By NANCY KEATES

From lobotomies with ice picks to early antidepressants that caused brain hemorrhaging, Americans have a complicated and ever-changing approach to treating mental illness. Now, spurred by the growing disenchantment with antidepressants, an increasing number of people are seeking treatment for depression, anxiety and eating disorders from naturopaths, acupuncturists and even chiropractors. At the same time, more traditional psychiatrists are incorporating massage and meditation in their practices.

The treatments go beyond needles and spinal manipulation. They include Emotional Freedom Techniques -- tapping on the body's "energy meridians" as the patient thinks about upsetting incidents -- and craniosacral therapy, which involves a gentle rocking of the head, neck, spine and pelvis. In cranial electrotherapy stimulation, a AA-battery-powered device sends mild electrical currents to the brain. (The procedure has its roots in ancient Greek medicine, when electric eels were used.) Clinicians are also prescribing supplements like omega-3 fatty acids, found in fish oil, or amino acids like L-theanine, found in green tea.

Sarah Spring had been in therapy with a psychiatrist and on the antidepressant Wellbutrin for four years to work through a childhood trauma, but felt she wasn't making any progress. So she went to a naturopath -- a practitioner trained in holistic therapy and alternative treatments like herbal medicine and nutrition. (They attend a four-year naturopathic school -- a bachelor's degree is a prerequisite -- but only 15 states license naturopaths.) After two sessions of Emotional Freedom Techniques, the tapping treatment that is meant to clear emotions and restore balance, Ms. Spring says she doesn't get the same shortness of breath and accelerated heart rate she used to. "It's remarkable," says the Portland, Ore., marketing manager, who just started to decrease her dose of Wellbutrin.

To address the growing interest from professionals, Harvard Medical School's Department of Continuing Education will have three classes on complementary and alternative medicine in psychiatry over the next year, up from one a year since the class was introduced in 2003. David Mischoulon, an assistant professor of psychiatry at Harvard, says doctors who have attended the class report that more patients are asking for alternative treatments -- due to the side effects of antidepressants, as well as a lack of response to the medication. Only about half of patients who take antidepressants respond, he says. "It is time to broaden the horizons," he says.

But there is no proof that many of these methods work for treating mental illness. One large study found Emotional Freedom Techniques were no more effective than a placebo, while evidence is limited for acupuncture and fish oil (thought to reduce some types of depression) in the treatment of mental health problems. Using herbal supplements with conventional medicine can be dangerous, psychiatrists say. "There are always snake oil salesmen," says Carolyn Rabinowitz, president of the American Psychiatric Association.

Traditional therapists worry that alternative treatments might sway patients to give up conventional treatments too quickly. "People with very little data often say, 'This works,' " says Philip Muskin, Chief of Consultation-Liaison Psychiatry at Columbia-Presbyterian Medical Center in New York. A psychiatrist and trained hypnotist, Dr. Muskin believes that wellness techniques like yoga, herbs and acupuncture can make people feel better psychologically. But he says alternative providers don't have adequate training to diagnose or treat severe mental-health disorders. "Many think if you get your liver and spleen into the right balance that will help," he says.
Safety Concerns

In any one-year period, 9.5% of the population, or about 20.9 million American adults, suffer from a mood disorder, according to the National Institute of Mental Health. A study by the World Health Organization, Harvard University School of Public Health and the World Bank found that by the year 2030, depression will be second only to HIV/AIDS in terms of disability caused world-wide.

A backlash against antidepressants sparked by concerns about their safety, efficacy and side effects is helping drive patients to alternative methods. Some 80% of antidepressants are currently prescribed by primary doctors who often diagnose depression in a 20-minute visit and don't provide accompanying therapy or help manage side effects.

Sales of all classes of antidepressants were $13.5 billion in 2006, down from a peak of $13.8 billion in 2004, according to IMS Health, a health-care information company. Usage of selective serotonin-reuptake inhibitors (SSRIs) dropped in 2005 after warnings about side effects -- particularly the risk of suicidal behavior in people aged 25 and under, which prompted the Food and Drug Administration to order drug makers to add warnings to their packaging in 2004. The introduction of generics onto the market (most recently, for Zoloft) also contributed to lower sales.

A spokesman for the Pharmaceutical Research and Manufacturers of America says pharmaceuticals like antidepressants undergo a rigorous assessment of benefits and risks by the FDA. Other methods have been used to treat depression historically, he says, but pharmaceuticals do and will continue to play a large role in therapy.

