) was as effective as the tricyclic antidepressant imipramine in treating Major Depression and Mg is considered safe and without side effects. Mg deficiency reduces serotonin levels, and antidepressant drugs have been shown to have the action of raising brain Mg. The Nation Institute of Health, Center for Biotechnology and Information states: We believe that, when taken together, there is more than sufficient evidence to implicate inadequate dietary Mg as contributing to the cause of MD, and we suggest that physicians prescribe Mg for its prevention and treatment.
Please note: The safety and efficacy of any product, whether a prescription drug or a supplement, depends upon its quality. This can best be determined by your health care providers’ recommendations or by assuring that an independent laboratory has assessed a products’ content and quality. Organic sources are always recommended.
Nootropics also sometimes referred to as Racetams are chemicals, supplements, and other substances that may improve cognitive function and provide neuroprotection. Under physician supervision, nootropics can be used as a complementary or stand alone treatment. This is a very new component of (CAM) but one that may hold significant promise, though further experimentation is required.
The practice of using yoga, meditation and breathing techniques to increase vagal parasympathetic activity has been shown to have a positive impact on both internalizing and externalizing behavior. Long-term meditators have shown increases in gray matter. Another practice that has some promise is Neurofeedback.
Neurofeedback (NF) allows patients to self-regulate and reinforce specific aspects of their own neuronal activity. The patient’s recorded EEG activity is entered into a computerized training program which then feeds the information back to the patient through visual cues on a monitor or acoustic cues such as radio carrier waves. These cues enable patients to self-regulate specific aspects of brain activity using the training program. (Sharma, A., Gerbarg, P. L. and Brown, R. P. Non-Pharmacological Treatments for ADHD in Youth. Adolescent Psychiatry, 2015; 5(2): 84–95.)
Some studies have demonstrated moderate statistically significant improvements in parent and teacher ratings of ADHD symptoms with NF but there can be vast differences in outcomes with NF. It is recommended that you search for practitioners certified by the International Society for Neurofeedback (www.isnr.org). The variance in NF outcomes appears to be related to, at least to some degree, the experience and level of expertise of the professional providing the treatment. It is recommended that you find a specialist whose scope of practice is limited to NF. As an informed consumer be aware that a Quantitative Electroencephalogram (QEE) must be done before any treatment is suggested. Practitioners who recommend treatment from a protocol without a baseline QEE are not recommended.
Meditation and relaxation strategies teach how to activate the parasympathetic system nervous system (calming system) for those with anxiety and behavioral challenges. Individuals with anxiety disorders often live in a state of flight or fight, a very uncomfortable place to be. These simple but highly effective methods can result in taking control of emotions that seemed so habitual that they could never be changed.
Sleep is probably the most important thing we can change in regard to mood, behavior and overall health. Poor sleep can be caused by our effects (improper choices) on circadian rhythm. One of the ways we affect the sleep centers in our brain is a loss of sunlight, and or spending too much time in the wrong type of light (screens, home, school and offices). Insufficient sunlight results in deficiencies in Vitamin D and other hormones essential to healthy brain function. Production of these hormones and vitamins occur in the digestive process so the brain is literally working with the gut. This brings us back to the need for a healthy organic primarily plant based diet to have the right building blocks within the body for the brain. We know that without sunlight our sleep is usually elongated sleep (over sleeping) and of poor quality (waking up tired). We are photosynthetic organisms. Inadequate light reduces our health.
Sleep timing and sleep time is also essential. Our circadian rhythm tries to send us the messages of when to go to sleep and when to wake up but our lives and behavioral choices often override this wisdom within the body. When we do we ultimately suffer the consequences.
Poor sleep affects attention, executive function, memory and learning. Stimulants used to address these problems actually negatively affect sleep which then continues to impact poor attention. Sleep deprivation can cause serious psychological conditions as well as contribute to obesity and addiction. Teenagers are often severely sleep deprived.
Some well documented suggestions for better sleep focus on lowering body temperature, and calming the body and mind before sleep. Body temperature can be lowered by a hot shower, hot tub or sauna before bed. It seems to violate common sense but doing one of these actually results in the body cooling down after warming up. When the body cools down we tend to sleep much better.
Doing some journaling, planning and goal setting before bed can also be a very helpful way to introspect, and organize at the end of the day. Journaling using a Thought Record (a tool employed in cognitive therapy) is a proven method to deal constructively with difficult situations, strong emotions and persistent negative thoughts that could interfere with sleep.
Dr. Perry Passaro
Licensed Educational Psychologist, a Licensed Psychologist and a credentialed school psychologist. He earned his doctorate in Educational Psychology, with an emphasis in Measurement, Evaluation and Statistical Analysis from the University of Kentucky, in Lexington. His dissertation studied the effects of perceptual errors on complex problem solving. He currently practices privately, in the areas of Cognitive Behavioral Therapy (serving children, adolescents, families and adults) as well as in the area of psycho-educational assessment, in Newport Beach. Dr. Passaro has worked in public education for over 20 years, primarily as a school psychologist. He has taught at the university level and has published numerous articles in professional journals related to education and psychology. He is a member of the Association of Behavioral and Cognitive Therapies (ABCT), a Diplomate in Cognitive Therapy granted by the Academy of Cognitive Therapy (ACT) and EMDR certified.
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