Effectiveness of complementary and self‐help treatments for depression

Abstract

EVERY YEAR, 5.8% of Australian adults experience a depressive disorder, 1 and such disorders are the biggest source of non-fatal disease burden in Australia, accounting for 8% of disability. 2 Depressive symptoms that fall short of a diagnosis of a depressive disorder are also very common and are an additional contributor to disability. 3 A number of treatments for depressive disorders are supported as effective by evidence-based systematic reviews, and these have been incorporated in clinical practice guidelines. However, it is estimated that only 50% of Australians who are depressed receive an evidence-based professional intervention. 4 One possible reason for this is that many Australians state a preference for self-help and complementary therapies for depression. 5,6 For example, in a national sample, 57% regarded vitamins, minerals, tonics or herbal medicines as likely to be helpful for treating depression, compared with 29% who regarded antidepressants as likely to be helpful. 5 People in the community have also been found to use self-help interventions more commonly than professional treatments when they have anxiety and depressive symptoms. In one survey, the most commonly used selfhelp interventions over a six-month period were taking alcohol to relax (55% of respondents), taking pain relievers (55%) or becoming involved in physical activity (50%), compared with 35% who consulted a general practitioner, 20% who took antidepressants, and 4% who received psychotherapy. 6 Australians also commonly use complementary therapies. It has been estimated that almost half of Australian adults used complementary medicines in the past year and a fifth consulted complementary practitioners. 7 Although we do not know how much of this use is attributable to mental health problems, results from surveys in the United States indicate that people who are depressed have a higher use of complementary treatments. 8,9 Given their frequent use, complementary and self-help treatments warrant the same degree of evaluation as conventional treatments. The community needs information about which treatments are likely to be effective, which are not, and which have not been adequately evaluated. General practitioners can play an important role in providing guidance.ABSTRACT Objectives: To review the evidence for the effectiveness of complementary and self-help treatments for depression. Data sources: Systematic literature search using PubMed, PsycLit, the Cochrane Library and previous review papers. Data synthesis: Thirty-seven treatments were identified and grouped under the categories of medicines, physical treatments, lifestyle, and dietary changes. We give a description of each treatment, the rationale behind the treatment, a review of studies on effectiveness, and the level of evidence for the effectiveness studies. Results: The treatments with the best evidence of effectiveness are St John's wort, exercise, bibliotherapy involving cognitive behaviour therapy and light therapy (for winter depression). There is some limited evidenc...

Public beliefs about treatment and outcome of mental disorders: a comparison of Australia and Japan

“…Some of these interventions have supporting evidence for the treatment of depression [24], but not for schizophrenia. In general, the beliefs of the Australian public about treatment are more positive towards lifestyle interventions than towards medical or psychological interventions.…”

Delivering interventions for depression by using the internet: randomised controlled trial

“…One site (BluePages, http://bluepages.anu.edu.au/) provided depression literacy, offering evidence based information (at 8th grade reading level) on depression and its treatment 10. The other site (MoodGYM, http://moodgym.anu.edu.au/) offered cognitive behaviour therapy for the prevention of depression 11.…”

Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care; a randomised clinical trial

“…Initially, the patients are encouraged to participate in low-level behavioural activation, depending on their capability. Attention is paid to restoring the sleep-wake-rhythm [55], self-relaxation-techniques [37,56] and diet [40,57]. As the patient improves, there are options for running-therapy, [37,58] which has recently been proved to be helpful in the treatment of (minor) depressive disorder, and promoting return to work.…”