Complementary herbal and alternative drugs in clinical practice.

TOPIC. Complementary and alternative medicine agents (CAMs) PURPOSE. To summarize the current empirical data about the major CAMs purporting to have psychotherapeutic value. SOURCES OF INFORMATION. Extant literature. CONCLUSIONS. Available evidence indicates that CAMs, while generally safe, are not risk free. While CAM use grows, nurses and other health professionals have a limited knowledge base about the action, side effects, and interactions of common CAM agents. Nurses need to increase their knowledge base about CAMs in order to help patients in decision making regarding the use of these agents to treat common psychiatric symptoms. Search terms: Alternative treatments, CAMs, herbal agents ********* From depression to dementia, Americans are increasingly self-medicating symptoms and illnesses with a wide array of herbal, or complementary and alternative medicines (CAMs) as these agents are known. CAMs are becoming an increasingly popular way to treat a wide array of healthcare concerns, many of them psychiatric in nature. CAMs represent a broad range of healing-oriented therapies that can be used as either a complement to, or an alternative for, traditional medical treatment. The 1994 Dietary Supplement, Health, and Education Act (Ramsey, Ross, & Fischer, 2000) classified almost all CAM agents as "dietary supplements," allowing them to avoid regulation by the Food and Drug Administration (FDA). Yet, while CAMs are available to anyone, without prescription and regardless of age, an increasing body of evidence supports these agents have clinically significant side effects and potential drug-drug interactions. With patients using more CAMs, healthcare providers are increasingly needing to gain a broader understanding of the use, efficacy, and risks of CAM agents. This article examines the common CAM agents used for psychiatric-related symptoms and summarize the current empirical data about the major CAM agents purporting to have psychotherapeutic value. What Are the Facts About CAMs? CAMs are perhaps most distinguished by their lack of acceptance by mainstream Western medicine. Because of this, most healthcare providers do not commonly prescribe or embrace the use of these agents (Fetrow & Avila, 1999). With little mainstream acceptance, little empirical study has occurred and, therefore, few hard data exist regarding the efficacy of CAM agents (Fugh-Berman, 2000). Yet despite the lack of acceptance and testing by health professionals, patients are buying more and spending more on CAM agents than ever before. It is estimated that 42% of American adults use CAM agents, reflecting an increase from 34% of adults in 1993 (Eisenberg et al., 1993, 1998). Increased use means increased cost, and Americans spent $27 billion in 1997, exceeding out-of-pocket hospitalization spending for the use of these agents (Fetrow & Avila). Considered natural products, CAMs are viewed by most consumers as safe, yet many side effects and potential drug-drug interactions have been identified. This is problematic when one considers that most patients using CAMs do not inform their healthcare providers (Weiss & Takakuwa, 2001). Given that conservative estimates indicate that 80% of the world's population uses a CAM for medicinal purposes, the issues surrounding CAM use are multiple for providers and consumers (Fetrow & Avila). The most commonly used CAMs are herbal preparations, sometimes referred to as "botanicals" or "phytomedicine," and the largest empirical knowledge base exists for these CAM agents. Megadose vitamin and mineral agents are the second most popular group of CAM agents, and a much smaller, far less clear knowledge base exists for these agents. Table 1 identifies the most common complaints for which people take CAMs, along with the common CAM agents used to treat those health concerns. …