Depression is a potentially serious mental or psychological illness characterized by prolonged feelings of despair and dejection, a loss of pleasure and interest in things you usually enjoy often accompanied by fatigue, sleeping problems, headaches and other physical symptoms ie affects the whole body that is treatable with drugs and psychological therapies

Anxiety can accompany depression and involves apprehensive or uneasy thoughts or fears about what may happen so that a person feels troubled, worried or has an uneasy feeling. This fear and mental tension makes them emotional, irritable and tired or fatigued.

Certain herbs and supplements have been thought to help depression. Four Cochrane reviews which evaluated these substances are summarised in this overview.

Health professionals often treat depression with commercial drugs, or with other therapies combined with drugs. But these drugs may have unpleasant side effects. Three reviews examine non-drug treatments for anxiety.

Effective treatments for depression may vary depending on the patient. Two reviews consider alternative therapies for young people and one for pregnant women.

Psychiatrists are often considered to be the main professionals who treat depression. Increasingly, though, people turn to other health practitioners for help with depression. Two Cochrane reviews discuss the roles of other professionals.

We present some of the evidence from Cochrane systematic reviews about complementary and supplementary therapies for depression. This evidence comes from carefully-done systematic reviews of information in the medical literature evaluating healthcare treatments. Trials are only included in these reviews if they meet pre-defined standards of high quality.

FOLATE FOR DEPRESSION

Folate is one of the B vitamins naturally present in many foods. Folic acid is the synthetic version of folate, and is added to many fortified foods such as cereals and baked goods. It might have fewer side effects than conventional drugs used to treat depression.

What the synthesised research says

Folate may be beneficial when used as a supplement to another antidepressant drug, but there is limited evidence.

How it was tested

The Cochrane researchers searched the medical literature for randomised controlled trials which compared treatment of depressive disorder with folic acid to another treatment, either with antidepressant or placebo (no medication). Three studies with a total of 247 people were found. In 2 studies, folate was used along with an antidepressant, and folate was found to reduce depression symptoms more than use of the antidepressant alone. The other study compared people who received folate to people who received the antidepressant trazodone; no difference in the groups was found. The authors recommend that more research be done.

Side effects and general cautions

No side effects of folate were noted in the studies reviewed. Other sources have reported skin and gastrointestinal complaints, and central nervous system side effects at high doses. Taking folic acid along with vitamin B12 might increase the risk of B12 deficiency. Consumers should consult with a health professional if taking more than the recommended daily allowance of folate (400 micrograms per day for adults over 14; 600 micrograms for pregnant women).

Source

Taylor MJ, Carney S, Geddes J, Goodwin G. Folate for depressive disorders. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003390. DOI: 10.1002/14651858.CD003390. Other source: Folate (folic acid). Natural Standard patient information. August 1, 2006. (Accessed March 29, 2007)

INOSITOL FOR DEPRESSION

Inositol, also called myo-inositol, is a natural substance related to the B vitamins. It is found in foods such as whole-grain cereals, fruits, plants, and meats, and the typical person consumes about 1g per day. People with depression, including suicide victims, have been found to have low levels of inositol in their bodies, so taking inositol might be helpful in treating depression.

Inositol is available from the diet or as a supplement, so people can try it without a prescription. As a natural substance, it might have fewer side effects than conventional drugs used to treat depression.

What the synthesised research says

There is not enough evidence to show whether inositol helps treat depression.

How it was tested

The Cochrane review authors looked for randomised controlled trials which compared treatment of depression with inositol to another treatment, either with antidepressant medication or a placebo (no medication). Four studies were identified with a total of 141 participants. These studies were short term and did not show any benefit to inositol. However, the total number of patients was low, so the review authors recommend that longer-term, larger trials be performed to further study inositol.

Side effects and general cautions

No side effects of inositol were noted in the studies reviewed. People considering taking inositol should check with a healthcare professional if taking doses larger than the usual dietary intake of 1 gram per day..

