Integrative Medicine Approaches and Depression

February 15, 2022 Joe Brady
Posted by Joe Brady on

COVID-19 has tripled the rate of depression in US adults in all demographic groups—especially in those with financial worries—and the rise is much higher than after previous major traumatic events, according to a study published in JAMA Network Open. Many people with depression turn to a complementary health approach in addition to or in place of conventional treatment. Research suggests that some approaches can be helpful in reducing depression symptoms in patients with mild to moderate levels of depression. For other approaches, benefits are uncertain or there are safety concerns. In severe cases of depression, complementary approaches can help reduce the need for medications, thus reducing the risk of side effects.

Here are 5 things you should know about complementary health approaches for depression:

  1. Depression can be a serious illness. Don’t use a complementary health approach to replace conventional care or to postpone seeing a health care provider about symptoms of depression. 
  2. Some evidence suggests acupuncture may modestly reduce depression symptoms.
  3. Music therapy may provide short-term benefits for people with depression. 
  4. Studies in adults, adolescents, and children have suggested that yoga may be helpful in reducing depressive symptoms.
  5. Exercise in general and Tai Chi, in particular, have been shown to have a moderate to large effect upon depression symptoms

Acupuncture

There is some evidence that suggests acupuncture may provide a modest reduction in symptoms of depression, particularly when compared with no treatment or a control.

What Does the Research Show?

  • A 2018 Cochrane review of 64 studies involving a total of 7,104 participants concluded that acupuncture may result in a moderate reduction in the severity of depression when compared with treatment as usual/no treatment, and the use of acupuncture may lead to a small reduction in the severity of depression when compared with a control. Reviewers also concluded that the effects of acupuncture compared with medication and psychological therapy are uncertain because of the low quality of evidence.
  • A 2019 meta-analysis of seven trials compared the effectiveness of acupuncture therapy in patients with post-stroke depression and found evidence to support the use of acupuncture for this condition. Subgroup analyses also showed that acupuncture alone resulted in better outcomes than drug therapy in improving depressive symptoms.
  • A 2019 systematic review and meta-analysis of 29 studies involving 2,268 participants (22 trials were conducted in China and 7 conducted outside of China) concluded that acupuncture may be a suitable adjunct to usual care and standard antidepressant medication. However, most of the trials included in the review and meta-analysis were at a high risk of bias.

Safety

  • Relatively few complications from using acupuncture have been reported. Still, complications have resulted from the use of nonsterile needles and improper delivery of treatments.
  • When not delivered properly, acupuncture can cause serious adverse effects, including skin infections, punctured organs, pneumothoraces, and injury to the central nervous system.

Exercise

Many studies have examined the efficacy of exercise to reduce symptoms of depression, and the overwhelming majority of these studies have described a positive benefit associated with exercise involvement. Research also suggests that the benefits of exercise involvement may be long-lasting.20 Depressed adults who took part in a fitness program displayed significantly greater improvements in depression, anxiety, and self-concept than those in a control group after 12 weeks. There have been several meta-analyses conducted on the literature examining the relationship between exercise and depression. North et al.28 included 80 studies in their meta-analysis and reported an overall mean ES of −0.53, indicating that exercise reduced depression scores by approximately one-half a standard deviation compared with those in comparison groups. 

Craft LL, Perna FM. The Benefits of Exercise for the Clinically Depressed. Prim Care Companion J Clin Psychiatry. 2004;6(3):104-111. doi:10.4088/pcc.v06n0301

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/

In one meta-analysis, a total of 23 RCTs and 977 participants were included. Physical exercise had a moderate to large significant effect on depression compared to control conditions. The study found:

  • Physical exercise is an effective treatment for unipolar depression.
  • Exercise compares favorably to no intervention and usual care for depression.
  • Exercise is comparable to psychotherapy and antidepressants for depression.
  • Exercise could be a viable adjunct and augmentation to antidepressants for depression.
  • Exercise may serve as an alternative to established treatments and waiting list.

Siri Kvam, Catrine Lykkedrang Kleppe, Inger Hilde Nordhus, Anders Hovland, Exercise as a treatment for depression: A meta-analysis, Journal of Affective Disorders, Volume 202, 2016, Pages 67-86, ISSN 0165-0327, https://doi.org/10.1016/j.jad.2016.03.063. (https://www.sciencedirect.com/science/article/pii/S0165032715314221)

Tai Chi 

Tai chi with its concentration on meditation combined with physical activity has shown very promising results in many studies on its’ effect upon depression. Tai chi is a centuries-old, mind and body practice. It involves certain postures and gentle movements with mental focus, breathing, and relaxation. The movements can be adapted or practiced while walking, standing, or sitting. Several clinical trials have evaluated the effects of tai chi in people with various health conditions. 

