“It is more important to know what sort of person has a disease than to know what sort of disease a person has.” — Hippocrates (460-377 B.C.E.)
“The art of healing comes from nature and not from the physician. Therefore, the physician must start from nature with an open mind.” — Paracelsus (1493 – 1541)
Treatment options that have long been considered outside the mainstream are becoming commonplace: a survey shows that nearly two in five adults in the United States have tried complementary or alternative therapy in the last year. As clinicians, it is our job to work with the individual to find the best treatment, whether that is Prozac or folate, light therapy or cognitive behavioral therapy. Each individual is unique, and treatments should be as well.
In Holistic Solutions for Anxiety & Depression in Therapy: Combining Natural Remedies with Conventional Care, Peter Bongiorno offers a comprehensive overview of options for treatment of anxiety and depression.
Bongiorno is a doctor of naturopathic medicine and currently vice president of the New York Association of Naturopathic Physicians. This is only the most recent in a series of books he has authored; others include Healing Depression: Integrated Naturopathic and Conventional Treatments and How Come They’re Happy and I’m Not? In his latest, he walks the practitioner through the many components of naturopathic therapy, but stays accessible for readers interested in using complementary and alternative medicine (CAM) themselves.
“All practitioners working with anxiety and depression should note that, overall, patients generally do their best with the treatment they choose and believe in, whatever that may be,” Bongiorno writes. By working with the individual, rather than just writing a script that may never be filled, we have a much better chance of helping that person find a path of wellness.
Bongiorno lays out when he believes CAM treatment is appropriate (most cases) and when more traditional treatment may be a better option, at least initially (e.g., in cases of severe depression or incapacitating anxiety). When CAM therapy is not able to be used as the first line treatment, he endorses a team approach, writing that “team management by the patient’s prescribing doctor, therapist, and CAM provider … will afford the best overall care and allow for comanagement needed to consider future discontinuation of medications when appropriate.” It is with this balanced outlook that he engages readers.
After going over who should consider CAM, Bongiorno delves into a discussion of underlying causes of depression and anxiety, encouraging the examination of both external and internal factors. He explores things like sleep, diet, and sunlight and blood sugar, thyroid function, and the hypothalamic-pituitary-adrenal axis. Throughout, he offers guidance on how to improve issues, such as steps for ensuring a healthy digestive tract and reducing inflammation. He then discusses supplement options that target anxiety and depression, including possible benefits and risks for each.
Bongiorno also covers various mind-body therapies such as yoga, acupuncture, and massage. He includes guidelines for how to integrate CAM with traditional treatments to get the most out of both. To help the clinician pull this all together, he ends with a discussion on designing individualized treatment plans that draw on various aspects of the CAM toolkit.
The end of the book includes a series of useful appendices, including recommended blood tests for an initial workup and further resources. It also includes a quick reference guide to supplements for anxiety and depression that include typical doses, side effects and toxicities, along with a similar guide to homeopathic treatments.
This book is extensively researched. As someone who likes to see the data behind the claims, I appreciated Bongiorno’s decision to include the results from primary research in his discussion of the risks and benefits of various treatment options.
In terms of research, CAM therapies can be at a disadvantage, as there are not the same financial incentives to exploring the effectiveness of acupuncture as there are in discovering the next blockbuster pill. That said, there is increasing interest in this field and Bongiorno does an excellent job integrating studies into the text without sacrificing overall readability.
My one (small) complaint is that while the book does give credit to the role of what Bongiorno terms “conventional biomedicine,” there is a slight bias in how he describes some of the risks behind these treatments. For instance, with one treatment, he cites a 45 percent increased risk of stroke in postmenopausal women. While this is what the study found, in absolute numbers, the risk goes from 0.29 percent to 0.41 percent per year. Significant? Sure, and something to be considered, but maybe not as concerning as that 45% increase would suggest.
Still, overall, this is a well-written book that serves as an excellent reference for those trying to better understand the role of CAM therapy and how to utilize these treatments, be it alone or integrated with more traditional options.
Holistic Solutions for Anxiety & Depression in Therapy: Combining Natural Remedies with Conventional Care
W. W. Norton & Company, March 2015
Hardcover, 416 pages