Complementary, Alternative Therapies for Mood Disorders

Question:

"Can you please provide some additional complementary, alternative therapies for mood disorders?"

Jon W. Draud, MD, MS:

My last post dealt with several of the complementary alternative therapies used to treat mood disorders including St. John’s Wort, s-aderosyl-methionine and omega-3 fatty acids.  This time we will focus on a few more alternative therapies. The other products that have been used to treat mood disorders have minimal data to support efficacy but they include:

• TRP and 5HTP which are amino acid precursors;
• The botamizal Rhodiolar rosea;
• Crocus rosea;
• Chromium piccolinate;
• Lavandula augustifolia;
• Ginko biloba;
• Chamomile

Some of the studies are minimally positive and others remain inconclusive. Therefore, we currently cannot state with certainty1 that these modalities are clearly effective.

Mind-body practices have become very attractive to many individuals seeking treatment for mood disorders. According to the National Institute of Mental Health (NIMH) study group in 2007, the most commonly employed practices include meditation, yoga, gi-gong, tai-chi, acupuncture and deep breathing exercises2.  Mindfulness meditation, the core of Buddhist meditation, has been incorporated into mindfulness-based stress reduction and mindfulness-based cognitive therapy, which are the most studied interventions of this type in mood disorders.

There are numerous studies now looking at yoga3-5 in the treatment of depression. They suggest that improvement in depression may relate to changes in brain waves and decreases in cortisol.

Finally, acupuncture remains controversial. However, a recent meta-analysis of eight randomized trials comparing 477 subjects showed that acupuncture did significantly reduce depressive symptoms measured by the Hamilton Rating Scale & Beck Depression Inventory6.

Over the next several years, I suspect more robust and methodologically- sound studies will flesh out which of these alternative or complementary methods may truly be the most helpful for us and our patients. For now, it is left to the clinician to attempt to wean these strategies in a comprehensive treatment strategy.

1. Shaw K, Turner J, Del Mar C.  Tryptophan and 5-hydroxytryptophan for depression.  Cochrane Database Syst. Rev. 1 , CD003198 (2002)
2. Bishop SR, Lau M, Shapiro S et al . Mindfulness, a proposed operational definition. Clin. Psychol. Sci. Pract . 11(3), 230-241 (2004).
3. Butler LD, Waelde LC, Hastings TA et al . Meditation with yoga, group therapy and hypnosis, and psychoeducation for long-term depressed mood, a randomized pilot trial. J. Clin. Psychol . 64(7), 806-820 (2008).
4. Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, Harish MG, Subbakrishna DK, Vedamurthachar A. Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia, a randomized comparison with electroconvulsive therapy (ECT) and imipramine. J. Affect. Disord . 57(1-3), 255-259 (2000).
5. Woolery , Myers H, Sternlieb B, Zeltzer L. A yoga intervention for young adults with elevated symptoms of depression. Altem. Ther. Health Med . 10(2), 60-63 (2004).
6. Wang H, Qi H, Wang BS, Cui YY, Zhu L, Rong ZX, Chen HZ. Is acupuncture beneficial in depression, a meta-analysis of 8 randomized controlled trials? J. Affect. Disord. 111(2-3), 125-134.

 xzx Meta-analysis of the effectiveness of acupuncture in patients with depression.