Complementary and alternative medicine for the treatment of depressive disorders in women

Screening, Assessment, and Treatment of Perinatal Mental Health in Obstetrical Settings

Perinatal mood and anxiety disorders (PMADs) are common, yet obstetricians receive little training prior to independent practice on screening, assessing, diagnosing, and treating patients with depression and anxiety. Untreated PMADs lead to adverse pregnancy and fetal outcomes. Obstetricians are in a unique position to address PMADs. The following serves as a resource for addressing PMADs in obstetric practice.

Management of Premenstrual Dysphoric Disorder: A Scoping Review

Premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS) refer to physical, cognitive, or affective symptoms that arise in the late luteal phase and remit with menses. The present work is a clinically focused scoping review of the last twenty years of research on treatment for these disorders. A search of key terms using the PubMed/Medline, the Cochrane Library, Embase, and Web of Science databases was performed, and 194 studies of adult women met initial inclusion criteria for review. Research studies concerning medications, pharmacological and non-pharmacological complementary and alternative medicine treatments, and surgical interventions with the most available evidence were appraised and summarized. The most high-quality evidence can be found for the use of selective serotonin reuptake inhibitors (SSRIs) and combined oral contraceptives (COCs), with gonadotropin releasing hormone (GnRH) agonists and surgical interventions showing efficacy for refractory cases. While there is some evidence of the efficacy of alternative and complementary medicine treatments such as nutraceuticals, acupuncture, and yoga, variability in quality and methods of studies must be taken into account. Reprinted from Int J Womens Health 2022; 14:1783-1801, with permission from Dove Medical Press Ltd. Copyright © 2022.

Management of Premenstrual Dysphoric Disorder: A Scoping Review

Premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS) refer to physical, cognitive, or affective symptoms that arise in the late luteal phase and remit with menses. The present work is a clinically focused scoping review of the last twenty years of research on treatment for these disorders. A search of key terms using the PubMed/Medline, the Cochrane Library, Embase, and Web of Science databases was performed, and 194 studies of adult women met initial inclusion criteria for review. Research studies concerning medications, pharmacological and non-pharmacological complementary and alternative medicine treatments, and surgical interventions with the most available evidence were appraised and summarized. The most high-quality evidence can be found for the use of selective serotonin reuptake inhibitors (SSRIs) and combined oral contraceptives (COCs), with gonadotropin releasing hormone (GnRH) agonists and surgical interventions showing efficacy for refractory cases. While there is some evidence of the efficacy of alternative and complementary medicine treatments such as nutraceuticals, acupuncture, and yoga, variability in quality and methods of studies must be taken into account.

Effectiveness of acupuncture in postpartum depression: A protocol for an overview of systematic reviews

INTRODUCTION

Since conflicting evidence from systematic reviews and meta-analyses (SRs/MAs) on the effectiveness of acupuncture in the treatment of postpartum depression is observed. To systematically collate, appraise and synthesize the evidence from these SRs/MAs, an overview will be performed, and this study is an overview protocol.

METHODS AND ANALYSIS

Eight databases will be searched: Medicine, Web of science, Cochrane Library, Embase, China National Knowledge Infrastructure, SinoMed, VIP, and Wanfang Data. SRs/MAs of acupuncture on postpartum depression will be included. Literature screening, data extraction, and evaluation of the review quality will be performed by 2 independent reviewers. The methodological quality, reporting quality, and evidence quality will be assessed using the assessment of multiple systematic reviews-2 tool, the preferred reporting items for systematic reviews and meta-analyses checklists, and the grading of recommendations, assessment, development, and evaluation system, respectively. The results will be presented in the context of the topic and the objects of the overview. This study will help bridge the implementation gap between clinical evidence and its translation in clinical application, identify flaws in research and guide future high-quality study.

Reliability of Evidence to Guide Decision-Making in the Use of Acupuncture for Postpartum Depression

Background

There is conflicting evidence on the effectiveness of acupuncture in the treatment of postpartum depression (PPD). This study aimed to assess previous systematic reviews/meta-analyses (SRs/MAs) on the effectiveness of acupuncture to treat PPD.

