Complementary treatments can be integrated with conventional medical practices to offer patients the best of both worlds. As clinician/researchers we seek new approaches to relieve emotional and physical problems while reducing medication side effects. The goal of this newsletter is to share with you Integrative Treatments we find to be safe and beneficial. We welcome your comments and contributions.
CAM Misinformation: When will they stop bashing SAMe?
An article in the October 2009 issue of Clinical Psychiatry News (Vol.37 No.10 pp. 1-2) discussed emerging evidence for the role of mitochondrial dysfunction in unipolar and bipolar depression and the potential benefit of medications such as mitochondrial-targeted antioxidants. Dr. Shelton was cited as recommending certain supplements, mitochondrial modulators, that could be helpful: N-acetyl cysteine (NAC) 2 g/day and acetyl-l-carnitine (ALCAR) 500 mg twice a day. In a double-blind study of 75 patients, NAC improved symptoms of bipolar depression (Biol. Psychiatry 2008:64:468-75). Other mitochondrial modulators of interest included coenzyme Q10, alpha-lipoic acid, and creatine monohydrate. Although multiple randomized controlled trials have demonstrated benefits, from S-adenosylmethionine (SAMe) in major depressive disorder, the physician who was interviewed for this article discouraged the use of SAMe because he expressed concern that the use of SAMe could cause elevated homocysteine levels. This physician disclosed that he receives grant/research support from 8 pharmaceutical companies and serves on the speakers bureau for 5 companies.
While we agree that mitochondrial dysfunction plays a major role in many psychiatric and medical disorders, and that there is great potential for treatments that improve mitochondrial function, we disagree with the implication that SAMe could be unsafe because it might raise homocysteine levels. In fact, although SAMe is involved in over 200 essential metabolic pathways, including homocysteine metabolism, there has never been a study in which SAMe increased homocysteine levels in a patient. In fact, studies have shown that it reduces homocysteine levels. Theoretically, SAMe could contribute to elevation of homocysteine in cases of very severe folate deficiency (folate is essential to SAMe metabolic pathways), which would be clinically evident (Brown et al. Psychiatric Annals:2002:32:29-44; T. Bottiglieri. Am J Clin Nutrition 2002:76:1151S-57S; T. Bottiglierei Prog Neuropsychopharm and Biol Psychiatr 2005: 29:1103-12). SAMe has been used to treat depression and arthritis for over 25 years by hundreds of thousands of people. SAMe is safer than any prescription antidepressant on the market in terms of its side effect profile and its lack of adverse interactions with other medications. It has been tested in more than 80 clinical trials involving over 24,000 people. It was approved for sale in the USA as a nutraceutical by the FDA in 1998. Based on a search of 25 biomedical databases, the US Department of Health and Human Services Agency for Healthcare Research and Quality Evidence Report/Technology Assessment No. 64 (2002) concluded that treatment with SAMe was equivalent to standard pharmacotherapy for depression and osteoarthritis 64 (www.ahrq.gov). SAMe has also been shown to increase the effectiveness of other antidepressants.
Why does the bugaboo about SAMe causing dangerous elevations of homocysteine continue to appear? It may be that because SAMe is as effective as prescription antidepressants and it is lower in side effects, it presents a threat to pharmaceutical companies marketing antidepressants. We hope that the unbalanced discussion of SAMe as reported in Clinical Psychiatry News was due to a lack of familiarity with all of the research literature on SAMe and not due to a biased interest in favor of pharmaceutical products. It would be unfortunate if physicians and consumers were discouraged from using SAMe, a treatment that has an excellent track record for safety and efficacy.
Metabolic Syndrome, Type 2 Diabetes, Cardiovascular Risk
The role of Mind-Body Practices and the Parasympathetic Nervous system in reducing risks of insulin resistance, metabolic syndrome, and type 2 diabetes will be discussed in the next issue of this newsletter. If you have any information to contribute to this topic, please send it to us at www.haveahealthymind.com
Current Projects & Workshops
Serving Those Who Serve (STWS) is a non-profit group providing services to people who are still suffering from physical and emotional illnesses related to the NY September 11th World Trade Center Attacks. The 9/11 Community includes First Responders, Ground Zero workers, WTC workers, and area residents. STWS sponsors our new Breath~Body~Mind© program for relief of physical and emotional distress as well as for personal development. Workshops are open to the public and a portion of the profits are donated to STWS. In addition to positive feedback from participants, our preliminary research data indicate significant improvement in measures of anxiety, depression and post-traumatic stress symptoms (Martin Katzman and Monica Vermani, in process). See www.stws.org.
Breath~Body~Mind Courses with Dr. Richard Brown
Dr. Brown teaches a fusion of modern and ancient practices to rapidly balance the stress response system, relieve stress and anxiety, and enhance physical and mental health. Training includes QiGong breathing and movement, Christian monk breath moving techniques, Coherent Breathing, and Open Focus Meditation. Proceeds from these courses will be used to benefit the 9/11 Community.
Manhattan, NY. Save the Dates: May 1 and May 2
Location and details to be announced. This will be the first Breath~Body~Mind Workshop open to the public, health practitioners, and members of the 9/11 community to be given in NYC in 2010. Proceeds will benefit Serving Those Who Serve. Watch for registration information in April at www.stws.org.
