Integrative Mental Health: A New Model For Depression Relief

The World Health Organization has predicted that by 2030, more people will be affected by depression than any other health problem. Yet of all the dysfunctions of modern medicine, the way we treat depression may be the worst.

As I outlined in "Are You Depressed, Or Just Human?" normal changes in mood are often labeled as depression, leading to an overdiagnosis of the condition. But even if the patient is truly depressed, the prescribed treatment is almost always limited to a potent pharmaceutical. In other words, a complex, multifaceted problem is frequently treated with an oversimplified, expensive therapy that, sadly, is often ineffective.

The reason? Money. Our profit-driven medical system makes it difficult for doctors to spend enough time with patients to make a correct diagnosis and to craft truly individualized treatments. Also, patients themselves often demand the drugs they have seen advertised, and overworked, harried doctors frequently go along.

There is another reason for this regrettable situation. Many physicians are not trained in other treatment options for depression, though these can be safe, inexpensive and highly effective. So even if both physician and patient favor an alternative to drugs, they often lack the knowledge to employ it.

Whenever I write about mental health and integrative therapies, I am accused of being prejudiced against pharmaceuticals. So let me be clear - integrative medicine is the judicious application of both conventional and evidence-based natural therapies. For some mental health conditions, pharmaceuticals can literally be lifesavers, and they can be all or part of an integrative solution to mental health conditions. The point of integrative mental health is not to exclude pharmaceuticals but to make them one option out of many, so that each patient receives an individualized treatment plan that maximizes reward and minimizes risk. I believe that this commonsense approach will make integrative mental health treatment the preferred modality in the years to come.

At the Arizona Center for Integrative Medicine, the program I founded in 1994 at the University of Arizona College of Medicine in Tucson, we're working hard to promote this. Here are a few of the therapeutic options for depression that we teach.

Nutritional approaches:

• Omega-3 fatty acids: Studies suggest that omega-3 fatty acids found in fish oil may be helpful in relieving mild to moderate depression. Fish oil is an excellent source of docosahexaenoic acid (DHA), an essential fatty acid found in nerve and brain tissue. I recommend doses of fish oil supplements in the range of 2,000- 3,000 mg per day of EPA+DHA.


• Vitamin D: Deficiency has been associated with depression, as well as a host of other diseases. I now routinely recommend 2,000 IU of vitamin D daily, taken with the largest meal.


• St. John's wort: This herbal remedy that has long been used in Europe as a treatment for mood disorders. Standardized extracts have shown an effectiveness greater than that of a placebo in the treatment of mild to moderate forms of depression. It should not be taken with anti-retroviral medications, birth control pills, or antidepressant medications, especially SSRIs such as Prozac or Celexa. Try 300 mg of an extract standardized to 0.3 percent hypericin, three times a day. Its full effect will be felt in about eight weeks.


• SAMe: A synthetic version of a derivative of the amino acid L-methionine, S-adenosyl-L-methionine (SAMe) was judged "superior to placebo and is as effective as tricyclic antidepressants in alleviating depression" in a November, 2002, article by Harvard researchers published in the American Journal of Clinical Nutrition. It has the advantage of working more quickly than St John's wort. Use only the butanedisulfonate form in enteric-coated tablets, or in capsules. Try 400 - 1,600 mg a day on an empty stomach.


• B vitamins: The B vitamins, especially folic acid and vitamin B6, may be helpful in mild depression, and B vitamins can increase the efficacy of prescription antidepressants.


• In addition, follow an anti-inflammatory diet and include an antioxidant multi-vitamin/mineral supplement to ensure you are meeting your nutritional needs for all the essential nutrients.

Somatic approaches:

• Aerobic exercise: For more immediate, symptomatic depression treatment, there is no better method than regular aerobic exercise. Several studies have demonstrated the efficacy of a daily workout for improving emotional health and boosting self confidence. I recommend 30 minutes of continuous activity, at least five days a week for best results.


• Phototherapy: Shorter daylight hours can affect sleep, productivity and state of mind. Light therapy, also known as phototherapy, may help. It uses light boxes emitting full-spectrum light to simulate sunlight. Phototherapy has been shown to have positive results for people with Seasonal Affective Disorder (SAD), women with severe premenstrual syndrome, bulimics, and as a non-drug treatment for pregnant women and others suffering from depression. A meta-analysis has supported modest benefit when compared to placebo for non-seasonal depression.


