Alternative Treatments: Are They Helpful for Mood Disorders

An MGH expert sheds light on supplements, yoga, and other approaches used to treat depression and anxiety.

Many people with mood disorders and anxiety turn to complementary and alternative medicines (CAMs) such as dietary supplements, meditation, massage therapy, and other treatment approaches for help with their mental dis-tress. But how well do these approaches work?

We asked MGH’s David Mischoulon, MD, PhD, Director of Research and Alternative Remedy Studies at the Depression Clinical and Research Program, to assess CAM therapies identified in 2008 in a large National Institutes of Health survey as among the most commonly used by Americans looking for relief of depression, stress, anxiety, and sleep problems. He urged caution.

“Many alternative and complementary techniques can be helpful,” says Dr. Mischoulon, “However, I suggest that individuals first consider more conventional treatments, such as talk therapy and an-tidepressant medications, which may be even more effective for mood and anxiety disorders.

“I would advise people who are experiencing acute distress that impairs daily functioning, or who suffer from persistent feelings of depression and/or anxiety, to ask their medical care advisor for a referral to a mental health professional before turning to CAM therapies. Because mood and anxiety disorders can be serious, it’s important to get a professional assessment.

“If you decide to use alternative or complementary therapies, do so under the supervision of your medical care provider to avoid inappropriate treatments and problems associated with potential interactions or unwanted side effects. Keep in mind that if a CAM treatment is ineffective, your mood disorder or anxiety may worsen as more appropriate therapy is delayed.”

A REVIEW OF ALTERNATIVE MEDICINES FOR MOOD DISORDERS 

Here are Dr. Mischoulon’s assessments of various popular CAM therapies:

* MIND/BODY TECHNIQUES: These techniques involve quiet sessions of 20 minutes or more opening the mind and focusing the attention in order to change mood. In a small study pub-lished online June 3, 2013 in the journal Social Cognitive and Affective Neuroscience, brain scans and self reports of anxiety among volunteers before and after training in meditation suggests that anxiety levels were reduced by up to 39 percent following meditation training. “Research indicates that meditation can lower stress and as-sociated depression and anxiety,” says Dr. Mischoulon. “For best results, seek training by a meditation expert before trying it on your own.”

*SUPPLEMENTS: St. John’s wort (hypericum perforatum), SAMe (S-adenosylmethionine), and omega-3 fatty acids (fish oil) are among the most effective herbal and dietary supple-ments used for depression. St. John’s wort has been associated in multiple studies with effects comparable to those of conventional antidepressants in individuals with mild to moderate depres-sion—although not in individuals with severe depression. Side effects are generally mild; however, Dr. Mischoulon advises checking with your doctor before taking St. John’s wort, as it can interfere with a large number of prescription drugs, has been known to cause psychosis in some individuals, and can be dangerous when taken in conjunction with certain prescription antidepressants. SAMe is a naturally occurring molecule whose production declines with age. Research suggests that taking a synthetic form of the chemical improves mood by promoting the production of the neurotransmitters serotonin and dopamine. The supplement, which should not be combined with certain antidepressants, can cause minor side effects such as insomnia and gastrointestinal upset. “Overall, SAMe appears to be safe and effective in the treatment of depression, but more research is needed to determine optimal doses,” Dr. Mischoulon says. Omega-3 fatty acids, which must be obtained from the diet or supplements, are found naturally in cold-water fish, nuts, and flax seed. They are essential for normal brain function and are lacking in many Americans’ diet. Higher levels of omega-3 consumption have been asso-ciated in multiple studies with reduced risk for depression. Generally mild side effects include indigestion and in-creased bleeding. “If you are taking a blood thinner such as warfarin or aspirin, check with your doctor before taking omega-3s,” says Dr. Mischoulon.

*YOGA: This traditional Indian exercise technique provides benefits for mood as well as flexibility and strength. A number of studies have associated yoga—a combination of concen-tration, meditation, controlled breathing, and the assumption of various physical postures—with reduced anxi-ety, improved sleep, and easing of mild-to-moderate depression.“ Among its great advantages is that it is widely available, affordable, and requires no medical supervision,” says Dr. Mischoulon. “Once taught by a certified yoga instructor, you can practice yoga on your own, if you wish.”

*RELAXATION TECHNIQUES: Researchers have linked relaxation techniques such as progressive muscle relaxation (PMR) and creative visualization with significant im-provements in levels of anxiety, depression, muscle tension, stress, and insomnia, and with improved quality of life. PMR involves alternately tensing and releasing muscles of the body, usually beginning with the feet and toes and working upwards, muscle group by muscle group, to the head and neck. Visualization involves sitting or lying quietly while imagining yourself in a beautiful, peaceful setting, such as a tropical beach. While breathing slowly and deeply, the practitioner imagines the sensations associated with the scene, such as a warm breeze, the sound of birds, the feel of the wind, or the smell of saltwater. “If practiced regularly for 20 minutes or so, these techniques help to lower levels of stress and anxiety, and may also ease depression,” says Dr. Mischoulon. “Some research suggests it can also help relieve distress in people coping with chronic pain or acute health issues.”

*SPECIALIZED TREATMENTS: Many people turn to massage therapy or acupuncture for help dealing with stress, depression, or anxiety. Manipulating the soft tissue of the body through massage is thought to help lower levels of the stress hormone cortisol and reduce depression by increasing levels of the neurotransmitters serotonin and dopamine. The ancient Chinese technique of acupuncture—in which trained practitioners insert needles into the skin at specific points of the body and manipulate them for the purpose of adjusting the body’s energy flow—may also help reduce anxiety and depression. In one example, a study of the technique used in pregnant women published in the June 18, 2013 issue of the journal Medical Acupuncture, researchers at Harvard concluded that “there is high-level evidence to support the use of acupuncture for treating major depressive disorder in pregnant women.”

“Acupuncture has been used very effectively in individuals with depression as an adjunctive therapy to speed their clinical response to selective serotonin reuptake inhibitor (SSRI) antidepressants,” says Dr. Mischoulon.

To find an acupuncturist or massage therapist in your area, contact:

American Massage Therapy Association
500 Davis Street, Evanston, IL 60201
(877) 905-0577
www.amtamassage.org/findamassage/index.html

National Certification Commission for Acupuncture and Oriental Medicine
76 South Laura Street, Suite 1290
Jacksonville, FL 32202, (904) 598-5001
http://www.nccaom.org/find-a-practitioner-directory/

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