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Haefner J. Complementary and Integrative Health Practices for Depression. J Psychosoc Nurs Ment Health Serv 2017; 55:22-33. [PMID: 28892554 DOI: 10.3928/02793695-20170905-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/26/2017] [Indexed: 11/20/2022]
Abstract
The current article reviews selected complementary health approaches for the treatment of depressive symptoms. Complementary and integrative health (CIH) focuses on the whole person with the goal of optimal health-body, mind, and spirit. Patient use of integrative health practices and products is increasing; therefore, providers must understand these practices and products and be able to recommend or advise for or against their use based on research and guidelines. Difficulty with the current limitations of research on CIH practices is discussed, as these studies often may not have the same rigor or scientific weight as conventional treatment research. Although some individuals may use certain treatment options alone, such as massage therapy, meditation, and supplements to diet, the article discusses ways to combine CIH with allopathic care. Nurse practitioners should be open to considering complementary practices for health care and knowledgeable to guide patients in making safe health decisions. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 22-33.].
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Rizzo AM, Corsetto PA, Montorfano G, Opizzi A, Faliva M, Giacosa A, Ricevuti G, Pelucchi C, Berra B, Rondanelli M. Comparison between the AA/EPA ratio in depressed and non depressed elderly females: omega-3 fatty acid supplementation correlates with improved symptoms but does not change immunological parameters. Nutr J 2012; 11:82. [PMID: 23046564 PMCID: PMC3499393 DOI: 10.1186/1475-2891-11-82] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 09/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is one of the most frequently missed diagnoses in elderly people, with obvious negative effects on quality of life. Various studies have shown that long chain omega-3 polyunsaturated fatty acids (n-3 PUFA) may be useful in its management. Our objective was to evaluate whether a supplement containing n-3 PUFA improves depressive symptoms in depressed elderly patients, and whether the blood fatty acid pattern is correlated with these changes. METHODS The severity of depressive symptoms according to the Geriatric Depression Scale (GDS), blood fatty acid composition and erythrocyte phospholipids were analyzed in 46 depressed females aged 66-95y, diagnosed with depression according to DSMIV, within the context of a randomized, double-blind, placebo-controlled trial. 22 depressed females were included in the intervention group (2.5 g/day of n-3 PUFA for 8 weeks), and 24 in the placebo group. We also measured immunological parameters (CD2, CD3, CD4, CD8, CD16, CD19 and cytokines (IL-5, IL-15). RESULTS The mean GDS score and AA/EPA ratio, in whole blood and RBC membrane phospholipids, were significantly lower after 2 months supplementation with n-3 PUFA. A significant correlation between the amelioration of GDS and the AA/EPA ratio with some immunological parameters, such as CD2, CD19, CD4, CD16 and the ratio CD4/CD8, was also found. Nevertheless, omega-3 supplementation did not significantly improve the studied immunological functions. CONCLUSIONS n-3 PUFA supplementation ameliorates symptoms in elderly depression. The n-3 PUFA status may be monitored by means of the determination of whole blood AA/EPA ratio.
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Affiliation(s)
- Angela Maria Rizzo
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Via D, Trentacoste 2, Milan 20134, Italy.
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Pakseresht S, Boustani H, Azemi ME, Nilsaz J, Babapour R, Haghdust MR. Evaluation of Pharmaceutical Products of St. John's Wort Efficacy Added on Tricyclic Antidepressants in treating Major Depressive Disorder: A Double Blind Randomized Control Trial. Jundishapur J Nat Pharm Prod 2012; 7:106-10. [PMID: 24624165 PMCID: PMC3941849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/14/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is the most common disorder in our community. Hypericum perforatumm, is a herb with a long application history in treating depression. A controlled study to evaluate the effects of this herbal medicine in Iran did not exist. OBJECTIVES This study aimed to assess the effect of Hypericum perforatom (perforan), in combination with tricyclic antidepressants in MDD treatment. MATERIALS AND METHODS The present study was a placebo-controlled double blind randomized clinical trial including 40 patients with major depressive disorder who referred to Psychiatric Clinic and Golestan Hospital in 2011. Patients were randomly distributed in 4 blocks with 10 patients in each. 5 out of 10 patients took medicine (group I) and the others received placebo (group II). RESULTS After six weeks, both groups indicated some improvement, there was also a significant degree of recovery in the perforan group (P = 0.04). CONCLUSIONS The results of the current study suggested that combinations of St. John's Wort and tricyclic antidepressants compared to tricyclic antidepressants alone had significant effect on mild to moderate depression improvement. According to the numerous side effects of antidepressants, their continuous use was not well tolerated. There is a strong global tendency to use herbal medicines. Hypericum perforatom (St. John's Wort) is one of the best types of unapproved MDD treatments. Also, the most common reason to discontinue antidepressant treatments is their sexual side effects. None of the patients in the two groups had complained about sexual side effects which was consistent with other studies and it was an advantage of using this herbal medicine. Perforan group had improved in quality of sleep and the increase of energy. This improvement had not been reported in previous studies. Sleep problems are common complications of specific serotonin reuptake inhibitors (SSRIs).
