Alternative treatments for depression: empirical support and relevance to women.
BACKGROUND
This article is a critical review of the efficacy of selected alternative treatments for unipolar depression including exercise, stress management techniques, acupuncture, St. John's wort, bright light, and sleep deprivation. Issues related to women across the life span, including pregnancy and lactation, are highlighted.


METHODS
Evidence of efficacy is based on randomized controlled trials. A distinction is made between studies that address depressive symptoms and studies that address depressive disorders. The review emphasizes issues related to effectiveness, such as treatment availability, acceptability, safety, and cost and issues relevant to women.


RESULTS
Exercise, stress reduction methods, bright light exposure, and sleep deprivation hold greater promise as adjuncts to conventional treatment than as monotherapies for major depression. The evidence to date is not sufficiently compelling to suggest the use of St. John's wort in favor of or as an alternative to existing U.S. Food and Drug Administration-regulated compounds. Initial evidence suggests that acupuncture might be an effective alternative monotherapy for major depression, single episode.


CONCLUSIONS
This review indicates that some unconventional treatments hold promise as alternative or complementary treatments for unipolar depression in women and have the potential to contribute to its long-term management. Additional research is needed before further recommendations can be made, and there is an urgent need to carefully document and report the frequency of minor and major side effects.
Manber
Rachel
R
Department of Psychiatry and Behavioral Sciences, Stanford University, Calif. 94305, USA. rmanber@stanford.edu
Allen
John J B
JJ
Morris
Margaret E
ME
Morris
Margaret M
MM
D026881:Acupuncture; D000529:Complementary Therapies / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D003866:Depressive Disorder / Q000191:economics / Q000523:psychology / Q000628:therapy*; D005081:Exercise Therapy; D005260:Female; D029001:Herbal Medicine; D006801:Humans; D020902:Hypericum; D008297:Male; D010789:Phototherapy; D008517:Phytotherapy / Q000379:methods; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012064:Relaxation Therapy; D012737:Sex Factors; D012892:Sleep Deprivation; D013315:Stress, Psychological / Q000523:psychology / Q000628:therapy; D016896:Treatment Outcome