Tai chi may promote quality of life and mood in people with heart failure and cancer. Tai chi also may offer psychological benefits, such as reducing anxiety. However, differences in how the research on anxiety was conducted make it difficult to draw firm conclusions about this.

Wang F, Lee EK, Wu T, Benson H, Fricchione G, Wang W, Yeung AS. The effects of tai chi on depression, anxiety, and psychological well-being: a systematic review and meta-analysis. Int J Behav Med. 2014 Aug;21(4):605-17. doi: 10.1007/s12529-013-9351-9. PMID: 24078491.

Tai Chi Is a Biological Treatment for Depression August 21, 2015 Alisa G. Woods, PhD Psychiatric Times, Vol 32 No 8, Volume 32, Issue 8

Does tai chi improve psychological well-being and quality of life in patients with cardiovascular disease and/or cardiovascular risk factors? A systematic review. Yang G, Li W, Klupp N, Cao H, Liu J, Bensoussan A, Kiat H, Karamacoska D, Chang D.
BMC Complement Med Ther. 2022 Jan 4;22(1):3. doi: 10.1186/s12906-021-03482-0.
PMID: 34983493 Free PMC article. 

Tai Chi on psychological well-being: systematic review and meta-analysis. Wang C, Bannuru R, Ramel J, Kupelnick B, Scott T, Schmid CH.
BMC Complement Altern Med. 2010 May 21;10:23. doi: 10.1186/1472-6882-10-23.
PMID: 20492638 Free PMC article. Review. 

Tai Chi exercise for psychological well-being among adults with cardiovascular disease: A systematic review and meta-analysis. Taylor-Piliae RE, Finley BA.
Eur J Cardiovasc Nurs. 2020 Oct;19(7):580-591. doi: 10.1177/1474515120926068. Epub 2020 Jun 9.
PMID: 32515204 

An evidence map of the effect of Tai Chi on health outcomes. Solloway MR, Taylor SL, Shekelle PG, Miake-Lye IM, Beroes JM, Shanman RM, Hempel S.
Syst Rev. 2016 Jul 27;5(1):126. doi: 10.1186/s13643-016-0300-y.
PMID: 27460789 Free PMC article. Review.

Conferences | APA MDD

Recent studies find powerful biological changes associated with mind-body interventions comparable to those associated with conventional antidepressants or psychotherapies.

Music Therapy

There is some evidence that music therapy may provide short-term benefits for people with depression.

What Does the Research Show?

  • A 2020 meta-analysis of 55 randomized controlled trials found that music therapy exhibited a significant reduction in depressive symptoms compared with the control group, and music medicine (i.e., music as therapy that is not managed by a music therapist, and does not involve a therapeutic relationship) exhibited a stronger effect in reducing depressive symptoms. Among the specific music therapy methods, recreative music therapy, guided imagery and music, music-assisted relaxation, music and imagery, improvisational music therapy, and therapeutic music listening exhibited a different effect, respectively.
  • A 2017 Cochrane review of 9 studies involving a total of 421 participants (411 of whom were included in the meta-analysis that investigated short-term effects of music therapy for depression) concluded that music therapy provides short-term beneficial effects for people with depression. Reviewers also found that music therapy shows efficacy in decreasing anxiety levels and improving functioning of depressed individuals.

Safety

  • There are no adverse effects associated with music therapy.

Yoga

There is some evidence that yoga may be helpful in reducing depressive symptoms.

What Does the Research Show?

  • A 2017 Cochrane review of 23 studies (involving 1,272 participants) in people with depressive symptoms (although not necessarily diagnosed with depression) found that yoga was helpful in reducing symptoms in 14 of the studies.
  • A 2017 systematic review of 7 studies (involving 240 participants) found some evidence of beneficial effects of yoga for major depressive disorder (MDD); however, the reviewers judged the evidence to be insufficient to justify recommending yoga for people with this condition. Problems included the small number of people studied and an inability to compare benefits with risks because of inadequate information on safety.
  • A 2020 systematic review of 27 studies evaluated yoga as an intervention for reducing anxiety and depression in children and adolescents. The reviewers concluded that yoga generally leads to some reductions in anxiety and depression in youth; however, the methodological quality of evidence included in the review was weak to moderate.

Safety

  • Yoga is generally considered a safe form of physical activity for healthy people when performed properly, under the guidance of a qualified instructor. However, as with other types of physical activity, injuries can occur. The most common injuries are sprains and strains. Serious injuries are rare.
  • People with health conditions, older adults, and pregnant women may need to avoid or modify some yoga poses and practices.

References

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH’s Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH website at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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