There are more than 70 different types of alternative
Some are so well known that they are almost mainstream
medicines, while others seem so bizarre as still to be on
the very fringes of fringe medicine.
Acupuncture, herbal medicine, Homoeopathy, and
Aromatherapy are already practised in several countries.
What is CAM?
(therapies): used in conjunction
with conventional medical
practice. (Wilkinson, p. 1019)
used instead of traditional care.
1.Be non-judgmental despite personal opinions
2. Build rapport by showing client respect – if not, he
may be afraid to tell about CAM use
3. Understand that C.A.M. can be beneficial, when
4. Be aware that C.A.M. can be dangerous if it
interacts or interferes with conventional treatment
5. Be willing to teach the public about the positive
and negative information regarding C.A.M.
6. Be aware that use of C.A.M. is popular and
increasing and must be included in the history &
7. Know that Herbals, in particular, can have
significant effect on prescription drugs and body
Depression is one of the top
10 diagnoses for which
patients seek natural
Commonly used among
Fewer than 30% of depressed
teens tell docs they are using
Clinicians need to ask!
Lifestyle - overview
Environment: More Sunshine,
Exercise/Sleep (more of both)
Nutrition (Essential nutrients for
optimal brain function, EFA,
amino acids, vitamins,
Mind-Body Therapies – manage
rhythms and sleep
Desynchronization of internal rhythms plays an
important role in the pathophysiology of
Resetting normal circadian rhythms can have
“Winter depression was first modeled on
regulation of animal behavior by seasonal
changes in day length, and led to application
of light as the first successful
chronobiological treatment in psychiatry.”
Fuchs E. Int Clin Psychopharmacol, 2006
Wirz-Justice A. Int Clin Psychopharmacol. 2006
Proven effective for SAD (Terman
M Evid Based Ment Health, 2006).
Benefits onset within 2 days; effective in
institutionalized elderly and community;
effective in summer and winter
Side effects: hypomania, autonomic
(Terman M, 2005)
Turn off Depressing TVDepressing TV
repeatedly saw "people
falling or jumping from the
towers of the World Trade
Center" had higher
prevalence of PTSD (17.4%)
and depression (14.7%) than
those who did not (6.2% and
Ahern, Psychiatry, 2002
McLeish. Depress Anx, 2008
Omega-3 fatty acids
Eating a diet rich in omega-3s or taking omega-3
supplements may help ease depression,
especially when used in addition to standard
These healthy fats are found in cold-water fish,
flaxseed, flax oil, and walnuts.
Omega 3 EFA’s: mechanism
Neuronal membrane structure
Second messenger inside
Mood and Omega-3’s
Inverse correlation between fish intake
and depression (Hibbeln: Lancet 1998;
351:1213; Crowe: Am J Clin Nutr, 2007)
Effective for bipolar patients (Stoll: Arch.
of Gen. Psych. 1999; 56: 407-12)
Effective for major depression (Nemets:
Am. J. Psych. 2002: 159 (3) 477-9)
Effective for depression in Children ( Am J
Pronounced "sammy," this is a synthetic form of a
chemical that occurs naturally in the body.
It's not approved by the FDA to treat
depression in the United States.
Rather, it's classified as a dietary supplement.
Side effects are usually minimal, but SAMe can
trigger mania in people with bipolar disorder.
Amino Acids: SAM-E
Produced from ATP and methionine
Low folate can lead to low levels
Meta-analysis: SAMe significantly
improves depression, comparable to
antidepressant medications (
In an open trial of 30 adults with MDD
for whom antidepressant meds
ineffective, SAM-E led to significant
improvements in 50% and remission in
43% (Alpert, 2004).
Low levels of folate, a B vitamin, may cause a
slowed response to some antidepressants.
Taking folate supplements (folic acid) may be
helpful when used in addition to antidepressants.