Source

Taylor MJ, Wilder H, Bhagwagar Z, Geddes J. Inositol for depressive disorders. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD004049. DOI: 10.1002/14651858.CD004049.pub2

ST JOHN'S WORT FOR DEPRESSION

The plant St John's wort (Hypericum perforatum L.) has been used traditionally as a treatment for depression and other conditions. Many studies suggest that St. John's wort works as well as some kinds of conventional antidepressant drugs. St. John's wort is widely available as an herbal supplement, so people can try it without a prescription.

What the synthesised research says

Evidence is inconsistent about whether St John's wort is effective for treating depression. The evidence is stronger for mild to moderate depression than it is for major depression.

How it was tested

The Cochrane researchers searched the medical literature for randomised controlled trials which compared St John's wort with either a standard antidepressant or a placebo (no medication) for treatment of depression. They found 37 studies, 26 of which compared St John's wort with placebo and 14 which compared it with antidepressant drugs. Many of the studies only included patients with major depression. St John's wort appears to be more effective than placebo and about as effective as tricyclic and newer SSRI antidepressant drugs for treating mild to moderate depression. It does not appear to be helpful in treating major depression.

Side effects and general cautions

There were only a few minor side effects seen in the studies reviewed. Other sources report a range of minor side effects as well as some more serious drug interactions. St John's wort interacts with many drugs, including antidepressants, and can interact with other herbal supplements. Consumers should consult a healthcare professional before taking St John's wort. In many countries, herbal supplements are not well-regulated, and dosages on the packaging may differ from the actual dosage.

Source

Linde K, Mulrow CD, Berner M, Egger M. St. John's wort for depression. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub2

Other source: Barrette, E-P et al. St. John's wort (Hypericum perforatum L.) Natural Standard patient information. August 1, 2006. (Accessed March 29, 2007)

TRYPTOPHAN AND 5-HYDROXY TRYPTOPHAN FOR DEPRESSION

Tryptophan and 5-hydroxytryptophan (5-HTP) are natural substances which are thought to be helpful in treating depression. These chemicals are found in foods such as turkey and milk, and are also available as supplements. They are used by the body to make serotonin, a substance known as a neurotransmitter. An imbalance in serotonin is thought to be a cause of depression, and many conventional antidepressant drugs work to make more serotonin available in the brain.

Tryptophan and 5-HTP are available from the diet or as supplements, so people can try them without a prescription. As natural substances, they might have fewer side effects than conventional drugs used to treat depression.

What the synthesised research says

Some limited research shows that tryptophan and 5-HTP are better than placebo for depression, but tryptophan and 5-HTP have potentially lethal side effects.

How it was tested

The Cochrane researchers looked for randomised controlled trials which compared 5-HTP or tryptophan to placebo (no treatment) for depression. Although many studies have been done on 5-HTP and tryptophan, only 2 were of high enough quality for the Cochrane review. These studies had a total of only 64 participants. In the studies, participants taking 5-HTP or tryptophan had fewer symptoms of depression, but also experienced some side effects.

Side effects and general cautions

Side effects noted in the studies included dizziness, nausea and diarrhea. The two studies in the review had a small number of participants, so more uncommon side effects may not have come up. Tryptophan and 5-HTP have been associated with a rare, potentially fatal condition, eosinophilia-myalgia syndrome. The Cochrane review authors recommend that more research be done on the effectiveness and safety of tryptophan and 5-HTP. Currently, they advise that conventional antidepressant drugs or other treatments should be used instead of tryptophan and 5-HTP.

Source

Shaw K, Turner J, Del Mar C. Tryptophan and 5-Hydroxytryptophan for depression. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD003198. DOI: 10.1002/14651858.CD003198.

ACUPUNCTURE FOR DEPRESSION

Acupuncture comes from traditional Chinese medicine, and involves putting thin needles into certain points on a patient’s body. Different points are used for different illnesses. Sometimes electrical or laser impulses or pressure applied by fingers are used on the points instead of needles. An imbalance in serotonin is thought to cause depression, and many antidepressant drugs work by making more serotonin available. Acupuncture may offer a non-medical alternative for treating depression.

