CAM Therapies in Mood Disorders

Abstract and Introduction

Abstract

This article reviews the potential uses of complementary and alternative medicine (CAM) techniques for individuals with mood disorders. Mood disorders are among the most prevalent mental health issues today and there are many approaches towards their management. While many different types of medication are available, more and more people turn to CAM interventions to help manage their mood disorders. CAM interventions can include herbal remedies, acupuncture and meditation. There is an increasing number of research studies on CAM intervention in mood disorders, and this article critiques such data and attempts to provide a clinical perspective within which these CAM interventions might be considered.

Introduction

Mood and anxiety disorders, which include a broad range of diagnoses, such as major depression, dysthymia and others, pose a significant public health burden on society because of their high prevalence rates^[1] and associated morbidity, mortality and healthcare costs.^[2–4] Despite the availability of many conventional treatment options, epidemiological studies have shown that only a minority of individuals with these disorders seek mental health treatment.^[5] Several studies have shown that the prevalence of mood and anxiety disorders is higher than that of any other chronic medical condition.^[6] Data from the WHO Composite International Diagnostic Interview (CIDI),^[7,8] demonstrated that more than a third of respondents typically met criteria for a lifetime CIDI disorder.^[8] More concerning, survey-specific treatment questions showed that most mental disorders were untreated.^[9,10] While secondary analyses of some of the CIDI surveys concluded that up to half of 12-month mental disorders were mild and found that treatment was consistently correlated with severity, between a third and two-thirds of serious cases in these surveys received no treatment.^[10,11] In addition, studies show that the unmet need for treatment is greatest in traditionally underserved groups, including elderly persons, racial–ethnic minorities, those with low incomes, those without insurance and residents of rural areas.^[12–15] This is particularly troubling because mood disorders can have a greater impact on daily functioning than many serious chronic physical illnesses.^[16]

There is evidence that a subset of individuals with depressive symptoms will seek nonconventional treatment with complementary and alternative medicine (CAM).^[17] CAM treatments are now widely available and have increased in use in recent decades. The 2007 National Health Interview Survey (NHIS), which included a comprehensive survey of CAM use by Americans, demonstrated that almost 40% of adults use CAM.^[18] Americans with depression are more likely to use CAM remedies than conventional antidepressants (ADs) or psychotherapy,^[19] and symptoms of depression, anxiety and insomnia are among the most frequently cited reasons for CAM use.^[19] A meta-analysis that assessed patient characteristics in randomized controlled trials (RCTs) of CAM therapies versus conventional AD for major depressive disorder (MDD) found no clinical variables, including severity of depression at baseline, to differ between CAM and standard AD trials, although there was a significantly higher proportion of women in the CAM trials than in standard AD trials.^[20] This is consistent with surveys that indicate a more prevalent use of CAM therapies among women.^[18,21] Many individuals taking conventional AD therapy either augment their treatment with a CAM therapy or switch to CAM remedies owing to medication-induced adverse effects, incomplete response to conventional treatment, cost or a desire to control their own treatment.^[22–25] There is some evidence that individuals seeking CAM treatments often come from vulnerable populations, such as the uninsured or racial and ethnic minorities.^[26–28]

This article provides an overview of currently available data on commonly used CAM treatments for depressive mood disorders. CAM interventions include a broad range of healing modalities and practices and the boundaries between CAM and allopathic healthcare domains are not always clearly defined or fixed.^[29] However, in general, CAM remedies include those practices that are thought to be outside of the dominant or conventional medical and psychological approach. The National Center for Complementary and Alternative Medicine classifies CAM modalities/practices into four broad categories (although a modality/practice can belong to more than one category): natural products; mind–body medicine; manipulative- and body-based practices; and other CAM practices. In this article, we will focus on the practices that have been most widely evaluated in the management of patients with mood disorders.

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