Current Research on Complementary and Alternative Medicine (CAM) in the Treatment of Depression: Evidence-Based Review

  • Karen Pilkington


Complementary and alternative medicine (CAM) refers to a range of treatments, therapies and practices that are not considered part of conventional medicine. CAM approaches are widely used, and depression has been identified as one of the most frequent indications for CAM use. Prevalence and patterns of use are highly variable across different countries but frequently involve self-diagnosis and self-treatment. A critical review of the evidence on efficacy of CAM treatments in depression indicates that the approaches that have generated the most research interest include acupuncture, Chinese herbs, hypericum (St John’s wort), mindfulness and omega-3 fatty acids. Based on a critical review of the evidence, it appears that the most promising evidence is for hypericum (but with concerns with adverse effects and interactions), mindfulness, relaxation and yoga. Many trials are small, comparison interventions are varied, and there is a lack of systematically collated data on adverse events or long-term effects. Even where there is a strong evidence base, there may be factors preventing wider adoption for clinical use, such as concerns related to interactions or lack of standardisation or regulation of the practice and practitioners. Challenges in developing a rigorous evidence base in this area are also briefly discussed.


Complementary and alternative medicine Complementary therapies Depression Depressive disorders Herb Acupuncture Yoga 


  1. Adler UC, Krüger S, Teut M, Lüdtke R, Schützler L, Martins F, Willich SN, Linde K, Witt CM. Homeopathy for depression: a randomized, partially double-blind, placebo-controlled, four-armed study (DEP-HOM). PLoS One. 2013;8(9):e74537.CrossRefGoogle Scholar
  2. Adler UC, Paiva NM, Cesar AT, Adler MS, Molina A, Padula AE, Calil HM. Homeopathic individualized Q-potencies versus fluoxetine for moderate to severe depression: double-blind, randomized non-inferiority trial. Evid Based Complement Alternat Med. 2011;2011:520182.CrossRefGoogle Scholar
  3. Akhondzadeh S, Kashani L, Fotouhi A, Jarvandi S, Mobaseri M, Moin M, Khani M, Jamshidi AH, Baghalian K, Taghizadeh M. Comparison of Lavandula angustifolia Mill. tincture and imipramine in the treatment of mild to moderate depression: a double-blind, randomized trial. Prog Neuropsychopharmacol Biol Psychiatry. 2003;27(1):123–7.CrossRefGoogle Scholar
  4. Al-Karawi D, Al Mamoori DA, Tayyar Y. The Role of Curcumin Administration in Patients with Major Depressive Disorder: Mini Meta-Analysis of Clinical Trials. Phytother Res. 2016;30(2):175–83.CrossRefGoogle Scholar
  5. Apaydin EA, Maher AR, Shanman R, Booth MS, Miles JN, Sorbero ME, Hempel S. A systematic review of St. John’s wort for major depressive disorder. Syst Rev. 2016;5(1):148.CrossRefGoogle Scholar
  6. Appleton KM, Sallis HM, Perry R, Ness AR, Churchill R. Omega-3 fatty acids for depression in adults. Cochrane Database Syst Rev. 2015;11:CD004692.Google Scholar
  7. Butler L, Pilkington K. Chinese herbal medicine and depression: the research evidence. Evid Based Complement Alternat Med. 2013;2013:739716.CrossRefGoogle Scholar
  8. Cavanagh HM, Wilkinson JM. Biological activities of lavender essential oil. Phytother Res. 2002;16(4):301–8.CrossRefGoogle Scholar
  9. Chan YY, Lo WY, Yang SN, Chen YH, Lin JG. The benefit of combined acupuncture and antidepressant medication for depression: a systematic review and meta-analysis. J Affect Disord. 2015;176:106–17.CrossRefGoogle Scholar
  10. Churchill R, Moore TH, Furukawa TA, Caldwell DM, Davies P, Jones H, Shinohara K, Imai H, Lewis G, Hunot V. ‘Third wave’ cognitive and behavioural therapies versus treatment as usual for depression. Cochrane Database Syst Rev. 2013;10:CD008705.Google Scholar