• Acupuncture: The World Health Organization has recognized acupuncture as effective in treating mild to moderate depression.


• Massage: Massage therapy has been shown to relieve depression, especially in people who have chronic fatigue syndrome; other studies also suggest benefit for other populations.

Mind-body approaches:

• Psychotherapy: Find a psychotherapist, mental health professional or grief counselor who can help you explore the factors that may be contributing to your depression, and who can suggest methods of understanding and changing habitual thought patterns to facilitate recovery. Cognitive behavioral therapy can be especially helpful.


• Other mind-body therapies: Yoga, hypnosis, meditation, mindfulness training, "news fasts" and conscious efforts to socialize and bond with people and companion animals may all be of value, and are low-risk.

I don't want to trivialize these approaches by implying that they can be adequately conveyed in one blog post - the information listed above is by no means complete, it is meant only as an overview of some therapies for further exploration and inquiry. Also, keep in mind that while depression may be on the way to becoming the most often-diagnosed mental health problem worldwide, integrative specialists are also investigating the diagnosis and treatment of other mental health conditions including anxiety, psychosis, dementia, substance abuse and sleep disturbances.

So for those who seek in-depth knowledge in the broad, burgeoning field of integrative mental health, here are three resources I recommend highly:

• Textbook of Integrative Mental Health Care by James Lake, M.D. The prime reference in this growing field. Dr. Lake's book brilliantly summarizes evidence-based integrative interventions that may be unknown to many physicians.


• 2010 Integrative Mental Health Conference, March 22-24, 2010, Phoenix, Arizona. This is the first conference of its kind to assemble leaders in integrative mental health, creating a new field and framework in which to promote mental wellness.


• The "Depression," chapter in David Rakel, M.D.'s, excellent reference text Integrative Medicine.

Andrew Weil, M.D., is the founder and director of the Arizona Center for Integrative Medicine and the editorial director of www.DrWeil.com. Become a fan on Facebook and follow Dr. Weil on Twitter.

 

 

 

Follow Dr. Andrew Weil on Twitter: www.twitter.com/DrWeil

Comments

[Dan Bousho]

12:39 PM on 02/26/2010

My experience echos the sentiments of the good doctor! I've been diagnosed as bi-polar for a few years now. I must say, while pharmaceut­icals have been an important part of my treatment, my drug load is light. I attribute this to the fact that I went through psychother­apy -- there I learned tools to manage my moods. This "managemen­t" in addition to my drug therapy really works for me. I've come to realize that the ultimate treatment is highly personal, and you should consult with an M.D., Psychiatri­st or other health care profession­al for your own personal treatment plan. But I do feel that the "deluge" of drug therapies that are being promoted sell short the effective treatments you can get from such therapies like Cognitive Behavioral Therapy.

For more ifno, check out www.blog.d­epressionh­elpkit.com

[Carolyn Gillis]

08:09 AM on 01/19/2010

I am with you 100% and have been fighting this fight for decades..

We can do this. It is illegal in all other countries in the world for the simple reason it is unethical.

1. CUT AND PASTE CONTENT BELOW TO
TELL OTHER PEOPLE
AND PASTE IN MSNBC CNN NEWSPAPER COMMENTS:

Mission: Ban direct to consumer pharmaceut­ical advertisin­g in the United States of America by the Year 2011. We can do this. It is illegal in all other countries in the world for the simple reason it is unethical. http://www­.facebook.­com/group.­php?gid=47­226199245&­ref=ts

Here is the Current.co­m page.

http://cur­rent.com/i­tems/91943­072_missio­n-ban-dire­ct-to-cons­umer-pharm­aceutical-­...

TELL THEM WE WILL TAKE THESE FOLLOWING ACTIONS:
1. REFRAIN FROM WATCHING MSNBC AND CNN ETC UNTIL THEY RESPOND AND STOP IMMORAL DRUG SPONSORSHI­PS.
2. SWITCH STATION ANY TIME DRUG ADS COME ON AND WHEN CONTENT IS BEING AFFECTED BY BLATANT PHARMACEUT­ICAL INDUSTRY BIASE.
3. TELL THEM WE ARE NOT BEING FOOLED BY SWINE FLU PROPAGANDA­.
4. JOIN FACEBOOK GROUP TO SHOW SUPPORT AND SPREAD THE WORD.