Deplin (in US)
Adjunct therapy in depression
Other indication as adjunct in schizophrenia
for negative and cognitive symptoms
Vitamin B6 - pyridoxine
Low levels of pyridoxal phosphate
(PLP) are associated with depressive
symptoms (Hvas AM 2004)
Dose: 100 – 200 mg daily benefits
PMS- depression (Wyatt KM. BMJ, 1999)
Side effects: nausea, vomiting, abd.
pain, anorexia, headache, somnolence,
lower B12 levels, sensory neuropathy
(typically with doses over 1000 mg
daily, can occur lower)
Food: Beans, nuts, legumes, fish, meat
Vitamin D and depression
Vitamin D receptors in brain
Low level of serum 25-hydroxyvitamin D
and high PTH are significantly
associated with depression (Jorde, 2005)
25-hydroxyvitamin D3 and 1,25-
dihydroxvitamin D3 levels are
significantly lower in psychiatric patients
than in normal controls (Schneider,
RCT of 44 Australian patients ( 400 IU
versus 800 IU vitamin D) vitamin D3
significantly enhanced mood
Mood and Minerals: Iron
Iron deficiency associated
Correcting iron deficiency
helps with mood and attention
Beard JL. J Nutr, 2005
LE Murray-Kolb. Am J Clin Nutr, 2007
Mood and Minerals: Calcium
Lower levels of calcium in
Higher PTH in depressed
Estrogen regulates calcium
and PTH metabolism;
sometimes dysregulates? (Thys-
Jacobs S. J Am Coll Nutr, 2000)
Supplementation may benefit
women with PMS-related
depression (Dickerson LM. Am Fam
1000 – 1200 mg daily
Non-dairy sources of calcium
Soy beans, tofu
Calcium fortified OJ
Green leafy vegetables
Chocolate and mood
Insulin inhibits theInsulin inhibits the
reuptake ofreuptake of
enhances the blood-enhances the blood-
brain transport ofbrain transport of
tryptophan, atryptophan, a
precursor ofprecursor of
Herbal remedies and supplements
St. John's wort. Known scientifically as Hypericum
perforatum, this is an herb that's been used for
centuries to treat a variety of ills, including depression.
It's not approved by the FDA to treat depression in the
Rather, it's classified as a dietary supplement.
However, it's a popular treatment in Europe for mild
or moderate depression.
But, it can interfere with other depression medicines, as
well as some drugs used to treat people with heart
disease, seizures, cancer and organ transplant.
Saint Johns wort
Comparable to sertraline in German RCT of 241
depressed adults (Gastpar. Pharmacopsychiatry,
2 open label trials in teens showed improvement
within 2 weeks in 25/33 and 9/11 patients
(Findling, 2003; Simeon, 2005); Improvement in 2
weeks predicts long-term response; if no benefit
in 2 weeks, stop.
Herb- drug interactions: SJW
of many drugs:
Other side effects - photosensitivity,
The connection between mind and body has
been studied for centuries.
Complementary and alternative medicine
practitioners believe the mind and body must be
in harmony for you to stay healthy.
Mind-body techniques that may be tried to ease
depression symptoms include:
- Acupuncture - Yoga
- Meditation - Guided
– Stress relief/ reduce anxiety
– Reduced levels of lactic acid
– Decreased oxygen consumption
– Slowed heart rate
– Decreased blood pressure
– Improved function of immune system
– Reduce pain
– Relieve symptoms of psoriasis
– Improve health
(References: Ignativicius; Wilkinson)
– To reduce anxiety, tension & emotional tension
which can exacerbate pain
Progressive muscle relaxation
Can be taught in home setting
– Distraction when confronting pain, discomfort
– Making decisions and altering behavior
– Caution: not recommended for emotionally
unstable or cognitively impaired client
– Helps reduce pain.
– Reduction of nausea & vomiting.
– Decreasing anxiety
– Promoting comfort during cancer treatment
Life force beliefs found in most cultures.
(Wilkinson, p 1020)
Faith healing (Wilkinson page 260)
Promote Social Support
Religiosity (participation) helps
protect against depression
Participation in extracurricular
clubs helps protect teens
Participation in organized
athletics is protective
Ongoing volunteer work is
Connected people are happier
Take Home Message
Keep in mind that nutritional and dietary
products aren't monitored by the FDA the
same way medications are.
You can't always be certain of what you're
getting and if it's safe.
Also, be aware that some herbal and dietary
supplements can interfere with prescription
medications or cause dangerous