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Holistic Medicine: Overview of Complementary and Alternative Medicine Therapies for Mood Disorders
Question:
Can you please provide an overview of the various ‘holistic’ or complementary and alternative medicine therapies commonly used to treat mood disorders?
Mood disorders are among the most prevalent illnesses in mental health and general medicine. They are debilitating, and only a minority of patients reaches a satisfactory endpoint with traditional treatments available. Accordingly, more patients and physicians are turning to complementary and alternative medicine (CAM) therapies to augment traditional modalities.1-2 Numerous studies have shown that mood and anxiety disorders are more prevalent than any other medical conditions.3 These conditions remain largely undertreated, which is very worrisome because they have a tremendous impact on daily functioning.4
There is mounting evidence that a certain percentage of patients will seek alternative medicine treatments.5 The National Health Interview Survey indicated that 40% of adults would seek CAM treatments.2 Women are more likely than men to seek CAM options.6
We will now review the most commonly used “natural products” that people tend to employ to treat mood disorders. Hypericum perforatum or St. John’s Wort is an herb that has been shown to inhibit monoamine reuptake and downregulate monoamine receptors in the brain.7 While St. John’s Wort was generally superior to placebo, it was only equivalent to standard antidepressants in mildly depressed patients; however, it is always cited as being better tolerated, which is why so many patients want this form of treatment.8 One caution is that photosensitivity is observed at high doses and there is induction of cytochrome P450 enzymes as well as potential toxicity with traditional antidepressants that can lead to serotonin syndrome.9
S-adenosylmethionine (SAMe) is an amino acid that is a major donor of methyl groups needed for synthesis of serotonin, norepinephrine, and dopamine, and is widely prescribed in Europe and gaining popularity in the United States. Some studies have shown levels to be reduced in patients with major depressive disorder.10 Double-blind studies have shown SAMe to be equally effective as standard antidepressants with fewer side effects.11 Adverse effects are mild, but can include insomnia and gastrointestinal side effects.
Omega-3 fatty acids have become increasingly popular and seem to play a role in stabilizing neuronal membranes and facilitating monoamine neurotransmission.12 The human body is unable to synthesize essential fatty acids and so they must be ingested. The most common source is fish oil and many studies have shown that these supplements may balance mood.13 Overall study results are mixed, but this treatment modality continues to gain ground.
There are several other products that are used, but there is really no supportive data and may include: 5-hydroxytryptophan, Rhodiola rosea , Crocus sativus , chromium picolinate, Lavandula angustifolia , Ginkgo biloba , and chamomile.
These are the most commonly employed “natural products” used to treat mood disorders with a few references supporting their efficacy. There is mounting data and many more studies, but these are too numerous to mention in this Q&A. My next Q&A will review the most commonly used “mind-body practices” in the treatment of mood disorders.
—Jon W. Draud, MS, MD
References
1. Wang PS, Berglund P, Kessler RC . Recent care of common mental disorders in the United States : prevalence and conformance with evidence-based recommendations. J Gen Intern Med. 2000;15(5):284-292.
2. Barnes PM, Bloom P, Nahin RL . Complementary and alternative medicine use among adults and children: United States, 2007. National health statistics reports; no 12. Hyattsville, MD: National Center for Health Statistics. 2008.
3. Demyttenaere K, Bruffaerts R, Posada-Villa J, et al . Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA. 2004;291(21):2581-2590.
4. Kessler RC, Greenberg PE, Mickelson KD, Meneades LM, Wang PS . The effects of chronic medical conditions on work loss and work cutback. J Occup Environ Med. 2001;43(3):218-225.
5. Mao JJ, Farrar JT, Xie SX, Bowman MA, Armstrong K . Use of complementary and alternative medicine and prayer among a national sample of cancer survivors compared to other populations without cancer. Complement Ther Med. 2007;15(1):21-29.
6. Unutzer J, Klap R, Sturm R, et al . Mental disorders and the use of alternative medicine: results from a national survey. Am J Psychiatry. 2000;157(11):1851-1857.
7. Field HL, Monti DA, Greeson JM, Kunkel EJ . St. John's Wort. Int J Psychiatry Med. 2000;30(3):203-219.
8. Kasper S, Gastpar M, Moller HJ, et al . Better tolerability of St. John's wort extract WS 5570 compared to treatment with SSRIs: a reanalysis of data from controlled clinical trials in acute major depression. Int Clin Psychopharmacol. 2010;25(4):204-213.
9. Boyer EW, Shannon M . The serotonin syndrome. N Engl J Med. 17 2005;352(11):1112-1120.
10. Bottiglieri T, Hyland K . S-adenosylmethionine levels in psychiatric and neurological disorders: a review. Acta Neurol Scand Suppl. 1994;154:19-26.
11. Mischoulon D, Fava M . Role of S-adenosyl-L-methionine in the treatment of depression: a review of the evidence. Am J Clin Nutr. 2002;76(5):1158S-1161S.
12. Haag M . Essential fatty acids and the brain. Can J Psychiatry. 2003;48(3):195-203.
13. Williams AL, Katz D, Ali A, Girard C, Goodman J, Bell I . Do essential fatty acids have a role in the treatment of depression? J Affect Disord. 2006;93(1-3):117-123.
