University of Ottawa, Seekers Centre for Integrative Medicine, 6 Deakin St, Ottawa, ON K2E 1B3.
Can Fam Physician. 2011 Jun;57(6):659-63.
To review the clinical evidence supporting complementary and alternative medicine interventions for treating major depressive disorder.
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.
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.
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.
回顾支持补充和替代医学干预治疗重度抑郁症的临床证据。
使用术语“抑郁症”，联合贯叶连翘、S-腺苷甲硫氨酸（SAM-e）、运动、针灸、ω-3 脂肪酸和叶酸，于 1966 年 1 月至 2010 年 2 月在 PubMed 上进行检索，仅选择相关的人类试验。
在一项大型荟萃分析中，发现贯叶连翘与抗抑郁药等效，且副作用更少。3 项荟萃分析显示运动降低抑郁评分。ω-3 脂肪酸在 16 项试验的荟萃分析中降低抑郁评分，但存在发表偏倚。口服 SAM-e 单药治疗在 5 项小型随机对照试验中的 4 项中降低抑郁评分。叶酸缺乏与更严重和难治性抑郁症相关，补充叶酸在 3 项随机对照试验中的 2 项中降低抑郁评分。针灸在 1 项荟萃分析和 5 项其他试验中显示出有限的疗效。
贯叶连翘和有规律的运动似乎对治疗抑郁症有效。针灸对抑郁症似乎无效，但可能对其他健康有益。其他有前途的治疗方法包括在特定患者中补充 SAM-e、ω-3 脂肪酸和叶酸；需要进一步研究。