Professional Lectures and Conferences
November 7, 2009 Pennsylvania Psychiatric Society
Integrative Healthcare Symposium
March 6 2010, Anxiety Disorders Association of America
Integrative treatments are needed to improve outcomes for anxiety disorders and to reduce the burden of medication side effects. By combining specific mind-body practices with standard treatments (psychotherapy, CBT, and medication) it is possible to obtain more rapid and more complete resolution of symptoms. Mental health practitioners are subject to caregiver stress and burn-out. Mind-body practices can help protect caregivers from the effects of professional stress. The goals of this symposium are to present the theoretical background, research evidence, and clinical applications of powerful self-regulation strategies to enable participants to improve their own well-being and the mental health of patients suffering from anxiety disorders including Generalized Anxiety Disorder and Post Traumatic Stress Disorder due to childhood abuse, military service, and mass disasters. How to build upon this knowledge and use it in clinical practice will be discussed.
Session# 195 Experiential Training in Breath-Body-Mind Practices for Stress Reduction
March 17-19, 2010 Integrative College of Medicine
March 26-27 Psychotherapy Networker Symposium: The Power of the Breath Neurophysiological Tools for Self-Regulation
There may be no clinical strategy as simple, effective, and useful as teaching clients soothing and healing breathing techniques. In fact, there’s now a large body of research demonstrating that a few easily learned breathing practices have powerful self-regulating effects that often quickly alleviate the symptoms of stress, insomnia, pain syndromes, anxiety disorders, and treatment-resistant PTSD without medication. In this workshop, we’ll review the neurophysiological research demonstrating the effectiveness of breathing techniques and their impact on cardiopulmonary function and the parasympathetic nervous system. You’ll learn a range of experiential breath-body-mind techniques, including “coherent” or “slowing down” breathing, Breath Moving, “ocean breathing”a Yoga-based practiceand Open-Focus meditation. We’ll then explore a variety of strategies for integrating these tools into work with anxious and traumatized clients.
Information & Registration: www.psychotherapynetworker.org
April 16 Ackerman Institute, New York
May 7, 2010 Neuropsychoanalytic Study Group, New York
May 22-235, 2010 American Psychiatric Association Annual Meeting
Course 07: Complementary and Integrative Treatments for Stress, Depression, Anxiety, PTSD, Mass Trauma, Cognitive Function, ADD, and Schizophrenia
Course 28: Yoga of the East and West: Integrating Breath Work and Meditation into Clinical Practice
9:00 am 4:00 pm Course Description: Participants will learn how to integrate complementary treatments with standard treatments in psychiatry practice. The course focuses on research and clinical applications of complementary treatments for which there is sufficient evidence of safety and efficacy. The authors have selected those treatments that are the most useful for clinicians to integrate into their practices from the following categories: herbs, adaptogens, nutrients, nootropics, hormones, mind-body practices, cranial electrotherapy stimulation, and neurotherapy. Evidence for efficacy and clinical practice guidelines for integrative approaches will include the following diagnostic categories: Anxiety Disorders, PTSD, Depression, Bipolar Disorder, Cognitive Enhancement, Brain Injury, ADD, and Schizophrenia.Participants will have an introduction to the experience breath techniques that rapidly relieve stress and anxiety.
Full Day Course: Yoga of the East and West: Integrating Breath Work and Meditation into Clinical Practice 9:00 am 4:00 pm Course Description: Participants will learn the theoretical background and applications of two powerful self-regulation strategies to improve their own well-being and the mental health of their patients. A program of non-religious practices will enable participants to experience “Coherent Breathing,” Victorious Breath, Bellows Breath, and “Open Focus” meditation. Through a sequence of repeated rounds of breathing and meditation with gentle movements and interactive processes, participants will discover the benefits of mind/body practices. How to build upon this knowledge and use it in clinical practice will be discussed. An in-depth case of a patient with posttraumatic stress disorder who benefited from the addition of yoga breathing to her ongoing therapy will be explored from the perspective of neuro-psychoanalytic theory. This will also highlight clinical issues to consider when introducing mind/body practices in treatment.
This course builds upon introductory material presented in the Course “Complementary and Integrative Treatments for Stress, Anxiety, Post-traumatic Stress Disorder, Depression, Bipolar, Cognitive Enhancement, Brain Injury, Attention Deficit Disorder, and Schizophrenia.” This course is suitable for novices as well as experienced practitioners.
Publications & Reviews
Effects of a Yoga-Breath Intervention Alone and in Combination with an Exposure Therapy for PTSD and Depression in Survivors of the 2004 Southeast Asia Tsunami.
Descilo T, Vedamurtachar A, Gerbarg PL, Nagaraja D, Gangadhar BNG, Damodaran B, Adelson B, Braslow LH, Marcus M, Brown RP. Acta Psyciatr Scand 2009 [in press].
Richard P Brown and Patricia L Gerbarg. Part I. Longevity and Aging Advancements. Yoga Breathing, Meditation, and Longevity. Annals of the New York Academy of Sciences. 2009, 1172:54-62.
"Yoga for Anxiety and Depression" Harvard Mental Health Letter April 2009 https://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2009/April/Yoga-for-anxiety-and-depression
Review of How to Use Herbs, Nutrients, and Yoga in Mental Health Care, by Cathy Durga, LA Yoga magazine, June 2009.
About the Authors
Richard P. Brown, MD, Associate Professor in Clinical Psychiatry, Columbia University Medical Center, NY is a psychopharmacologist and a certified teacher of Aikido (4th Dan), Yoga, Qi Gong, and meditation.
Patricia L. Gerbarg, MD, Assistant Professor in Clinical Psychiatry, New York Medical College, has a clinical practice in psychiatry and provides consultation for research on mind-body practices.