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Affiliation(s)
- Sirus Pakseresht
- Department of Psychiatry, Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Hatam Boustani
- Department of Psychiatry, Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Mohammad Ebrahim Azemi
- Department of Pharmacognosy, School of Pharmacy, Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Medical Herbs and Natural Products Research Center, Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Jale Nilsaz
- School of Medicine, Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Reza Babapour
- School of Medicine, Jundishapur University of Medical Sciences, Ahvaz, IR Iran
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Pakseresht S, Boustani H, Azemi ME, Nilsaz J, Babapour R, Haghdust MR. Evaluation of Pharmaceutical Products of St. John’s Wort Efficacy Added on Tricyclic Antidepressants in treating Major Depressive Disorder: A Double Blind Randomized Control Trial. Jundishapur J Nat Pharm Prod 2012. [DOI: 10.17795/jjnpp-4318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Evaluation of Pharmaceutical Products of St. John’s Wort Efficacy Added on Tricyclic Antidepressants in treating Major Depressive Disorder: A Double Blind Randomized Control Trial. Jundishapur J Nat Pharm Prod 2012. [DOI: 10.5812/jjnpp.4318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Vieira ML, Hamada RY, Gonzaga NI, Bacchi AD, Barbieri M, Moreira EG, Mesquita SDFP, Gerardin DCC. Could maternal exposure to the antidepressants fluoxetine and St. John's Wort induce long-term reproductive effects on male rats? Reprod Toxicol 2012; 35:102-7. [PMID: 22824787 DOI: 10.1016/j.reprotox.2012.07.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 07/06/2012] [Accepted: 07/13/2012] [Indexed: 11/17/2022]
Abstract
Based on the limited number of studies that have investigated the adverse effects of maternal treatment with antidepressants on the development of male descendents, this study was carried out in rat in order to evaluate if maternal exposure to fluoxetine (FLX) or St. John's Wort (SJW) could disrupt the development of male offspring. The dams were treated daily, by gavage, with 7.5 mg/kg of FLX or 100 mg/kg SJW during pregnancy and lactation. The reproductive and behavior parameters were analyzed in male pups. Results showed decreases in the weight of the full seminal vesicle and in the number of spermatozoa. Moreover, FLX-exposed pups presented reduced seminiferous epithelium height and diameter of seminiferous tubules. The present study shows that maternal exposure to FLX, but not SJW could interfere on reproductive parameters in adult male rats.
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Affiliation(s)
- Milene Leivas Vieira
- Department of Physiological Sciences, State University of Londrina-UEL, Londrina, Paraná, Brazil
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Iovieno N, Dalton ED, Fava M, Mischoulon D. Second-tier natural antidepressants: review and critique. J Affect Disord 2011; 130:343-57. [PMID: 20579741 DOI: 10.1016/j.jad.2010.06.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 04/29/2010] [Accepted: 06/03/2010] [Indexed: 12/16/2022]
Abstract
The use of Complementary and Alternative Medicine (CAM) for physical and mental problems has increased significantly in the US over the past two decades, and depression is one of the leading indications for the use of CAM. This article reviews some of the lesser-known natural products with potential psychiatric applications that are starting to emerge with some scientific and clinical evidence and may constitute a next wave of natural antidepressants: Rhodiola rosea, chromium, 5-Hydroxytryptophan (5-HTP) and inositol. Background information, efficacy data, proposed mechanisms of action, recommended doses, side effects, and precautions are reviewed. We found some encouraging data for the use of these natural products in specific populations of depressed patients. R. rosea is an adaptogen plant that can be especially helpful in treating asthenic or lethargic depression, and may be combined with conventional antidepressants to alleviate some of their common side effects. Chromium has a beneficial effect on eating-related atypical symptoms of depression, and may be a valuable agent in treating atypical depression and seasonal affective disorder. Inositol may be useful in the treatment of bipolar depression when combined with mood stabilizers. Evidence for the clinical efficacy of 5-HTP is also promising but still preliminary. Although more well-designed and larger controlled studies are needed before any substantive conclusions can be drawn, the available evidence is compelling and these natural products deserve further investigation as a possibly significant addition to the antidepressant armamentarium.
