Mood disorders and complementary and alternative medicine: a literature review

The Efficacy of Body-Oriented Yoga in Mental Disorders–A Systematic Review and Meta-Analysis

BACKGROUND

The efficacy of body-oriented yoga in the treatment of mental disorders has been investigated in numerous studies. This article is a systematic review and meta-analysis of the relevant publications.

METHODS

All studies in which the efficacy of hatha-yoga, i.e., body-oriented yoga with asanas and pranayama, was studied in adult patients suffering from a mental disorder (as diagnosed by ICD or DSM criteria) were included in the analysis. The primary endpoint was disorder-specific symptom severity. The publications were identified by a systematic search in the PubMed, Web of Science, PsycINFO and ProQuest databases, supplemented by a search with the Google Scholar search engine and a manual search in the reference lists of meta-analyses and primary studies, as well as in specialized journals.

RESULTS

25 studies with a total of 1339 patients were included in the analysis. A large and significant effect of yoga was seen with respect to the primary endpoint (symptom severity) (Hedges' g = 0.91; 95% confidence interval [0.55; 1.28]; number needed to treat [NNT]: 2.03), with substantial heterogeneity (I2 = 69.8%) compared to untreated control groups. Small but significant effects of yoga were also seen in comparison with attention control (g = 0.39; [0.04; 0.73]; NNT: 4.55) and physical exercise (g = 0.30; [0.01; 0.59]; NNT: 5.75); no difference in efficacy was found between yoga and standard psychotherapy (g = 0.08; [-0.24; 0,40]; NNT: 21.89). In view of the relatively high risk of bias, these findings should be interpreted with caution.

CONCLUSION

Body-oriented yoga with asanas and pranayama as central components is a promising complementary treatment for mental disorders and should be investigated in further high-quality studies.

Nutrition and Bipolar Depression

As with physical conditions, bipolar disorder is likely to be impacted by diet and nutrition. Patients with bipolar disorder have been noted to have relatively unhealthy diets, which may in part be the reason they also have an elevated risk of metabolic syndrome and obesity. An improvement in the quality of the diet should improve a bipolar patient's overall health risk profile, but it may also improve their psychiatric outcomes. New insights into biological dysfunctions that may be present in bipolar disorder have presented new theoretic frameworks for understanding the relationship between diet and bipolar disorder.

Mind-Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review

Mind-body approaches are commonly used to treat a variety of chronic health conditions, including depression and anxiety. A substantial proportion of individuals with depression and anxiety disorders do not receive conventional treatment; disadvantaged individuals are especially unlikely to receive treatment. Mind-body approaches offer a potentially more accessible and acceptable alternative to conventional mental health treatment for disadvantaged individuals, who may not otherwise receive mental health treatment. This review examines evidence for the efficacy of mind-body interventions for mental health symptoms among disadvantaged populations. While rates of utilization were relatively lower for racial/ethnic minorities, evidence suggests that significant proportions of racial/ethnic minorities are using complementary health approaches as health treatments, especially prayer/healers and natural or herbal remedies. This review of studies on the efficacy of mind-body interventions among disadvantaged populations found evidence for the efficacy of mind-body approaches for several mental and physical health symptoms, functioning, self-care, and overall quality of life.

Use of complementary and alternative medicine within Norwegian hospitals

Background

Over the recent decades complementary and alternative medicine (CAM) use within and outside of the public health care system in Norway has increased. The aim of this study is to describe to what extent CAM is offered in Norwegian hospitals in 2013 and investigate possible changes since 2008.

Methods

In January 2013 a one-page questionnaire was sent to the medical director of all included hospitals (n = 80). He/she was asked to report whether or not one or more specific CAM therapies were offered in the hospital. Fifty-nine (73.8 %) hospitals responded and form the basis for the analyses.

Results

CAM was offered in 64.4 % of the responding hospitals. No major differences were found between public and private, or between somatic and psychiatric, hospitals. Acupuncture was the most frequent CAM method offered, followed by art- and expression therapy and massage.

The proportion of hospitals offering CAM has increased from 50.5 % in 2008 to 64.4 % in 2013 (p = 0.089). The largest increase was found in psychiatric hospitals where 76.5 % of hospitals offered CAM in 2013 compared to 28.6 % in 2008 (p = 0.003). A small decrease was found in the proportion of hospitals offering acupuncture between 2008 (41.4 %) and 2013 (37.3 %).