At the same time, the rise of managed care and changes in Medicaid and Medicare have resulted in companies paying far less for mental health coverage. Employer spending on mental health care dropped to 1.3% of an employee's medical care costs in 2006, from 10.9% in 1988, according to employee-benefits firm Towers Perrin. While most employees with health insurance have some mental-health coverage, only 13% have coverage for an unlimited number of outpatient visits to providers such as psychiatrists, psychologists and social workers, says a 2006 survey of employers by the Kaiser Family Foundation. That's down from 19% in 2004. Most insurance policies pay for a limited number of visits, often 20 or 30 per year, and some put a cap on the dollars they'll pay.

Over the past decade, insurers have started covering more alternative procedures. Plans vary, from unlimited visits to 12 or 20 visits per year, according to Doug Metz, Chief Health Services Officer at American Specialty Health, which runs complementary medicine benefits plans for insurance companies. Co-payments typically run $10 to $20, and plans limit the reasons for visits to scientifically proven techniques -- which generally does not include treatments for mental health. While coverage for visits to naturopaths is mandated by law in Connecticut, Vermont and Washington, employers can still limit the number of visits and restrict it to a network.

Aetna, for one, will cover acupuncture used to treat migraine headaches or chronic lower back pain, but not for depression; it will cover biofeedback for migraines, but not stress. The options are growing: Starting this month, members can get at least 25% off standard fees for visits to an approved list of 19,000 credentialed "natural therapy professionals," including massage therapists and dietetic counselors, for any condition. (Standard fees for a first-time acupuncturist visit can be $90 to $120.)

The shift comes as scientific research sheds new light on the causes of depression. The use of SSRIs, introduced in the 1980s, aim to increase levels of serotonin in the brain. More recent research suggests that a range of factors -- including genetic predisposition and hormones linked to stress -- can play a role.

Proponents of alternative medicine say the wide range of treatments used address broader causes like hormonal imbalances and stress. Treatment can mean spending time talking to patients about their physical and emotional problems, examining their diet and exercise habits, and doing blood tests to look for medical or environmental causes for depression, such as Lyme disease, toxic chemicals or mold.

In Los Angeles, naturopath Holly Lucille has seen 30% more patients in the past two years whose chief complaint is mental-health-related, while Sara Thyr, a naturopath in Manchester and Concord, N.H., has seen a 20% rise. Margot Longenecker's naturopathy practice in Branford and Wallingford, Conn., now has half of its patients come for anxiety and depression, compared with 25% three years ago.

"Half the time you feel like you have a psychiatric degree more than a chiropractic degree," says Basking Ridge, N.J., chiropractor Jerry Szych, who's seen a 25% rise in patients seeking counseling services over the same period. Columbus, Ohio, chiropractor Ronald Farabaugh says he has seen an increase of 20% over the past three years in those cases.

Melissa Mannon, a 36-year-old photographer in Bedford, N.H., saw psychologists for years about her depression and anxiety. Then she visited a naturopath for help with infertility, and was diagnosed with an intolerance to 90 different foods, including gluten. She changed her diet and within seven months, she got pregnant and most of her anxiety and depression went away, she says. She still sees her naturopath if she's feeling down and to discuss what's happening in her life. "She understands me," says Ms. Mannon.

Some say the extra time and intimacy of the treatments can encourage patients to open up. Naturopath Mark Sanders, who has seen the number of patients coming for mental health rise threefold to about 60% since he started his practice five years ago, says patients tend to open up when he performs craniosacral therapy. (It is meant to ease stress and improve physical movement.) "I've had people tell me stuff they don't tell their therapist," he says.

Stanford University Medical School clinical professor of medicine Kenneth Pelletier says chiropractors and naturopaths aren't adequately trained to recognize true psychopathology. But Dr. Pelletier believes most of these practitioners are ethical about remaining within the scope of their practice and refer patients to licensed mental-health-care practitioners when they think the diagnoses are severe.

That's what Portland, Ore., naturopath Samantha Brody has been doing as she increasingly sees patients with eating disorders, anxiety and depression. While the stigma of seeing a shrink may have declined in cities like New York and Los Angeles, it is alive and well in Portland, and some patients won't follow up on her referrals. Still, Ms. Brody steers away from serious counseling. "I don't dig into childhood stuff," she says.

Cheryl Higgins started seeing Ms. Brody three years ago for acupuncture because her back hurt. She was also driving her friends crazy by trying to use them as therapists and needed an outlet for her anxiety and depression. "I spilled my guts to her at the first session," says the 26-year-old office manager. Her treatment: chemical and amino-acid supplements, plus acupuncture three times a week.

Ms. Higgins hesitated to follow Ms. Brody's referral to a psychologist, but eventually she did see one who recommended that her primary care doctor put her on an antidepressant. She went on Lexapro for nine months, then went back to the naturopath to help her get off of it. "It made me yawn all the time," she says.

