Complementary and alternative mental health treatments
Complementary and alternative mental health treatments (CAM) encompass a variety of non-traditional therapies utilized by individuals coping with psychological issues such as mood, anxiety, sleep, and eating disorders. These therapies can be employed in conjunction with conventional treatments or as standalone options. Common CAM approaches include acupuncture, herbal remedies, meditation, yoga, and creative arts therapies, each presenting a different method of addressing mental health concerns. The popularity of CAM in the U.S. has grown significantly, with surveys indicating that nearly half of American adults have experimented with such remedies. Despite this popularity, the scientific evidence supporting the efficacy and safety of many CAM treatments remains inconsistent and often limited, necessitating cautious consideration. Some herbal remedies, for instance, may interact negatively with conventional medications. As people increasingly seek alternative options to enhance their mental well-being, it is crucial to evaluate the effectiveness and potential risks of these treatments, as well as to understand that many mental health issues can fluctuate independently of interventions.
Complementary and alternative mental health treatments
DEFINITION: Treatment of psychological and other mental health disorders.
Overview
People with psychological conditions, including mood, anxiety, eating, sleep, and sexual disorders, may seek complementary and alternative medicine (CAM) treatments. In some cases, they rely on these treatments in lieu of extant therapies; in other cases, they use CAM treatments along with traditional therapies.
CAM treatments for mental illness are remarkably diverse in scope: There are many widely used CAM techniques for mental health, including aromatherapy, acupuncture, herbal remedies, biofeedback, meditation, yoga, homeopathy, and creative arts (music, art, and dance) therapies. The research evidence for these and other CAM techniques varies in quality and quantity..
Prevalent Mental Illness and Popularity of CAM
CAM usage in the United States has became popular. Based on the 2017 Pew Research Center poll, the last for which such data are available, found that nearly half of American adults had tried CAM.
The National Alliance on Mental Illness reported that in 2020, 19.1 percent of Americans had an anxiety disorder, 8.4 percent experienced major depression, 3.6. percent had post-traumatic stress disorder (PTSD), and 2.8 percent experienced bipolar disorder. Additionally, schizophrenia, obsessive-compulsive disorder (OCD), and borderline personality disorder each affected about 1 percent of the population. Thus, it can be inferred that substantial proportions of persons with mental disorders in the US use one or more CAM remedies. Indeed, the 2021 survey found that 50 percent of adults had used CAM to manage depression and 40 percent had used CAM to manage depression and anxiety.
One study from 1997–98 also found that people with mental disorders who used CAM treatments were as likely as those without mental disorders to seek conventional mental health treatments, such as psychotherapy and psychotropic medication. This information is important because certain herbal remedies can interfere with the effects of some widely used medications.
Because of the prevalence of psychological problems among Americans and the general popularity of CAM treatments, it is essential to ascertain whether CAM treatments are effective for psychological problems and whether any could be harmful. The sections that follow briefly examine the scientific evidence concerning four commonly used CAM treatments for mental illness: acupuncture, herbal remedies, yoga and meditation, and creative arts therapies.
Treatments and Techniques
Acupuncture. Several investigators have examined the efficacy of acupuncture for clinical depression. A few early studies suggested that acupuncture may alleviate the symptoms of depression, but most of these studies were not conducted in a double-blind fashion and, therefore, may have been influenced by the expectations of treatment providers or patients, or both.
One of the most methodologically rigorous studies, published in 2006, randomly assigned 151 persons with major depression to one of three conditions lasting eight weeks: traditional Chinese medicine acupuncture (condition 1), a sham acupuncture condition involving needles inserted into the “wrong” areas (condition 2), and a wait-list control condition (condition 3). The results revealed that both conditions (1) and (2) outperformed (3), but that (1) and (2) did not differ significantly from each other. Moreover, the effects of both genuine and sham acupuncture on depressive symptoms were relatively weak. These findings raise questions concerning the efficacy of acupuncture for depression and suggest that the effects of acupuncture on mood may be attributable to nonspecific influences, such as placebo effects; that is, improvement was caused by the mere expectation of improvement.
