The quality of evidence for the use of complementary and alternative medicine (CAM) treatments for clinical depression was found to be generally low for all but two therapies investigated in a recent systematic review.

To better understand the safety and efficacy of CAM in the treatment of clinical depression, study authors searched various databases for randomized clinical trials (RCTs) assessing CAM as monotherapy or in combination with other treatments. Studies were included if they evaluated the effect of CAM on depression severity, response, remission, and relapse, in addition to adverse events; the GRADE method was used to assess the quality of evidence.

Of the total 3582 articles that were identified in the search, 26 meta-analyses were included in the review; the meta-analyses included between 1 and 49 RCTs involving 40 to 7104 adult patients. Results showed that only two treatments, St. John’s wort and mindfulness-based cognitive therapy, were associated with moderate quality evidence. 

“Moderate-quality evidence suggested the efficacy, comparative effectiveness to standard antidepressants and safety of St. John’s wort on depression severity and response rates,” the authors stated, adding that evidence related to remission and relapse rates was observed to be of lower quality. Results also showed that in patients with recurrent major depression, mindfulness-based cognitive therapy was found to be superior to standard antidepressant treatment for prevention of depression relapse.

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With regard to other CAM therapies included in this analysis (acupuncture, aromatherapy, whole-diet interventions, magnesium, omega-3 fatty acids, probiotics, tryptophan, vitamins B and D, zinc, among others), the evidence for effectiveness in depression was found to be of low or very low quality.

Based on their findings, the authors concluded that further research is needed to better understand the long term effects of CAM therapy for depression. For patients who do not wish to take or who do not tolerate antidepressants, the authors suggest St. John’s wort, if appropriate, as an alternative treatment option. However, they caution that as the supplement has been known to interact with several other drugs, patients should be educated on possible side effects and interactions. 

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