The following information is a summary of the findings of two reviews of the evidence of the effectiveness of complementary and self help treatments for depression and anxiety, published in the Medical Journal of Australia "Effectiveness of complementary and self-help treatments for anxiety disorders, Effectiveness of complementary and self-help treatments for depression".
Alternative or complementary therapies are ones involving practices and beliefs that are not generally upheld by the conventional health system in Western countries. Self-help treatments are those that can be used without necessarily consulting a doctor or health professional.
Many Australians prefer self-help and complementary therapies for anxiety and depression. For example, in a national sample, 57% regarded vitamins, minerals, tonics or herbal medicines as likely to be helpful for treating depression, compared with 29% who regarded antidepressants as likely to be helpful. People in the community have also been found to use self-help interventions more commonly than professional treatments when they have anxiety and depressive symptoms. In one survey, the most commonly used self-help interventions over a six-month period were taking alcohol to relax (55% of respondents), taking pain relievers (55%) or becoming involved in physical activity (50%), compared with 35% who consulted a general practitioner, 20% who took antidepressants, and 4% who received psychotherapy.
Given the frequent use of complementary and self-help treatments, it is important for general practitioners and others who are treating people for depression and anxiety to routinely ask them if they are using other types of therapies as well. An important reason is to prevent interactions between the complementary therapies and conventional treatments with potentially harmful effects.
Given their frequent use and the benefits that some people find, complementary and self-help therapies warrant the same degree of evaluation as conventional treatments. The community needs information about which treatments are likely to be effective, which are not, and which have not been adequately evaluated, to help people to make better choices. If they choose to use alternative therapies, it is preferable that they use those best supported by evidence. For severely depressed people, only conventional medical treatment is supported by evidence.
Alternative and self help therapies can be grouped under the following categories: medicines and homoeopathic remedies, physical treatments, lifestyle, and dietary changes.
Medicines and homoeopathic remedies
Examples of these remedies are bach flower remedies, herbal remedies, vitamins, minerals, St. John's Wort, valerian and Homeopathy. These remedies can be prepared in liquid or tablet form, as a tincture, powder or drops and are best administered by a Naturopath.
There tends to be limited evidence to support the use of these remedies in the treatment of anxiety and depression with the exception of support for the use of St. John's Wort for mild to moderate depression.
Some remedies appear to have promising results in the treatment of depression and anxiety but require a great deal more indepth investigation into their effectiveness and the safety of their use for the woman, particularly during pregnancy and breastfeeding. For example despite evidence of effectiveness of kava in treating general anxiety, rare cases of liver toxicity have led to advice against its use. Licorice should be used with caution, as excessive use can lead to hypertension, oedema and, in pregnancy, preterm birth.
Examples of physical treatments include acupuncture, kinesiology, bowen therapy, aromatherapy, hydrotherapy, massage/touch therapy and light therapy.
There are many benefits from the hands on and caring techniques of physical treatments, in relaxation, energy balance and the nurturing they provide to someone with depression and anxiety. Their use as a part of an overall therapy plan is really beneficial.
Acupuncture, performed by stimulating designated points of the body through the insertion of needles, finger pressure, application of heat, or a combination of these treatments has promising impact on the reduction of anxiety and depression symptoms but requires further investigation. So too with hydrotherapy - immersion in warm (close to body temperature) moving water, and the physical touch of massage is shown to have short term benefits for those with depression.
Examples of lifestyle changes include autogenic training (self relaxation), bibliotherapy, dance and movement therapy, exercise, humour, meditation, music, prayer, relaxation, yoga, pleasant activities and pets.
As with physical treatments there is evidence to support the use of a range of these lifestyle strategies but significantly more research is required to show evidence of how they support depression and anxiety. Unlike some of the physical treatments there is unlikely to be any disadvantage or negative impact from these strategies so their use should be determined by how beneficial they are to the individual.
Exercise has received more research attention and there are positive findings that support the use of exercise in the treatment of depression and anxiety. Humour allows us to see as amusing or ridiculous aspects of both everyday life and the unusual events that confront us, reducing anxiety. Meditation is a very pleasant activity that can have positive benefits for anxiety, relaxation and concentration, provided the woman is well enough to participate.
Examples of dietary changes include alcohol reduction, caffeine reduction, dietary changes, fish oils, sugar reduction and nicotine reduction.
There is some evidence to show that these dietary changes can benefit anxiety and depression but there is need for more ongoing research. There are also benefits for the physical well being of the woman.
Alcohol can be used as a form of self medication for depression and anxiety as can illegal drug use. Prolonged use can however lead to greater levels of anxiety and depression and should be avoided. Caffeine is also known to increase levels of anxiety and can contribute to depression, reduction in levels of intake is thought to be of benefit but needs further investigation.
Fish oils are a natural source of omega-3 fatty acids that are important in nervous system function and fish oils are a major dietary requirement. Low levels of fatty acid have been associated with low concentrations of a serotonin metabolite in cerebrospinal fluid which in turn has been associated with depression and suicide. There is however no evidence to support the use of fatty acids in the treatment of depression.
The complementary and self-help treatments with the best evidence of effectiveness are St John's wort, physical exercise, self-help books involving cognitive behaviour therapy, and light therapy for winter depression. However, none of these has as much support as antidepressants or face-to-face cognitive behaviour therapy, both of which are standard treatments recommended in clinical practice guidelines.
- Effectiveness of complementary and self-help treatments for anxiety disorders
Anthony F Jorm, Helen Christensen, Kathleen M Griffiths, Ruth A Parslow, Bryan Rodgers and Kelly A Blewitt Medical Journal of Australia 2004; 181 (7): S29-S46
- Effectiveness of complementary and self-help treatments for depression
Anthony F Jorm, Helen Christensen, Kathleen M Griffiths and Bryan Rodgers Medical Journal of Australia 2002; 176 (10 Suppl): S84-S9