Complementary treatment options for depression

This page gives a brief overview of the most common complementary approaches in depression.

Most complementary approaches are used by people alongside lifestyle changes such as a healthy diet and stressRelating to injury or concern.-management techniques.

Many of the approaches listed only have a limited amount of scientific evidence to support their use. This is partly because there is a lack of good-quality trials and partly because their effectiveness is difficult to evaluate with many established research methods.

It is important to speak to your doctor before you try any of these approaches, as some, such as herbal remedies, may interfere with conventional treatment.

Summaries about therapies are placed under five standard headings below to indicate what evidence there is for effectiveness:

• Positive evidence and likely to help
• Unclear evidence but MAY help
• Unclear evidence and NOT likely to help
• Negative evidence
• Unclear or lacking evidence and unknown if likely to help

Important
Speak to your doctor before you try any of these approaches. Some therapies interfere with conventional treatment - for example, herbs may interact with medication you are taking and can present their own side-effects. Herbs should be supplied by a qualified, registered herbalist.

Positive evidence and likely to help

There are currently no complementary approaches listed in this section

Unclear evidence but MAY help

Acetyl-L-carnitine

Acetyl-L-carnitine is an amino acidAn organic compound that is the basic building block of all proteins. that is made in the liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats.. It is also found in some foods, including red meat, dairy products, avocado and fermented soybean products. Acetyl-L-carnitine is needed to transport long chain fatty acids into the energy-producing structures (mitochondria) of cells. Three randomised controlled trialsStudies comparing the outcomes between one or more different treatments for a disease (or in some instances, preventive measures against that disease) and no active treatment at all (the placebo group). Study participants are allocated to the various groups on a random basis. May be abbreviated to RCT. suggest that taking acetyl-l-carnitine supplement may help to improve depressive disorders, with two showing it was better than placebo, and one showing it was as effective as an antidepressant drug (amisulpride).  The way in which it works is unknown, but may involve the improved production of energy in brain cells. [1]

Autogenic Training

Autogenic Training (AT) is a relaxation technique developed in 1932 by a German psychiatrist, Johannes Schultz. AT involves mental exercises such as visualisation and concentration on breathing and heart beat to reduce stressRelating to injury or concern. and promote relaxation.  Two studies suggest that AT used under the supervision of a therapist may help to lift a depressed mood when practised twice a day over a 10 to 12 week period.  More research is needed to confirm this, however. The effectiveness of self-taught AT has not been studied [1,2].

5-HTP

5-hydroxy-tryptophan (5-HTP) is a substance derived from an amino acidAn organic compound that is the basic building block of all proteins., l-tryptophan, which is present in small amounts in foods such as turkey, chicken, meat and dairy products. The 5-HTP in supplements is extracted from the seeds of a West African medicinal plant, Griffonia simplicifolia.  Once it crosses the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid.-brain-barrier, some 5-HTP is converted into serotonin (5-hydroxytryptamine or 5-HT), which helps to regulate mood, sleep and impulse control.  A meta-analysis of two studies suggest that 5-HTP supplements are more effective than placebo for alleviating depression but further well-designed trials are needed to fully assess its effectiveness. [3]

Hypericum extracts - St John's Wort

The herb, St John's Wort, contains a number of substances that have an antidepressant action. These include hypericin, pseudohypericin, hyperforin and adhyperforin. It appears to affect the levels of a number of brain neurotransmitters, including serotonin, noradrenaline, dopamineA type of neurotransmitter - chemicals that help the communication between nerve cells (neurons). , gamma-aminobutyric acid (GABA) and L-glutamate. A meta-analysis of data from 29 trials, involving almost 5500 patients (who took St John's Wort for between 4 and 12 weeks) found that Hypericum was more effective than placebo in treating major depression and of similar effectiveness to standard antidepressant drugs, but produced fewer side effects. Hypericum may be suitable for the treatment of mild to moderate depression where prescribed drugs are not possible or are poorly tolerated  [1,4,5].

Mindfulness-Based Cognitive Therapy

This therapy, which is derived from mindfulness-based stressRelating to injury or concern. reduction programmes and cognitive-behavioural therapy, has been shown to  be beneficial for people with recurrent  depression who are at risk from relapse. The therapy aims to enable people to learn to become more aware of the thoughts and feelings related to depression and to help people cultivate beneficial strategies to deal with these thoughts and feelings [22].