Conclusions

A majority of Norwegian hospitals offer some sort of CAM. The largest increase since 2008 was found in psychiatric hospitals. Psychiatric hospitals seem to have established a practice of offering CAM to their patients similar to the practice in somatic hospitals. This could indicate a shift in the attitude with regard to CAM in psychiatric hospitals.

The use of complementary and alternative medicine in adults with depressive disorders. A critical integrative review

BACKGROUND

Depression has been identified as one of the most frequent indications for CAM use and is a strong predictor of CAM use. The present article provides a critical review of CAM use for depressive disorders including bipolar depression by addressing prevalence of CAM use and CAM users׳ characteristics, motivation, decision-making and communication with healthcare providers.

METHODS

A comprehensive search of 2003-2014 international literature in the Medline, CINAHL, AMED, and SCOPUS databases was conducted. The search was confined to peer-reviewed articles published in English with abstracts and reporting new empirical research findings regarding CAM use and depressive disorders.

RESULTS

A considerable level of CAM use was observed among both general and clinical populations of people suffering from depressive disorders, many of whom use CAM concurrently with their conventional medicine. In particular, high rates of CAM use were found among those with bipolar disorder, an illness known to cause substantial impairments in health-related quality of life. Concomitant prescription medication use ranged from 0.52% to as high as 100%.

LIMITATIONS

Study design such as the inclusion of bipolar and depression in the same diagnostic category hamper the differentiation and attribution of CAM usage for symptoms.

CONCLUSION

Findings of our review show that enduring impairments in function and persistence of symptoms (as reflected by increased CAM use proportional to severity of illness and comorbidity) are the impetus for sufferers of depressive illness to seek out CAM. The psychosocial factors associated with CAM use in depressive illnesses and severe mental illness are yet to be established. Subsequent research amongst those with depressive disorders would be informative in clarifying the range of motivations associated with mental illness.

Prescription of Chinese Herbal Medicine in Pattern-Based Traditional Chinese Medicine Treatment for Depression: A Systematic Review

Traditional Chinese medicine (TCM) treatments are often prescribed based on individuals' pattern diagnoses. A systematic review of randomized controlled trials in Chinese and English literatures on TCM pattern-based treatment for depression has therefore been conducted. A total of 61 studies, 2504 subjects, and 27 TCM patterns were included. Due to the large variation of TCM pattern among participants, we only analyzed the top four commonly studied TCM patterns: liver qi depression, liver depression and spleen deficiency, dual deficiency of the heart, and spleen and liver depression and qi stagnation. We found that Xiaoyao decoction was the most frequently used herbal formula for the treatment of liver qi depression and liver depression with spleen deficiency, while Chaihu Shugan decoction was often used for liver depression and qi stagnation. Bai Shao (Paeonia lactiflora Pall.) and Chai Hu (Bupleurum chinense DC.) were commonly used across different TCM patterns regardless of the prescribed Chinese herbal formulas. The rationale underlying herb selection was seldom provided. Due to the limited number of studies on TCM pattern-based treatment of depression and their low methodological quality, we are unable to draw any conclusion regarding which herbal formulas have higher efficacy and which TCM patterns respond better to CHM.

Medical students' knowledge, attitude, and practice of complementary and alternative medicine: a pre-and post-exposure survey in Majmaah University, Saudi Arabia

BACKGROUND

Evidently, complementary and alternative medicine (CAM) is a recognized medical practice that efficiently uses multiple treatment therapies and techniques in the prevention and management of a variety of human disorders. Many medical schools have integrated CAM curriculum in medical education system worldwide. Research in knowledge, attitude, and practice (KAP) of diverse health professionals exposed to CAM courses is important from many perspectives including improvement in KAP and teaching skills of faculty, together with capacity building and curriculum development.

OBJECTIVE AND SETTING

This pre- and post-design cross-sectional study aimed to assess CAM-KAP of two intakes of medical students in Majmaah University, Saudi Arabia.

METHODS

The second-year medical students of the first (year 2012-2013) and second (year 2013-2014) intake (n=26 and 39, respectively) were selected for this study. A reliable, 16-item self-administered questionnaire was distributed among all the students for answering before and after the 48-hour CAM course. The data were analyzed using appropriate statistical test of significance.

RESULTS

Medical students' knowledge and attitude toward CAM significantly improved across some subitems of CAM questionnaire with a positive trend in the rest of its items including their views on CAM practices.

