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June 2007

An NSAID for Schizophrenia?
Adjunctive celecoxib (Celebrex) may be beneficial for treating schizophrenia.

Psychotropics and Fracture Risk
Patients (especially elderly ones) taking psychiatric medications are at increased risk for fractures.

Riluzole Augmentation for Depression
Preliminary evidence suggests riluzole (Rilutek) may be helpful in treating mood and anxiety disorders.

CBT Beats Zopiclone for Insomnia in Elderly
Cognitive behavioral therapy (CBT) was superior to zopiclone (Ambien) for chronic primary insomnia.

Alternative Medicines Are Commonly Used
Surveys show alternative medicines used by more than half of US population.

Hyponatremia with Antidepressants
Hyponatremia reported in patients treated with escitalopram (Lexapro) or duloxetine (Cymbalta).

In Brief
Dosing Strategies for Risperidone Long-Acting Injection; Deaths Associated with Methadone Treatment for Pain

Prolactin Levels and Associated Side Effects with Risperidone
Initial elevation of prolactin levels with risperidone (Risperdal) returns to normal with long-term treatment.

Mifepristone for Psychotic Depression?
Treatment with mifepristone (Mifeprex) improves psychosis but not depression in patients with psychotic depression.

rTMS: Inferior to ECT?
Repetitive transcranial magnetic stimulation (rTMS) is not as efficacious as electroconvulsive therapy (ECT) in patients referred for ECT.

Alternative Medicines Are Commonly Used

June 2007

Surveys find that more than half of the US population uses some form of complementary and alternative medicine. The most popular are chiropractic or other manual therapies (such as massage or acupuncture), medicinal herbs and teas, and vitamins and nutritional supplements. Two surveys bear this out.

In one, Wu and coauthors telephoned over 3000 women in the United States.1 Of 220 with depression, 54% reported use of complementary and alternative medicine in the past year. African-American women were less likely and non-Hispanic white women more likely to use these therapies. Reasons cited were a preference for a "natural" approach and lack of efficacy of previous traditional medicines or their unpleasant side effects.

In another project, Fang and Schinke surveyed 153 Chinese-American patients coming to an urban community mental health service.2 Eighty-two percent of them reported current use of complementary therapies—including mega-vitamins, herbal medicine, massage, acupuncture, and spiritual healing. Women were more likely than men to use these alternative approaches.

We reported in the past that some herbal treatments, such as St John's wort, can interact with prescription medications (BTP 2006;29:11-14). For biological, as well as psychosocial reasons, it behooves treating clinicians to ask patients—both initially and periodically—about their use of alternative and complementary medicines.

1Wu P, Fuller C, Liu X, Lee HC, Fan B, Hoven CW, Mandell D, Wade C, Kronenberg F: Use of complementary and alternative medicine among women with depression: Results of a national survey. Psychiatr Serv 2007;58:349-356.

2Fang L, Schinke SP: Complementary alternative medicine use among Chinese Americans: Findings from a community mental health service population. Psychiatr Serv 2007;58:402-404.