What the synthesised research says

There is not enough evidence to show that acupuncture helps with depression.

How it was tested

The Cochrane review authors searched the medical literature for randomised controlled trials comparing acupuncture, electro-acupuncture or laser acupuncture with some other treatment for adults with depression. The authors found 7 studies with a total of 517 participants. Five of the studies compared acupuncture with antidepressant drugs; no difference was seen in the two groups. Two studies compared acupuncture with no treatment - in one study, one group was put on a waiting list for acupuncture, while in the other study, "sham acupuncture" was used in which needles were inserted into non-acupuncture points. Again, no improvement was seen in the groups which received acupuncture compared with the control groups.

Side effects and general cautions

No side effects of acupuncture were noted in the studies reviewed. However, acupuncture has been known to cause occasional mild reactions such as nausea and vomiting, fainting and increased pain. Most participants in the studies reviewed had mild to moderate depression. People with severe depression or suicidal thoughts should consult with a healthcare professional rather than relying solely on self-help techniques.

Source

Smith CA, Hay PPJ. Acupuncture for depression. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD004046. DOI: 10.1002/14651858.CD004046.pub2.

LIGHT THERAPY FOR NON-SEASONAL DEPRESSION

The use of bright artificial light during the winter months has been effective in treating seasonal affective disorder (SAD), which has symptoms similar to depression. Depression and SAD seem to involve disrupted daily rhythms. Exposure to bright light, especially in the morning, is thought to restore the body’s clock and improve mood and fatigue. Light therapy is given with special artificial lamps or light boxes, with light usually at an intensity of 2500 lux or higher. Light therapy may offer relief from depression which people can use.

What the synthesised research says

Light therapy has some benefit for non-seasonal depression, especially when given in the morning.

How it was tested

The Cochrane review authors searched the medical literature for randomised controlled trials comparing people with depression who received light therapy to those who did not. The authors located 20 studies, with a total of 647 participants. Most of the studies used light therapy in addition to another treatment, such as drug therapy, sleep deprivation, or both. The benefit of light therapy was found to be greatest during the first week of treatment, and for people who are using sleep deprivation as an additional treatment for depression. The studies were short term, the longest lasting only 4 weeks. Because of this and the small benefit seen in most studies, the Cochrane review authors recommend that more research be done before light therapy can be recommended for non-seasonal depression.

Side effects and general cautions

Light therapy caused hypomania, or a mild manic state, in some patients. Therefore, people with bipolar disorder may need to be cautious in using light therapy. Other side effects reported included headache, eye irritation, and sleep problems. People with severe depression or suicidal thoughts should consult with a healthcare professional rather than relying solely on self-help techniques.

Source

Tuunainen A, Kripke DF, Endo T. Light therapy for non-seasonal depression. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004050. DOI: 10.1002/14651858.CD004050.pub2

TRANSCRANIAL MAGNETIC STIMULATION FOR DEPRESSION

Transcranial magnetic stimulation (TMS) involves the use of a machine which can either excite or inhibit parts of the brain. TMS is non-invasive. Repetitive TMS (rTMS) is a type of TMS that is applied in a rhythmic way. Many studies have been done in recent years to evaluate whether TMS can treat depression as TMS may offer a complementary treatment for depression.

What the synthesised research says

Studies suggest that TMS is not helpful for depression.

How it was tested

The Cochrane review authors searched the medical literature for randomised controlled trials comparing TMS to other kinds of treatment or no treatment for depression. They found 16 studies with a total of 394 participants. Two of these studies had problems which prevented the reviewers from comparing them with the rest. Some studies compared rTMS with sham TMS, in which the brain was not actually stimulated. Others compared rTMS with electroconvulsive therapy, or rTMS in different parts of the brain. None of the studies showed any benefit to rTMS for depression, but the number of participants in each study was small. Studies involving more people might show some benefit for particular groups of people. The Cochrane review authors recommend more research be done.

Side effects and general cautions

The only side effect noted was mild headache, but the participants in the studies were screened to make sure they had no risk of seizures. Because of the small number of people studied, rare side effects of rTMS may have been missed.

