18 - Complementary and alternative treatments for mood disorders

Summary

This chapter discusses complementary and alternative medicine (CAM) treatments preferred by patients with mood disorders. Omega-3 fatty acids are lower in depressed suicide attempters and completers compared with depressed nonattempters, a concentration-dependent effect, suggesting increased suicide risk in individuals with extremely low omega-3 levels. St. John's wort (SJW) has been extensively studied as a monotherapy for the treatment of depression. Among the CAM treatments, evidence supports the use of SJW as a monotherapy, and omega-3, S-adenosyl-methionine (SAMe), and several methylators as augmentation strategies in the treatment of depression. Methodological flaws are a consistent critique of CAM, and larger, longer-term studies are needed to assess CAM efficacy. Interventions such as yoga, acupuncture, and improved nutrition are inherently difficult to blind, complicating their assessment. Clinical experience suggests that CAM may be helpful in engaging patients and useful in the treatment of carefully selected patients.