Expert Q&A: Complementary and alternative medicine
People with depressive or anxiety disorders often combine complementary and alternative medicine (CAM) therapies with medications to self-treat symptoms.
CAMH’s Dr. Arun Ravindran, Chief of the Mood and Anxiety Disorders Service, and Tricia da Silva, researcher in the program discuss their recent review of natural practices and mental illness.
What are CAM therapies?
Complementary and alternative medicine (CAM) therapies are natural practices or products that are seen as separate from conventional Western medicine. They have 3 main categories:
- Physical therapies, e.g. exercise, yoga, bright light, acupuncture.
- Nutraceuticals (vitamins and minerals), e.g. Vitamin D, folic acid, magnesium, omega-3 fatty acids
- Herbal remedies, e.g. St. John’s wort, roseroot and saffron.
Used both to help manage existing conditions and to maintain good health, CAMs are often seen as more ‘natural’, tolerable and affordable than standard medications, as well as less stigmatizing and more accessible, as no prescription is needed.
Have CAMs been studied in mental illnesses?
Compared to the huge amount of data on standard medications or psychotherapies, research on CAMs is still limited. Few CAM studies have consistently positive results. Additionally, due to poor study designs, the results of many studies may be difficult to replicate in the community. Another note is that most studies looked at CAMs in major depression, with very few studies in other common mental disorders, such as anxiety disorders, bipolar disorder, or schizophrenia. Similarly, physical therapies have been far more investigated than nutraceuticals or herbal remedies.
Which CAMs appear to be helpful for mental illnesses?
Some CAMs may be beneficial in depression, either alone or when used with medication. These include exercise, yoga, bright light therapy, S-adenosylmethionine (an amino acid), omega-3 fatty acids, and St. John’s wort.. No CAMs have sufficient positive data to be recommended for severe depression, anxiety disorders or schizophrenia.
How does an activity like yoga improve the symptoms of anxiety disorders or depression?
We are not absolutely certain, but scientific evidence suggests that yoga practice provides benefit by acting on stress reactivity. People with anxiety or depressive disorders are often highly sensitive to stress and have overactive sympathetic nervous system reactions (the excitation system “fight or flight” response). When a person is under stress or perceives a threat, the sympathetic nervous system kicks in (inner tension, sweaty palms, quickened heartbeat, etc.) to help them get ready to avoid that threat, with increased secretion of such hormones as adrenaline. Yoga has been found to help improve stress tolerance by stimulating the parasympathetic nervous system (the calming system) and reducing the activity of the sympathetic nervous system. When stress tolerance rises, stress sensitivity is reduced and a person’s daily life can be more manageable.
Are CAMs safe to use?
Despite their perceived ‘naturalness’, CAMs can have side effects similar to standard medications, such as nausea, diarrhoea, sedation/insomnia, agitation and irritability, as well as more serious effects, such as induced mania and worsening of depression. They can also have cancer-causing, liver toxicity or anti-blood clotting properties, or may interact negatively with existing medications (psychiatric or non-psychiatric) or medical conditions.
What precautions should people take before starting to use CAMs?
The pros and cons of the specific CAM, and your personal health and medication status, are key factors to consider. Your family doctor or psychiatrist can provide comprehensive advice, and should be consulted before CAMs are added to your existing health or treatment regimes.
Will you continue to research the potential benefits of CAMs for mental illness?
Research on CAMs is a longstanding interest of our group. We recently completed a study of yoga as augmentation for unipolar and bipolar depression, and are currently running a study of yoga for social anxiety disorder. We intend to continue research on yoga in depression and anxiety, and also plan to explore the benefit of herbal remedies for these conditions. Researchers in the Division of Mood and Anxiety Disorders also have been very active in the area of light therapy, and we anticipate that this research will also continue long-term.