Source

Martin JLR, Barbanoj MJ, Schlaepfer TE, Clos S, Perez V, Kulisevsky J, Gironell A. Transcranial magnetic stimulation for treating depression. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003493. DOI: 10.1002/14651858.CD003493.

EXERCISE TO PREVENT OR TREAT ANXIETY AND DEPRESSION AMONG CHILDREN AND YOUNG PEOPLE

Depression and anxiety are common conditions in children and adolescents. These young people are often treated with drugs, but often drugs are not thoroughly studied in children, or have unpleasant side effects. Many families may be unable to afford the money or time involved with talk therapies, and some people are reluctant to see a health professional for other reasons. Exercise is inexpensive, has few negative side effects, and can be done without the supervision of a health professional. It has a variety of health benefits, and may help treat or prevent anxiety and depression in young people.

Research in adults has shown that exercise can have beneficial effects on mental health. Some older studies in children have also suggested positive effects of exercise on specific conditions such as depression, anxiety, and hyperactivity. The authors of this Cochrane review set out to find newer research on children and adolescents.

What the synthesised research says

Randomised controlled trials show that exercise has a modest benefit in reducing depression and anxiety in the general population of children and adolescents aged 11-19, when compared with no treatment. However, the evidence is unclear whether exercise helps prevent anxiety or depression from developing, or if it treats existing anxiety or depression, or both.

How it was tested

The Cochrane review authors searched the medical literature for randomised controlled trials comparing young people under 20 who participated in vigorous exercise programs with their peers who did not. Sixteen studies with a total of 1191 participants between age 11 and 19 were included in the review. Eleven of the studies compared vigorous exercise with no treatment; 6 of these found less anxiety in the exercise group, while 5 found less depression in the exercise group. Five other studies compared vigorous exercise with lower intensity exercise; no difference was found. Four studies also compared exercise with psychosocial interventions (such as cognitive behavioral therapy), and found no difference between the groups.

The authors note that most of the research participants were college students, and the kinds of exercise, types of young people and different measurements used in each study varied widely. They conclude that more research needs to be done before recommending exercise as a treatment for anxiety or depression in young people.

Side effects and general cautions

No side effects were noted in the studies in the Cochrane review. While exercise is generally beneficial, some forms of exercise can cause negative side effects in some people. This is especially true of people with a known medical issue, such as a heart disorder or asthma. Many groups recommend consulting with a health professional before starting a new exercise program.

Source

Larun L, Nordheim LV, Ekeland E, Hagen KB, Heian F. Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004691. DOI: 10.1002/14651858.CD004691.pub2.

PSYCHOLOGICAL AND EDUCATIONAL INTERVENTIONS FOR PREVENTING DEPRESSION IN CHILDREN AND YOUNG PEOPLE

Depression and anxiety are common conditions in children and adolescents. Depression in young people can lead to problems in school, dysfunctional relationships, substance abuse, and even suicide. Effective techniques to prevent depression would improve the quality of life of many young people.

Worldwide, many programs have been developed to prevent depression in young people. Such programs may target specific groups at high risk, or may be delivered to a more general group, such as all students of a certain age. Many of these programs meet weekly in a small group setting for a few months. Educational programs only provide information about depression, while psychological programs also aim to teach young people coping skills to reduce depression. Despite the large number of such programs, studies show mixed results regarding their effectiveness in preventing depression.

What the synthesised evidence says

Currently there is not enough evidence to recommend any psychological or educational interventions to prevent depression in young people.

How it was tested

The Cochrane review authors searched the medical literature for randomized controlled trials which used a psychological or educational intervention for preventing depression in young people aged 5-19. They found 21 studies: 18 on psychological programs, 1 on an educational program, and 2 on combined psychoeducational programs. Some of the studies showed a short-term reduction in depressive symptoms after the interventions. However, there were many problems with the studies. For example, most of them did not compare a group who got the intervention to a group who got no treatment (placebo).

