Positive Health Online

Abstract

THACHIL and co-authors, Kings College London, Section of Cultural Psychiatry, HSRD, PO: 25, Institute of Psychiatry, DeCrespigny Park, London SE5 8AF, UK,  afthachil@yahoo.co.uk, have reviewed (55 references) the evidence base for CAM therapies in depression.

Background

Depression is one of the leading indications for using Complementary and Alternative Medicine (CAM). This paper reviews the evidence of efficacy of different types of CAM in depression with the aim of identifying the highest level of evidence.

Methodology

Literature searches were conducted for studies on CAM as the only treatment in depression. All papers were reviewed by two researchers and the evidence was ranked according to a widely referenced hierarchy of evidence.

Results

19 papers formed the final review. Grade 1 evidence was found on the use of St. John's wort, Tryptophan/5-Hydroxytryptophan, S-adenosyl methionine, Folate, Inositol, Acupuncture and Exercise in Depressive disorders, none of which was conclusively positive. RCTs at the Grade 2 level were found on the use of Saffron (Herbal medicine), Complex Homoeopathy and Relaxation training in Depressive disorders, all of which showed inconclusive results. Other RCTs yielded unequivocally negative results. Studies below this level yielded inconclusive or negative results. Searches were restricted to the English language. The author’s list of CAM approaches may not have been comprehensive. Studies on the use of CAM as an adjunctive treatment were excluded, and this review aimed to identify only the highest level of evidence.

Conclusion

None of the CAM studies show evidence of efficacy in depression according to the hierarchy of evidence. The RCT model and the principles underlying many types of CAM are dissonant, making its application in the evaluation of those types of CAM difficult. The hierarchy of evidence used here has limited utility in grading trials of CAM.

References

Thachil AF, Mohan R, Bhugra D. The evidence base of complementary and alternative therapies in depression. Journal of Affective Disorders 97 (1-3): 23-35, Jan 2007.

Comment

It is perhaps not surprising, given that the pharmaceutical drug evidence for evidence was similarly inconclusive, that this review of a variety of complementary therapies for Depression didn’t yield conclusive evidence of efficacy for single types of therapies, since depression is such a complex condition, with a variety of causes and therefore, potentially useful therapeutic approaches. People are highly complex and this is why effective treatments probably have to be individually targeted.