  11. Coelho HF, Boddy K, Ernst E. Massage therapy for the treatment of depression: a systematic review. Int J Clin Pract. 2008;62(2):325–33.CrossRefGoogle Scholar
  12. Cramer H, Anheyer D, Lauche R, Dobos G. A systematic review of yoga for major depressive disorder. J Affect Disord. 2017;213:70–7.CrossRefGoogle Scholar
  13. Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for depression: a systematic review and meta-analysis. Depress Anxiety. 2013;30(11):1068–83.CrossRefGoogle Scholar
  14. Cramer H, Ward L, Saper R, Fishbein D, Dobos G, Lauche R. The safety of yoga: a systematic review and meta-analysis of randomized controlled trials. Am J Epidemiol. 2015;182(4):281–93.CrossRefGoogle Scholar
  15. Darbinyan V, Aslanyan G, Amroyan E, Gabrielyan E, Malmstrom C, Panossian A. Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression. Nord J Psychiatry. 2007;61:343–8.CrossRefGoogle Scholar
  16. Dwyer AV, Whitten DL, Hawrelak JA. Herbal medicines, other than St. John’s Wort, in the treatment of depression: a systematic review. Altern Med Rev. 2011;16(1):40–9.PubMedGoogle Scholar
  17. Feng L, Chiam PC, Kua EH, Ng TP. Use of complementary and alternative medicines and mental disorders in community-living Asian older adults. Arch Gerontol Geriatr. 2010;50(3):243–9.CrossRefGoogle Scholar
  18. Fißler M, Quante A. A case series on the use of lavendula oil capsules in patients suffering from major depressive disorder and symptoms of psychomotor agitation, insomnia and anxiety. Complement Ther Med. 2014;22(1):63–9.CrossRefGoogle Scholar
  19. Freeman MP, Mischoulon D, Tedeschini E, Goodness T, Cohen LS, Fava M, Papakostas GI. Complementary and alternative medicine for major depressive disorder: a meta-analysis of patient characteristics, placebo-response rates, and treatment outcomes relative to standard antidepressants. J Clin Psychiatry. 2010;71(6):682–8.CrossRefGoogle Scholar
  20. Galizia I, Oldani L, Macritchie K, Amari E, Dougall D, Jones TN, Lam RW, Massei GJ, Yatham LN, Young AH. S-adenosyl methionine (SAMe) for depression in adults. Cochrane Database Syst Rev. 2016;10:CD011286.PubMedGoogle Scholar
  21. Hansen AH, Kristoffersen AE. The use of CAM providers and psychiatric outpatient services in people with anxiety/depression: a cross-sectional survey. BMC Complement Altern Med. 2016;16(1):461.CrossRefGoogle Scholar
  22. Hausenblas HA, Saha D, Dubyak PJ, Anton SD. Saffron (Crocus sativus L.) and major depressive disorder: a meta-analysis of randomized clinical trials. J Integr Med. 2013;11(6):377–83.CrossRefGoogle Scholar
  23. Henderson L, Yue QY, Bergquist C, Gerden B, Arlett P. St John’s wort (Hypericum perforatum): drug interactions and clinical outcomes. Br J Clin Pharmacol. 2002;54(4):349–56.CrossRefGoogle Scholar
  24. Hou WH, Chiang PT, Hsu TY, Chiu SY, Yen YC. Treatment effects of massage therapy in depressed people: a meta-analysis. J Clin Psychiatry. 2010;71(7):894–901.CrossRefGoogle Scholar
  25. Hsu MC, Creedy D, Moyle W, Venturato L, Tsay SL, Ouyang WC. Use of complementary and alternative medicine among adult patients for depression in Taiwan. J Affect Disord. 2008;111(2–3):360–5.CrossRefGoogle Scholar
  26. Jain FA, Walsh RN, Eisendrath SJ, Christensen S, Rael Cahn B. Critical analysis of the efficacy of meditation therapies for acute and subacute phase treatment of depressive disorders: a systematic review. Psychosomatics. 2015;56(2):140–52.CrossRefGoogle Scholar
  27. Jeong HG, Ko YH, SY O, Han C, Kim T, Joe SH. Effect of Korean Red Ginseng as an adjuvant treatment for women with residual symptoms of major depression. Asia Pacific Psychiatry. 2015;7(3):330–6.CrossRefGoogle Scholar
  28. Jorm AF, Morgan AJ, Hetrick SE. Relaxation for depression. Cochrane Database Syst Rev. 2008;4:CD007142.Google Scholar