Side effects and general cautions

No side effects were noted in the review. The review authors recommend that more research be done, especially on educational interventions. Also, future research should consider whether gender makes a difference in program effectiveness. Some studies showed different outcomes for boys and girls, but there was not enough data to make firm conclusions.

Source

Merry S, McDowell H, Hetrick S, Bir J, Muller N. Psychological and/or educational interventions for the prevention of depression in children and adolescents. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD003380. DOI: 10.1002/14651858.CD003380.pub2.

PSYCHOSOCIAL AND PSYCHOLOGICAL INTERVENTIONS FOR PREVENTING POSTNATAL DEPRESSION

Postpartum depression affects 10-15% of mothers, usually in the first few months after birth. This condition can affect bonding between mother and child, can inhibit the infant’s development, and in some cases, may lead to the mother harming herself or her child. Preventing depression before it begins can avoid these outcomes.

The cause of postpartum depression is unknown, but some research suggests psychosocial factors, such as stress, marital conflict, and lack of social support, play a role. One large study found that women lacking social support were twice as likely to develop postpartum depression compared to women who had support. Psychosocial or psychological interventions, such as counseling during pregnancy or soon after birth, may be able to prevent postpartum depression.

What the synthesised research says

The evidence does not show that psychosocial or psychological interventions can prevent postpartum depression.

How it was tested

The Cochrane review authors searched the medical literature for randomized controlled trials comparing women who received a psychosocial or psychological intervention to those who did not. They found 15 studies involving 7697 mothers. The interventions studied included classes before and after birth; home visits by health care professionals or laypeople; postpartum follow up care given earlier than usual; and psychotherapy. Most of the interventions showed no benefit. However, one study found that weekly home visits by nurses did reduce the risk of postpartum depression over the short term.

Side effects and general cautions

No side effects were noted in the review. The review authors recommend more research be done, especially on home visits and on interventions focused on at-risk women rather than women in general.

Source

Dennis C-L, Creedy D. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews. 2004, Issue 4. Art. No.: CD001134. DOI: 10.1002/14651858.CD001134.pub2.

PARAPROFESSIONAL CARE FOR ANXIETY AND DEPRESSION

Anxiety and depression are common conditions. There are not enough mental health professionals to meet growing needs. Paraprofessionals might be able to help some people with anxiety or depression.

Paraprofessionals can include anyone who is not qualified as a psychiatrist, psychologist, counselor, social worker or nurse. People who coordinate self-help or bibliotherapy (reading for emotional growth and health) groups are usually paraprofessionals. Paraprofessionals may be volunteers or paid workers, and in many contexts they are trained by mental health professionals. Some research suggests that paraprofessionals are effective in providing psychological treatment.

What the synthesised research says

There is not enough evidence to determine how paraprofessionals compare to professionals in treating anxiety and depression. However, studies showed some benefit of seeing a paraprofessional compared with receiving no treatment.

How it was tested

The Cochrane review authors searched the medical literature for randomized controlled trials which compared the effects of treatments given by paraprofessionals with treatments given by mental health professionals, as well as with no treatment. The authors found 5 studies, each of which compared paraprofessionals with professionals (total number of participants: 106) as well as comparing paraprofessional treatment with no treatment (total number of participants: 220). No differences were found between professionals and paraprofessionals. Three studies showed that paraprofessional treatment was better than no treatment.

Side effects and general cautions

No negative effects of paraprofessional treatment were noted in the reviews. However, there were few studies included with a small total number of participants. Some patients with anxiety or depression may be better helped by a professional, particularly if drugs are needed for effective treatment since only licensed professionals can prescribe medication.

Source

den Boer PCAM, Wiersma D, Russo S, van den Bosch RJ. Paraprofessionals for anxiety and depressive disorders. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004688. DOI: 10.1002/14651858.CD004688.pub2.

PSYCHOSOCIAL INTERVENTIONS BY GENERAL PRACTITIONERS FOR DEPRESSION

Many people visit their general practitioner or physician (GP) for help with mental health problems. This may be due to their familiarity and comfort with the GP, or concerns about cost and waiting time to see a psychiatrist or other specialist. Since GPs are not specialised in mental health and are often very pressed for time, they need effective, efficient interventions for helping patients with mental health concerns.