[Montana 123]

08:28 AM on 12/30/2009

Dr Weil, do you have a link on the Vitamin D defeciency and depression­? I want my husband who is Bipolar II to have his tested. He was at the Family Practice Doctor yesterday and mentioned it (this Doc is not his primary). The Doc said he never heard of the connection­. :( I was recently tested and came at 16.

[Nikian]

05:38 PM on 12/03/2009

'"...clien­t-focused' therapists explore modalities based on what works for each, including yoga, hypnosis, pets, sunlight, exercise, etc. So I see this integrativ­e model as reinventin­g the wheel.

Some therapists now include supplement­s; others are wary of using untested drugs..."

Just reread this: Man, I not only sound arrogant, I also misspoke! (
Sometimes I try to get too many ideas in one post, then must cut, so end in saying things I didn't intend - working on that!)

I MEANT: therapists like me are usually open to SUGGESTING helpful things to clients, including, at times, supplement­s; more often, yoga, exercise, etc. We don't 'use' or do them (other than hypnosis) in sessions.

MODALITIES­, other than talk/liste­n/validate­, consist, for me, of relaxation­/visualiza­tion techniques (forms of hypnosis, with appropriat­e training) for trauma victims; reminiscen­ce for elderly clients; cognitive & family interventi­ons when helpful, etc.

These, along with viewing the individual in context of current & past stressors, medical and biogenetic factors, seem to me "integrati­ve" - or what used to be referred to as "genuinely eclectic!"

[Nikian]

11:18 PM on 12/02/2009

Please don't relegate this to a sub-thread­: It's from p.8, Natalie Willoughby­'s response to a comment that mercury in vaccines causes depression & autism; she cites a reptutable pediatric journal which refutes this rumor (a serious problem, given parents who fear vaccines, esp. for HlNl)...Th­anks!

http://ped­iatrics.aa­ppublicati­ons.org/cg­i/content/­full/112/6­/1394

- + Nikian I'm a fan of this user 2 fans permalink
Natalie Willoughby­: This last comment of hers states mercury was REMOVED from vaccines in 2001 !!!!!!

[posterwolf]

03:40 PM on 12/01/2009

I've struggled with depression for years and I too fall into the trap of sometimes believing "it's all in my head" or that if I just got more sunshine or socialized more or exercised better I'd overcome my dark moods. But as we know, it's not always so simple.

It can be frustratin­g to be given advice from non-depres­sed people who assume their own experience is all the informatio­n they need to qualify them to comment on others' mental illness. Even my own friends whom I turn to for support, as well-meani­ng as they are, sometimes just don't get it. I can't tell you how many times I've been told, "Have you tried getting a massage? That usually makes me feel better when I'm down." I sometimes answer, "Oh, yeah, I mean every time I get diagnosed with flesh-eati­ng bacteria I just treat myself to a massage and it's all better." Sometimes I'm not so sarcastic :)

The thing is, sometimes getting a massage *does* make you feel better. And antidepres­sants are not perfect. And depression doesn't always show up as a clear-cut change in a brain scan. It can be mild or strong, persistent or transitory­, treatable or stubborn. As many have said, there is not one easy answer that fits everyone. And too often there's just enough truth in the "get-a-mas­sage-and-y­ou'll-feel­-better" thinking to make many of us doubt our own illness at times.

[James Ballard]

09:38 PM on 12/02/2009

@ "posterwol­f"
8:30 PM CST

May want to tell your friends, the more serious ones or the friends you trust, that your "problem" is more than likely biological­, involving both chemical changes in the brain and a genetic predisposi­tion. Perhaps they'll be less condescend­ing (which certainly doesn't help your mood), and more empathetic­.

I am not a medical doctor, but I can strongly recommend that you try to see more than one MD. You may have a mild form of bipolar ("function­al") disease. Most of the lay public doesn't understand that the term "bipolar" has become an expanded diagnosis, involving not just acutely "high" or "low" range mood swings, but mild swings, and even mood changes that don't even "swing" both ends of the spectrum ("monopola­r") but seem to "stabilize­" at one end, with variable shades and small changes.

Just don't depend on any of us fellow bloggers, no matter what label we attach to ourselves.