CONCLUSION

CAM course tends to have a positive impact on KAP of medical students. The preliminary results of this study call for further research with a larger sample in academic settings across the nation.

Pharmacological approaches to the challenge of treatment-resistant depression

Although monoaminergic antidepressants revolutionized the treatment of Major Depressive Disorder (MDD) over a half-century ago, approximately one third of depressed patients experience treatment-resistant depression (TRD). Such patients account for a disproportionately large burden of disease, as evidenced by increased disability, cost, human suffering, and suicide. This review addresses the definition, causes, evaluation, and treatment of unipolar TRD, as well as the major treatment strategies, including optimization, augmentation, combination, and switch therapies. Evidence for these options, as outlined in this review, is mainly focused on large-scale trials or meta-analyses. Finally, we briefly review emerging targets for antidepressant drug discovery and the novel effects of rapidly acting antidepressants, with a focus on ketamine.

On Gelsemium and Complementary and Alternative Medicine (CAM) in Anxiety and Experimental Neurology

A recent discussion expanded the debate about the experimental research on Gelsemium in anxiety. Herbal medicine is widely used in anxiety and mood disorders, often with contradictory evidence, although some authors are yet prompted to promote their full introduction in pharmacology as a promising therapy. Complementary and alternative medicine (CAM) in anxiety is particularly appreciated by individual healthcare, but deserves further investigation, as many critical issues have been recently raised. Comments about the ability of negligible doses of Gelsemium hydroalcoholic extracts to affect gene expression were recently reported.

The potential utility of pharmacogenetic testing in psychiatry

Over the last decade, pharmacogenetics has become increasingly significant to clinical practice. Psychiatric patients, in particular, may benefit from pharmacogenetic testing as many of the psychotropic medications prescribed in practice lead to varied response rates and a wide range of side effects. The use of pharmacogenetic testing can help tailor psychotropic treatment and inform personalized treatment plans with the highest likelihood of success. Recently, many studies have been published demonstrating improved patient outcomes and decreased healthcare costs for psychiatric patients who utilize genetic testing. This review will describe evidence supporting the clinical utility of genetic testing in psychiatry, present several case studies to demonstrate use in everyday practice, and explore current patient and clinician opinions of genetic testing.

Evaluation of the influence of ayurvedic formulation (Ayushman-15) on psychopathology, heart rate variability and stress hormonal level in major depression (Vishada)

INTRODUCTION

Ayurveda (Indian-complimentary and alternative medicine) is still most sought after in India and has promising potential in management of Vishada [major depressive disorder (MDD)]. But, systematic research is lacking. In this study we evaluated of influence of ayurvedic treatment (Panchakarma and Ayushman-15) on psychopathology, heart rate variability (HRV) and endocrinal parameters in patients with major depression.

METHODS

81 drug naive patients diagnosed as Vishada by ayurvedic physician and MDD according to DSM IV-TR were given ayurvedic Virechana module (therapeutic purgation) and were randomized into two groups. Patients in group A (n=41) received Ayushman-15A while group B (n=40) received Ayushman-15B for two months and Shirodhara (forehead-oil pouring therapy). Patients were assessed with Hamilton Depression Rating Scale (HDRS), Montgomery Asberg Depression Rating Scale (MADRS), Heart Rate Variability (HRV). Cortisol and adrenocorticotropic hormone (ACTH) were estimated at baseline and after ayurvedic therapy. HRV and endocrinal parameters were compared with age and gender matched healthy volunteers.

RESULTS

HRV parameters showed significant sympathetic dominance in patients compared to healthy volunteers. Two months of ayurvedic treatment significantly decreased psychopathology, showed increase in vagal tone, decrease in sympathetic tone and reduced cortisol levels. However, there was no significant difference between groups receiving Ayushman A and B.

CONCLUSION

This study provides evidence for antidepressant, cardiac (HRV) and beneficial neuroendocrine modulatory influence of Ayurveda therapy in patients of Vishada (MDD). Further studies are needed to confirm these findings. Greater insight into the neurobiology behind this therapy might provide valuable information about newer drug target.