According to a 2018 review of sixty-four studies, acupuncture may reduce depressive symptoms somewhat more than the standard of care or a control; however, the quality of evidence was low. Similarly, a meta-analysis published the following year reported that acupuncture could improve depressive symptoms among patients recovering from stroke more than medication could. Another 2018 review of seven PTSD trials suggested acupuncture might be more effective than passive controls, usual treatment, or active interventions in reducing symptoms.
Acupuncture may also benefit people experiencing psychosis. Based on a 2009 review of thirteen trials, laser acupuncture and electroacupuncture might improve hallucination in patients with schizophrenia. A later review of thirty trials conducted in 2014 found the addition of acupuncture to standard antipsychotic medications was linked to reduced symptoms, fewer side effects such as dry mouth, and less likelihood of relapse in at least one study.
Herbal remedies and supplements. Although numerous herbal remedies are available for treating psychological problems, perhaps the two best known are St. John’s wort (Hypericum perforatum) and kava (Piper methysticum). Following the passage of the Dietary Supplement Health and Education Act by the US Congress in 1994, these and other herbal remedies for mood have not been regulated by the US Food and Drug Administration. Therefore, mental health consumers in the United States take them at their own risk.
The data on the efficacy of St. John’s wort for mood disorders have been inconsistent. A 2005 meta-analysis (quantitative review) revealed that St. John’s wort exerted positive effects relative to a placebo among persons with mild to moderate depression. Nevertheless, the analysis also indicated that St. John’s wort may be largely or entirely ineffective relative to placebo for persons with major depression and for those with prolonged depression. The study also found no evidence that St. John’s wort is more effective than standard antidepressants, such as the selective serotonin reuptake inhibitors Prozac and Paxil.
A 2010 randomized-controlled trial of 189 persons suggested that St. John’s wort may be more effective than placebo among persons with atypical depression, namely, among those persons who exhibit “reversed” features, such as overeating and oversleeping. However, the National Center for Complementary and Integrative Health reported in 2017 that St. John's wort is not consistently effective in treating depression and should not be used to replace conventional medicine.
Moreover, persons who take St. John’s wort should be certain to inform their physicians, because the remedy can interfere with the effects of many other medications. For example, St. John’s wort can impede the effectiveness of chemotherapy medications and those used to treat human immunodeficiency virus (HIV) infection. Evidence also shows that St. John’s wort can interfere with the effects of birth control pills, anticoagulants (blood thinners), and antidepressants, among many others.
Kava is an herbal remedy that has been used medicinally in the South Pacific to reduce anxiety. The practice of using kava as an anxiolytic has spread to other regions. A 2019 study showed that while kava was effective in reducing anxiety in the short term, it was not effective in treating generalized anxiety disorder (GAD, a condition marked by high levels of nervousness across many situations). Other evidence suggests that kava is not more effective than buspirone, an antianxiety agent.
Kava has been deemed unsafe because of its potential to create toxic liver reactions. Researchers have been assessing the efficacy of an aqueous extract of kava to create a mixture that reduces the toxicity of the herb. Further inquiry is required to ascertain this extract’s safety and efficacy.
Other supplements that have been considered for treating depression include omega-3 fatty acids (particularly from fish oil), S-Adenosyl-L-methionine (SAMe), and Inositol, none of which have not been demonstrated conclusively to be more effective than placebo.
Supplements have also been investigated as potential treatments for anxiety. Melatonin has been studied as a possible sleep aid in seasonal affective disorder, but evidence has been limited by the number of trials and small samples; its use in reducing anxiety related to surgery appears more promising. Patients with GAD may benefit from chamomile extract or lavender oil, according to early studies. However, the effectiveness of passionflower and valerian on anxiety disorders remains inconclusive.
