For depression, probiotics, omega-3 and methylfolate likely have some of the best supplement evidence, and N-acetylcysteine for OCD is dosed from the studies at 2.4 to 3 grams. Many herbs and supplements are unregulated and some have stimulant properties, so ask about them when looking for causes of mania, and for melatonin, steer patients to a product approved by the pharmaceutical testing board.
Where they have a place
For depression, probiotics, omega-3 and methylfolate likely have some of the best evidence.
“I think probiotics, omega-3, and methylfolate are where we have some of the best evidence for depression”
16:16The Deficit Model in Psychiatry & Difficult to Treat Depression with Dr. Chris Aiken | Episode 18Mar 2025Guest episode For N-acetylcysteine (NAC) in OCD, we go off the available studies and usually target something between 2.4 and 3 grams. Some patients complain about the taste or smell.
“I go off of the available studies for NAC and OCD, and I usually target something between 2.4 to 3 grams of NAC. I have had patients complain of the taste or smell, though”
34:42Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication ApproachAug 2025
Pitfalls and safety
When looking for causes of mania, do not forget random herbs and supplements: many are unregulated and have some stimulant properties.
“Don't forget also random herbs and supplements. A lot of these are unregulated and have some stimulant properties. And then finally, steroids, prednisone, or any other more esoteric or unique medications, prescription medications that can cause mania”
16:59How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening QuestionsFeb 2026 For melatonin, ask patients to use a product approved by the pharmaceutical testing board at least. Nature Made or the Costco brand are usually the easiest to find.
“I just ask patients to use ones that have been Approved by like that pharmaceutical testing board at least. So that's basically nature made or like Costco brand is usually the easiest to find”
47:50Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026
It also comes up on
- AugmentationFor OCD, lamotrigine is a reasonable add-on, N-acetylcysteine (a supplement) is particularly good, especially with skin picking, and ondansetron may be one of the most effective add-ons.
- Differential diagnosisIn every patient, consider substances, herbs, supplements, natural remedies, energy drinks, caffeine, medical conditions and other psychiatric conditions, eating disorders included: if you are not eating correctly, you will not function correctly.
- Major depressive disorderFor this supplement, the proper dose is 15 mg a day, available through several products on Amazon for about $5 a month.
- Substance use disordersIn every patient, consider substances, herbs, supplements, natural remedies, energy drinks, caffeine, medical conditions and other psychiatric conditions.
- ADHDStart at the top of the hierarchy with organic and medical causes (brain, thyroid, cortisol), and in every patient ask about substances, herbs, supplements, energy drinks, caffeine and eating problems.
- AripiprazoleFor treatment-resistant depression, the top-line interventions are ECT, TMS, antipsychotics, lithium, thyroid supplement and the ketamines. Among the antipsychotics, aripiprazole has the best evidence and the biggest effect size.
- ECTFor treatment-resistant depression, the best evidence goes to ECT and TMS, then antipsychotics (aripiprazole with the best evidence and biggest effect size), lithium, thyroid supplement, and ketamine or esketamine.
- EsketamineFor treatment-resistant depression, the ketamines (esketamine and ketamine) are on the list of top-line interventions with the best evidence, alongside ECT, TMS, antipsychotics (aripiprazole most of all), lithium and thyroid supplement.
From these episodes
- Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026 · 1 point
- How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening QuestionsFeb 2026 · 1 point
- Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication ApproachAug 2025 · 1 point
- The Deficit Model in Psychiatry & Difficult to Treat Depression with Dr. Chris Aiken | Episode 18Mar 2025 · 1 point
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.