Complementary and Alternative Therapies for Treatment-Resistant Depression: A Clinical Perspective

  • Rosalia Sun Young Yoon
  • Nisha Ravindran
  • Arun RavindranEmail author


Complementary and alternative medicine (CAM) therapies are a group of diverse medical and health systems, practices, and products not currently considered to be part of conventional medicine. These therapies are growing in popularity, with approximately 50% of patients with depressive disorders reported to use some form of alternative treatment. Often perceived as natural and safer alternatives without many of the adverse effects commonly associated with pharmacotherapy, CAM therapies have great potential in the management of treatment-resistant depression (TRD). Many CAM therapies work via mechanisms other than those of antidepressant medications and, as such, may be viable options for patients who have failed to achieve remission with pharmacotherapy and for those who cannot adhere to medications due to intolerable adverse effects. Moreover, augmentation of pharmacotherapy with CAMs can be a practical option for partial responders for whom antidepressant medication doses cannot be increased due to issues of safety and tolerability. However, the evidence on efficacy and safety of different CAM interventions in TRD is limited. The aim of this chapter is to present the available evidence on CAM therapies for TRD, to serve as a guide for the clinician to tailor an alternate therapeutic approach for patients with treatment resistance. Based on the available data on efficacy, safety, and practicality, the most robust evidence is for exercise, mindfulness-based cognitive therapy, and omega-3 fatty acids as adjunctive treatments. There is less evidence on efficacy of yoga, light therapy, and S-adenosyl-L-methionine. Despite current limitations in the availability of studies in TRD, there is a growing body of evidence in support of specific CAMs in TRD, indicating therapeutic potential. As such, CAM therapies as add-on to evidence-based first-line interventions may be considered as part of an integrative approach to the management of treatment resistance.


Treatment-resistant depression (TRD) Complementary and alternative medicine (CAM) Mechanism of action Efficacy Safety 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Rosalia Sun Young Yoon
    • 1
    • 2
  • Nisha Ravindran
    • 1
    • 2
  • Arun Ravindran
    • 1
    • 2
    Email author
  1. 1.Department of PsychiatryUniversity of TorontoTorontoCanada
  2. 2.Centre for Addiction and Mental Health, Mood and AnxietyTorontoCanada

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