Considerations for the Use of Alternative Therapies in the Treatment of Depression

Abstract

Approximately 65%–75% of patients with major depression will respond to drug therapy. However, conventional antidepressants may be costly and have side effects and drug interactions that may inconvenience the patient, limit the use of the particular drug, or require the discontinuation of a particular therapy. In this past decade, there has been a renewed interest in alternative medicines, especially for depression, that are available without a prescription. The ability of patients to self-medicate depression presents a risk of inappropriate treatment, thereby increasing the morbidity and mortality rates associated with this sometimes fatal disease. In addition, herbal products are not regulated by the government, leading to problems with batch-to-batch consistency and adulteration, even for products that have evidence of efficacy in depression. The potential for herbal-pharmaceutical grade drug interactions increases the need for input and follow-up from health care practitioners. There is limited quality evidence describing the efficacy and optimal dosing for these products. Clinicians must acknowledge that patients are using herbal products and educate on their use to avoid negative outcomes in patients with depressive disorders.