67 natural therapies. 1,796 randomized trials. Dosing, risks, and lab-tested products.
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 on to something.
How I Wrote It
I gathered every randomized, placebo-controlled trials on CAM therapies for psychiatric disorders. For each indication, I rated the evidence as confirmed, probable, or possible, based on the size and outcomes of the trials. A large excel spreadsheet was my daily grind.
Next, I studied the risks, mechanisms, drug interactions, and medical benefits. For product recommendations, I relied on 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 ran the fact sheets through OpenEvidence to see if I’d missed ― or misinterpreted ― any trials.
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 the top “confirmed” treatment, like lavender oil for generalized anxiety disorder. But most patients have multiple problems ― medical and psychiatric ― and here the book helps you personalize the treatment. Here are some examples where CAM therapies have more than one potential benefit:
| 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 shows you 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’m not particularly interested in CAM, but I do care about what works for patients. The book passes over promising theories in favor of clinical trials. How we categorize treatments has more to do with legislation than science. Bupropion, valproate, and varenicline were derived from plant medicines, and lithium has been CAM all along.
The book does emphasize four categories that tell us something about the safety record. Here they are, in order of safety:
- Lifestyle: Exercise, diet, light, environment
- 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
How it Changed My Practice
I thought I knew CAM when I set out to write this, but I learned so much more. Now I’ll use magnesium in alcohol use disorder to protect the liver. I understand how to use adaptogens for symptoms of acute stress. I know when to test for iron and how to time melatonin, and which therapies have secondary benefits for symptoms that matter to my patients, like sleep, sex drive, and cognition.
And I have a better sense of what’s dangerous and what doesn’t work (there are chapters on that at the end).
Sample Pages
Read more sample pages. Purchase from Carlat or Amazon.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
