Complementary and Alternative Medicine in Major Depressive Disorder

Complementary and Alternative Medicine (CAM) is a term used to represent a number of specific treatments with potentially high public health importance and benefits. That which constitutes conventional or mainstream medicine is subjective and evolves over time. “Complementary” refers to approaches that are not considered mainstream or conventional, but are consistent with Western concepts based on the biomedical model. “Alternative” approaches are usually considered outside of the traditional Western medical conceptual framework. “Integrative” medicine refers to the combination of CAM and conventional treatments with the goal of achieving the best clinical outcomes for patients. CAM has also been defined as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine” (NCCAM, 2002). Many CAM treatments are commonly used and readily accessible, though few have received adequate study for psychiatric conditions. CAM use has increased in recent decades (Eisenberg et al., 1998; Barnes et al., 2008). It is not well established how often CAM treatments are prescribed by a health care provider, in comparison to self-prescribed. Approximately 72 million adults in the U.S. use at least one CAM therapy annually, representing over one-third of the population (Tindle et al., 2005). Many individuals with psychiatric disorders turn to CAM either as adjunctive to or in lieu of conventional therapies. In a survey of CAM utilization, one research group reported that approximately 10% of U.S. adults surveyed who had visited a CAM provider had a self-reported psychiatric diagnosis, and approximately half of those respondents had sought care from a CAM provider specifically for a psychiatric indication (Druss and Rosenheck, 2000). Simon et al. (2004) assessed visits to CAM providers, and found 11% of visits were sought for mental health conditions in a representative sample of naturopathic physicians, acupuncturists, chiropractors, and massage therapists. The majority of patients were selfreferred and care with conventional medical providers was poorly coordinated. In a survey of a nationally representative U.S. sample, Kessler et al. (2001) found that over half of respondents with self-reported depression or anxiety disorders used CAM therapies, although only a small proportion were doing so in coordination with a conventional health care provider. The majority of those using CAM treatments were also receiving treatment from conventional health care providers. In a study of patients hospitalized for psychiatric indications, 63% reported having used a CAM therapy within the past year (Elkins et al., 2005). Major depressive disorder (MDD) was the most common diagnosis associated with CAM use. Of importance, most of these patients had not disclosed CAM use to their psychiatrist (79%). Unutzer et al. (2000) demonstrated that individuals with diagnoses of MDD were significantly more likely than those without MDD to use CAM therapies. The widespread use of CAM treatments and the particular association of CAM use for highly prevalent mental illnesses, compel psychiatrists to understand the benefits and risks of CAM, as well as the role of CAM treatments in health care.