Searching for new therapies on a tropical farm, PubMed in hand
BOOK: Aiken C, Complementary and Alternative Medicine in Psychiatry, 2026
TYPE: A Carlat fact book
FUNDING: I have a major conflict of interest on this one
Background
The first Carlat Psychiatric Medication Fact book came out in 2007, followed by editions on child, geriatric, and hospital psychiatry. Last year, I set out to add complementary and alternative medicine (CAM) to the list.
I planted myself on a farm in Bali and set to work. Tropical flowers scented the air and turmeric sprang from the ground. My host showed me how he boiled the turmeric roots to treat COVID during the pandemic, and PubMed told me he was onto something.
At the Gates of Heaven at Lempuyang Temple in Bali, Indonesia
How I Wrote It
A large excel spreadsheet was my daily grind, as I tallied close to 2,000 randomized, placebo-controlled trials for 67 CAM therapies. For each psychiatric use, I rated the evidence as confirmed, probable, or possible, based on the size and results of the trials.
Next, I studied the risks, drug interactions, mechanisms, and medical benefits. For product recommendations, I turned to independent labs like ConsumerLab, NSF International, Labdoor, and the US Pharmacopeia, ranking the ones that passed by price.
It was all manual labor. At the end, I fed the fact sheets into OpenEvidence for robot assistance, checking for trials I missed or misinterpreted. Richard Brown, MD and the Carlat editorial staff gave a final review.
Bravo! The wave of evidence for-and against-CAM treatments is distilled by one of my favorite voices in psychiatry.
― Drew Ramsey, MD, author of Healing the Modern Brain and Eat to Beat Depression and Anxiety
How to Use it
If your patient has one disorder, start with a “confirmed” treatment, like lavender oil for generalized anxiety disorder. But most patients have several problems, and that’s where the book helps personalize the treatment. Here are some examples where therapies cover multiple bases:
| Irritability, ADHD, acne, and elevated triglycerides | Omega-3 fatty acids |
| Bipolar depression, nicotine use, and wants to prevent renal problems on lithium | N-Acetylcysteine |
| Autism, anxiety, obesity, and irritable bowel syndrome | Probiotics |
| Depression, insomnia, and sexual dysfunction | Saffron |
| Tremor, akathisia, and elevated prolactin on an antipsychotic | Vitamin B6 |
The book covers risks and how to manage them, like using the active form of vitamin B6 to prevent neuropathy.
When my colleagues at the NIMH started testing light therapy, I laughed. When I saw the trial results, I learned never to laugh at a novel idea.
― Robert Post, MD, former chief of the NIMH’s Biological Psychiatry Branch
Why CAM?
I don’t have a special interest in CAM. I do care about what works for patients, so this book favors clinical trials over promising theories. Whether a therapy gets categorizing as standard or alternative is a bit arbitrary. Lithium is a medicine, but magnesium is a mineral, and standard pharmaceuticals like bupropion, valproate, and varenicline got their start as plant medicines.
There are a few categories that matter, however. The book sorts treatments based on how natural they are to the body, as that gives a hint of its safety record:
- Lifestyle: Exercise, diet, light, environment; not only safe, but good for health
- Nutraceuticals: These are already in the body, like vitamins, minerals, and fatty acids
- Phytochemicals common in diet: Plant-based medicines like ginger, cocoa, and l-theanine
- Phytochemicals not found in diet: Ashwaganda, chasteberry, and ginseng
Complementary and alternative medicine approaches can add new insights and results in difficult-to-treat patients. Dr. Aiken is the right physician to endorse and prioritize these multiple approaches.
― Robert Post, MD, former chief of the NIMH’s Biological Psychiatry Branch
I thought I knew CAM when I started, but I learned far more. I now use magnesium to protect the liver in alcohol use disorder. I understand how adaptogens help in acute stress, relieving anxiety while improving functioning. I know when to test for iron, how to time melatonin, and which therapies have additional benefits for symptoms my patients care about, like sleep, sex drive, cognition, obesity, and skin wrinkles.
I also have a clearer sense of what is dangerous or ineffective. There are chapters at the end on that.
Sample Pages
Read more sample pages. Purchase from Carlat or Amazon.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