  29. Kasper S, Volz HP, Dienel A, Schläfke S. Efficacy of Silexan in mixed anxiety-depression–A randomized, placebo-controlled trial. Eur Neuropsychopharmacol. 2016;26(2):331–40.CrossRefGoogle Scholar
  30. Kessler RC, Soukup J, Davis RB, Foster DF, Wilkey SA, Van Rompay MI, Eisenberg DM. The use of complementary and alternative therapies to treat anxiety and depression in the United States. Am J Psychiatry. 2001;158(2):289–94.CrossRefGoogle Scholar
  31. Komori T, Fujiwara R, Tanida M, Nomura J, Yokoyama MM. Effects of citrus fragrance on immune function and depressive states. Neuroimmunomodulation. 1995;2(3):174–80.CrossRefGoogle Scholar
  32. Kulkarni SK, Bhutani MK, Bishnoi M. Antidepressant activity of curcumin: involvement of serotonin and dopamine system. Psychopharmacology (Berl). 2008;201(3):435–42.CrossRefGoogle Scholar
  33. Lai J, Moxey A, Nowak G, Vashum K, Bailey K, McEvoy M. The efficacy of zinc supplementation in depression: systematic review of randomised controlled trials. J Affect Disord. 2012;136(1–2):e31–9.CrossRefGoogle Scholar
  34. Lemon K. An assessment of treating depression and anxiety with aromatherapy. Int J Aromather. 2004;14(2):63–9.CrossRefGoogle Scholar
  35. Linde K, Berner MM, Kriston L. St John’s wort for major depression. Cochrane Database Syst Rev. 2008;4:CD000448.Google Scholar
  36. Linde K, Mulrow CD, Berner M, Egger M. St John’s wort for depression. Cochrane Database Syst Rev. 2005;2:CD000448.Google Scholar
  37. Liu X, Clark J, Siskind D, Williams GM, Byrne G, Yang JL, Doi SA. A systematic review and meta-analysis of the effects of Qigong and Tai Chi for depressive symptoms. Complement Ther Med. 2015;23(4):516–34.CrossRefGoogle Scholar
  38. Lopresti AL, Drummond PD. Saffron (Crocus sativus) for depression: a systematic review of clinical studies and examination of underlying antidepressant mechanisms of action. Hum Psychopharmacol. 2014;29(6):517–27.CrossRefGoogle Scholar
  39. Mao JJ, Xie SX, Zee J, Soeller I, Li QS, Rockwell K, Amsterdam JD. Rhodiola rosea versus sertraline for major depressive disorder: a randomized placebo-controlled trial. Phytomedicine. 2015;22(3):394–9.CrossRefGoogle Scholar
  40. Ng QX, Koh SSH, Chan HW, Ho CYX. Clinical use of curcumin in depression: A meta-analysis. J Am Med Dir Assoc. 2017;18(6):503–8.CrossRefGoogle Scholar
  41. Ng QX, Venkatanarayanan N, Ho CY. Clinical use of hypericum perforatum (St John’s wort) in depression: a meta-analysis. J Affect Disord. 2017;210:211–21.CrossRefGoogle Scholar
  42. Oh B, Choi SM, Inamori A, Rosenthal D, Yeung A. Effects of qigong on depression: a systemic review. Evid Based Complement Alternat Med. 2013;2013:134737.CrossRefGoogle Scholar
  43. Okamoto A, Kuriyama H, Watanabe S, Aihara Y, Tadai T, Imanishi J, Fukui K. The effect of aromatherapy massage on mild depression: a pilot study. Psychiatry Clin Neurosci. 2005;59(3):363.CrossRefGoogle Scholar
  44. Parslow RA, Jorm AF. Use of prescription medications and complementary and alternative medicines to treat depressive and anxiety symptoms: results from a community sample. J Affect Disord. 2004;82(1):77–84.CrossRefGoogle Scholar
  45. Pilkington K, Kirkwood G, Rampes H, Fisher P, Richardson J. Homeopathy for depression: a systematic review of the research evidence. Homeopathy. 2005;94(3):153–63.CrossRefGoogle Scholar
  46. Pilkington K, Kirkwood G, Rampes H, Richardson J. Yoga for depression: the research evidence. J Affect Disord. 2005;89(1–3):13–24.CrossRefGoogle Scholar
  47. Ranjbar E, Kasaei MS, Mohammad-Shirazi M, Nasrollahzadeh J, Rashidkhani B, Shams J, Mostafavi SA, Mohammadi MR. Effects of zinc supplementation in patients with major depression: a randomized clinical trial. Iran J Psychiatry. 2013;8(2):73–9.PubMedPubMedCentralGoogle Scholar
  48. Riley D. Hatha yoga and the treatment of illness. Altern Ther Health Med. 2004;10(2):20–1.Google Scholar