Method

SRs/MAs regarding the use of acupuncture for PPD were identified from the establishment of digital databases to November 2021. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) was applied to evaluate the methodological quality of included SRs/MAs. The Grades of Recommendations, Assessment, Development and Evaluation (GRADE) was utilized to evaluate the evidence quality for outcomes of interest.

Results

Six studies that conducted quantitative syntheses were included. According to AMSTAR-2, the methodological quality of these SRs/MAs was critically low owing to limitations of items 2, 4, and 7. According to GRADE, no study included high-quality evidence and most studies included low-quality evidence.

Conclusions

Acupuncture m be beneficial for PPD, however, due to limitations of current evidence and inconsistent findings, further studies are needed to provide stronger evidence to draw definitive conclusions.

Gender Differences in Attachment Anxiety and Avoidance and Their Association with Psychotherapy Use—Examining Students from a German University

Attachment anxiety and avoidance might explain gender differences in psychotherapy use, which is generally lower in men. In addition, university students are a particularly vulnerable group for mental health problems, and understanding psychotherapy use, especially among mentally distressed male students, is pivotal. A total of 4894 students completed an online survey answering questions regarding psychotherapy use and completing the PHQ-D identifying psychological syndromes. In addition, the ECR-RD12 was used to measure attachment anxiety and avoidance. Significant gender differences for attachment anxiety and avoidance emerged, showing higher attachment anxiety in female students and higher attachment avoidance in male students. Male students used psychotherapy significantly less than female students. Male students’ attachment anxiety and avoidance predicted psychotherapy use, while for female students, only attachment anxiety emerged as a significant predictor. Attachment anxiety is positively associated with psychotherapy use, and lower attachment anxiety in men may explain lower psychotherapy use in male students.

Mothers' Experiences of Childbirth and Perspectives on Korean Medicine-Based Postpartum Care in Korea: A Qualitative Study

This study aimed to record the experiences of childbirth and postpartum care of postpartum women and gain an in-depth understanding of their experiences of Korean medicine-based postpartum healthcare. The investigator conducted a 60–90-min interview with the 8 participants (mean age 34 years), and the comments were analyzed using the thematic analysis method. The two major themes emerging from the participants’ comments were: “experience and awareness of childbirth and postpartum care” and “experiences of the Korean medicine-based postpartum program”. The first theme was analyzed in four primary categories: (1) experiences of breakdown of the body and mind; (2) impossibility of postpartum care without help; (3) experiences of relentless effort for recovery; and (4) experiences of body and mind recovery. The second theme was analyzed in four primary categories: (1) participation with vague expectations; (2) experiences of the effects of managing postpartum symptoms; (3) the need for a comprehensive Korean medicine management for postpartum women; and (4) suggested improvements for the Korean medicine-based postpartum program. Mothers recognized the importance of Korean medicine treatment during the postpartum period for the management of Sanhupung symptoms and postpartum care and reported the benefits of body warming, Sanhupung prevention, pain reduction, and sense of psychological stability.

Acupuncture as an Independent or Adjuvant Management to Standard Care for Perimenopausal Depression: A Systematic Review and Meta-Analysis

Background: Many women with perimenopausal depression (PMD) have sought alternative therapies such as acupuncture because of concerns about risks associated with antidepressant and hormone replacement therapy (HRT). This systematic review aimed to clarify if acupuncture is effective for PMD compared with waitlist control or placebo/sham acupuncture, and if acupuncture alone or combined with standard care (antidepressant and/or HRT) is more effective in ameliorating PMD in comparison with standard care alone. Methods: Randomized controlled trials (RCTs) of PMD treatment via acupuncture vs. waitlist control or placebo/sham acupuncture, and RCTs of PMD treatment via acupuncture alone or combined with Western pharmacotherapy vs. Western pharmacotherapy were searched for from seven databases from inception to December 2020. Cochrane criteria were followed. Results: Twenty-five studies involving 2,213 women were analyzed. Meta-analyses indicated that acupuncture significantly reduced the global scores of Hamilton Depression Scale (HAMD) [standardized mean difference (SMD) = -0.54, 95% CI (-0.91, -0.16), p < 0.01], compared with standard care. The therapeutic effect of acupuncture maintained at 2-, 4-, and 12-week follow-ups. Acupuncture combined with standard care was more effective than standard care alone in decreasing HAMD scores [SMD = -0.82, 95% CI (-1.07, -0.58), p < 0.01]. Too few RCTs were available to assess the clinical efficacy differences between acupuncture and placebo/sham acupuncture or HRT alone. Acupuncture also showed better effects in decreasing Kupperman index (KI) scores, whether compared with antidepressant alone [MD = -4.55, 95% CI (-8.46, -0.65), p = 0.02] or antidepressant combined with HRT [MD = -0.89, 95% CI (-1.34, -0.43), p < 0.01]. Conclusions: In comparison with standard care, acupuncture alone or combined with standard care was associated with significant improvements in PMD and reductions of other menopausal symptoms. This finding suggests that acupuncture may be a useful addition to treatment for PMD.

