Abstract ID: 2184
State of the science/evidence base for integrative modalities
Complementary therapies for depression: a systematic review of reviews
Heidemarie Haller, MSc; Dennis Anheyer, MA; Holger Cramer, PhD; Gusatv Dobos, MD, University of Duisburg-Essen, Essen, Germany
Late Breaker: No
Standard antidepressants were shown to be superior to placebo only for very severe symptoms of depression. Clinical depression guidelines, however, still do not systematically search for alternatives and vary widely in their recommendations of complementary (CAM) therapies. This systematic review therefore aimed at summarizing the recent level-1 evidence of CAM in patients with primary depression.
PubMed, PsycInfo and Central were searched through July 2017 to identify meta-analyses of randomized controlled trials (RCTs) on CAM for depression. Outcomes included depression severity, response, remission, relapse, and safety and were pooled as standard mean differences, risk ratios, hazard ratios, and odds ratios. Grades of recommendations were given according to the Oxford levels of evidence considering the quality of the original RCTs and meta-analyses (AMSTAR), effect sizes, heterogeneity, and safety characteristics.
Literature search revealed 24 meta-analyses conducted between 2003 and 2017 on 2 to 29 RCTs in patients with major, minor, and seasonal depression. The quality of RCTs and meta-analyses ranged between low to high. Based on consistent high-quality evidence, grade A recommendations can be given for St. John’s wort as it was superior to placebo and a safer equivalent to standard antidepressants for mild to moderate major depression. Moderate-quality evidence resulted in Grade B recommendations for Saffron and Mindfulness-based Cognitive Therapy as well as bright light, dance and music therapy as adjunctive treatments, and acupuncture for treating drug side effects. Grade D recommendations were given for Mindfulness-based Stress Reduction, spiritual-adapted cognitive therapy, selected supplements, and yoga showing several promising effects, however, across low-quality studies.
CAM treatments can be recommended with different grades for treating depression. Quality of further research needs improvement.