  49. Russo E, Scicchitano F, Whalley BJ, Mazzitello C, Ciriaco M, Esposito S, Patanè M, Upton R, Pugliese M, Chimirri S, Mammì M, Palleria C, De Sarro G. Hypericum perforatum: pharmacokinetic, mechanism of action, tolerability, and clinical drug-drug interactions. Phytother Res. 2014;28(5):643–55.CrossRefGoogle Scholar
  50. Sánchez-Vidaña DI, Ngai SP, He W, Chow JK, Lau BW, Tsang HW. The effectiveness of aromatherapy for depressive symptoms: a systematic review. Evid Based Complement Alternat Med. 2017;2017:5869315.PubMedPubMedCentralGoogle Scholar
  51. Sarris J, Murphy J, Mischoulon D, Papakostas GI, Fava M, Berk M, Ng CH. Adjunctive nutraceuticals for depression: a systematic review and meta-analyses. Am J Psychiatry. 2016;173(6):575–87.CrossRefGoogle Scholar
  52. Sarris J, Panossian A, Schweitzer I, Stough C, Scholey A. Herbal medicine for depression, anxiety and insomnia: a review of psychopharmacology and clinical evidence. Eur Neuropsychopharmacol. 2011;21(12):841–60.CrossRefGoogle Scholar
  53. Sayyah M, Sayyah M, Kamalinejad M. A preliminary randomized double blind clinical trial on the efficacy of aqueous extract of Echium amoenum in the treatment of mild to moderate major depression. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30(1):166–9.CrossRefGoogle Scholar
  54. Schrader E. Equivalence of St John’s wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mildmoderate depression. Int Clin Psychopharmacol. 2000;15(2):61–8.CrossRefGoogle Scholar
  55. Shaw K, Turner J, Del Mar C. Tryptophan and 5-hydroxytryptophan for depression. Cochrane Database Syst Rev. 2002;1:CD003198.Google Scholar
  56. Shih M, Yang YH, Koo M. A meta-analysis of hypnosis in the treatment of depressive symptoms: a brief communication. Int J Clin Exp Hypn. 2009;57(4):431–42.CrossRefGoogle Scholar
  57. Smith CA, Hay PP, Macpherson H. Acupuncture for depression. Cochrane Database Syst Rev. 2010;1:CD004046.Google Scholar
  58. Solomon D, Adams J, Graves N. Economic evaluation of St. John’s wort (Hypericum perforatum) for the treatment of mild to moderate depression. J Affect Disord. 2013;148(2–3):228–34.CrossRefGoogle Scholar
  59. Solomon D, Adams J. The use of complementary and alternative medicine in adults with depressive disorders. A critical integrative review. J Affect Disord. 2015;179:101–13.CrossRefGoogle Scholar
  60. Sorbero ME, Reynolds K, Colaiaco B, Lovejoy SL, Farris C, Vaughan CA, Sloan J, Kandrack R, Apaydin E, Herman PM. Acupuncture for major depressive disorder: a systematic review. Rand Health Q. 2016;5(4):7.PubMedPubMedCentralGoogle Scholar
  61. Taylor MJ, Carney S, Geddes J, Goodwin G. Folate for depressive disorders. Cochrane Database Syst Rev. 2003;2:CD003390.Google Scholar
  62. Taylor MJ, Wilder H, Bhagwagar Z, Geddes J. Inositol for depressive disorders. Cochrane Database Syst Rev. 2004;2:CD004049.Google Scholar
  63. Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol. 2000;68(4):615–23.CrossRefGoogle Scholar
  64. Unützer J, Klap R, Sturm R, Young AS, Marmon T, Shatkin J, Wells KB. Mental disorders and the use of alternative medicine: results from a national survey. Am J Psychiatry. 2000;157(11):1851–7.CrossRefGoogle Scholar
  65. Yary T, Lehto SM, Tolmunen T, Tuomainen TP, Kauhanen J, Voutilainen S, Ruusunen A. Dietary magnesium intake and the incidence of depression: a 20-year follow-up study. J Affect Disord. 2016;193:94–8.CrossRefGoogle Scholar
  66. Yeung WF, Chung KF, Ng KY, Yu YM, Zhang SP, Ng BF, Ziea ET. Prescription of Chinese herbal medicine in pattern-based traditional Chinese medicine treatment for depression: a systematic review. Evid Based Complement Alternat Med. 2015;2015:160189.CrossRefGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.School of Health Sciences and Social WorkUniversity of PortsmouthPortsmouthUK

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