Major depressive disorder Health Article

Alternative and complementary treatments

The National Center for Complementary and Alternative Medicine (NCCAM) is conducting an ongoing series of clinical tests of alternative and complementary treatments for depression. Those that have been shown to reduce symptoms of depression and compare favorably with conventional treatments include acupuncture; Ayurvedic medicine; meditation; and a therapeutic diet designed to be free of caffeine and refined sugar.

Herbal preparations are common alternative treatments for depression; in fact an NCCAM study found that depression is the single most common reason for people in the United States to purchase herbal remedies. Some, such as St. John's wort, have been used in Europe for decades. The German Commission E, which regulates government approval of herbal preparations in German-speaking Europe, recently approved the use of Gingko bilobaextract as a treatment for depression. The most important caution is that persons who are using herbal remedies, whether to treat depression or other conditions, should always tell their doctor what they are taking, how much, and how often. This warning is crucial because some herbal preparations that are safe in themselves can interact with prescription medications. In particular, St. John's wort has been reported to cause interactions with fluoxetine (Prozac).

Some complementary approaches appear to be helpful to persons with depression because they offer pleasurable experiences for the senses or lift the person's spirit. These include aromatherapy; music therapy; pet therapy; humor; therapeutic massage; and yoga.

Prognosis

Major depression is increasingly viewed as a chronic condition for many people. Left untreated, a depressive episode may last four months or longer, regardless of the age of onset. While most people recover fully from a given depressive episode, eventual recurrence is common. Long-term studies of people with MDD indicate that about 60% of patients who have one episode of depression will have a second episode; with each succeeding episode, the chances of a subsequent episode increase. For example, persons having a third episode stand a 90% chance of having a fourth. Between depressive episodes, the patient's mood may return to a nondepressed state (in about two-thirds of the cases) or continue to show some degree of impairment (one-third of cases). Patients who recover only partially between episodes appear to be at especially high risk of recurrence.

Community studies indicate that about 60% of the people diagnosed with MDD are greatly improved or fully recovered by one year after diagnosis. A very severe initial episode of depression, the presence of a coexisting dysthymic disorder, or the existence of a serious medical condition are associated with a poorer prognosis.

Prevention

While programs specifically aimed at preventing MDD are not widespread, early interventions with children to address some of the issues related to depression have met with success. In particular, social skills training has been found to reduce symptoms of depression, perhaps by enabling children to develop the kinds of social supports and friendships that promote good mental health. Cognitive behavioral techniques that teach people to challenge dysfunctional thought patterns, such as the tendency to deny responsibility for good outcomes and to feel overly responsible for negative events, has been found to successfully reduce the rates of depressive symptoms in children and college students. In addition, psychoeducational work with parents having mood disorders has been effective in improving the adjustment of their children. Long-term follow-up of such approaches is incomplete, but these studies support the possibility that improved individual and family functioning may help to lower rates of depression in the future.

As the factors that increase an individual's vulnerability to depression become better understood, effective strategies for early interventionand possible prevention become possible. Brief therapies that target such symptoms as maladaptive thought patterns or interpersonal problems may lower the risk of serious mood disturbances. Knowledge of the mental health implications of natural or humanly caused disasters has already resulted in much improved mental health services to communities in need. It is realistic to expect that appropriate treatment will become more available and accessible to people experiencing less dramatic setbacks to their ability to function in the future.

See also Adjustment disorder; Catatonic disorder; Children's Depression Inventory (CDI); Creative therapies; Family psychoeducation; Genetic factors and mental disorders; Grief