Integrative Mental Health Psychotherapy Networker Symposium 2013 Rubin Naiman, PhD

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1 Integrative Mental Health Psychotherapy Networker Symposium 2013 Rubin Naiman, PhD Program Handouts CONTENTS Page I. The Basic Tenants of Integrative Medicine 1 II. Integrative Mental Health Screening Guide 2 III. IV. Nutrition for Mental Health A. The Anti-Inflammatory Food Pyramid 3 B. Basic Nutrients for Mental Health 4 C. Omega 3 Fatty Acids 4 Botanical & Nutraceuticals for Mental Health A. Botanicals and Nutraceuticals for Anxiety 4 B. Additional Herbs for Anxiety 5 C. Botanicals and Nutraceuticals for Depression 5 D. Adult Dosages for popular CAM Sleep Aids 5 V. Commonly Used Meds that Can Interfere with Sleep 6 VI. Rubin Naiman, PhD - brief bio 6 VII. Recommended Readings and Web Resources 7 I. The Basic Tenets Integrative Medicine Andrew Weil, MD 1. Sees the healing process as partnership between patient and practitioner 2. Uses conventional and CAM to facilitate the body's innate healing 3. Considers all factors impacting health: body, mind, spirit, and community 4. Neither rejects conventional medicine nor accepts CAM uncritically 5. Recognizes that good medicine is scientific and open to new paradigms 6. Uses natural, effective, less-invasive interventions whenever possible 7. Emphasizes health promotion and disease prevention as well as treatment 8. Trains practitioners to be role models for healthy living 1

2 II. Basic Integrative Mental Health Screening Guide* Rubin Naiman, PhD Clinical Assistant Professor of Medicine University of Arizona Center for Integrative Medicine BIOMEDICAL FACTORS 1. Illnesses: chronic inflammation, obesity, diabetes, CVD, cancer, etc. 2. Medications: energetic and psychological side effects, 3. Nutrition & Supplements: general nutrition, essential supplements, 4. Exercise: extent and limitations, 5. Substances: ETOH, tobacco, marijuana, other, ENVIRONMENTAL FACTORS 1. Nature Exposure: entrainment, nature deficit, 2. Toxic Exposure: home, neighborhood, 3. Light/darkness: Outdoor light exposure, LAN (light at night) exposure, 4. Circadian rhythms: sleep-wake schedule, life pace, PSYCHO/SOCIAL FACTORS 1. Relaxation: yoga, meditation, breathing, lightheartedness, 2. Social Life: family, relationship, friends, community, 3. Psychospiritual: religious life, spiritual beliefs, forgiveness, surrender 4. Sleep: quality, quantity, daytime sleepiness, fatigue, 5. Dreaming: extent, recall, nightmares, * This form is designed to complement standard psychotherapy screening and evaluation approaches by identifying areas requiring further evaluation, referral and intervention. 2

3 III. Nutrition for Mental Health A. The Anti-Inflammatory Food Pyramid Andrew Weil, MD 3

4 B. Basic Nutrients for Mental Health - Vitamin D: Deficiency associated with depression, as well as a host of other diseases. Dr. Weil recommends 2,000 IU of vitamin D3 daily with the largest meal - B vitamins: The B vitamins, especially folic acid and vitamin B6, may be helpful in mild depression; B vitamins can increase the efficacy of prescription antidepressants; B-12 deficiency associated with fatigue. - Minerals: calcium, phosphorus, magnesium, potassium, selenium, etc. C. Omega 3 Fatty Acids - Significant data links low levels of EPA & DHA to wide range of mental disorders - Can be effective for bipolar disorder, ADHD, postpartum depression, SADS, MDD, etc. - Can also help prevent depression & enhance emotional well-being - High doses of 20 grams/day or more used without any ill effects - Dose: 2-4 gm/day including both EPA & DHA (more of the former) on full stomach - Avoid products with omega-6 or omega-9 fatty acids - Use brands that are "molecularly distilled" or free of toxic contaminants - Possible contraindications around bleeding and blood thinners IV. Botanical & Nutraceuticals for Mental Health A. Botanicals and Nutraceuticals for Anxiety - L-Theanine: neurologically active amino acid extracted from green tea potent anti-anxiety properties - Lemon balm: anti-anxiety and sleep promotion; usually combined with other herbs - Kava kava: for daytime relief of anxiety properties, also helps promote sleep concerns re liver toxicity - Valerian for the treatment of anxiety and insomnia functions as a sedative and analgesic safe to use for short periods of time; long-term effects are not known 4

