December 1, 2009
Complementary &Alternative Medicine? Yes & No…
A national study has revealed that 54 percent of people with self-reported severe depression have used complementary and alternative medicine (CAM) in the last 12 months. Two-thirds of them were also receiving conventional therapies (Saeed et al 2009). The October 2009 edition of Current Psychiatry features a meta-analysis that investigates the evidence base for the use of different CAM options in the treatment of severe depression: yoga, exercise, St John’s Wort, SAMe, fatty acids, L-tryptophan, and acupuncture.
The benefits of exercise in the treatment of depression are well documented, and the meta-analysis confirmed this. Interestingly, however, the analysis also revealed that research into the health benefits of exercise in depression has tended to involve mainly young, physically sound patients, which means there’s little clinical evidence to support the extent of efficacy for older, less physically able patients. Still, the researchers recommend that the side effect profile of exercise is benign if a sensible exercise regime is accompanied by appropriate nutrition and hydration. While some studies have found that rigorous exercise (eg aerobics or resistance training) is more effective in treating depression than moderate exercise (eg walking), the meta-analysis revealed that yoga is just as effective as high intensity exercise in inducing symptom remission in severe depression.
Polyunsaturated fatty acids—most commonly omega-3 and omega-6 oils derived from fish—are being praised lately for all sorts of health benefits for the joints, skin, and cardiovascular system. Research also indicates that they may be beneficial in treating depression, especially in combination with an SSRI (Saeed et al 2009). Some studies have also demonstrated that omega-3 is helpful in relieving symptoms of depression in patients suffering from Parkinson’s disease.
Our bodies make S-adenosyl-L-methionine (SAMe) from methionine, an amino acid found in protein-rich foods. The molecule is a metabolite used in the bio-synthesis of norepinephrine, serotonin, and dopamine. Since the 1990s, it’s been available in the US as a dietary supplement and heralded in the popular press for its benefits in treating depression, arthritis, and liver problems.
Most of the favorable studies for St John’s Wort have come from Europe, whereas American trials have not been able to establish a significant difference between the herb and placebo in treating major depression (Saeed et al 2007). While numerous studies have found that St John’s Wort can assist in inducing remission of depressive symptoms, research conducted by the National Center for Complementary & Alternative Medicine (NCCAM) at the National Institutes of Health (2007) did not find that St John’s Wort was any more effective than placebo. It also has some serious side effects which suggest that it shouldn’t be treated as an innocuous herbal remedy. It can also limit the effectiveness of other drugs including the birth control pill, antidepressants, cyclosporine, digoxin, medicines used to control HIV infection, anticancer medications, and anticoagulants as just a few examples (NCCAM 2007)
L-tryptophan is an amino acid used in the biosynthesis of serotonin. It can be derived from foods or ingested as a dietary supplement. While a couple studies demonstrate benefits in combining L-tryptophan with conventional pharmacology in treating depression, the meta-analysis concluded that little clinical evidence exists to support its use. L-tryptophan is also implicated in causing eosinophilia-myalgia syndrome, which led the FDA to ban the sale of L- tryptophan in 1991. The FDA has since loosened the restrictions, although importation is still banned.
While acupuncture may result in some symptom relief, the meta-analysis found that there’s no clinical evidence to suggest that it’s more effective than placebo. Research to date has been poorly designed and inconsistent. The side effect profile, however, seems to be rather benign.
As always, if you intend to utilize a complementary medical treatment please advise your physician.
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
Further reading:
Agency for Healthcare Research & Quality 2002 S-adenosyl-L-methionine for treatment of depression, osteoarthritis, and liver disease, US Deparment of Health & Human Services Evidence Report, no. 64.
National Center for Complementary & Alternative Medicine (National Institutes of Health) | Get the Facts | St John’s Wort & Depression 2007.
Saeed A., Bloch, R., et al 2009 CAM for your depressed patient: six recommended options, Current Psychiatry, vol. 8
Posted by at 11:12 AM | Permalink | Comments (0) | TrackBacks (0)April 3, 2009
Stress Hormone May Identify Risk For Postpartum Depression
Risk factors for postpartum depression include depression before or during pregnancy, a history of premenstrual syndrome as well as a history of mood changes with oral contraceptive use. Social risks include inadequate family support, or personality factors such as trait anxiety.
A recent study found that levels of a stress hormone, corticotrophin-releasing hormone (CRH) elevated during the 25th week of pregnancy was correlated with patients who went on to develop postpartum depression. Levels of the hormone normally surge with pregnancy, however the amount of CRH was also assessed at weeks 15, 19, 31 and 35 and none of these (even if elevated) were predictive of a mood episode. Researchers admit that the correlation was not 1:1 but elevated CRH at 25 weeks was able to predict likelihood of depression onset with 75% accuracy.
Researchers are unsure why there is a biologic vulnerability for excess CRH in some women, however this study points to a possible test that may be used clinically to screen for depression.
The study was funded by the National Institute of Child Health and Human Development. An abstract of the study may be found online “Risk of Postpartum Depressive Symptoms with Elevated Corticotropin-Releasing Hormone” in the February Archives of General Psychiatry.
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
July 14, 2007
PMS? All in your head - or hormones?
For some women PMS is more than a minor annoyance, in 5-8% categorized as a more severe condition, PMDD or “premenstrual dysphoric disorder”. Although antidepressants can be helpful, new research suggests hormonal treatments may be equally effective. Researchers believe that PMDD mood symptoms are related to progesterone and estrogen elevations approximately 2 weeks subsequent to ovulation (during the so-called late luteal phase of the monthly cycle). Looking at placebo-controlled studies, links were found between levels of progesterone and excitability of the amygdala (a part of the brain involved in processing of environmental stimuli and subsequent emotional responses). Functional MRI studies utilizing exogenously administered progesterone to healthy women revealed decreased communication between the amygdala and the fusiform gyrus (a part of the brain involved in higher order processing of emotionally laden stimuli); and an increased activation of the amygdala and dorsal anterior cingulate gyrus (a more rudimentary brain region activated during evaluation of stimuli that is perceived as “threatening”)
Potential evolutionary antecedents/ potential benefits of premenstrual emotion sensitivity and perhaps amplification; are still speculative. Although I did have a male professor tell me his wife gave him her prempro once, instead of his cardiac medication; his only response was that he felt “warm and fuzzy—more maternal inside”, adding that he had an unusual urge to use psychotherapy with his patients rather than prescribe medication. Although we could all use some help with the kids from time to time; for now, I think we should probably avoid slipping progesterone into our husband’s coffee -- tempting as it may be.
Citations:
Joan Arehart-Treichel
Brain Imaging Suggests Origin of Premenstrual Dysphoric Disorder
Psychiatric News, Sep 2007; 42: 13 - 20.
Studd, J. Ovariotomy for menstrual madness and premenstrual syndrome--19th century history and lessons for current practice. Gynecologic Endocrinology, 2006 Aug; 21(8)
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