Depression during perimenopause: the role of the obstetrician-gynecologist

Depression in women is more common during perimenopause (the transition to menopause) than at other times in the life cycle. Symptoms of depression may be different in perimenopausal women compared to younger or older women, and are often dismissed as part of normal menopause. This is an expert narrative review. There are several evidence-based screening modalities which can be integrated into routine women's health visits, and can facilitate distinguishing between depression and normal perimenopausal symptoms. There is emerging evidence regarding the effect of hormonal changes on the development of perimenopausal depression and its optimal treatment, though critical research gaps remain. Obstetrician-gynecologists and other primary care providers play a vital role in the detection and management of depression in women. Providers caring for women during perimenopause have a unique opportunity to diagnose depression in their patients and identify appropriate treatment options.

How often do women use non-drug treatment methods for psyschiatric symptoms during pregnancy and postpartum periods?

The aim of this study was to determine the prevalence of complementary and alternative medical applications (CAM) and non-drug treatments of women during their pregnancies, postpartum periods and the changes between these periods. The Screening Form for Non-pharmacologic Methods Used during Pregnancy and Postpartum period was administered to the participants. Passiflora (Incarnata), Hypericum perforatum (St. John's Wort), omega 3 supplements, bright light treatment, transmagnetic stimulation, S-adenosyl- methionine, herbal teas, biofeedback/neurofeedback, amulets, exercise, acupuncture and psychotherapy were investigated. The ratio of the use of one of the CAM methods for psychiatric complaints during people's lifetime was found to be 33.3% (n=162). Herbal teas were the main practice used during pregnancy (58.8%) and the postpartum. The use of CAM according to the utilization periods of the participants statistically significantly decreased in those who were currently pregnant (Cochran's Q=298.007; P<0.05). The use of participants' non-drug treatments in the periodical follow-up decreased in those who are currently pregnant and increased during the postpartum period.

Evaluation of antidepressant activity of methanolic extract of Saraca asoca bark in a chronic unpredictable mild stress model

It is well established that chronic exposure to stressful events plays an important role in the etiology of depression. Saraca asoca (Roxb.), De. wild, or Saraca indica, belonging to family Fabaceae, is endogenous to India. The flowers, seeds, bark, and leaves of the plant have been used widely in Ayurveda medicine. The bark extract of S. asoca has shown chemoprotection, myeloprotection, and antioxidant potential. Owing to the above-mentioned properties of the plant, the present study sought to evaluate the effect of a methanolic extract of S. asoca bark in rats exposed to chronic unpredictable mild stress (CUMS) daily for 8 weeks using a forced-swim test, an open-field test, and a sucrose-preference test. The effect of the extract on endogenous antioxidant levels in the brain was also assessed using catalase activity, superoxide dismutase activity, reduced glutathione levels, and malondialdehyde levels in the brain. Male Sprague-Dawley rats received 100 mg/kg (oral) of the extract daily 1 h before daily stress exposure for 8 weeks. The extract showed a significant reduction in the immobility time in the forced-swim test, increased the total number of line crossing, rearing, and grooming in the open-field test, and increased the sucrose consumption as well as the levels of endogenous antioxidants significantly in comparison with the CUMS control group. Therefore, S. asoca might be a useful agent for the treatment or alleviation of symptoms associated with depression possibly by reducing CUMS-induced oxidative stress and reactive oxygen species in the brain.

Treatment of Depression and Anxiety by Naturopathic Physicians: An Observational Study of Naturopathic Medicine Within an Integrated Multidisciplinary Community Health Center

OBJECTIVES

This project was designed to assess the quality of care received by patients with depression and anxiety who were seen by naturopathic physicians in a community health center.

