What is integrative psychiatry?
A definition, its evidence base, and the boundary around it.
In short
Integrative psychiatry is the practice of psychiatry in which the full range of available assessment and treatment methods is applied to a case, and in which the patient’s functioning and quality of life serve as the primary outcomes.
There is no board certification in integrative psychiatry, and the label is unregulated, so the practice underneath it varies a great deal. The scope page sets out which methods the evidence supports and which fall outside.
The term currently has no owner
Integrative psychiatry is used daily in clinical practice, in patient searches, and in practice marketing. It has no canonical definition. The gap is unusually complete, and it is worth stating plainly because it explains why descriptions of the field vary so widely.
- There is no encyclopedia entry. Reference works carry articles on integrative psychotherapy, on nutritional psychiatry, and on orthomolecular psychiatry, and general-purpose encyclopedias treat integrative medicine as a section within their article on alternative medicine.
- The National Center for Complementary and Integrative Health defines integrative health, and distinguishes complementary use from alternative use, without addressing psychiatric practice.1
- The Academic Consortium for Integrative Medicine and Health defines integrative medicine generically across all of medicine, and names no outcome.2
- There is no board certification in integrative psychiatry. Details on what does exist are on the credentials page.
Within psychiatry, the closest published formulation describes integrative practice as the coordinated use of complementary and conventional approaches for the management of specific symptoms.3 A taskforce white paper set out a research and education agenda for integrative mental healthcare in 2014.4 Neither has become the definition the field actually uses.
The definition this project uses
Integrative psychiatry
Integrative psychiatry is the practice of psychiatry in which the full range of available assessment and treatment methods is applied to a case, and in which the patient’s functioning and quality of life serve as the primary outcomes.
v1.0 · 2026-08-30 · full statement, clauses, and version history
Two features distinguish this formulation from the descriptions in circulation.
The first is that it names assessment alongside treatment. Much of what a broadened approach adds happens before any prescription: collateral history, functional assessment, sleep and activity data, and evaluation of the medical contributors that psychiatric assessment often handles briefly.
The second is that it names an endpoint. Existing definitions describe a method set and stop. Specifying the outcome does considerable work, because it converts the scope question from a philosophical dispute into a measurement question. A method belongs when there is evidence it moves functioning or quality of life at acceptable risk. A method that has been tested against those outcomes and failed does not belong, and neither does one that has never been tested against them at all.
The demarcation follows from the endpoint. Once functioning is the target, an unvalidated laboratory panel is excluded by the definition itself, with no separate argument required.
Why psychiatry has room for a broader method set
The clinical case rests on a number that has been stable for two decades. In the STAR*D trial, about a third of outpatients with major depression reached remission on the first medication step, with cumulative remission reaching roughly two thirds only after as many as four sequential steps.5 That leaves a large population carrying residual illness through long sequences of treatment changes.
Several methods with meaningful evidence sit outside the medication-and-therapy pair that most sequences move within. Cognitive behavioural therapy for insomnia carries a clinical practice guideline recommendation as first-line treatment of chronic insomnia.6 A network meta-analysis of 218 randomised trials covering 14,170 participants reported benefit for structured exercise in depression.7 A randomised trial of dietary improvement as an adjunct in moderate to severe depression reported remission in 32 percent of the intervention group against 8 percent of controls.8
Each of these is treated in detail, with its limitations, on the evidence pages.
What changes in the consulting room
| Usual practice | Under this definition | |
|---|---|---|
| Assessment | Symptoms, history, medication trials, risk. | The same, with sleep, activity, diet, substance use, and functional status assessed as clinical targets carrying their own interventions. |
| Treatment | Medication and psychotherapy, sequenced. | The same, with additional evidence-supported methods prescribed to a specified protocol and dose. |
| Primary outcome | Symptom-scale score and remission status. | Functioning and quality of life, with symptom scales retained as instruments. |
| Deciding what to add | Clinical judgement and guideline sequence. | The same, applied to a wider method set through an explicit grading framework. |
Where the label gets misused
Because the term is unregulated, two quite different practices operate under it.
The first applies additional evidence-supported methods to conventional psychiatric care and measures whether the patient’s life improves. The second sells testing and supplements. The second is recognisable by structure rather than by vocabulary: broad laboratory panels ordered before assessment, supplement regimens directed by genotype, and a dispensary margin earned by the prescriber. The scope page places those arrangements outside the term as defined here, and explains why the economics matter as much as the modalities.
Naming this boundary is uncomfortable within the field, and the discomfort is the reason most published descriptions avoid it. A definition that admits everything offered under its name describes a market.
Where integrative methods are the wrong starting point
Additional methods follow guideline treatment, or at minimum follow its documented recommendation. That sequencing rule is long established in the integrative mental health literature and exists to prevent an adjunct from displacing indicated care.9
Mania, psychosis, catatonia, severe depression with suicidal ideation, eating disorders at medical risk, delirium, and withdrawal states are handled under standard psychiatric care first. Anyone in crisis in the United States can call or text 988 to reach the Suicide and Crisis Lifeline.
Frequently asked questions
Is integrative psychiatry a recognised subspecialty?
No. No board certifies in integrative psychiatry. The American Board of Integrative Medicine certifies in integrative medicine generally, through the American Board of Physician Specialties. See the credentials page.
Does it replace medication?
No. Medication and psychotherapy stay in place. What the approach adds is a wider assessment and treatment set around them, and a change in the outcome being measured.
How does it differ from functional psychiatry?
Functional practice is organised around identifying a root cause, usually through extensive laboratory testing. The definition here makes no root-cause claim and admits a method only on evidence that it improves functioning or quality of life. See the comparison.
Is it the same as alternative medicine?
No. Alternative use means replacing conventional care. Nothing here replaces conventional care.1
Is it evidence-based?
Parts of it are, and parts of what is sold under the name are not. That is what the grading framework exists to sort.
References
- National Center for Complementary and Integrative Health. Complementary, Alternative, or Integrative Health: What’s In a Name? nccih.nih.gov
- Academic Consortium for Integrative Medicine and Health. Mission and Vision. imconsortium.org
- Varteresian T, Lavretsky H. Complementary and integrative therapies in psychiatry. FOCUS (Am Psychiatr Publ). 2018;16(1):54–56. PMID 31975900. doi:10.1176/appi.focus.20170056
- Sarris J, Glick R, Hoenders R, Duffy J, Lake J. Integrative mental healthcare White Paper: establishing a new paradigm through research, education, and clinical guidelines. Adv Integr Med. 2014;1(1):9–16. doi:10.1016/j.aimed.2012.12.002
- Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905–1917. PMID 17074942. doi:10.1176/ajp.2006.163.11.1905
- Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125–133. PMID 27136449. doi:10.7326/M15-2175
- Noetel M, Sanders T, Gallardo-Gómez D, et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2024;384:e075847. PMID 38355154. doi:10.1136/bmj-2023-075847
- Jacka FN, O’Neil A, Opie R, et al. A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med. 2017;15:23. doi:10.1186/s12916-017-0791-y
- Hoenders HJR, Appelo MT, van den Brink EH, Hartogs BMA, de Jong JTVM. The Dutch Complementary and Alternative Medicine (CAM) Protocol. J Altern Complement Med. 2011;17(12):1197–1201. doi:10.1089/acm.2010.0762