Complementary and Alternative Approaches

According to a recent national survey, 50% or more of patients who report severe depression have used complementary and alternative therapies in an attempt to alleviate symptoms (Kessler et al. 2001). These approaches include cognitive techniques such as relaxation and biofeedback, oral medications such as herbal medicine and homeopathy, physical treatments such as massage and chiropractic, and other approaches such as spiritual healing and dietary modification. Most persons using these approaches also seek treatment professionally (e.g., by a psychiatrist, psychologist, or general physician), which provides an opportunity to assess for possible adverse effects of combining alternative therapies with pharmacotherapies (e.g., mild serotonin syndrome from mixing St. John's wort and SSRIs). Clinicians need to inquire about the use of complementary and alternative approaches, become familiar with current data on efficacy, and inform patients of any potential known risks. A recent meta-analysis on adverse effects of St. John's wort concluded that it is safe and well tolerated if taken under control of a physician (Knuppel and Linde 2004), but use of this supplement appears to have declined among adults in the United States from a peak in the 1990s (Kelly et al. 2005).

Encouraging lifestyle modifications such as regular exercise may be useful in reducing depressive symptoms, especially in combination with other therapies. Group therapy that used an eclectic approach that combined exercise and preventive health behaviors with psychotherapies (including cognitive and reminiscence therapies) and social skills training was effective in reducing depressive symptoms among a large group of older women living in subsidized housing; however, it was more effective among relatively young (55- to 75-year-old) white women than among minority women and individuals older than 75 (Husaini et al. 2004).

Educational materials that explain geriatric depression and its effect on family systems (e.g., Miller and Reynolds 2003) are a potentially beneficial adjunct to family, group, or individual therapy. However, few controlled studies of the effectiveness of such self-help materials in treating depression have been done. A recent meta-analytic review (Anderson et al. 2005) not limited to studies of geriatric patients found beneficial effects compared with a de-layed-treatment control condition for bibliotherapies that use the popular book Feeling Good (Burns 1999); however, many other self-help depression books on the market have not been systematically studied.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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