METHODS

The Natural Medicine Quality Improvement Project for the Treatment of Depression and Anxiety (NMQP-DA) was conducted over a 26-month period from December 2009 through February 2012 at HealthPoint, a non-profit, consumer-governed, community health center network located in suburban King County, Washington. A total of 112 patients enrolled in the NMQP-DA, and 60 were seen for two or more visits, thus meeting eligibility criteria for inclusion in the study. The mean number of visits was 3.3. The Patient Health Questionnaire (PHQ-9) depression screener and the Generalized Anxiety Disorder 7-item scale (GAD-7) anxiety screener were the outcome measures.

RESULTS

The overall improvement in symptoms of depression and anxiety was highly significant (p < 0.0001) when comparing the group's average initial screener scores to their average final screener scores for both depression (16.4 vs. 8.6) and anxiety (12.4 vs. 7.2). The response rate, as measured by a 50% decrease in scores, for those with initial scores ≥10 was 58.6% for depression (PHQ-9) and 50% for anxiety (GAD-7).

CONCLUSIONS

This study adds new data to the limited literature on the nature and effectiveness of naturopathic medicine to treat anxiety and depression in the context of an integrative community health center.

Evaluation and Management of Behavioral Health Disorders in Women: An Overview of Major Depression, Bipolar Disorder, Anxiety Disorders, and Sleep in the Primary Care Setting

Providers of obstetric and gynecologic care are often the most commonly seen medical providers for adult women, providing primary and reproductive care. Even where psychiatric care is readily available, obstetricians/gynecologists are frequently the front line for recognition, education, and initial management of many mental health problems. In settings where psychiatric treatment is a more scarce resource, obstetricians/gynecologists often are responsible for ongoing treatment of these disorders. This review focuses on the impact of the female reproductive life cycle on the presentation and management of some of the most common behavioral health problems in women: major depression, bipolar disorder, anxiety disorders, and primary sleep disorders.

Ginsenoside Rb1 rescues anxiety-like responses in a rat model of post-traumatic stress disorder

Single prolonged stress (SPS), a rat model of post-traumatic stress disorder (PTSD), induces alterations in the hypothalamic-pituitary-adrenal axis. Korean red ginseng, whose major active component is ginsenoside Rb1 (GRb1), is one of the widely used traditional anxiolytics. However, the efficacy of GRb1 in alleviating PTSD-associated anxiety-like abnormalities has not been investigated. The present study used several behavioral tests to examine the effects of GRb1 on symptoms of anxiety in rats after SPS exposure and on the central noradrenergic system. Male Sprague-Dawley rats received GRb1 (10 or 30 mg/kg, i.p., once daily) during 14 days of SPS. Daily GRb1 (30 mg/kg) administration significantly increased the number and duration of open-arm visits in the elevated plus maze (EPM) test, reduced the anxiety index, increased the risk assessment, reduced grooming behaviors in the EPM test, and increased the total number of line crossings of an open field after SPS. The higher dose of GRb1 also blocked SPS-induced decreases in hypothalamic neuropeptide Y expression, increases in locus coeruleus tyrosine hydroxylase expression, and decreases in hippocampal mRNA expression of brain-derived neurotrophic factor. These findings suggest that GRb1 has anxiolytic-like effects on both behavioral and biochemical symptoms similar to those observed in patients with PTSD.

Modulation of prenatal stress via docosahexaenoic acid supplementation: implications for child mental health

Pregnant women living in poverty experience chronic and acute stressors that may lead to alterations in circulating glucocorticoids. Experimental evidence from animal models and correlational studies in humans support the hypothesis that prenatal exposure to high levels of glucocorticoids can negatively affect the developing fetus and later emotional and behavioral regulation in the offspring. In this integrative review, recent findings from research in psychiatry, obstetrics, and animal and human experimental studies on the role of docosahexaenoic acid in modulation of the stress response and brain development are discussed. The potential for an emerging field of nutritionally based perinatal preventive interventions for improving offspring mental health is described. Prenatal nutritional interventions may prove to be effective approaches to reducing common childhood mental disorders.

