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Many people associate the word “natural” with safe and think that alternative medicines must be benign. This is often not the case! For example, cyanide and arsenic are natural substances and have the potential to create much harm (even death). While most CAM therapies are safe, many have side effects or can interfere with standard medical prescriptions. Problems often arise when people take large amounts of natural supplements thinking that “more is better”, or when people take supplements along with standard medications without first checking to see if mixing treatments in this fashion might cause problems.

Complementary and Alternative medicines have the advantage of being easily available over-the-counter (a prescription is not necessary). The ease of obtaining CAM medicines may lead to a false sense of security about their safety. Remember that CAM remedies are not harmless. Natural substances can have side effects and/or interfere with conventional drugs (either by strengthening or weakening their effects). If you are taking any prescription medications, always check with a qualified health practitioner before starting any natural therapy.

Supplement quality is also a concern. There is very little oversight of supplement manufacturing companies; as a result, these companies may at times skimp on ingredients or fail to follow good manufacturing practices. Your CAM or standard health care provider is probably the best source of information useful for determining which brands of supplements are worth purchasing and which are not.

There has been a recent move to standardize herbal preparations. While standardization is mostly a good thing, the end result is that the final herbal products are more highly concentrated. A highly concentrated herb acts much more like a drug than a benign plant. Standardized St. John’s Wort, for example, interferes with the metabolism of many other drugs (usually making prescription drugs less effective). Again, caution is warranted with these medicines, and self-treatment (without the guidance of a qualified practitioner) is not recommended.

Understanding that “natural” does not necessarily mean harmless is a good place to start. Checking with your health care practitioner whenever you decide to start taking a new supplement is an essential part of taking care of yourself.

The Role of Alternative Medicine in Mental Health

Alternative medicines for mental disorders occupy a supportive care role, for the most part. However, for a few select mental disorders, there are well-researched supplements that may stand on their own and substitute for standard medicines. St. John’s Wort for depression and Kava for anxiety are two examples. For the bulk of CAM therapies, though, this is not this case. Research investigating the effectiveness of these treatments is either minimal, poorly done, or inconclusive (contradictory results across studies make broad conclusions difficult).

The selection of a CAM therapy is best determined by the severity of your disease, how well it helps or hinders conventional therapy, and your willingness to try a therapy that is largely untested. Some supplements, such as the Omega-3 fatty acids (fish oils), will probably always remain in a supportive role and never stand as a solo-therapy.

It is the experience of many practitioners who use alternative and complementary medicines that the patients who approach a problem from more than one angle are the most successful. That is, if you try taking a supplement and an herb and also incorporating some form of exercise (yoga, running, biking) into your treatment regimen, then you are much more likely to have success. Using a good health care practitioner who can help you to integrate different therapies, along with avoiding drug interactions and other pitfalls, tends to be the most effective strategy for any health condition.

Prior to the 20th century, natural medicines were the only real medicines available. The rise of science and the scientific method, which first took off during the European enlightenment, caused this situation to change dramatically; mostly within the last hundred years. Natural vitamins and medicines were largely abandoned as modern so-called “miracle” drugs became available in the early part of the 20th century. These wonder drugs, mostly taken for granted today, were truly revolutionary and were welcomed as the solution to many previously hopeless health problems. Antibiotics, steroid anti-inflammatories such as cortisol, and other drugs were developed in laboratories. Accompanying these new drugs was the thought that science would eventually discover the cure for all diseases. As a result, things natural seemed old-fashioned and out-of-date.

As the 20th century closed, the failing of many “miracle” medicines prompted a search for alternative treatments. The decreasing effectiveness of antibiotics, in particular, spurred this search for replacements. For example, the rise in popularity of Echinacea (a common herb use to treat colds and flu) can be traced to the decline of antibiotic usage.

Contemporary Use of Complementary and Alternative Medicine

Determining how many people currently use complementary and alternative medicine is difficult. If prayer used as a medical treatment is considered a CAM therapy, then it is estimated that over 50% of the people in the United States use some from of alternative medicine; without including prayer, that number is around 20-30%. The use of CAM varies across religious, cultural, and racial sub-groups, but remains around the 30% range for people in the United States.

A study conducted by the prestigious Journal of the American Medical Association found that people who use alternative medicine tend to be more educated and in poorer health than individuals who use traditional therapies. Participants in the study reported that chiropractic, lifestyle/diet, exercise/movement and relaxation therapies were the most commonly used CAM treatments.

Alarmingly, very few of the study participants used CAM in isolation; instead, they often mixed standard and CAM medications without alerting their doctor! This strategy is potentially very harmful! Many complementary and alternative medicines can interfere with conventional medications. In addition, many CAM therapies lack studies determining their potential for interaction effects (serious side effects occurring when drugs are combined). It is always a good idea to inform your doctor about all medicines you are taking, CAM or otherwise. It is also typically a good idea to seek professional guidance from a Naturopathic Physician or similarly trained alternative health care provider before selecting and using natural medicines as treatments for complex health problems.

The most common reasons for a visit to a CAM practitioner are back pain or back problems, head or chest colds, neck pain or neck problems, joint pain or stiffness, and anxiety or depression. The number of people using CAM specifically for mental disorders is similar to the numbers of individuals seeking CAM treatment for other general conditions. In one study, 10% percent of patients with schizophrenia and 30% of patients with an affective disorder (major depressive disorder, bipolar disorders, and anxiety disorders) consulted an alternative care practitioner for either physical or psychiatric symptoms.