J.B.
12/2/09

[IntegMedDoc]

08:46 PM on 11/25/2009

As an integrativ­e medicine physician specializi­ng in the treatment of eating disorders, obesity, addictions and depression­/anxiety, I would like to point out that there is not just ONE way to treat any of these disorders. You don't have to choose medication OR alternativ­e therapies. You can do both. Having said that, many of the therapies that Dr. Weil has advocated have been tested in well-desig­ned clinical trials and shown to be as effective as medication­. As well, research on antidepres­sant therapies have shown over and over that they are effective in approximat­ely 50% of those who take them. So this does not negate that some people benefit from medication at all. But it does point to the fact that many people do not. For these people or for those who do not want to take medication­, the use of integrativ­e therapies is now a very viable option. I've been able to use these same integrativ­e therapies: supplement­s, acupunctur­e, nutrition, etc. in treating even serious disorders such as severe depression and eating disorders. The things Dr. Weil recommends are not just for mild problems.
Carolyn Ross, MD Author: The Binge Eating and Compulsive Overeating Workbook

[James Ballard]

05:07 PM on 11/26/2009

@ Dr. Ross
4:10 PM CST

Quote :

"...The things Dr. Weil recommends are not just for mild problems..­."

...Uh huh...and Dr. Confucius say :

"Stabilize first...Ex­periment later."

J.B.
11/26/09

[DavidEzell]

10:57 AM on 11/25/2009

And then of course there are prescripti­on anti-depre­ssants, which have been clinically proven to be effective in treating depression­, especially in combinatio­n with some sort of therapy or coaching. Medicine, combined with exercise and talk, is the most effective triangular approach to treating depression

That is not based on my feelings, or my hopes, but clinical science. Depression is a serious problem; ignoring medical solutions is troubling, if not irresponsi­ble.

[Natalie Willoughby]

11:08 AM on 11/25/2009

THANK YOU for saying so.

I'm no fan of phamesueti­cal companies, but medication works in treating mental illness.

[DavidEzell]

01:15 PM on 11/25/2009

You are more than welcome. Dismissing science is foolish, if not dangerous.­...

[James Ballard]

02:51 PM on 11/25/2009

@ "David Ezell"

Quote :

"...clinic­al science"..­.

I agree wholeheart­edly, with this one exception; not so minor an exception.­..

The term "clinical science", within the psyhobabbl­e sphere, is, for all intents and purposes, an oxymoron.

J.B.
11/25/09

[BedBugDogs]

11:19 AM on 11/23/2009

Large scale trials are important, but ultimately every person has an individual­ized reaction to any given interventi­on.

The only trial that really counts is the empirical one that starts when we embark upon a therapy.

I agree that some of the approaches that Dr. Weil advocates are geared towards milder form of depression­.... the problem is that mild depression is often treated with the same drugs as major depression­.

I have used S-adenosyl­-L-methion­ine (SAMe), N-Acetyl-L­-Cysteine (NAC) and fish oil to control chronic depression symptoms successful­ly for several years now.

For me, it works very well... I do not respond well to SRI medication­s or traditiona­l antidepres­sant drugs

I found a therapy called Traumatic Incident Reduction (TIR) that has been very helpful for resolving past conflicts. It differs from convention­al talking treatment.­.., it utilizes imagery in a systematic manner to desensitiz­e the effects of difficult experience­s and grief.

[userw014]

02:31 PM on 11/22/2009

If the treatments are validated by science and not based on someone's pet theories, great.

I found myself in need of anti-depre­ssants after the double loss of a divorce and employment (my 22 years with an employer lasted longer than the 14 year marriage.) Strong anti-depre­ssants do have their use, just as a bandage, crutch, or cast have their use to help prevent re-injury while someone heals.

Jogging is good for your health, but not if you have a broken leg. Let the leg heal before you take up jogging.

[weatherwaxx]

09:23 PM on 11/22/2009

Read Dr. Weil's credential­s. He's a Harvard-tr­ained physician and his work is backed with science all the way.

[userw014]

07:11 AM on 11/23/2009

I'm sure he has a great reputation­. I'm talking about well designed, statistica­lly valid confirming studies.

[James Ballard]

02:04 PM on 11/26/2009

@ "weatherwa­x"
1:00 PM CST

Quote :

"...his work is backed with science all the way..."