Association between fatty acid supplementation and prenatal stress in African Americans: a randomized controlled trial

OBJECTIVE

To test the association between docosahexaenoic acid (DHA) supplementation and perceived stress and cortisol response to a stressor during pregnancy in a sample of African American women living in low-income environments.

METHODS

Sixty-four African American women were enrolled at 16-21 weeks of gestation. Power calculations were computed using published standard deviations for the Perceived Stress Scale and the Trier Social Stress Test. Participants were randomized to either 450 mg per day of DHA (n=43) or placebo (n=21). At baseline and at 24 and 30 weeks of gestation, perceived stress was assessed by self-report. Cortisol response to a controlled stressor, the Trier Social Stress Test was measured from saliva samples collected upon arrival to the laboratory and after the completion of the Trier Social Stress Test.

RESULTS

Women in the DHA supplementation group reported lower levels of perceived stress at 30 weeks of gestation, controlling for depression and negative life events (mean 27.4 compared with 29.5, F [3, 47] 5.06, P=.029, Cohen's d=0.65). Women in the DHA supplementation had lower cortisol output in response to arriving to the laboratory and a more modulated response to the stressor (F [1.78, 83.85] 6.24, P=.004, Cohen's d=0.76).

CONCLUSION

Pregnant women living in urban low-income environments who received DHA reported reduced perceived stress and lower levels of stress hormones in the third trimester. Docosahexaenoic acid supplementation may be a method for attenuating the effects of maternal stress during late pregnancy and improving the uterine environment with regard to fetal exposure to glucocorticoids.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, www.clinicaltrials.gov, NCT01158976.

Use of complementary and alternative medicine during pregnancy and the postpartum period: an analysis of the National Health Interview Survey

INTRODUCTION

Complementary and alternative medicine (CAM) is commonly used among women, but few national data exist regarding CAM use during pregnancy or the postnatal period.

METHODS

Data from the 2007 National Health Interview Survey were analyzed for women ages between the ages of 18 and 49 years who were pregnant or had children less than 1 year old. CAM use was identified based on standard definitions of CAM from the National Institutes of Health's National Center for Complementary and Alternative Medicine. CAM use among women who were pregnant or with a child less than 1 year was compared with the other similarly aged female responders. CAM use was examined among these women stratified by sociodemographics, health conditions, and conventional medicine use through bivariable and multivariable logistic regression models.

RESULTS

Among pregnant and postpartum women from the ages of 19 to 49 years in the United States, 37% of pregnant women and 28% of postpartum women reported using CAM in the last 12 months compared with 40% of nonpregnant/non-postpartum women. Mind-body practices were the most common CAM modality reported, with one out of four women reporting use. Biological therapies, excluding vitamins and minerals, during the postpartum period were used by only 8% of women. Using multivariable regression modeling, we report no significant difference in CAM use among pregnant compared with non-pregnant women (adjusted odds ratio [AOR], 0.88; [95% confidence interval 0.65-1.20]), but lower CAM use among postpartum women compared with non-pregnant women (AOR 0.67; [0.52-0.88]), while adjusting for sociodemographics.

CONCLUSION

CAM use among pregnancy similar to women who are not pregnant, while postpartum CAM use decreases. Further evaluation of CAM therapies among pregnant and postpartum women is necessary to determine the costs and benefits of integrative CAM therapies in conventional care.

L-tetrahydropalmatine ameliorates development of anxiety and depression-related symptoms induced by single prolonged stress in rats

Abnormal adaptation of the stress-response system following traumatic stress can lead to alterations in the hypothalamic-pituitary-adrenal (HPA) axis that may contribute to the development of post-traumatic stress disorder (PTSD). The present study used several behavioral tests to investigate the anxiolytic-like and antidepressant activity of L-tetrahydropalmatine (L-THP) in an experimental rat model of anxiety and depression induced by single prolonged stress (SPS), an animal model of PTSD. Male rats were treated intraperitoneally (i.p.) with vehicle or varied doses of THP 30 min prior to SPS for 8 consecutive days. Daily THP (50 mg/kg) administration significantly increased the number and duration of open arm visits in the elevated plus maze (EPM) test, reduced the anxiety index, increased the risk assessment, and increased the number of head dips over the borders of the open arms after SPS. THP was also associated with increased time spent at the center of the open field, reduced grooming behaviors in the EPM test, and reduced time spent immobile in the forced swimming test (FST). It also blocked the decrease in neuropeptide Y (NPY) and the increase in corticotrophin-releasing factor (CRF) expression in the hypothalamus. This is the first study to determine that THP exerts pronounced anxiolytic-like and antidepressant effects on the development of the behavioral and biochemical symptoms associated with PTSD, indicating its prophylactic potential. Thus, THP reversed several behavioral impairments triggered by the traumatic stress of SPS and is a potential non-invasive therapeutic intervention for PTSD.