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Affiliation(s)
- Nadia Iovieno
- Depression Clinical and Research Program at Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Rondanelli M, Giacosa A, Opizzi A, Pelucchi C, La Vecchia C, Montorfano G, Negroni M, Berra B, Politi P, Rizzo AM. Long chain omega 3 polyunsaturated fatty acids supplementation in the treatment of elderly depression: effects on depressive symptoms, on phospholipids fatty acids profile and on health-related quality of life. J Nutr Health Aging 2011; 15:37-44. [PMID: 21267525 DOI: 10.1007/s12603-011-0011-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Recent observations showed that long chain omega 3 polyunsaturated fatty acids (n-3 LCPUFA) could represent a potential treatment for elderly depression. To determine if a n-3 LCPUFA containing supplement improves depressive symptoms, changes phospholipids acids profile and ameliorates Health related quality of life (HRQoL) in depressed elderly patients. DESIGN Two-months, randomized, double-blind, placebo-controlled trial. SETTING Nursing home in Pavia, Italy. SUBJECTS Forty-six depressed females, aged 66-95 years. INTERVENTION 22 depressed females were included in the intervention group (n-3 group, that received 2.5 g/day of n-3 LCPUFA, with 1.67 grams of EPA and 0.83 grams of DHA), and 24 patients in the placebo group. The primary endpoint was the improvement of depressive symptoms as evaluated by Geriatric Depression Scale (GDS). Secondary endpoints were the evaluation of modifications of erythrocyte membrane phospholipids fatty acid profile and of of HRQoL, by using the Short-Form 36-Item Health Survey (SF-36). All parameters were assessed before and after the treatment period of 8 weeks. RESULTS The mean GDS at 2 months was significantly lowered only for the n-3 group. SF-36 physical and mental components were significantly increased in the intervention group. Compliance was good, as confirmed by erythrocyte membrane phospholipid FA concentrations, with significant increase of EPA and DHA in the intervention group. CONCLUSION The supplementation of n-3 LCPUFA in elderly female patients reduces the occurrence of depressive symptoms, improves phospholipids fatty acids profile and health-related quality of life.
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Affiliation(s)
- M Rondanelli
- Department of Applied Health Sciences, Section of Human Nutrition and Dietetics, Faculty of Medicine, Azienda di Servizi alla Persona di Pavia, University of Pavia Istituto di Cura Santa Margherita, Via Emilia 32, 27100 Pavia, Italy.
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Long chain omega 3 polyunsaturated fatty acids supplementation in the treatment of elderly depression: Effects on depressive symptoms, on phospholipids fatty acids profile and on health-related quality of life. J Nutr Health Aging 2010. [DOI: 10.1007/s12603-010-0321-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Huffman JC, Alpert JE. An approach to the psychopharmacologic care of patients: antidepressants, antipsychotics, anxiolytics, mood stabilizers, and natural remedies. Med Clin North Am 2010; 94:1141-60, x. [PMID: 20951275 DOI: 10.1016/j.mcna.2010.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The number of safe and effective medication treatments for psychiatric illness has expanded substantially over the past 10 to 15 years. Knowing when and how to prescribe psychotropics--and knowing which medication to prescribe--can be challenging, but with knowledge of some basic principles, this task can be performed adeptly by physicians of all specialties. In this article, the authors discuss basic principles of psychopharmacology and outline an approach to using several commonly prescribed classes of medications.
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Affiliation(s)
- Jeff C Huffman
- Harvard Medical School, 260 Longwood Avenue, Boston, MA 20115, USA.