While the research is limited, some studies have shown promise in using alternative methods to treat mental illness. A recent study at Boston University School of Medicine and McLean Hospital in Belmont, Mass., showed a neurochemical response to the practice of yoga that's similar to neurochemical responses seen when people are treated with antidepressants.

Even pharmaceutical companies are starting to look at ingredients that have traditionally been part of natural medicine. Last year, Novartis bought the U.S. rights to a drug called agomelatine -- a melatonin-related agonist that is thought to influence mood in part through the sleep-wake cycle.

Of course, alternative medicine has been used for mental health issues for years. A 2001 study by Ron Kessler and David Eisenberg at Harvard Medical School found that among those with anxiety and or depression, more than half used alternative medicine therapies; among those who sought the treatment of a licensed conventional provider, two-thirds also used alternative medicine during the prior year. The perceived helpfulness of the alternative therapies was similar to the perceived helpfulness of conventional therapies.

Some critics say the growing interest is, in a sense, a step backwards. As people become frustrated with the shortcomings of new treatments, they become more inclined to try age-old therapies, regardless of whether they've been rigorously tested. The treatment of depression is "a constant succession of hyped theories and overall pathetically little progress," says John Horgan, director of the Center for Science Writings at the Stevens Institute of Technology in Hoboken, N.J.
Serious Applications

Now, community clinics are using the approach. The Mental Health Center of Greater Manchester, N.H. -- which combines traditional psychiatry with naturopathic treatments for seriously mentally ill patients -- received a two-year grant last summer from the New York-based Ittleson Foundation to promote the intermingling of naturopathy and psychiatry. "It's just a better way to approach the problem," says Ronald Parks, an internist and psychiatrist in Asheville, N.C., who uses alternative methods and was just approached to create a community-based model near his practice.

Aliza Sherman Risdahl agrees. She began experiencing uncontrollable rage, irritation and anxiety after the birth of her daughter. Though the 42-year-old Anchorage, Alaska, consultant was already seeing a therapist, she didn't want to go on antidepressants. She turned to a naturopath, who diagnosed her with overactive adrenal glands and suggested an amino acid to spray under her tongue.

Now she's no longer throwing dirty plates from the dinner table up in the air, screaming at her husband to "give me the baby, you can't keep her from me!" and running through the house slamming doors and cursing at him. "I am so grateful," she says.

We frequently criticize the media for gullible reporting of pseudoscience and inaccurate reporting of real science. But sometimes they exceed our fondest hopes and get it spectacularly right. On December 25, 2008, the Wall Street Journal gave us all a Christmas present: they printed an article by Steve Salerno that was a refreshing blast of skepticism and critical thinking about alternative medicine.

Salerno points out that 38% of Americans use "complementary and alternative medicine" (CAM) and it is being increasingly accepted in hospitals and medical schools. He says this should be a laughing matter but isn't because of the huge amounts of money being spent on ineffective treatments. Not to speak of the huge amounts of money being wasted on implausible research at the NCCAM.
He highlights a painful irony: the same medical centers that once fought quackery are now embracing it, not because they think it will improve patient care, but because it will increase their revenue.

Salerno quotes Dr. George Lundberg, one of the many who have said there is no such thing as CAM. There can be alternatives within medicine (like which antibiotic to choose) but there can be no "alternative medicine." There is only medicine that has been proven to work and medicine that hasn't. If science showed that an "alternative" treatment really worked, it would be promptly and enthusiastically incorporated into standard medical practice and would no longer be considered "alternative." So the very term is misleading.

"Alternative medicine" is not a scientific concept. It is a political, ideological ploy intended to raise public respect for a mishmash of untested, unproven, and even disproven treatments that are rejected by the scientific community. We used to call those treatments quackery, folk remedies, untested, belief-based. A rose by any other name...

Why should we have "alternative" medicine if we don't have "alternative" engineering? Dr. Mark Crislip wrote a brilliant satire entitled "Alternative Flight."

He says, "Americans want choice....People need to be free to choose their mode of flight based on alternative concepts of gravity and alternative airplane design....you can focus your Qi dong to harmonize with the airplane to decrease the mass of the airplane and provide a more efficient forward motion. Or collapse your personal wave function to arrive at your destination early."

It's easy to see why alternative flight is nonsense. Why is it so hard for most people to see that most of "alternative" medicine is equally nonsensical? Most people are smart enough not to fly on an "alternative" airplane, but they're eager to fork out $125 for an hour-long session of DNA Activation Healing, they buy water disguised as homeopathic remedies, and they let reflexologists treat their gallbladder by pressing on their feet.