ω-3 and major depression: a review

BACKGROUND

The World Health Organization estimates that major depression affects about 350 million people all over the world and reports this disorder as the major contributor to the global burden of diseases. Despite the well-defined symptomatology, major depression is a heterogeneous psychiatric disorder whose pathophysiology is not clearly established. Although several treatments are available, most depressed patients do not achieve the complete remission of symptoms. Factors linked to the persistence of the disorder have been investigated, particularly those related to the way of life. Moreover, it has been suggested that nutritional aspects may influence its development. Among them, a diet rich in ω-3 has been associated with a reduced risk of major depression, although its deficiency is associated with depressive disorders.

METHODS

This review provides a general view about evidences of the use of ω-3 in major depression cases.

RESULTS

Several studies have demonstrated beneficial effects of ω-3 in the prevention and treatment of major depression. However, not all the results have shown significant statistical benefits.

CONCLUSIONS

More studies are necessary to clarify detailed mechanisms of the antidepressant effects of ω-3 and may explain the source of contradictions in results published until the moment.

Chronic administration of catechin decreases depression and anxiety-like behaviors in a rat model using chronic corticosterone injections

Previous studies have demonstrated that repeated administration of the exogenous stress hormone corticosterone (CORT) induces dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis and results in depression and anxiety. The current study sought to verify the impact of catechin (CTN) administration on chronic CORT-induced behavioral alterations using the forced swimming test (FST) and the elevated plus maze (EPM) test. Additionally, the effects of CTN on central noradrenergic systems were examined by observing changes in neuronal tyrosine hydroxylase (TH) immunoreactivity in rat brains. Male rats received 10, 20, or 40 mg/kg CTN (i.p.) 1 h prior to a daily injection of CORT for 21 consecutive days. The activation of the HPA axis in response to the repeated CORT injections was confirmed by measuring serum levels of CORT and the expression of corticotrophin-releasing factor (CRF) in the hypothalamus. Daily CTN administration significantly decreased immobility in the FST, increased open-arm exploration in the EPM test, and significantly blocked increases of TH expression in the locus coeruleus (LC). It also significantly enhanced the total number of line crossing in the open-field test (OFT), while individual differences in locomotor activities between experimental groups were not observed in the OFT. Taken together, these findings indicate that the administration of CTN prior to high-dose exogenous CORT significantly improves helpless behaviors, possibly by modulating the central noradrenergic system in rats. Therefore, CTN may be a useful agent for the treatment or alleviation of the complex symptoms associated with depression and anxiety disorders.

Building an evidence base in complementary and integrative healthcare for child and adolescent psychiatry

Complementary and integrative strategies are widely used by families with children who have mental health diagnoses. The therapies used by these children include herbs, dietary supplements, massage, acupuncture, meditation, and naturopathy. The literature on efficacy of complementary and alternative approaches is of limited value, and studies are needed to test efficacy and safety. Interpretation of complementary and integrative health care studies for symptomatic management of mental health conditions is hampered by study design and methodological limitations. Well-designed, adequately powered, and suitably controlled clinical trials on promising complementary and integrative modalities are needed for children and adolescents with psychiatric conditions.

