Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Alternative Treatments, Complementary Therapies, and Electroconvulsive Therapy
Several nonprescription herbal
and dietary supplements are used by some people to treat depression. Little is
known about the safety, effectiveness, or appropriate dosage of these remedies, although they are taken by thousands of people around the world.
A few of the best-known alternative remedies continue to be studied
scientifically to see how well they work, but to date, there is little
evidence that herbal remedies effectively treat moderate to severe clinical
Medical professionals usually are hesitant to recommend herbs or dietary supplements because they are not regulated by the U.S. Food and Drug Administration (FDA), as prescription drugs
are, to ensure their purity and quality. Regardless, if you are on any medication, dietary supplement, or other remedy, be sure to check with your health-care provider before starting an herbal or dietary supplement.
When you buy a supplement from the drugstore or
health-food store, you cannot be sure exactly what you are getting and what is the appropriate dosage.
There are few guidelines for correct doses. Potency can vary from product to product, even batch to batch of the same product.
St. John's wort: This is probably the best-known alternative therapy for depression. It is derived from a plant,
Hypericum perforatum, and has been part of folk medicine for centuries.
It has been widely used in North America and Europe to treat anxiety, depression
that is of mild severity, and sleep disorders.
It is available in pill form, like capsules, tablets, as a liquid extract, and in various teas.
Studies conducted in Europe suggested that St. John's
wort works as well as prescription antidepressants with fewer side effects. In other more recent studies sponsored and well designed by the National Institutes of Health, St. John's wort worked no better than a sugar pill (placebo) in relieving depression.
St. John's wort is not without its own negative effects.
One problem with St. John's wort is that it interacts
with many other medications. Some of these interactions can be dangerous.
It also may make other medications stop working, including some that are used to treat cancer or HIV infection or to
prevent organ rejection after transplant.
If taken with an SSRI drug, St John's wort can cause
a potentially dangerous condition called serotonin syndrome. The combination
is not recommended.
Common side effects include dry mouth, dizziness, digestive symptoms, fatigue, and increased sensitivity to sunlight. It is not recommended for people with seasonal depression using bright light therapy.
SAM-e: The chemical name of this agent is S-adenosyl-methionine. It occurs naturally in the body and has many functions.
Some believe that it increases neurotransmitter
levels in the brain, but this has not been proven.
In Europe, it is a prescription drug.
In the United States, it is available without
prescription and is sold as a dietary supplement, although it is quite
Its effectiveness in depression is unknown.
It has few side effects.
5-HTP: This agent, 5-hydroxytryptophan, is another substance that occurs naturally in the body, where it is used to make serotonin. Although there is some evidence that this agent relieves depression with fewer side effects than SSRIs, the evidence is by no means conclusive.
Omega-3 fatty acids: Deficiencies in these natural substances have been linked to depression, especially bipolar disorder. They are found in certain plants and fish oil. Fish-oil capsules are available at natural-food stores, but they have digestive side effects in many people. By far the best source is fish, especially oily fish such as salmon and mackerel. These fatty acids also promote a healthy heart and blood vessels.
Many different complementary therapies are advocated by different groups and individuals to assist in dealing with depression. These include the following:
Lifestyle changes such as adopting a healthy diet, exercise, and stress
and other relaxation therapies
Hypnosis to help the individual focus their attention more constructively may be a helpful addition to the treatment of depression
Physical therapies such as massage, reflexology, and acupuncture
Environmental therapies such as aromatherapy and music therapy
Spiritual or faith-based activities
Interactions with other people and animals
Limiting alcohol intake and refraining from using illicit drugs or abusing
prescription drugs altogether
Most of these are safe for all or most people and may contribute to your overall well-being.
They are not, however, a replacement for medical
therapy known to be effective in most people.
Check with your health-care provider, especially if you are taking antidepressant medication, before starting any new diet or exercise program, new medications, or herbal preparations or supplements.
Electroconvulsive (ECT) or shock therapy is safe and effective on a short-term basis as an alternative for people with very severe clinical depression who have not improved with a number of other treatments or in people who cannot safely take antidepressant medication. It involves the induction of seizures in a controlled medical setting by a trained health-care practitioner in a patient who is appropriately sedated. Although there has been much controversy about ECT, much of this debate has been caused by impressions of ECT when it was fairly new (its use was begun in 1939) and not as sophisticated or specifically done as it is today. ECT has been shown to alter the levels of brain neurotransmitters that may cause depression.
ECT is often reserved for those with severe symptoms
that do not respond to medications or for people who are suicidal.
Elderly people who cannot tolerate the side effects
of antidepressant medications are sometimes good candidates for ECT. Specifically, elderly individuals have been found to tolerate and benefit from ECT as well as younger adults.
Prior to undergoing ECT, you would have a complete
medical evaluation. Typically, you are sedated and cannot remember the ECT
Commonly, you might have a brief period of confusion after the procedure. You may feel muscle aches or a headache after
treatment. Some memory loss, usually quite temporary, is fairly common with
ECT as well. Those who receive 12 or more ECT treatments may experience more long-lasting memory and learning problems.
ECT treatments are generally given every other day for two to three weeks (for about
six to 10 treatments). The actual duration of therapy depends on your response to it. Some people need to follow up with regularly scheduled "booster treatments," or so-called "maintenance ECT," after improving with this treatment. Over the longer term, the effects of ECT may fade.