We have seen in this volume that natural medications represent an exciting and rapidly growing field in the treatment of psychiatric disorders. Natural remedies in the United States are no longer a fringe subculture, but a potential “impact player” in the world of medicine. Since the appearance of the first edition of this book, there have been many advances in the field of complimentary and alternative medicine (CAM) in psychiatry, though they still occur less rapidly than in conventional medicine. Publications in the psychiatric and medical literature dealing with complementary medicine interventions have increased. Funding by the National Institutes of Health and the National Center for Complementary and Alternative Medicine has continued to grow in the support of researchers seeking to understand the workings of CAM, and we are just starting to see some of the fruits of these investments and initiatives.

Better quality clinical trials on these medicines have been carried out, many with double-blind, randomized controlled designs and samples large enough to generate statistically sound data. New insights into the mechanisms of these remedies have also been proposed and investigated. Yet when considering the studies that have emerged in the past decade, the body of knowledge as a whole remains plagued by contradictory and inconsistent data. We are still far from being able to say exactly how these medications work, what are their appropriate doses are, and for what indications and patient populations are they are optimal. We have made progress, but while the new data are compelling enough to encourage further research, they also illustrate how little we still know.

In reviewing the afterword from the first edition, in which we provided conservative guidelines for clinicians who were considering recommending these medications to their patients, it was humbling to realize that there was very little to change, since the original questions that spawned this volume have remained stubbornly in place.