Blackmores Institute

In response to a call from The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) for the development of a comprehensive set of clinical guidelines in the area of ‘Integrative and Complementary Medicine’, in March 2022 a taskforce was established to develop and publish a set of guidelines for the use of nutraceutical and phytoceuticals for the management of psychiatric disorders.1These guidelines offer natural medicine alternatives and adjunctive therapeutic options to practitioners for the management of mental health conditions. There is a lot to unpack in these comprehensive guidelines, however, they provide practitioners with the reassurance that they can maintain an evidence-based practice when supporting patients with psychiatric conditions by using naturaceuticals and phytoceuticals. The guidelines provide an analysis of the efficacy of each therapeutic and include: <ul><li>Dosage recommendations</li><li>Suitability for special populations </li><li>Adverse effects and tolerability </li><li>Safety profile </li><li>Pharmacokinetic and pharmacodynamic interactions </li><li>Information on supporting research1</li></ul> Each therapeutic was also assessed for its benefit as a monotherapy or adjunctive therapy.1 While not all nutraceuticals and phytoceuticals were found to be beneficial across all of the different conditions, effective therapeutics for the treatment of the following conditions were identified: <ul><li> Major depressive disorder (MDD) </li><li> Bipolar Depression </li><li>Obsessive Compulsive Disorder (OCD) </li><li>Generalised Anxiety Disorder (GAD) </li><li>Schizophrenia </li><li>Attention Deficit Hyperactivity Disorder (ADHD)
 
 </li></ul><h3>Nutraceutical for psychiatric treatment </h3>Nutraceuticals are nutrient-based products standardised as part of the pharmaceutical Good Manufacturing Process (GMP).1A summary of three nutraceuticals with promising prescriptive support for psychiatric treatment were: <ul><li>Adjunctive omega-3 was found to be beneficial for the management of MDD and may support bipolar depression.¹</li><li>The connection between vitamin D and depression was weakly recommended with adjunctive or monotherapy vitamin D found to treat MDD and attention deficit hyperactivity disorder (ADHD). </li><li>Folate in the form of methylfolate provisionally recommended for the treatment of both the negative symptoms of schizophrenia and MDD¹
 
 </li></ul><h3>Phytoceuticals for psychiatric treatment </h3>Phytoceuticals involved in the guidelines include both whole plant-medicines and isolated constituents forming plant-based natural products, standardised as part of pharmaceutical GMP.1Three phytoceuticals identified as having therapeutic benefit for psychiatric conditions were: <ul><li>St John’s Wort in the management of MDD - the study identified St John’s Wort to be better than placebo¹</li><li>Monotherapy saffron, another known phytoceutical for the treatment of MDD was provisionally recommended as beneficial for MDD management, with the study calling for further research into saffron’s benefits with MDD¹</li><li>Adjunctive and monotherapy ashwagandha (withania somnifera) efficacy was identified in three randomised control trials for the treatment of generalised anxiety disorder (GAD) and is provisionally recommended in the guidelines¹</li></ul>Caution is recommended when practitioners prescribe nutraceuticals or phytoceuticals as monotherapies, with the recommendations stipulating that monotherapies only be considered for patients with severe MDD, bipolar disorder and schizophrenia when used with conventional care in the absence of contraindications for their adjunctive use for prescribed psychotropic medications.1In addition to the provision of the guidelines, the paper discusses the use of therapeutics in special populations in detail and stresses the importance of using reputable manufacturers when choosing natural supplements to ensure quality and standardisation for the best therapeutic result. References:<ol><li>https://www.tandfonline.com/doi/epub/10.1080/15622975.2021.2013041</li></ol>

On the back of the pandemic, there has been a new wave of Australians accessing mental health support services - 13% of Australians sought mental health support from their general practitioner in 2020-2021.

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