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Abstract
Treatment-resistant depression (TRD) presents major challenges for both patients and clinicians. There is no universally accepted definition of TRD, but results from the US National Institute of Mental Health's (NIMH) STAR*D (Sequenced Treatment Alternatives to Relieve Depression) programme indicate that after the failure of two treatment trials, the chances of remission decrease significantly. Several pharmacological and nonpharmacological treatments for TRD may be considered when optimized (adequate dose and duration) therapy has not produced a successful outcome and a patient is classified as resistant to treatment. Nonpharmacological strategies include psychotherapy (often in conjunction with pharmacotherapy), electroconvulsive therapy and vagus nerve stimulation. The US FDA recently approved vagus nerve stimulation as adjunctive therapy (after four prior treatment failures); however, its benefits are seen only after prolonged (up to 1 year) use. Other nonpharmacological options, such as repetitive transcranial stimulation, deep brain stimulation or psychosurgery, remain experimental and are not widely available. Pharmacological treatments of TRD can be grouped in two main categories: 'switching' or 'combining'. In the first, treatment is switched within and between classes of compounds. The benefits of switching include avoidance of polypharmacy, a narrower range of treatment-emergent adverse events and lower costs. An inherent disadvantage of any switching strategy is that partial treatment responses resulting from the initial treatment might be lost by its discontinuation in favour of another medication trial. Monotherapy switches have also been shown to have limited effectiveness in achieving remission. The advantage of combination strategies is the potential to build upon achieved improvements; they are generally recommended if partial response was achieved with the current treatment trial. Various non-antidepressant augmenting agents, such as lithium and thyroid hormones, are well studied, although not commonly used. There is also evidence of efficacy and increasing use of atypical antipsychotics in combination with antidepressants, for example, olanzapine in combination with fluoxetine (OFC) or augmentation with aripiprazole. The disadvantages of a combination strategy include multiple medications, a broader range of treatment-emergent adverse events and higher costs. Several experimental pharmaceutical treatment alternatives for TRD are also being explored in combination with antidepressants or as monotherapy. These less studied alternative compounds include pindolol, inositol, CNS stimulants, hormones, herbal supplements, omega-3 fatty acids, S-adenosyl-L-methionine, folic acid, lamotrigine, modafinil, riluzole and topiramate. In summary, despite an increasing variety of choices for the treatment of TRD, this condition remains universally undefined and represents an area of unmet medical need. There are few known approved pharmacological agents for TRD (aripiprazole and OFC) and overall outcomes remain poor. This might be an indication that depression itself is a heterogeneous condition with a great diversity of pathologies, highlighting the need for careful evaluation of individuals with depressive symptoms who are unresponsive to treatment. Clearly, more research is needed to provide clinicians with better guidance in making those treatment decisions--especially in light of accumulating evidence that the longer patients are unsuccessfully treated, the worse their long-term prognosis tends to be.
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Affiliation(s)
- Richard C Shelton
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Complementary and Alternative Medicine (CAM) treatments and pediatric psychopharmacology. J Am Acad Child Adolesc Psychiatry 2008; 47:364-368. [PMID: 18356703 DOI: 10.1097/chi.0b013e31816520e5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
PURPOSE OF REVIEW There is well documented evidence for the increasing widespread use of complementary and alternative medicine in the treatment of physical and psychiatric symptoms and disorders within Western populations. Here we provide a review of the recent literature on evidence for using such interventions in the treatment of anxiety and depression. RECENT FINDINGS With regard to herbal treatments, kava is effective in reducing anxiety symptoms and St John's wort in treating mild to moderate depression. The association of kava with hepatotoxicity, however, is a significant concern. Promising data continue to emerge for the use of omega-3 fatty acids in managing depression. Evidence for the use of acupuncture in treating anxiety disorders is becoming stronger, although there is currently minimal empirical evidence for the use of aromatherapy or mindfulness-based meditation. SUMMARY The evidence base for the efficacy of the majority of complementary and alternative interventions used to treat anxiety and depression remains poor. Recent systematic reviews all point to a significant lack of methodologically rigorous studies within the field. This lack of evidence does not diminish the popularity of such interventions within the general Western population.
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Tao R, Moore JK, Mayes TL, Emslie GJ. Depression in children and adolescents: optimizing treatment. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/17455111.1.2.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Depression is a severe and prevalent illness among children and adolescents. Recent controversies regarding antidepressant use among pediatric patients have left healthcare providers, particularly primary-care providers, feeling uncertain of how to approach the care of depressed pediatric patients. Several large-scale studies of the treatment of pediatric depression have been completed. In addition, substantial progress has been made in our understanding of benefit versus risk in the treatment of pediatric depression. This paper presents the most updated scientific evidence in pediatric depression treatment. The review covers a wide range of treatment modalities including psychotherapy, antidepressant and alternative remedies. Recommendations based on both the scientific evidence and the most current guidelines and treatment algorithms are outlined.
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Affiliation(s)
- Rongrong Tao
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
| | - Jarrette K Moore
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
| | - Taryn L Mayes
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
| | - Graham J Emslie
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
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Nutritional Aspects of Child and Adolescent Psychopharmacology. Psychiatr Ann 2007. [DOI: 10.3928/00485713-20070701-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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