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An Overview of Complementary and Alternative Medicine Therapies for Anxiety and Depressive Disorders

Supplement to Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder

Evidence-based Synthesis Program

Investigators: John W Williams, Jr, MD, MHSc, Jennifer M Gierisch, PhD, Jennifer McDuffie, PhD, Jennifer L Strauss, PhD, and Avishek Nagi, MS.

Evidence-based Synthesis Program (ESP) Center, Durham Veterans Affairs Healthcare System
Washington (DC): Department of Veterans Affairs; 2011 Aug.
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ABSTRACT

BACKGROUND:

VA is committed to expanding the breadth of posttraumatic stress disorder (PTSD)-related services available to Veterans. Since depressive and anxiety disorders share common features with PTSD, this report was commissioned to examine the efficacy of complementary and alternative medicine (CAM) therapies for the treatment of depressive and anxiety disorders as a means to detect treatments that might be applicable to PTSD.

METHODS:

The key questions (KQs) were adapted from the parent report, Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder. We searched MEDLINE® (via PubMed®) and the Cochrane Database of Systematic Reviews for recent English-language systematic reviews (SRs) that examined the literature on mind-body medicine, manipulative and body-based practices, and movement or energy therapies, excluding nutritionals, herbal remedies and other supplements. To be included, SRs had to be published within the past five years and be evaluated as a “fair” or “good” quality. Titles, abstracts, and articles were reviewed in duplicate, and relevant data were abstracted by authors trained in the critical analysis of literature.

KEY FINDINGS:

We identified five relevant SRs on mind-body CAM therapies, but none on manipulative and body-based, movement-based, or energy therapies. Most primary studies were small trials that did not provide descriptions of CAM strategies adequate to permit replication. Dose, duration, and frequency of interventions sometimes varied widely. Key findings were:

  • For anxiety disorders, there is limited evidence on the effectiveness of meditation (n = 2 studies). Studies reported high rates of dropout, suggesting that adherence to meditation may be problematic in a clinical setting; therefore, it is difficult to draw conclusions about the efficacy of meditation for the treatment of anxiety disorders.
  • Relaxation and/or breathing retraining show promise as a CAM therapy for panic disorders. Evidence, however, is limited.
  • Acupuncture shows some promise as a CAM therapy for depression, but results were mixed. For major depressive disorder (MDD), acupuncture showed greater effects than sham control on depressive symptoms but did not improve response or remission rates. It did not differ significantly from short-term use of antidepressants. However, for patients with post-stroke depression, acupuncture was more effective than short-term use of antidepressants.
  • Mindfulness-based stress reduction has shown positive effects on anxiety and depressive symptoms. However, studies are poor to fair quality.
  • No included SRs reported effects on health-related quality of life. Reported results provided limited data on adverse effects or retention rates.

The limitations of the current evidence preclude strong conclusions about specific CAM interventions for the treatment of depressive and anxiety disorders. However, limited evidence supports the use of meditation, relaxation training and/or breathing retraining, and mindfulness-based stress reduction for anxiety, as well as acupuncture for depression. This evidence should be considered together with the direct data on CAM treatments for PTSD when planning further treatment studies.

Contents

Medical Editor: Liz Wing, MA

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Durham Veterans Affairs Healthcare System, Durham, NC, John W Williams Jr., M.D., M.H.Sc, Director

Suggested citation:

Williams JW Jr, Gierisch JM, McDuffie J, Strauss JL, Nagi A. An Overview of Complementary and Alternative Medicine Therapies for Anxiety and Depressive Disorders: Supplement to Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder. VA-ESP Project #09-010; 2011.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Durham VA Medical Center, Durham, NC, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.

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