Treating Depression with Integrative Medicine: An Evidence-Based
Approach
Yoon Hang John Kim* MD MPH and **Jeanne Bowers LAPC
Georgia Integrative Medicine
What is Depression?
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and sense of wellbeing(1). Depressed people can feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable and/or restless. They may lose interest in activities that were once pleasurable, experience either loss of appetite or overeat, have problems concentrating, have difficulty remembering details or making decisions, and may contemplate, attempt or commit suicide. Insomnia, excessive sleeping, fatigue, aches, pains, digestive problems or reduced energy may also be present. (2)
According to the CDC, about 9% of Americans report they are depressed at least occasionally, and 3.4% suffer from major depression.(3) The analysis, part of the CDC’s Morbidity and Mortality Weekly Report(MMWR) for Oct. 1, was based on a survey of 235,067 people aged 18 and older in 45 states, Washington, D.C., Puerto Rico, and the Virgin Islands.
Depressed mood may not require any professional treatment, and may be a normal reaction to certain life events, a symptom of some medical conditions, or a side effect of some drugs or medical treatments. A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition, e.g., of a mood disorder, which may benefit from treatment. (4)
What is Integrative Medicine?
Integrative medicine is healing-oriented medicine that takes into account the whole person. In integrative medicine, an examination of the whole extends to exploring a patient’s spirituality, emotional state, relationships, and behaviors as they relate to health and wellness. Integrative medicine draws from conventional as well as complementary and alternative medicine, and offers an array of treatment and care options from each field that may be used alone or in combination. (5)
Integrative medicine utilizes the strengths of conventional medicine and the wisdom of complementary and alternative healing modalities. Alternative modalities include acupuncture, Chinese herbs, and supplements (5).
Evidenced Based Medicine & Cochrane Library
Evidence-based medicine emphasizes the use of evidence from well-designed and conducted research in healthcare decision-making. The term “evidence-based medicine” was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians (6).
Cochrane Reviews, a database of systematic reviews and meta-analyses which summarize and interpret the results of medical research. The Cochrane Library aims to make the results of well-conducted controlled trials readily available and is a key resource in evidence-based medicine (7).
Evaluation of Integrative Medicine Modalities to Treat Depression:
Music therapy for depression
Authors’ concluded that the findings from individual randomized trials suggest that music is accepted by people with depression and is associated with improvements in mood. However, the authors express concern due to small number and low methodological quality of studies (8).
Exercise for depression
Authors concluded that exercise is moderately effective for reducing symptoms of depression, but methodologically robust trials only shows a small effect. When compared to psychological or pharmacological therapies, exercise appears to be no more effective, though this conclusion is based on a few small trials (9).
St. Johns-wort-for-treating-depression
Authors concluded that the hypericum extracts tested in the included trials a) are superior to in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants (10).
Light Treatment for Non-SAD Depression
Authors concluded that for patients suffering from non-seasonal depression, light offers modest though promising anti-depressive effect , especially when administered during the first week of treatment, in the morning. Authors caution that due to limited and of studies these results need to be interpreted with caution. (11)
Discussion:
The art of practicing medicine is based on science of medicine. However, the art goes further and deeper than what the current evidence provides the practitioners. For example, in addition to music therapy, exercise, light treatment, and St. John’s Wort, I have seen impressive results with acupuncture with electrical stimulation. In addition, Chinese herbs can also provide a valuable additional tool for treating depression. Lastly, counseling allows patients to experience growth and healing in a time of great suffering.
Conclusion:
A current review of evidence indicates that music therapy, exercise, St. John’s Wort, and light therapy all have positive anti-depressive effect. However, the number of studies are small and the quality of the studies are low.
Caution:
If you have symptoms of severe depression or suicidal ideations, you need to seek out an experienced integrative medicine physician, psychiatrist, or counselor.
References:
1. Salmans, Sandra (1997). Depression: Questions You Have – Answers You Need. People's Medical Society. ISBN 978-1-882606-14-6.
2. "NIMH · Depression". nimh.nih.gov. Retrieved 15 October 2012.
3. http://www.cdc.gov/mmwr/pdf/wk/mm5938.pdf
4. Cheog J et al. for PsychCentral.com. Last reviewed August 26, 2010. Frequently Asked Questions About Depression Accessed May 11, 2013
5. http://www.georgiaintegrativemedicine.com/Integrative_Medicine.html
6. Evidence-Based Medicine Working Group (November 1992). "Evidence-based medicine. A new approach to teaching the practice of medicine". JAMA 268 (17): 2420–5.
7. http://en.wikipedia.org/wiki/Cochrane_Library
8. Maratos A, Gold C, Wang X, Crawford M. Music therapy for depression. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004517. DOI: 10.1002/14651858.CD004517.pub2.
9.Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M, Mead GE. Exercise for depression. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub6 - See more at: http://summaries.cochrane.org/CD004366/DEPRESSN_exercise-for-depression#sthash.DrCaPbSh.dpuf
10. Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3
11. 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.
* Yoon Hang John Kim, Director, Georgia Integrative Medicine. E-mail: drkim@georgiaintegrative.com
** Jeanne Bowers, Counselor, Georgia Integrative Medicine. E-mail: jeanne@georgiaintegrative.coms
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