Antidepressant-like effect of oleanolic acid in mice exposed to the repeated forced swimming test

The study aimed to explore the antidepressant-like effect of oleanolic acid and its possible mechanism related to the monoaminergic system and neurotrophin in mice exposed to the repeated forced swimming test (FST). Both the duration and the latency of immobility affected by oleanolic acid (10, 20 and 40 mg/kg) were evaluated in the FST repeated at intervals on days 1, 7 and 14, followed by neurochemical and brain-derived neurotrophic factor (BDNF) analyses in the mouse brain regions of frontal cortex and whole hippocampus. A repeated analysis of variance (ANOVA) indicated that over retesting the immobility time increased, whereas latency to immobility tended to decrease. Minute-by-minute analysis showed that immobility time also increased during the 4-min course of the test. In addition, post-hoc Dunnett's test demonstrated that sub-chronic and chronic, but not acute, oleanolic acid treatment reduced the immobility time (sub-chronic: 20 mg/kg, 43.5%; chronic: 10 mg/kg, 19.3%; 20 mg/kg, 31.8%) and increased the latency to immobility (sub-chronic: 10 mg/kg, 60.6%; 20 mg/kg, 80.1%; chronic: 10 mg/kg, 121.8%; 20 mg/kg, 140.8%; 40 mg/kg, 80.0%). Furthermore, chronic administration of oleanolic acid significantly increased serotonin (5-HT) levels (frontal cortex: 44.5%, 41.9%, 27.5% for 10, 20, 40 mg/kg; hippocampus: 57.2%, 80.9% for 10, 20 mg/kg), decreased 5-hydroxyindoleacetic acid (5-HIAA)/5-HT ratio (frontal cortex: 31.6%, 30.1%, 23.5%; hippocampus: 40.6%, 47.7%, 29.2% for 10, 20, 40 mg/kg) and elevated norepinephrine (NE) levels (hippocampus: 20 mg/kg, 45.4%) but did not alter dopamine (DA) levels. Moreover, BDNF levels in the two brain regions were also elevated by chronic oleanolic acid treatment (frontal cortex: 20 mg/kg, 67.2%; hippocampus: 10 mg/kg, 36.4%; 20 mg/kg, 55.1%). Taken together, these findings imply that functions of 5-HT, NE and BDNF may be involved in the antidepressant-like effect of oleanolic acid.

Mood disorders and complementary and alternative medicine: a literature review

Mood disorders are a major public health problem and are associated with considerable burden of disease, suicides, physical comorbidities, high economic costs, and poor quality of life. Approximately 30%-40% of patients with major depression have only a partial response to available pharmacological and psychotherapeutic interventions. Complementary and alternative medicine (CAM) has been used either alone or in combination with conventional therapies in patients with mood disorders. This review of the literature examines evidence-based data on the use of CAM in mood disorders. A search of the PubMed, Medline, Google Scholar, and Quertile databases using keywords was conducted, and relevant articles published in the English language in the peer-reviewed journals over the past two decades were retrieved. Evidence-based data suggest that light therapy, St John's wort, Rhodiola rosea, omega-3 fatty acids, yoga, acupuncture, mindfulness therapies, exercise, sleep deprivation, and S-adenosylmethionine are effective in the treatment of mood disorders. Clinical trials of vitamin B complex, vitamin D, and methylfolate found that, while these were useful in physical illness, results were equivocal in patients with mood disorders. Studies support the adjunctive role of omega-3 fatty acids, eicosapentaenoic acid, and docosahexaenoic acid in unipolar and bipolar depression, although manic symptoms are not affected and higher doses are required in patients with resistant bipolar depression and rapid cycling. Omega-3 fatty acids are useful in pregnant women with major depression, and have no adverse effects on the fetus. Choline, inositol, 5-hydroxy-L-tryptophan, and N-acetylcysteine are effective adjuncts in bipolar patients. Dehydroepiandrosterone is effective both in bipolar depression and depression in the setting of comorbid physical disease, although doses should be titrated to avoid adverse effects. Ayurvedic and homeopathic therapies have the potential to improve symptoms of depression, although larger controlled trials are needed. Mind-body-spirit and integrative medicine approaches can be used effectively in mild to moderate depression and in treatment-resistant depression. Currently, although CAM therapies are not the primary treatment of mood disorders, level 1 evidence could emerge in the future showing that such treatments are effective.