It is commonly thought that people visit CAM practitioners because they don’t like or are concerned about the side effects of standard medications. Patient surveys reveal that this isn’t so. Patients tend to choose CAM because it matches their values, beliefs, and philosophical orientation to life and health. In other words, dissatisfaction with conventional medicine does not necessarily predict who will use CAM.

While defining CAM medicine is hard, determining whether someone is a CAM practitioner is also difficult. A medical doctor may prescribe a vitamin to lessen the side effects of a drug. Is he practicing CAM medicine? Maybe or maybe not. Is a doctor who advocates exercising suggesting an alternative treatment? What about someone who recommends light therapy for seasonal depression? Clearly herbs and vitamins fall under the CAM umbrella, but what about yoga or dietary modifications? Or, what about a health care provider who offers an herbal preparation that has been concentrated to the point that it behaves more like a drug? Many drugs, such as digitalis (used for heart disease) are concentrated forms of natural herbs.

A medical doctor using herbs and vitamins may consider himself or herself a standard practitioner because the supplements he or she suggests are backed by scientific studies. Chiropractors or acupuncturists may also consider themselves standard practitioners and be insulted if they are labeled alternative. Acupuncture has been around for over 3000 years. Who is the conventional and who is the alternative practitioner when you look through the eyes of 3000 years of continuous practice?

Clearly, there is a lot of confusion and debate surrounding the definition of CAM medicine and CAM practitioners.

Choosing a CAM Practitioner

Not all CAM practitioners are created equal.

Choosing a CAM practitioner requires some investigative work. There is potential for harm from practitioners who don’t know what they are doing, who aren’t aware of the harmful side effects of what they are prescribing, and who are ignorant of the dangers associated with the course of different illnesses. Many seemingly innocent conditions, like a headache, drooling in a child with a cold, and gas and bloating in a post-menopausal woman all have the potential to be very serious. Is your CAM practitioner willing to refer you to standard medical care if the situation warrants it? Most good CAM practitioners have associations with standard medical practitioners; make sure to ask about this when interviewing a CAM practitioner.

When visiting any complementary and alternative practitioners, checking their background is essential. Many good CAM practitioners attend certified schools and are licensed by the state in which they live; however, other practitioners do not have such education and oversight. While attending a qualified school and being licensed does not necessarily guarantee that the practitioner is honest and knowledgeable, it does amount to some measure of safety. Passing a required exam ensures that a practitioner possesses a basic level of knowledge in the field. In addition, state boards often act as a secondary oversight of the practitioner and can strip them of their ability to practice if they fail to meet certain standards.

Most states license chiropractors and acupuncturists. In addition, naturopathic doctors attend qualified schools and are licensed in some states. Be aware, however, that some people call themselves naturopaths without ever attending a naturopathic medical school and this often leads to confusion.

If practitioners you are thinking of working with are licensed, ask to see their license. Check with the state licensing board if you have any questions about the health care provider, or their medical practices. Asking practitioners about their training and to provide references is also helpful.

If the practitioner is not licensed, then you have more work in front of you. Be more diligent about asking for references and training descriptions. As mentioned above, be certain to discuss relationships with standard medical professionals and what happens if the alternative therapies aren’t working. The severity of your illness is a good barometer for determining how extensively you should investigate the practitioner. A toenail fungus might be easily taken care of through a variety of practitioners; but cancer, heart disease, or severe mental illness require experts who have skill in treating those conditions. Mild depression or anxiety may be remedied with a trip to the health-food store, but self-medicating can often lead to trouble. Having a qualified CAM practitioner and a standard health care practitioner working together, on your behalf, can strengthen the odds that you are getting the best quality of care.

Alternative medicine is the medicine of many different names. The therapies that this medicine encompasses are constantly shifting and dependent on opinion and perspective. Consider the following list: acupuncture; biofeedback training; chiropractic; exercise; energy healing; herbal remedies; homeopathic treatment; hypnosis; imagery or relaxation techniques; massage therapy; nutritional/dietary advice; spiritual healing or prayer; traditional medicine (for example, Chinese or Indian medicine); meditation, vitamin therapy, and yoga. It is difficult to coin one term, which covers this entire list of diverse practices.

Some practitioners prefer the term Natural medicine. This term, however, can be somewhat misleading. While many of the products that are used in this type of medicine come from nature, many do not. For example, S-adenosyl-L-methionine (SAMe), a typical CAM remedy, doesn’t grow on a tree but is found circulating in our blood. However, it must be manufactured/synthesized in large quantities in a laboratory before it can be used as a natural medicine therapy. Likewise, how natural is it to supplement with vitamins and minerals, which are also manufactured products? In addition, the term “Natural Medicine” does not capture practices such as acupuncture, massage, light therapy and many other common CAM treatments.

Other practitioners prefer the term Complementary medicine. This word suggests a type of medicine, which complements standard medical practice. This term has been combined in recent years with alternative medicine to produce another term: Complementary and Alternative Medicine (CAM). CAM practitioners offer treatments that are either an alternative or a complement to standard medicine.

Integrative medicine is latest term used to describe this approach. Many practitioners feel that “integrative” more accurately describes the collaboration between standard and alternative medicine, rather than assuming one (standard) is better than the other.

Complementary and alternative medicine is probably the most accurate description of this style of practice, and is the term, which will be used throughout this article. CAM describes an approach that (at times) can stand on its own as an alternative to standard medicine, and at other times is used as an adjunct (add-on) to standard medicine. Many CAM supplements help standard medications work better or reduce their side effects.