A systematic review on the efficacy, safety and types of Chinese herbal medicine for depression

Chinese herbal medicine (CHM) is one of the commonly used complementary and alternative medicine therapies for major depressive disorder. The objective of this study was to review the efficacy, safety and types of CHM for depression. We systematically searched key databases (9 Chinese and 7 English) up until May 2013 for randomized controlled trials (RCTs) and examined 7 systematic reviews for additional articles. Methodological quality was assessed by modified Jadad scale and Cochrane's risk of bias assessment. Only studies with moderate methodological quality, defined as modified Jadad scale score ≥3, were included in meta-analysis for efficacy. Of the 296 RCTs that were assessed in details, 278 (93.9%) had modified Jadad scale score < 3, and only 21 scored ≥ 3. The frequently used formulas were Xiao Yao decoction, Chaihu Shugan decoction and Ganmai Dazao decoction; while Chaihu, Bai Shao and Fu Ling were the frequently used single herb. Meta-analyses showed that CHM monotherapy was better than placebo and as effective as antidepressants in reducing Hamilton Depression Rating Scale (HDRS) score (CHM vs. placebo: mean difference: -7.97, 95% CI: -10.25 to -5.70, P < 0.00001, 2 studies; CHM vs. antidepressants: mean difference: 0.01, 95% CI: -0.28 to 0.30, P = 0.95, 7 studies). CHM were associated with less adverse events than antidepressants, and adding CHM to antidepressants reduced adverse events. Despite the overall positive results, due to the small number of studies with sufficient methodological quality, it is premature to accurately conclude the benefits and risks of CHM for depression.

Nanotechnology: an effective tool for enhancing bioavailability and bioactivity of phytomedicine

To achieve the desired therapeutic objective, the drug product must deliver the active drug at an optimal rate and amount. By proper biopharmaceutic design, the rate and extent of drug absorption (also called as bioavailability) or the systemic delivery of drugs to the body can be varied from rapid and complete absorption to slow and sustained absorption depending upon the desired therapeutic objective. Phytomedicine have served as the foundation for a larger fraction of the current pharmacopeia. But the delivery of phytomedicine is always problematic due to poor aqueous solubility, poor permeation, low systemic availability, instability and extensive first pass metabolism. Current review will discuss in detail about how nanotechnology can enhance the bioavilability and bioactivity of the phytomedicine.

Natural products and supplements for geriatric depression and cognitive disorders: an evaluation of the research

Numerous geriatric patients are using Complementary and Alternative Medicine (CAM) for late-life mood and cognitive disorders. Natural products and supplements are a common CAM intervention which have risks and benefits of which patients should be appropriately advised. The data for omega-3 fatty acids, ginkgo biloba, SAMe, St John's wort, B vitamins and vitamin D, huperzine, caprylidene, and coconut oil will be evaluated. Since the evidence basis for natural products and supplements is limited, especially for the geriatric population, studies involving the general adult population are included to infer effects in the aging population. Despite the data available, more rigorous studies with larger sample sizes over longer periods of time are still needed. Regardless of a physician's preference to recommend various natural supplements and products, a physician could protect their patients by having an understanding of the side effects and indications for various natural products.

Single-micronutrient and broad-spectrum micronutrient approaches for treating mood disorders in youth and adults

Several different vitamins and minerals appear to be effective augmenting agents for mood-modifying drugs, but are not potent monotherapies in themselves for treating psychiatric disorders. In contrast, broad-spectrum micronutrient interventions appear in early trials to be as effective as psychiatric medications with fewer adverse effects for treating mood disorders, ADHD, aggressivity, and misconduct in youth and adults. Broad-spectrum treatments also may improve stress responses, cognition, and sense of well-being in healthy adults, but have been less well studied in youth. Current clinical data justify an extensive expansion of research on micronutrient mechanisms and treatments in psychiatry.

Celecoxib: a new augmentation strategy for depressive mood episodes. A systematic review and meta-analysis of randomized placebo-controlled trials

OBJECTIVE

The aim of this research was to perform a systematic review to identify all randomized controlled trials (RCTs) evaluating the efficacy and safety of add-on celecoxib for treatment of depressive mood episodes.

METHODS

Four electronic databases were systematically searched from their inception to 8 August 2013: PubMed, Cochrane Library (Cochrane Central Register of Controlled Trials), Scopus, and PsychINFO. Pooled difference in means of Hamilton Depression Rating Scale score, pooled odds ratio (OR) of treatment response, and pooled OR of remission were calculated as the main effect size. A random-effects model was used to pool the data across studies.