Music Therapy

Music therapy is believed to activate emotional pathways in the brain. A meta-analysis of date from a number of studies suggest that listening to music can lead to temporary depression or elevation of mood (depending on the type of music) for periods of less than an hour. A single session of listening to music is unlikely to reduce depression for a prolonged period of time. However, listening to music regularly can have a beneficial longer-term  effect with most benefits gained after 16 sessions [1,6].

Omega 3

Fish oils contain two long-chain omega-3 fatty acids  which are important for brain health. Docosahexaenoic acid (DHA) is incorporated into synaptic neuronal cellThe basic unit of all living organisms. membranes to improve membrane structure and fluidity, while eicosapentaenoic acidAn essential omega-3 fatty acid found in oily fish. (EPAAn essential omega-3 fatty acid found in oily fish.) appears to play a functional role to improve cellThe basic unit of all living organisms. signalling. The anti-inflammatoryAny drug that suppresses inflammation effects of these oils may also be important. Several studies suggest that long-chain omega-3 fatty acids are more effective than placebo in improving depression in both children and adults, but some other studies have not shown significant results.  Some evidence suggests that EPAAn essential omega-3 fatty acid found in oily fish.-rich oils are more effective than DHA-rich oils, but this has not yet been proven conclusively  [1,4,7].

Relaxation training

Progressive relaxation training involves the tensing then relaxing of different muscles groups in the body.  Some studies suggest that relaxation training is helpful for people with depressive disorder. However, a meta-analysis of results from six trials suggests that relaxation training may be less helpful in improving depression than psychological therapies [1,2,8]

SAMe

S-Adenosylmethionine (SAMe) is a substance made in the body which is involved in many metabolic reactions in the brain. A meta-analysis of 28 trials suggests that people with depression who take SAMe will show greater improvement than those taking inactive placebo and that is may be as effective as standard tricyclic antidepressant drugs. It is available as a supplement in some countries but not in others [1].

Yoga

Yoga is an oriental technique that uses a variety of postures (asanas), breathing exercises (pranayama) and meditation to relax the mind and body.  A systematic review of five trials involving different types of yoga found that it was potentially beneficial for treatment depressive disorders, but more research is needed to confirm this [1,2,9].

Unclear evidence and NOT likely to help

Ginkgo

Extracts from the leaves of the Ginkgo biloba tree have been used in the treatment of depression, but no improvements have been shown  [1,2].

There are currently no complementary approaches listed in this section

Negative evidence

There are currently no complementary approaches listed in this section.

Unclear or lacking evidence and unknown if likely to help

Acupuncture

Acupuncture is an oriental therapy based on the belief that a vibrant life energy, known as Qi,  flows through our body along channels known as meridians. Qi is believed to become concentrated at certain points - known as acupoints - where it can enter or leave the body. During acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points., a therapist inserts fine, sterile, disposable needles into the skin at selected acupoints to stimulate or suppress the flow of Qi.  Although acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. has been used to treat depressive disorders, its effectiveness is uncertain [10,11,12].

Aromatherapy

Aromatherapy uses aromatic essential oils that are derived from plants, to produce effects on the mind and body. The oils may be inhaled, or diluted with a carrier oil and applied to the skin.  Although certain aromatherapy oils (bergamot, geranium, jasmine, lavender and Egyptian rose) have been used to treat depressive disorders, their effectiveness is uncertain [1].

Ayurvedic herbs

Ayurveda is an Indian traditional medical system which includes dietary recommendations, herbal remedies, massage and sometimes meditation, yoga and exercise. It originated more than 5,000 years ago. Literally translated, it means "the knowledge of life". Although the Ayurvedic herb, Bacopa monnieri has been used with some success in the treatment of depressive disorders, its effectiveness remains uncertain [13].

Borage

Oil extracted from the borage plant (also known as Starflower oil) may have a small antidepressant effect but in one study, this effect had disappeared after six weeks. Its effectiveness is therefore uncertain [1].

