title: Complementary and alternative medicine for the treatment of major depressive disorder.
abstract: OBJECTIVE
  To review the clinical evidence supporting complementary and alternative medicine interventions for treating major depressive disorder.
  
  
  METHODS
  PubMed was searched from January 1966 to February 2010 using the term depressive disorder in combination with St John's wort, S-adenosylmethionine (SAM-e), exercise, acupuncture, omega-3 fatty acids, and folate. Only relevant human trials were selected.
  
  
  RESULTS
  In a large meta-analysis, St John's wort was found to be equivalent to antidepressant drugs with fewer side effects. Exercise reduced depressive scores in 3 meta-analyses. Omega-3 fatty acids reduced depressive scores in a meta-analysis of 16 trials, but publication bias was identified. Oral SAM-e monotherapy reduced depressive scores in 4 of 5 small randomized controlled trials. Folate deficiency is associated with more severe and refractory depression, and supplementation reduced depressive scores in 2 of 3 randomized controlled trials. Acupuncture demonstrated limited efficacy in 1 meta-analysis and 5 other trials.
  
  
  CONCLUSIONS
  St John's wort and regular exercise appear effective in the treatment of depression. Acupuncture appears ineffective for depression, but it might offer other health benefits. Other promising therapies include SAM-e, omega-3 fatty acid, and folic acid supplementation in selected patients; further study is warranted.
authors.affiliation: University of Ottawa, Seekers Centre for Integrative Medicine, 6 Deakin St, Ottawa, ON K2E 1B3. richard@seekerscentre.com
authors.forename: Richard
authors.initials: R
authors.lastname: Nahas
authors.forename: Osmaan
authors.initials: O
authors.lastname: Sheikh
mesh_terms: D015670:Acupuncture Therapy; D000529:Complementary Therapies; D003865:Major Depressive Disorder / Q000628:therapy*; D019587:Dietary Supplements; D005081:Exercise Therapy; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005492:Folic Acid / Q000627:therapeutic use; D006801:Humans; D020902:Hypericum; D008517:Phytotherapy; D012436:S-Adenosylmethionine / Q000627:therapeutic use
chemical_list: D015525:Fatty Acids, Omega-3; D012436:S-Adenosylmethionine; D005492:Folic Acid