5 B. Additional Herbs for Anxiety - Ashwaganda: a primary strengthening tonic in Ayurveda - California poppy: a potent tranquilizer - Chamomile: a gentle nervine that also settles the stomach - Ginkgo biloba: increases circulation in the brain - Ginseng: energy booster, adaptogen - Hops: muscle relaxant, helpful with sleeplessness - Passion flower: a gentle sedative, reduces tension, promotes sleep - Fennel: reduces anxiety-related gastrointestinal upset - Peppermint: soothes upset stomach and is generally calming - Skullcap: reduces anxiety and tension and promotes sleep C. Botanicals and Nutraceuticals for Depression - St.-John's Wort: Long history of folk use for depression and anxiety. For treatment of mild to moderate forms of depression Fewer side effects that prescription antidepressants May improve sleep quality - SAMe A derivative of a natural amino acid Found "superior to placebo and as effective as TCAs Works more quickly than St John's Wort D. Adult Dosages for popular CAM Sleep Aids Melatonin: mg min before bed, preferably sublingual & sustained release Valerian: mg standardized extract of 0.8% valerenic acid; or as a tea of 2-3 grams of dried root steeped for minutes; take min before bed for 2-4 weeks to determine effectiveness Hops: in a 5:1 ethanol extract, 1 2 to 1 dropper full, min before bed Tryptophan: 1-3grams; 5-HTTP: mg; PS: mg; GABA: mg L-theanine (2-300mg); Lemon balm (500mg); Passion flower (500mg) Olfactory agents: Lavender and Jasmine 5

6 V. Commonly Used Medications / Substances that Can Interfere with Sleep Alcohol Antiarrhythmics Anticonvulsants Antihistamines Appetite suppressants Benzodiazepines Bronchodilators Caffeine Carbidopa/levodopa Corticosteroids Diuretics Decongestants Estrogen Lipophilic beta blockers Monoamine oxidase inhibitors Nicotine Pseudoephedrine SSRI s Sedatives Statins Sympathomimetics Tetrahydrozoline Thyroid hormones Tricyclic antidepress VI. Rubin Naiman, PhD - Brief Biography Rubin Naiman, PhD is a psychologist, clinical assistant professor of medicine and the sleep and dream specialist at the University of Arizona's Center for Integrative Medicine, directed by Dr. Andrew Weil. He is director of Circadian Health Associates, an organization that offers sleep related services, training and consultation internationally. Dr. Naiman is also the director of the sleep and dream advisor board for Sleep Studio, LLC. He is a leader in the development of integrative medicine approaches to sleep and dream disorders, integrating conventional sleep science with depth psychological and spiritual approaches. Dr. Naiman is the author of a number of groundbreaking works on sleep, including Healing Night, Healthy Sleep (with Dr. Weil), To Sleep Tonight, The Yoga of Sleep, Ask the Sleep Doctor, The Nature of Sleep as well as professional book chapters. (See 6

7 Suggested Readings VII. Recommended Readings and Web Resources Breggin, Peter. Psychiatric Drug Withdrawal. Springer, Chaisson, Ann Marie. Energy Healing For Beginners: Ten Essential Practices for Self- Care. Sounds True, Lake, James H. Textbook of Integrative Mental Health Care. Thieme, Low Dog, Tieraona. Life Is Your Best Medicine: A Woman's Guide to Health, Healing, and Wholeness at Every Age. Maizes, Victoria. Be Fruitful: The Essential Guide to Maximizing Fertility and Giving Birth to a Healthy Child. Scribner, National geographic, Naiman, Rubin. Healing Night: The Science and Spirit of Sleeping, Dreaming and Awakening. Syren, Pert, Candace. Your Body Is Your Subconscious Mind. Sounds True, Rakel, David. "Depression," in Integrative Medicine, Elsevier, Weil, Andrew, Integrative Mental Health: Huffington Post, March 15, Weil, Andrew. Spontaneous Happiness. Little, Brown & Co Selected Web Resources Dr. Andrew Weil s website: Arizona Center for Integrative Medicine: Holistic Online: James Lake, MD s website: The Vaults of Erowid: Psychiatric Drug Facts: Peter Breggin: Integrative Sleep and Dream Medicine Health: Integrative Mental Health Conference: 7

SLEEP DISORDERS

SLEEP DISORDERS 17.03.2013 Well this is a problem that is close to my heart, because for most of my life I have had problems sleeping. Many nights I have watched with envy as my husband goes to bed and