Issues Magazine

Complementary Medicine and Depression

By beyondblue: the national depression initiative

Many Australians use alternative treatments for depression, but do they work?

An estimated one million people in Australia live with depression. Despite this statistic, research into treatments for depression other than psychotherapy and medication is largely inconclusive. Certain alternative treatments – like St John’s wort, acupuncture and yoga – are used by many but more studies need to be done on their effectiveness or otherwise.

Although some complementary and self-help treatments may be useful, the available evidence is almost entirely confined to people with mild to moderate depression and anxiety. For severely depressed people, only conventional medical treatment is currently supported by evidence.

Do you find chocolate lifts your mood? Does aromatherapy relax you or do naturopathic remedies give you more energy? Although these things may stave off the blues in someone with a normal mood, research shows they do very little for depression.

Associate Professor Michael Baigent, clinical advisor for beyondblue: the national depression initiative, says the only clinically proven treatments for severe depression are psychotherapy and antidepressant medication. However, more Australian research is currently underway to find good alternatives to treat mild and moderate cases.

Baigent believes that depression is not a “black and white” condition, and nor should its treatment be. “There is reasonable evidence for other things that will be helpful in the course of treatment,” he says. “Exercise has been found to be beneficial, particularly for the elderly. There is growing use of meditation and, to some extent, yoga as an adjunct to CBT [cognitive behavioural therapy].”

He says there is still a lot of misinformation about treatments for depression, particularly around naturopathic remedies: “With vitamins and aromatherapy you’d have to say the evidence isn’t enormous,” he says. “There have been studies to show omega-3 fatty acids are helpful and other equally good studies to show they aren’t.

“St John’s Wort – which is used extensively in Germany – acts as a serotonin reuptake inhibitor when it’s taken at reasonably high doses,” he says. However, the herb, which is becoming increasingly popular as a treatment for mild to moderate depression, does carry a serious health risk when combined with antidepressants or other medications.

Research published in the Australian Medical Journal in 2002 by Professor Anthony Jorm and colleagues shows that only 29% of people believe anti-depressants are an effective treatment for depression despite overwhelming medical evidence that they are highly effective in many people.

In rare cases, people experiencing depression react negatively to medication. Melbourne mother Georgina Martyn was diagnosed with severe depression when she was 21 years old after experiencing symptoms of the illness from the age of 15. For years after diagnosis her mental illness went unmanaged. She attempted suicide twice at ages 21 and 22, with short stays in psychiatric hospitals at that time.

Now 34, Georgina runs her own highly successful garden design company in Camberwell, has won four consecutive gold medals at the Melbourne International Garden Show and is president of the Whitehorse Toastmasters Club.

After being prescribed medication to treat her depression she discovered she was highly sensitive to it. Georgina had a rare negative reaction to lithium, which her doctors described as similar to narcolepsy.

In 2000, after the birth of her son, she experienced postnatal depression but this time decided not to take medication. Over time, and with advice from health professionals, she found alternative treatments that worked for her. Now she manages her periodic depression with exercise, healthy eating and yoga, and by practising the principles of cognitive therapy.

Although she still experiences low moods from time to time, Georgina successfully looks after her 8-year-old son as a sole parent while continuing to expand her garden design business, lecture, write and present on community radio.

“I realise that depression is often rooted in the emotional and spiritual plane, manifesting in the mental and physical body,” Georgina says. “So now I attend yoga regularly, which helps to release physical tension and emotional blocks.

“When I am feeling low, I think about what I can do for myself to effect a change in mood, using cognitive therapy to shift the focus.

“I think it is important to find a balance between alternative and standard treatments. It comes down to what feels right and what works for each person.”

Having a good professional support network apart from your friends and family is vital, she says.

The research by Professor Anthony Jorm and colleagues estimated that half of Australians who are depressed use treatments that are not based on evidence. 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 anti-depressants as likely to be helpful. This is interesting given there is little evidence of vitamins as an effective treatment.

Professor David Clarke, beyondblue’s research advisor, says that contrary to popular belief, almost all herbal remedies have not been proven to be effective for the treatment of depression. “Out of all of the herbal things, St John’s Wort is the only one with some supportive evidence,” he says. “As for vitamins, folate has been proven but apart from that there are very few others.”

He said other treatments for depression were being researched in Australia and internationally, including a relatively new procedure called transcranial magnetic stimulation (TMS). TMS involves placing a magnetic coil next to the scalp, which sends strong magnetic pulses to produce electrical changes in the brain. Some psychiatrists believe this area is underactive in depression and that TMS increases its activity. It is a new treatment and has not been researched thoroughly yet. However, the studies carried out so far show only small benefits that disappear after a couple of weeks. “It has only been trialled in resistant depression. No one is suggesting it’s a first level treatment, but if it works it potentially could be,” Professor Clarke says.

For more information on treatments for anxiety and depression go to www.beyondblue.org.au or call 1300 22 4636 (local call). Information in this article was sourced from Help for Depression: What Works and What Doesn’t, by Professor Anthony Jorm. beyondblue is currently funding further research for a second edition of this publication.