General Administration for Research and Studies, Sulaimania Medical Complex, Riyadh, Saudi Arabia.
Neuropsychiatr Dis Treat. 2013;9:639-58. doi: 10.2147/NDT.S43419. Epub 2013 May 14.
Mood disorders are a major public health problem and are associated with considerable burden of disease, suicides, physical comorbidities, high economic costs, and poor quality of life. Approximately 30%-40% of patients with major depression have only a partial response to available pharmacological and psychotherapeutic interventions. Complementary and alternative medicine (CAM) has been used either alone or in combination with conventional therapies in patients with mood disorders. This review of the literature examines evidence-based data on the use of CAM in mood disorders. A search of the PubMed, Medline, Google Scholar, and Quertile databases using keywords was conducted, and relevant articles published in the English language in the peer-reviewed journals over the past two decades were retrieved. Evidence-based data suggest that light therapy, St John's wort, Rhodiola rosea, omega-3 fatty acids, yoga, acupuncture, mindfulness therapies, exercise, sleep deprivation, and S-adenosylmethionine are effective in the treatment of mood disorders. Clinical trials of vitamin B complex, vitamin D, and methylfolate found that, while these were useful in physical illness, results were equivocal in patients with mood disorders. Studies support the adjunctive role of omega-3 fatty acids, eicosapentaenoic acid, and docosahexaenoic acid in unipolar and bipolar depression, although manic symptoms are not affected and higher doses are required in patients with resistant bipolar depression and rapid cycling. Omega-3 fatty acids are useful in pregnant women with major depression, and have no adverse effects on the fetus. Choline, inositol, 5-hydroxy-L-tryptophan, and N-acetylcysteine are effective adjuncts in bipolar patients. Dehydroepiandrosterone is effective both in bipolar depression and depression in the setting of comorbid physical disease, although doses should be titrated to avoid adverse effects. Ayurvedic and homeopathic therapies have the potential to improve symptoms of depression, although larger controlled trials are needed. Mind-body-spirit and integrative medicine approaches can be used effectively in mild to moderate depression and in treatment-resistant depression. Currently, although CAM therapies are not the primary treatment of mood disorders, level 1 evidence could emerge in the future showing that such treatments are effective.
心境障碍是一个主要的公共卫生问题，与相当大的疾病负担、自杀、躯体合并症、高经济成本和生活质量差有关。大约 30%-40%的重性抑郁症患者对现有药物和心理治疗干预仅有部分反应。补充和替代医学（CAM）已被单独或与传统疗法联合用于心境障碍患者。本文献综述检查了心境障碍中使用 CAM 的基于证据的数据。使用关键词在 PubMed、Medline、Google Scholar 和 Quertile 数据库中进行了搜索，并检索了过去 20 年在同行评议期刊上发表的英语相关文章。基于证据的数据表明，光照疗法、贯叶连翘、红景天、ω-3 脂肪酸、瑜伽、针灸、正念疗法、运动、睡眠剥夺和 S-腺苷甲硫氨酸对心境障碍的治疗有效。维生素 B 复合物、维生素 D 和甲硫氨酸的临床试验发现，虽然这些对躯体疾病有用，但在心境障碍患者中结果不确定。研究支持ω-3 脂肪酸、二十碳五烯酸和二十二碳六烯酸在单相和双相抑郁症中的辅助作用，尽管躁狂症状不受影响，且在抵抗性双相抑郁症和快速循环患者中需要更高剂量。ω-3 脂肪酸对患有重性抑郁症的孕妇有用，且对胎儿无不良影响。胆碱、肌醇、5-羟色氨酸 L-和 N-乙酰半胱氨酸在双相患者中是有效的辅助治疗。脱氢表雄酮在双相抑郁症和躯体合并症相关抑郁症中均有效，尽管应调整剂量以避免不良反应。阿育吠陀和顺势疗法有可能改善抑郁症状，但需要更大规模的对照试验。身心精神和综合医学方法可有效用于轻度至中度抑郁症和治疗抵抗性抑郁症。目前，尽管 CAM 疗法不是心境障碍的主要治疗方法，但未来可能会出现 1 级证据表明这些治疗有效。