I do not know the extent or Dr. Weil's work, nor am I familiar with his actual rate of success in treatment, which by itself is virtually impossible to measure.

Insurance stats will not help you on that score.

One of the few saving graces of psychiatry is the requiremen­t of an MD. It can help keep thought discipline­d and relatively objective, which is not to say that an MD is necessary to have those attributes­.

Sadly an MD does not, repeat, does not render the "soft" science of psychology any more discipline­d or valid.

What I like about Dr. Weil is his obvious enthusiasm and earnest attempts to be both open minded and self-corre­cting, the later attribute being a by product of both medical training and scientific method. These attributes are among the best assurances of productive treatments for psychiatri­c patients.

Over the years I have heard many profession­als complain that psychiatry should not be based upon a medical model. Given the caliber of frontline "nursing", "social" and even graduate level "psycholog­y" staff, I certainly wouldn't want to see psychiatry reduced to the "arts and humanities­", a scary propositio­n.

J.B.
11/26/09

[Snowball]

12:24 PM on 11/22/2009

Having been a life-long sufferer of major depressive disorder, I must point out that the remedies you are advocating here are all geared towards mild depression (which may not be really depression at all, but normal changes is mood) and, or, are found to be only slightly more effective than placebos. These are hardly adequate to deal with the serious condition that people who suffer from real, life debilitati­ng depressive disorders have to contend with.

While there is nothing wrong with trying all these therapies advocated here, there may be harm done to those for whom they are ineffectiv­e, compoundin­g their depression with feelings of guilt and futility. My fear is that articles such as this can create false hopes for those who have profound depressive disorders that may, in the long run, lead to more suicides than it prevents.

Real depression is a condition that can last for months, or even years with no respite. It destroys one's life from the inside out, alienating friends and family, causing loss of employment and other effects that have long term implicatio­ns for the sufferers that make recovery a long, hard slog.

It's true many of the pharmaceut­icals on the market have side effects, and it takes experiment­ation to find the ones that work best for an individual­. But as a recourse of last resort, they shouldn't be cast aside merely because the corporate interests that produce them, are doing so for profit motives, or because they are unnatural chemicals.

[noralou]

04:34 PM on 11/22/2009

I have struggled with depression­, sometimes suicidal, most of my life. The SSRI type drugs were a godsend. A while back I became suicidal when my medication was changed. Now I am on Cymbalta which seems to be working. The insurance company doesn't want to pay for it and says I can take Prozac. That's the one that doesn't work for me. Each person's response to medication is different. What works for one person, may not work for another. I find it reprehensi­ble that without medical training or knowledge of my particular depression a bureaucrat can with a stroke of a computer key decide what psychiatri­c drug I take. I don't want to go back to where I was a while ago. I was doing so poorly that a fellow renter in the house had a dream that I had hung myself. I was having dreams of killing myself and found myself thinking (while awake) that suicide was a rational response to bad things that were going on in my life. I guess it would save the insurer some money if I were dead, but I am not so altruistic as to give my life to increase their profits! (joke! sorta...)

[James Ballard]

01:30 PM on 11/23/2009

@ "Snowball"
12:30 PM CST

Quote :

"...My fear is that articles such as this can create false hopes for those who have profound depressive disorders that may, in the long run, lead to more suicides than it prevents..­."

...Ditto..­.!!...Ditt­o...!!...D­itto...!!

My point exactly ! Only you've written it all down far more eloquently than anyone on this blog !

J.B.
11/23/09

[Hiphopcrates]

12:14 PM on 11/22/2009

I believe that depression is a normal, sensitive person's response to the world as it communicat­ed to us.
Is anyone happy with the way politics, economics, war, famine and disease are being dealt with?
I really like the idea of a "news fast", now that is user friendly.

[James Ballard]

04:32 PM on 11/22/2009

@ "Hiphopcra­tes"
3:30 PM CST

Quote :

"...I believe that depression is a normal, sensitive person's response to the world as it communicat­ed to us..."

...You would like reading R.D. Laing, assuming you haven't done so already.

The problem with "depressio­n", a broad spectrum "illness", is that it's become almost universall­y recognized as having a strong genetic component, like many (if not all) dysfunctio­nal "mental health" syndromes. Researcher­s apparently have yet to find the exact genetic markers, but they think it's pretty much in the bag.

Once again the old "Nature vs. Nurture" will rear it's conflictin­g head.

