Natural Medications in Psychiatry
* Natural options cannot be patented and as result almost always have limited clinical trials due to lack of financial incentives to do more expensive, more rigorous studies. The following is a list of options that I and other psychiatrists have found helpful and have some clinical positive trials though too small and limited for official FDA approval.
1. S-Adenosyl Methionine (SAMe): Dose range usually 400 – 3200 mg/day. Fairly expensive. Cost $27 - $40/month for 800mg/day.
Dosage Start 400 mg/day, raise by 200–400 mg every three to seven days to a target dose of 800–1600 mg daily; take on an empty stomach for better absorption
Side Effects: Nausea, vomiting, abdominal discomfort, diarrhea, constipation, dry mouth, sweating, dizziness, anxiety
Caution in patients with history of bipolar disorder, with cardiac arrythmia, or who are pregnant
2. L-Methylfolate: 7.5mg for a week then 7.5 – 15mg. Generally well tolerated
3. Omega -3 Fatty Acid from fish oil (not flax seed): In brain Omega-3 fatty acids coat nerve cell membranes and provides neuroprotective and anti-inflammatory effects. They have also shown some efficacy as augmenting agent for bipolar depression.
Side effects: Nausea, fishy taste, belching. Recommend enteric coated formulation or refrigerate the capsules.
Dose usually 1,000mg a day (total EPA+DHA) for a month. If no benefit in 3 weeks, increase to 2,000mg for another 3 – 4 weeks.
5. Vitamin D: Virtually everyone in Seattle Area show deficiency in Vit D levels during winter season. Vit D deficiency has been associated with greater risk of depression. Optimal level in blood test is between 20 - 40 ng/ml. If the levels are something less than 12 ng/ml, recommend 2000 IU of Vit D3 per day. If the levels are between 12 - 20ng/ml, 1000 IU per day. Labs should be rechecked in 3 months and target levels 30 - 40 ng/ml.
2. Lavender extract tablets: Recommend "Calm-Aid" made by Nature’s Way and take 1 - 2 a day. SE of lavender burping. Might try refrigerating if that happens.
3. Ashwagandha: Prefer "Cortisol Manager" made by Integrative Therapeutics. Take 1 at night.
4. Rhodiola Rosea (see below)
Sleep: Please also see Insomnia Guide on this website.
1. Melatonin: Dose 0.25 – 5mg.
3. Various natural concoctions that combines several ingredients like Theonine, Tryptophan, Valerian, chamomile, lavender, others... One suggestion is ZzzQuil Pure Zzzs or Nature's Bounty Sleep3 from Costco both over the counter.
Emotional Dysregulation: There are numerous nutrients, cofactors, minerals that are essential for brain functioning. Some have found the following compounds helpful for for emotional regulation and depression. Pricey but generally well tolerated. Might want to consider
1. Empower Plus: www.truehope.com
2. Enlyte: www.enlyterx.com
Rhodiola Rosea. Usually does not cause anxiety and less frequent crash at end of day. Recommend "Rosavin Plus" 1 pill in morning for few days and if no effect, try 2 pill in morning. Stop if get more anxious.
American Gingseng (Panax quinquefolius) with 10% ginsenoside 500mg twice a day. Well tolerated but caution in patients with anticoagulants or undergoing surgery.
N-Acetylcysteine 600mg twice a day for couple of weeks. Then 1200mg twice a day for 2 more weeks and up to 1800mg twice a day. Data suggests taking for 2 months before deciding does not help. Swanson Brand.