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 St John's Wort 

 

 

St John's Wort is an unlicensed herbal medicine extracted from te botanical source of Hypericum perforatum consisting of the following excipients: naphthodianthrons, flavonoids, xanthons, and biflavonoids. It is available over the counter and from healthand well being stores. It is thought that St John's Wort inhibits Monoamine oxidase, and the reuptake of serotonin and noradrenaline, however the mechanism of action still remains undetermined. 

 

What does NICE say ?

NICE recognises that St John's Wort may be of benefit for mild-moderate depression, however discourage prescribers to use it as a method of treatment. This is due to the various drug interaction profile that it posesses, and the "uncertainty" regarding ... doses. If practitioners do decide to use it, they must advise patients of different strengths it is available in, and the numerous interactions with various other drugs.

 

What does the evidence say?

A Cochrane review (2009) revealed that the efficacy of St John's Wort in clinical trials were the following:

  • Compared to placebo, St John's Wort showed greater efficacy, and it had similar efficacy as the common antidepressants.

  • It also showed that there were less adverse effects compared to common antidepressants. 

Due to the fact that St John's Wort is available in a variety of forms on the market, they differ from one another in concentrations and therefore professional advise must be sought before using it. Although adverse effects are usually minimal and unlikely, the interactions with other drugs must be considered.  

 

                                                                            Acupuncture       

Acupuncture as been used for a long time in China and Japan. It acts to restore normal energy flow within the body by the insertion of fine needles into various regions of the body. 

 

What does the evidence say?

 

A Cochrane review revealed that there is limited evidence to  suggest that aupuncture can aid the treatment of depression. However a recent study (2013) analysing how acupuncture and counselling influence the ..... Dr Hugh Mach has .... "We have provided evidence that acupuncture versus usual care andcounselling versus usual care are both associated with a significantreduction in symptoms of depression in the short to medium term,and are not associated with serious adverse events"

Yoga 

 

Yoga is a form of exercise deriving from the Indian culture, with the aim of making the patient more self aware. Western yoga is based on Hatha yoga.

 

This form of yoga is based on 3 core principles:

  1. Postures (usanas) : Flexibility and strength is improved by standing, bending, twisting and balancing.

  2. Breathing exercises (Pranayama): focuses and calms the mind.

  3. Meditation (dhyuna) : Soothes the mind 

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​Yoga has several benefits including the following: 

  • Stress and pain relief 

  • improved breathing and circulation 

  • Increased flexibility and strength 

Folate 

 

Folate can be used as adjunctive therapy to enhance the treament of depression. It is required for the synthesis of: 

  • Dopamine 

  • Norepinephrine 

  • Serotonin

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​It is more common for individulas who have a folate deficiencey to suffer from depression, and  they are 6 times less likely to be responsive to antidepressants. The depressive episodes also tend to be more severe and individuals experience longer lasing relapses. It may be useful to screen and treat patients for folate deficiency as it is associated wih poorer outcomes in: 

  • Depression 

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  • Mild cognitive impairment 

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  • Megalo blastic anaemia 

 

However, there are increased risks of colorectal cancer in folate doses >1mg/d.

 

What does the evidence say? 

A Cochrane review (2009) has concluded that there is limited evidence that using folate in conjunction with another antidepressant may be useful, however larger trials are required before health professionals can be confident that it is. 

Massage therapy 

 

This includes the "manipulation of soft tissue by trained therapists" in order to exert a therapeutic effect. This intervention combines several beneficial techniques such as: 

 

  • The therapist use their hands to stimulate blood circulation, allowing the patient's muscles to relax

  • Simultaneously the heat due to the friction between the therapist's hand and the individual's body, enables the oils to diffuse through the skin exerting their particular effect

 

​What does the evidence say?

There is limited evidence to suggest that massage therapy treats depression, however it does seem to be beneficial in the short term. Long term effects are yet to be evaluated. 

 

 

Music therapy 

 

 

Music therapy is a common intervention used in mental health services offered as eiher indiviual or group programmes.  Several studies have demonstrated the effects that music exerts in mental states e.g. : 

  • ​Mozart's effect condition: (Mozart's Sonata for wo pianos in D. major K. 448). This has proven to improve brain capacity by activating several signal pathways. 

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  • Bach's Italian Concertos: it has displayed memory recovery in adults with neurological disorders.

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  • Corelli's Clavier Sonatus: In premature babies it has shown enhancement of neuronal development.

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It is therefore feasible to assume that music could show similar benefits in psychiatric disorders such as depression. 

 

 

There are two techniques that are used in treating patients

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  1. Active techniques: necessary when individuals are unable to confidently express their feeling. In such cases the therapist attempts to encourage increased dialogue

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  1. Receptive techniques: music is particularly used in patients who need to relax, where music enables them to contemplate and enhance their mood. 

 

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​What does the evidence say? 

A Cochrane systematic review (2009) was conducted in determining whether music therapy was successful in alleviating depressive symptoms. It was found that music therapy as a treatment for depression is acceptable however, there is a need for further research. 

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Aromatherapy 

Essential oils are extracted from flowers, leaves, root, bark, peel and resin, heated up and used in masage oils and as fragrances. Aromatherapy is proposed to alleviate depressive symptoms.

Essential oils thought to be useful in depression are : 

  • Bergamot 

  • Geranium 

  • German chamomile 

  • Lavendar

  • Rosemary 

​Researchers cannot ascertain how aromatherpay works, however it is thought to stimulate the olfactory system which communicates with the amygdala and hippocampus (which are responsible for emotions and behaviour. Some researchers think that when the molecules of essential oils are inhaled, it stimulates the amygdala and hippocampus, influencing physical, emotional and mental health. 

 

Several studies have been conducted in order to determine the efficacy of aromatherapy. There have been several conflicting studies, some involving controlled studies (comparing placebo with aromatherapy), and other studies have been less reliable. The efiicacy, or whether it works at all remains inconclusive. However, there have been some studies showing taht aromatherapy has mild and short-lasting effects in alleviating anxiety and depressive symptoms.

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Alternative treatments for depression.

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