RESULTS

Five RCTs (four unipolar depression studies and one bipolar depression study) were included in the systematic review for qualitative data synthesis. Moreover, quantitative results of four RCTs (unipolar depression studies) were meta-analyzed. The add-on celecoxib group had a statistically significant decrease in means of the Hamilton Depression Rating Scale score at week 4 (pooled difference in means=3.3, 95%CI [1.2-5.3], p=0.002) and week 6 (pooled difference in means=3.43, 95%CI [1.9-4.9], p<0.0001). The add-on celecoxib group also showed higher response (pooled OR=6.6, 95%CI [2.5-17], p<0.0001) and remission rates (pooled OR=6.6, 95%CI [2.7-15.9], p<0.0001) compared with the placebo group.

CONCLUSIONS

Celecoxib can be considered as an effective add-on treatment for unipolar depressive patients. Making conclusion regarding the efficacy and safety for longer duration warrants further studies with a larger sample size and longer follow-up duration.

A meta-analysis of the efficacy and safety of traditional Chinese medicine formula Ganmai Dazao decoction for depression

ETHNOPHARMACOLOGICAL RELEVANCE

Ganmai Dazao (GMDZ) decoction is a traditional Chinese herbal formula commonly used for the treatment of depression. The objective of this study was to assess the efficacy and safety of GMDZ, either alone or as co-therapy, for depression.

MATERIALS AND METHODS

We systematically searched key databases (9 Chinese and 7 English) up until May 2013 for randomized controlled trials (RCTs). The primary outcomes were effective rate and self-rated or clinician-rated severity of depression. The secondary outcome was the occurrence of adverse events. Methodological quality of the RCTs was assessed by the Cochrane׳s risk of bias assessment.

RESULTS

Ten RCTs were included. All were written in Chinese and the methodological quality was generally low. Pooled analysis of 5 studies which compared GMDZ with antidepressants showed that GMDZ was significantly more efficacious than antidepressants in effective rate (risk ratio: 1.14, 95% CI: 1.02 to 1.27, P=0.02, I(2)=0%), but comparable in Hamilton Depression Rating Scale (HDRS) score (mean difference: -2.10, 95% CI: -4.62 to -0.41, P=0.10, I(2)=92%). With regard to the other 5 studies which compared GMDZ plus antidepressants with antidepressants alone, there was no significant difference in effective rate (risk ratio: 1.24, 95% CI: 0.99 to 1.55, P=0.07, I(2)=93%), but the end-point HDRS score was significantly lower in GMDZ antidepressants combination (mean difference: -4.25, 95% CI: -6.50 to -2.00, P=0.0002, I(2)=96%). Adverse events were more common with antidepressants than GMDZ (rate ratio: 0.52, 95% CI: 0.32 to 0.82, P=0.005, I(2)=37%) and in antidepressants alone compared to GMDZ antidepressants combination (rate ratio: 0.23, 95% CI: 0.08 to 0.68, P=0.08, I(2)=0%).

CONCLUSION

The overall results suggest that GMDZ has few side effects and the potential as an antidepressant. Adding GMDZ to antidepressants reduces side effects and enhances efficacy of antidepressants. However, due to the small number of studies and their limitations, further studies with better methodological quality and more comprehensive safety assessment are needed to determine the benefits and risks of GMDZ in the treatment of depression.

Mental health system in Saudi Arabia: an overview

BACKGROUND

There is evidence that mapping mental health systems (MHSs) helps in planning and developing mental health care services for users, families, and other caregivers. The General Administration of Mental Health and Social Services of the Ministry of Health over the past 4 years has sought to streamline the delivery of mental health care services to health consumers in Saudi Arabia.

OBJECTIVE

We overview here the outcome of a survey that assessed the Saudi MHS and suggest strategic steps for its further improvement.

METHOD

The World Health Organization Assessment Instrument for Mental Health Systems was used systematically to collect information on the Saudi MHS in 2009-2010, 4 years after a baseline assessment.

RESULTS

Several mental health care milestones, especially provision of inpatient mental health services supported by a ratified Mental Health Act, were achieved during this period. However, community mental health care services are needed to match international trends evident in developed countries. Similarly, a larger well-trained mental health workforce is needed at all levels to meet the ever-increasing demand of Saudi society.

CONCLUSION

This updated MHS information, discussed in light of international data, will help guide further development of the MHS in Saudi Arabia in the future, and other countries in the Eastern Mediterranean region may also benefit from Saudi experience.