Likewise, no benefits have been established for Ayurvedic herbal preparations in treating schizophrenia and related psychoses.
Meditation. Meditation comprises a heterogeneous array of self-control techniques, stemming largely from Buddhist and Hindu traditions and designed to enhance awareness and attention. A 2010 review of more than sixty studies (spanning thirty-five years) examined the effects of meditation techniques on a host of mental health difficulties, including mood, anxiety, and sleeping problems. Although several of the studies in the review reported negative findings, most yielded preliminary evidence that various forms of meditation exert beneficial effects across a variety of psychological outcome variables. However, the overall quality of the research was limited by lack of controls or expectancy effects, rendering any conclusions tentative.
Based on several systematic reviews published in the 2010s meditation has also shown promise for treating GAD and reducing anxiety symptoms, but the data on its use for anxiety disorders in particular remain limited.
Yoga. Yoga consists of a variety of physical and psychological techniques designed to heighten awareness. Hatha yoga, which originated in India but has substantially influenced Western forms of yoga, comprises postures (such as bending and balancing the body), breathing exercises, and meditation. A 2005 review of five randomized-controlled trials concluded that yoga shows some promise as an intervention for depression. Researchers also revealed that the studies varied considerably in the severity of the depression and nature of the yoga intervention delivered, and often omitted crucial methodological details. Reviews conducted in 2017 found yoga may aid in alleviating depressive symptoms, but one set of studies involved participants who had no formal diagnosis of depression and the other involved small samples.
Moreover, it remains unclear if any beneficial effects of yoga on depression, anxiety, or other psychological difficulties are attributable to yoga per se or to the relaxation or exercise associated with it.
Creative arts therapies. Creative arts therapies encompass a plethora of CAM treatments and are used in various guises to enhance mental health and to improve creativity, productivity, and interpersonal relations. Such therapies include those of art, music, dance, and poetry.
Of all creative arts therapies, music therapy has been perhaps the most extensively investigated. A 2008 review of five studies of music therapy on depression revealed low rates of dropout and positive results in four of the studies. Nevertheless, as the study’s authors noted, the substantial variations in the populations studied, the nature of the interventions, and the outcome measures administered again render any conclusions tentative. A 2017 review of nine studies found the combination of music therapy and treatment as usual improved depressive symptoms over a short period, lowered anxiety, and boosted functioning.
Music therapy may also help patients with schizophrenia or related psychoses as well; according to one study published in 2018, music therapy helped patients with schizophrenia feel comfort, relief, and happiness.
Conclusions
Survey data demonstrate that large percentages, and perhaps majorities, of people with mental health problems, including mood and anxiety disorders, seek CAM therapies. These findings are troubling, given that most CAM therapies have been insufficiently investigated for such problems. However, preliminary evidence suggests that certain CAM therapies, including some herbal remedies, meditation, yoga, and music therapy, hold promise for certain psychiatric conditions. Still, even these interventions must be regarded as only promising, and all require additional research before they can be regarded as empirically supported and, in the case of herbal remedies, safe for widespread public consumption.
A variety of other widely used CAM methods, including homeopathy, chiropractic, energy therapies, chelation therapy, and craniosacral therapy, are not empirically supported for mental health problems. Therefore, they should not be used in lieu of treatments of established effectiveness.
Mental health consumers should be aware that a host of factors may contribute to erroneous beliefs in the effectiveness of certain CAM treatments for psychological problems. In particular, many emotional difficulties, such as depression, panic disorder, and sleep, sexual, and eating disorders, often wax and wane in severity over relatively short time periods. As a consequence, persons with mental health problems may mistakenly attribute naturally occurring improvement in their symptoms to CAM interventions. In addition, the placebo effect can generate improvement that is independent of the ingredients of the CAM treatments themselves. For these and other reasons, one should rely on controlled studies, rather than subjective judgments or anecdotes, to ascertain whether these treatments are effective.
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