Homeopathy

Homeopathy is a complementary practice based on the 'Law of Similars' also known as 'like cures like'.  Homeopathic substances undergo a process called 'potentisation', which involves a procedure of vigorous shaking and considerable dilution of the original 'active' ingredient. Although  homeopathic remedies have been used to help treat depressive disorders, their effectiveness is uncertain [14]

Massage

During massage, a therapist uses a variety of strokes  to stimulate the soft tissues of the body, such as rubbing, drumming, kneading, wringing, friction strokes and applying deep pressure. It produces  muscleTissue made up of cells that can contract to bring about movement. relaxation and may also increase brain serotonin levels through effects on stressRelating to injury or concern. hormones, or by stimulation of the vagus nerveBundle of fibres that carries information in the form of electrical impulses..  Preliminary evidence suggests that massage may improve depressive disorders, but its effectiveness is uncertain [1,2]

Meditation

Meditation is a relaxation technique in which the mind is emptied of thought, or allowed to dwell on a particular activity, to achieve a state of calm and heightened awareness. It may be helpful for treating depressive disorders by allowing distance from negative thoughts, however studies to date have given inconsistent results and its effectiveness remains uncertain. Further studies are currently being conducted which show more promising results. [20].

Melatonin

Melatonin is a hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. produced in the pineal glandAn organ with the ability to make and secrete certain fluids. to regulate sleep/wake cycles and biorhythms. Supplements containing melatonin are available in some countries over the counter, and in others on prescription. Although  has been used to treat depressive disorders, the limited evidence available suggests it is ineffective for this indication [1].

Panax Ginseng

Korean Ginseng (Panax ginseng) has been used in the Orient as a revitalising tonic for several thousand years. Its root contains unique substances, known as ginsenosides, of which 29 have been identified. Those with a sedative action are mostly derived from small lateral roots, while those with a more stimulating action are mostly  derived from the main root. Although  Panax ginseng has been used to treat depressive disorders, a trial involving over 80 people found that ginseng had no significant effect [1].

Tai chi

Tai chi is a non-combative Chinese martial art that is more accurately described as a movement therapy. It uses slow, graceful, relaxed movements plus meditation and breathing techniques to improve the flow of energy (Chi) through the body.  Tai chi  has a beneficial effect on mood in non-clinically depressed people but there is no currently evidence that it is effective in treating depressive disorders  [1].

Traditional Chinese herbal medicine

In traditional Chinese herbal medicine a number of herbs are used to help treat depressive disorders.  However, a systematic review of 18 studies involving 1,260 patients found no evidence to support their effectiveness and more research is needed to fully assess their effectiveness [15].

Qigong

Qigong (pronounced Chee Gong) is a traditional Chinese healing art that is sometimes referred to as 'Chinese yoga' or 'acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. without needles'. It involves the use of gentle movements, stretches, guided imagery and meditation to promote relaxation.  Although  qigong has been used to treat depressive disorders, its effectiveness is uncertain [1]

Vitamin B6, B12 and folate

Three B vitamins, B6, B12 and  folate (whose synthetic form is known as folic acid) may have an  antidepressant action through their ability to lower bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. levels of the potentially harmful amino acidAn organic compound that is the basic building block of all proteins., homocysteineA type of amino acid (the building block of all proteins).. However, studies in which all three vitamins were given found it was no better than placebo in the treatment of severe depression. Folate has only shown a beneficial effect when  added to other antidepressant therapy regimes - not when used alone [4, [16,17].

Vitamin D3

Vitamin D3 is a fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body.-soluble vitamin that can be made in the skin on exposure to sunlight. Food sources of vitamin D3 include oily fish, fish liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats. oils, animal liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats., fortified margarine, eggs, butter and fortified milk.  There appears to be a relationship between bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. levels of vitamin D and the development of depressive disorder, and taking supplements may improve symptoms. Researchers are currently looking into the effectiveness of vitamin D3 as a treatment for depression but it is too early to draw any firm conclusions  [18,19].

*Please note: All herbs should be taken under the direction of a qualified, registered herbalist. Even though these are natural products, side-effects may occur and herbs may interact with medication you are taking. Please also be sure to inform your medical team before you decide to take any herbal remedies or supplements.

References

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2. Ernst E, Pittler MH, Wider B et al. Oxford Handbook of Complementary Medicine. Oxford University Press, p. 360.
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