Fucoidan prevents depression-like behavior in rats exposed to repeated restraint stress

Previous studies have demonstrated that repeated restraint stress in rodents increased depression-like behavior and altered the expression of corticotrophin-releasing factor in the hypothalamus. The current study focused on verifying the impact of fucoidan (FCN) administration on repeated restraint stress-induced behavioral responses using the forced swimming test (FST). Additionally, we examined the effect of FCN on the central noradrenergic system by observing changes in neuronal tyrosine hydroxylase (TH) immunoreactivity and brain-derived neurotrophic factor (BDNF) mRNA expression in the rat brains. Male rats received 10, 20, or 50 mg/kg FCN (i.p.) 30 min before daily exposures to repeated restraint stress (2 h/day) for 14 days. Repeated restraint stress increased immobility in the FST. Daily administration of FCN during the repeated restraint stress period significantly inhibited the stress-induced behavioral deficits in this behavioral test. Administration of FCN also significantly blocked the increase in TH expression in the locus coeruleus and the basolateral nucleus of the amygdala, and the decrease in BDNF mRNA expression in the hippocampus. Taken together, these findings indicate that administration of FCN prior to restraint stress significantly improved helpless behavior in rats, possibly through modulating the central noradrenergic system. Therefore, FCN may be a useful agent for treating complex symptoms of depression disorder.

Treating postpartum depression and anxiety naturally

Postpartum depression and or perinatal mood disorders are complex phenomena with numerous interrelated factors. Approximately 13% of women experience some degree of depression following childbirth. Mental health professionals have described postpartum depression as encompassing a variety of syndromes and as ranging from mild depression and anxiety to more severe forms of emotional disorders. Evidence is accumulating that postpartum depression/perinatal mood disorders may adversely affect the mother-child relationship, and that it may also have long-term effects on the child if the mother does not receive treatment. Postpartum depression and anxiety disorders can have devastating effects on the mother, her baby, and the entire family. Frontline management typically includes medication, therapy, and social support. However, many women feel conflicted about using psychotropic medications during pregnancy and breastfeeding and are interested in learning about alternative therapies. If a pregnant or breastfeeding mother is prescribed psychiatric medications, she may not follow the prescription and may also be afraid to tell her provider. Women may refuse medications, even after weighing the pros and cons and safety issues with health care providers. For mild to moderate depression and anxiety, nonpharmacological choices need to be available for these women to provide them with alternative options and to encourage adherence to treatment.

The effects of powdered fertilized eggs on depression

This 12-week, double-blind, placebo-controlled study investigated the effects of fertilized egg powder (Young Tissue Extract; YT®) intake on outcome measures for depression. Fifty-five patients with depression were randomly assigned to receive YTE, YTE plus Melissa officinalis, or placebo for 12 weeks. At baseline, there were no significant differences in scores on the Hamilton Depression Rating Scale (HAM-D) or Beck Depression Inventory II (BDI-II) among the 3 groups. At 12 weeks, the HAM-D scores in groups treated with YTE or YTE with M. officinalis were both significantly lower than those in the placebo group. In addition, both treatment groups showed a significant improvement in depression as measured by the change in HAM-D scores from baseline to 12 weeks, whereas the placebo group showed no significant change. There were no significant differences between the 2 treatment groups. The study indicates that the fertilized egg powder has an antidepressive effect and may be an alternative or adjunct to antidepressive medication for some patients, but further research is necessary.

Involvement of monoaminergic system in the antidepressant-like effect of the flavonoid naringenin in mice

Dietary flavonoids possess a multiplicity of neuroprotective actions in various central nervous pathophysiological conditions including depression. In this study, the neuropharmacological mechanism of the dietary flavonoid naringenin was investigated in the mouse behavioral models of depression. For this purpose, we investigated the influence of pretreatment with the inhibitors of serotonin or noradrenaline synthesis, p-chlorophenylalanine methyl ester or α-methyl-p-tyrosine, respectively in the anti-immobility effect of naringenin. Compared to the control group, naringenin significantly decreased the immobility time after acute treatment in the mouse tail suspension test (10, 20 and 50 mg/kg), but not in the forced swimming test, without producing locomotor alteration in the open-field test. In addition, pretreatment of mice with p-chlorophenylalanine methyl ester (100 mg/kg) or α-methyl-p-tyrosine (100 mg/kg) prevented the anti-immobility effect of naringenin (20 mg/kg) in the tail suspension test. Taken together, this data demonstrated that naringenin possessed potent antidepressant-like property via the central serotonergic and noradrenergic systems. Thus, our findings suggest the therapeutic potential of this dietary flavonoid in central nervous system disorders especially depression where monoaminergic systems are involved.