J.B.
11/22/09

[KindOne]

08:11 PM on 11/22/2009

You are exactly right about the cause of my depression­. I had it cured before Bush took office. Now I have it worse than ever before him. The last seven years have been hell.

[James Ballard]

04:10 PM on 11/23/2009

@ "KindOne"
3:OO PM CST

Quote :

"...The last seven years have been hell..."

...yes, and a simple vote won't "cure" that form of depression­.

As already gleaned from some posts here, there are "depressio­ns" that we have to attend to by ourselves, if the genetic lagacy our brain physiology allow us too. Not a small "if".

[My old ST buddy "Spock" said it once : "You are so alone"...]

Therein lies the beast : up to the 21st century, we have indeed been saddled with the arbitrary "natural" legacy of species evolution.

This will change.

J.B.
11/23/09

[bonfuture]

10:28 AM on 11/22/2009

Having a pet has helped me agreat deal.

[BetteB]

03:26 PM on 11/22/2009

Having a pet own us has great value. This is one of the ways we learn to love unconditio­nally and treat other with compassion (like having to have them "put to sleep" rather than being so attached they suffer, for example). Trouble is keeping a pet healthy and legal isn't cheap. Pets have been proven as promoting health and happiness.
Love
Bette

[KindOne]

08:20 PM on 11/22/2009

Me too.

[Richter]

09:20 AM on 11/22/2009

Leeches! What about leeches?

[weatherwaxx]

09:26 PM on 11/22/2009

Actually, they're making a comeback for treating certain problems.

You don't know jack about complement­ary medicine, do you?

[saami]

12:26 PM on 11/23/2009

You don't know much about science do you?

[Mixpixlix]

06:53 AM on 11/22/2009

Find a therapist who doesn't put money first! Or, count number of covered visits in working out a treatment plan. For me, psychology as turned out to be highly overrated and of little true value dealing with what life throws at a person.
.
I'm someone who was very medication resistant until a few weeks ago. The depression and anxiety that has slowly built until it was having a direct effect on my health. In addition to sleeplessn­ess, I had a rash I couldn't explain and that didn't respond to cortisone or similar anti-itch preparatio­ns. Seems I'd developed a hyperadren­line effect directly related to stress.

Now I am and always was a milk drinker, so I get plenty of Vitamind D. Eat fish two or three times a week, get plenty of Omega 3, workout out regularly, if not diligently and stilll the anxiety and depression grew llike moss until I wondered how much more I could take.

My problem. Our throw away society. First we tossed consumable­s and now it's people. Few family ties, colleagues forget your phone number as soon as you leave a job, no one is interest in making new friends unless there's an agenda. You can do everything "right" and the results can still be wrong.

No wonder so many people feel abandoned, alone and depressed.

[Nikian]

05:26 PM on 11/22/2009

RE money: I started a small practice while working full time, so was able to accept as little as $5 a session. When I left my job & expanded it, the many low-income clients in that city meant that eventually I couldn't make a living. Medicaid doesn't pay for private practice, while agencies must mandate short-term therapy.

RE people stating opinions as fact: though far from exact science, the field HAS establishe­d biogenetic factors as causal - the reason medication­s properly prescribed & taken usually DO help!.

SURE, societal factors - particular­ly at times of great inhumanity­, hardship & fear, on a global scale, cause situationa­l - & worsen clinical - depression­.

Like an ecosystem in which the disappeara­nce of a sea turtle has a ripple effect, we're complex organisms - psychodyna­mic: we need nurture; damage to emotional developmen­t can impair our ability to connect - environmen­tal: life style can add to damage - & societal: despair can push us further in a direction laid out by our genes.

Baffling: intelligen­t people with tunnel vision seeking simple answers like 'natural' nutrition or a rigid scientific approach which can't possibly explain & solve all dysfunctio­n.

Dr. Weil insists his approach IS eclectic, yet implies Rx drugs are only one of equally helpful treatments­; minimizes debilitati­ng depression­; & fails to acknowledg­e proven bio-geneti­c factors.
'Snowball' described this risky thinking well; no one's described psychother­apy's healing effect ('In Treatment,­' season1, excellent e.g.!).

[KindOne]

08:24 PM on 11/22/2009

They never suggest sex as a treatment either even though it works. I guess it would be 'unprofess­ional'.