Complementary and Alternative Medicine (CAM): considerations for the treatment of major depressive disorder

The use of complementary and alternative medicine (CAM) has increased among patients with psychiatric disorders, as it has in the general population, over recent decades. Psychiatrists, therefore, need to inquire about and discuss the use of these treatments with patients and offer up-to-date information about risks and benefits. However, evidence-based information is limited. To address the needs of practicing psychiatrists and the public, the American Psychiatric Association has set up a task force on CAM to review the evidence for the efficacy and safety of CAM treatments in major depressive disorder (MDD). Some CAM treatments have known general health benefits but currently equivocal evidence of benefit in MDD. Exercise, folate, and omega-3 fatty acids can be recommended to most patients with MDD for their general health benefits, and St John's wort and S-adenosyl-L-methionine (SAM-e) may be appropriate to treat depression in some patients. In all instances, use of CAM therapies should not take the place of diagnostic assessment and evaluation for MDD and consideration of standard treatment use. Patients should receive advice about all available treatment options, including risks, benefits, and possible drug interactions, as well as full evaluations and regular monitoring.