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
