Last updated: Dec 05, 2008
alternative-medicine-controversey
Are natural remedies safer than antidepressants? The jury is still out on that one.
(GETTY IMAGES)
In some circles, alternative treatments for depression are gaining in popularity. That's partly because there is a growing backlash against antidepressants as a solution to mental-health problems, says James S. Gordon, MD, the founder of the Washington, D.C.–based Center for Mind-Body Medicine, and the author of Unstuck: Your Guide to the Seven-Stage Journey Out of Depression.


"Most primary care physicians write a prescription within the first three minutes," he says. "You dont use something that has potentially harmful side effects if you have an alternative." Dr. Gordon recommends an integrated treatment approach that mixes traditional talk therapy with alternatives to antidepressants, such as exercise, meditation, supplements (including omega-3 fatty acids), self-expression through words and art, and yoga.

Vagus Nerve Stimulation Relieved Her Depression
beth-jerman
A mother of three lost a decade to mental illness. Now she is smiling again  Read more
"What we call alternative therapies should be the primary therapies," Dr. Gordon says.

"Natural" is not always better
However, nonprescription remedies are not subject to the same rigorous research standards that prescription medications must meet before theyre approved for use. And unlike drugs, natural solutions are not regulated for purity and quality, says Matthew Rudorfer, MD, a psychiatrist and the associate director for treatment research in the Division of Services and Intervention Research at the National Institute of Mental Health.

"When agents are regulated as dietary supplements and not as medications by the government, the same level of quality assurance may be lacking," he says. "The ingredients in the St. Johns wort capsule might differ from one brand to another. Basic issues like safety are the other way around from prescriptions: Dietary supplements are assumed to be safe unless demonstrated otherwise."

Dr. Rudorfer gives the example of kava kava, a top-selling supplement that many patients used to treat anxiety disorders as recently as a decade ago. However, it was eventually linked to liver toxicity and pulled from the market in a handful of European countries. The U.S. Food and Drug Administration issued a consumer warning.


A lack of research raises doubts
Ken Robbins, MD, a clinical professor of psychiatry at the University of Wisconsin–Madison, urges caution when choosing a natural product. "Until there is a good placebo-controlled study and there's enough people to make the results statistically significant, it's always hard to be sure if a product is effective and safe," he says.

It's a challenge for researchers to test many of the alternative therapies through general standards: How do you make a placebo for a piece of cooked salmon, or a mile-long walk in the park?

However, Dr. Robbins says that most of his patients are interested in low-risk complementary treatments, such as meditation, light therapy, and exercise. They've also become more cautious about using natural supplements.

"I think that people are becoming educated, that just because someone says a substance is natural doesn't mean there's no risk in taking it," he says. "People are becoming more sophisticated, more cynical about claims that people make for substances that are being sold for a profit."