Psychosocial interventions focus on dealing with problems through psychological rather than medical means. Many people prefer psychosocial interventions to avoid the side effects of taking drugs for a mental health condition. Psychosocial interventions include counselling, problem solving therapy, cognitive behavioural therapy, and psychotherapy.

What the synthesised research says

Some evidence shows that problem-solving treatment for depression may be an effective technique for GPs. There is not enough evidence for other psychosocial interventions that might be used by GPs.

How it was tested

The Cochrane researchers searched the medical literature for controlled trials which compared psychosocial interventions by GPs for any condition with other treatments for that condition. Eight studies were identified, with a total of 2114 participants. The health conditions addressed included depression, smoking, alcohol usage, and accompanying physical symptoms (somatisation disorder). Only depression itself was found to be helped by psychosocial techniques guided by a GP.

Side effects and general cautions

No negative effects of psychosocial therapies were noted in the reviews. The included studies varied widely in terms of treatments provided and conditions addressed, making it difficult to draw conclusions from the review.

Source

Huibers MJH, Beurskens AJHM, Bleijenberg G, Schayck CP van. Psychosocial interventions delivered by general practitioners. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003494. DOI: 10.1002.14651858.CD003494.

MUSIC THERAPY FOR DEPRESSION

People with depression often have difficulty meeting social expectations, are unable to work or function effectively and have poor self esteem and quality of life.

Music therapy is practiced by a trained practitioner who uses music and related activities to help people in a number of health conditions including depression. Therapy takes place either in groups or individually. For receptive therapy participants listen to music. The therapist may also introduce as activity such as relaxation, meditation, movement, drawing or reminiscing. The intent is to reduce physical and emotional stress, sooth pain and energize the body. These are the approaches used more widely in the US.

Active therapy is where people re-create, improvise or compose music using a musical instrument of choice, which may be voice or percussion. The therapist stimulates, guides or responds to the participant. This approach is most often used in Europe. The therapy is used to enable the person to experience him or herself differently and to gain insight into his or her relational and emotional problems through talking about the music. The main therapeutic change agent could be the music, the relationships or the talking which stems from the music.

What the synthesized research says

Findings from controlled trials suggest that music therapy is associated with improvements in mood and is well accepted by people with depression. This was shown by the low number of people who dropped out of therapy.

Four of the five identified controlled studies individually reported greater reduction in symptoms of depression among those randomized to music therapy than with standard care. The age of participants varied from older adults (60 to 85 years old) to adolescents (14 or 15 years old) at junior high school. Only one study tested the effects of an active approach (in a large group of elderly inpatients - in contact with mental health services. The other studies used listening to pre-recorded music with a therapist, either in a group or individually, sometimes combined with reflection or exercise.

The fifth study, which found no difference in mental state compared with standard care, involved nursing home residents with moderate to severe depression listening to music of different styles, including old-time favorites, hymns and country melodies. This suggests that without a clear therapeutic framework, listening to music alone within a large group, even with a trained therapist, is not effective.

How it was tested

The Cochrane researchers searched the medical literature for randomized controlled trials which randomized a total of 237 participants between treatments for depression that included music therapy, standard care or cognitive behavioral therapy. The treatment was given over 6 to 10 weeks. Sessions ranged from one hour to 90 minutes. The number of sessions per week varied from once to 6 times per week.

The studies were reported on in the 1990s. The age of participants varied across studies. Three studies focused on older adults (60 to 85 years old). One study included adults aged 21 to 62 years and another treated adolescents aged either 14 or 15 years at junior high school.

Side effects and general cautions

The types of therapy and standard care used varied a lot as did the populations studied and the way any benefit was measured. Some people in the control groups were on antidepressant medication. The small number of participants and low methodological and reporting quality of studies means that it is not possible to be confident about the effectiveness of music therapy.

Source

Maratos AS, Gold C, Wang X, Crawford MJ. Music therapy for depression. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004517. DOI: 10.1002/14651858.CD004517.pub2.