For most of human history, people used medicines recommended by friends or tradition. Sometimes they worked; sometimes they didn't. Then humanity discovered a wonderful thing: the scientific method. Medicines could be tested to find out the truth about what really worked. Alternative medicine is a step backwards: it asks us to forget about good science and believe in testimonials, untested treatments, irrational, and even disproven treatments.

I can hear readers now, saying "But some of those treatments might really work." Maybe, but only science can tell us which ones. Science doesn't waste time testing every crackpot idea; it has to choose promising avenues of research. Would you want to divert funds from cancer research to re-evaluate the efficacy of bloodletting for balancing the humours? Or to re-examine all those alleged perpetual motion machines? It may have been reasonable to test St. John's wort; but it is not reasonable to keep testing ultra-dilute homeopathic remedies. It is not reasonable to keep looking for a mythical chiropractic "subluxation" after a century of failure to find it. It is not reasonable to fund studies on "therapeutic touch" unless someone can demonstrate that "human energy fields" exist and can be detected by nurses' hands.

Is there any "alternative" treatment that was ever tested, found to be effective, and subsequently incorporated into standard medical practice? I don't think that has ever happened except for herbal remedies. Herbal remedies are a special, plausible subset of "alternative" treatments in that they contain active ingredients with physiologic effects. They are drugs. Plants are regularly evaluated by scientific pharmacology. Many of the remedies touted by "alternative" advocates have not been properly tested by pharmacology, usually because they don't offer enough promise to warrant further testing.

Foxglove was a folk remedy for heart disease. It clearly worked. The effects were robust and consistent, not marginal and erratic like so many alternative remedies today. It was promising enough to warrant proper scientific testing. It was analyzed, purified, and a standardized product was developed. It had side effects and the therapeutic dose was dangerously close to the lethal dose, so scientists developed a synthetic variant that was safer. Today we can buy a Digoxin pill with a precise dose instead of crushing a foxglove leaf and taking potluck.

Is foxglove an example of an alternative medicine that was adopted by scientific medicine? Not really. It's simply a good example of science in action.

As Bob Park says in his book Superstition, if it's not science, it's superstition. There is only one kind of medicine we can trust: science-based medicine. We should be trying to weed out every vestige of superstition in scientific medical practice, not embracing new superstitions from alternative medicine. Thank you, Wall Street Journal, for the injection of sanity!

Something rather unsettling I read of the other day...

A group of anthropologists, and scientists, studied a colony of chimpanzees and noted a group within the colony who were listless, apathetic, isolating themselves, and for all indications showed signs of depression.

This group of chimps were removed from the colony, for six months, and when the scientists returned to re-integrate the 'depressed' chimps, they discovered the entire colony dead. Not gone, not moved on... dead.

What they surmised, is that depression within a society is an early warning system for the colony, that something is not right...

Depression.... when diagnosing depression and other forms of societal dis-ease.. the benchmarks, or parameters, are so vastly blurred, it really is a hit and miss diagnosis.

Societal pressures... perceived or otherwise, as well as having an unhealthy image or picture of what one is supposed to be, are strong contributors to 'depression'...

I like to think that depression, is an undoing of repression.. it is present for a specific organic reason, and sedating, or masking these sensations are inappropriate...

More emotional support, and connection with clients, family, society in general is a more effective form of treatment.

As a race/cutlure, humans have become so separated, insular, and isolated, emotionally,the sense of dis-connection is becoming more and more prevalent.

Joad - maybe the best we can do, if we intend to maintain it, to fix it - but what if we tear it all down?

Something rather unsettling I read of the other day...

A group of anthropologists, and scientists, studied a colony of chimpanzees and noted a group within the colony who were listless, apathetic, isolating themselves, and for all indications showed signs of depression.

This group of chimps were removed from the colony, for six months, and when the scientists returned to re-integrate the 'depressed' chimps, they discovered the entire colony dead. Not gone, not moved on... dead.

What they surmised, is that depression within a society is an early warning system for the colony, that something is not right...

Depression.... when diagnosing depression and other forms of societal dis-ease.. the benchmarks, or parameters, are so vastly blurred, it really is a hit and miss diagnosis.

Societal pressures... perceived or otherwise, as well as having an unhealthy image or picture of what one is supposed to be, are strong contributors to 'depression'...

I like to think that depression, is an undoing of repression.. it is present for a specific organic reason, and sedating, or masking these sensations are inappropriate...

More emotional support, and connection with clients, family, society in general is a more effective form of treatment.

As a race/cutlure, humans have become so separated, insular, and isolated, emotionally,the sense of dis-connection is becoming more and more prevalent.