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

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Complex Clinical Conundrums in Psychiatry

Abstract

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.

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Authors and Affiliations

  1. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Rosalia Sun Young Yoon MSc, PhD, Nisha Ravindran MD, FRCPC & Arun Ravindran MB, PhD

  2. Centre for Addiction and Mental Health, Mood and Anxiety, Toronto, ON, Canada

    Rosalia Sun Young Yoon MSc, PhD, Nisha Ravindran MD, FRCPC & Arun Ravindran MB, PhD

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  1. Rosalia Sun Young Yoon MSc, PhD
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  2. Nisha Ravindran MD, FRCPC
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  3. Arun Ravindran MB, PhD
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Correspondence to Arun Ravindran MB, PhD .

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  1. Department of Psychiatry, Northern Ontario School of Medicine Psychiatry Department, Sudbury, Ontario, Canada

    Kuppuswami Shivakumar

  2. Woodstock General Hospital, Woodstock Ontario, University of Western Ontario, London, Ontario, Canada

    Shabbir Amanullah

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Yoon, R.S.Y., Ravindran, N., Ravindran, A. (2018). Complementary and Alternative Therapies for Treatment-Resistant Depression: A Clinical Perspective. In: Shivakumar, K., Amanullah, S. (eds) Complex Clinical Conundrums in Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-70311-4_12

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