Where Does CAM Fit in When Treating Mood, Anxiety Disorders?
Mood disorders (eg, major depressive disorder [MDD] and anxiety disorders (eg, panic disorder [PD], obsessive-compulsive disorder [OCD], phobias)1 are among the most prevalent mental disorders.2 Data from the US National Comorbidity Survey Replication revealed that among adults, 18.1% (40 million) experienced anxiety disorders and 9.5% had experienced (20.9 million) mood disorders.
Overall, 14% of the US population is estimated to have a moderate or serious mental disorder,1,3 and more than 40% of these cases were comorbid mental disorders.3 Among those who commit suicide, about 90% have a mental disorder.1
According to data from the National Health Interview Survey, nearly 40% of Americans use complementary and alternative medicine (CAM),4 including physical therapy (eg, acupuncture, exercise, light therapy, yoga), nutraceuticals (eg, minerals and vitamins), and herbal (plant/plant-based) remedies.2 Many patients with psychiatric disorders turn to nontraditional treatment options, in addition to pharmacotherapy, to help with their symptoms.2
Ravindran and da Silva2 performed a search of PubMed articles that covered the use of CAMs as augmentation (added to existing antidepressant or anxiolytic) therapy in anxiety and mood disorders. They evaluated studies according to the following criteria:
- Level 1: Meta-analysis/double-blind, randomized controlled trial (including placebo condition)
- Level 2: ≥1 double-blind randomized controlled trial/active comparison condition
- Level 3: Prospective uncontrolled trial/high quality retrospective study or case series
- Level 4: Anecdotal report/expert opinion2
Free and Easy Wanderer Plus (FEWP), an 11-herbal Chinese compound, reportedly acts on monoamine and benzodiazepine receptors and neurosteroid and cytokine function, thereby producing antidepressant and anxiolytic effects. The authors made the following recommendations for FEWP augmentation:
- Level 2 evidence in unipolar depression/BD
- Recommendation: third-line adjunctive treatment only, due to weakness in study methodology and limited clinical experience in the United States
- Adverse effects included mild headache, dizziness, diarrhea, constipation, dry mouth, and tachycardia.
- There are no long-term efficacy or safety data for FEWP.
- There is anecdotal evidence that FEWP is well tolerated and may lessen the adverse effects of other medications.
St John's wort (hypericum perforatum) has been the subject of study for depression more than any other herbal remedy, but according to the authors, there are no published data for adjunctive St John's wort in depression.
The authors found:
- Level 3 evidence for unipolar/bipolar depression (BPD), generalized anxiety disorder (GAD), OCD, PD
- Recommendation: third-line therapy for unipolar depression, and possible third-line adjunct for GAD and PD, due to mixed trial results
- Level 3 evidence in unipolar depression, with possible third-line use
- Rare adverse effects
Light Therapy (LT)
- Level 3 evidence for seasonal/nonseasonal unipolar depression, BPD
- Recommendation: third-line therapy only due to flawed study methodology and lack of long-term data; also, light therapy may have drug interactions, along with increased photosensitivity for those who use psychotropics