Cited by 121Complementary and Alternative Medicine StudiesTreatment of Major DepressionMedicinal Plant Extracts Effects

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Complementary and alternative therapies as add-on to pharmacotherapy for mood and anxiety disorders: A systematic review

Ravindran, Arun V., da Silva, Tricia L.·2013·Journal of Affective Disorders

DOI 10.1016/j.jad.2013.05.042

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Abstract

Background Depressed and anxious patients often combine complementary and alternative medicine (CAM) therapies with conventional pharmacotherapy to self-treat symptoms. The benefits and risks of such combination strategies have not been fully evaluated. This paper evaluates the risk-benefit profile of CAM augmentation to antidepressants in affective conditions.Methods PubMed was searched for all available clinical reports published in English up to December 2012. Data were evaluated based on graded levels of evidence for efficacy and safety.Results Generally, the evidence base is significantly larger for depression than for anxiety disorder. In unipolar depression, there is Level 2 evidence for adjunctive sleep deprivation (SD) and Free and Easy Wanderer Plus (FEWP), and Level 3 for exercise, yoga, light therapy (LT), omega-3 fatty acids, S-adenosylmethionine and tryptophan. In bipolar depression, there is Level 1 evidence for adjunctive omega-3s, Level 2 for SD, and Level 3 for LT and FEWP. In anxiety conditions, exercise augmentation has Level 3 support in generalized anxiety disorder and panic disorder. Though mostly well-tolerated, these therapies can only be recommended as third-line interventions due to the quality of available evidence.Limitations Overall, the literature is limited. Studies often had methodological weaknesses, with little information on long-term use and on potential drug-CAM interactions. Many CAM studies were not published in English.Conclusions While several CAM therapies show some evidence of benefit as augmentation in depressive disorders, such evidence is largely lacking in anxiety disorders. The general dearth of adequate safety and tolerability data encourages caution in clinical use.

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“An ever-growing number of patients with depression and anxiety report using CAM therapies to treat their symptoms, often in addition to conventional medications, and usually without medical supervision (Wahlström et al., 2008).”
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Authors: Ravindran, A. V., & da Silva, T. L.
Affiliations: Centre for Addiction and Mental Health (CA)
Corresponding author: Ravindran, Arun V.
ORCID: Ravindran, Arun V.
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2013-09
Volume: 150
Issue: 3
Pages: 707-719
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/j.jad.2013.05.042
OpenAlex: W1977854880
Cited by: 121
References: 201
Citations by year: 2026: 2 · 2025: 3 · 2024: 7 · 2023: 3 · 2022: 5 · 2021: 9 · 2020: 12 · 2019: 10 · 2018: 9 · 2017: 14 · 2016: 18 · 2015: 18 · 2014: 7 · 2013: 4
FWCI: 3.64
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Health Sciences › Medicine › Complementary and alternative medicine › Medicinal Plant Extracts Effects
Keywords: complementary and alternative medicine, adjunctive therapy, antidepressants, depression, anxiety disorders, bipolar depression, sleep deprivation, physical activity, yoga, phototherapy, omega-3 fatty acids, S-adenosylmethionine, tryptophan, generalized anxiety disorder, panic disorder, safety and tolerability
MeSH terms: Complementary Therapies, Anxiety Disorders, Combined Modality Therapy, Female, Humans, Male, Phototherapy, S-Adenosylmethionine, Tryptophan, Yoga, Fatty Acids, Omega-3, Meditation, Mood Disorders

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Complementary and alternative therapies as add-on to pharmacotherapy for mood and anxiety disorders: A systematic review

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