Complementary medicines in mental health

Remedy Effectiveness at RCT/meta-analysis (META) level in placebo (PLB) or equivalence (EQU) studies Receptor targets/mechanism of action Selected safety concerns Affective disorders St John's wort META PLB (n=26): marginally effective in major depression 5HT CYP 3A4 and p-glycoprotein induction may lead to significant pharmacological interactions, serotonergic side effects including serotonin syndrome and induction of mania possible META EQU (n=14): effective (3) GABA META PLB (n=18): trend towards reduction in effect size in meta-analysis, effect size inversely associated with sample size (4) MAO inhibition S-Adenosyl-methionine (SAMe) META PLB (n=6) EQU (n=7) and RCTs EQU (n=2): effective in major depression (5,6,7) Facilitates monoamine synthesis (5HT, NA, DA) Serotonergic side effects as above Modification of 2nd messenger systems n-3 fatty acids RCT: no effect on mild to moderate depression (8) Modification of 2nd messenger systems Toxicity possible if combined with other vitamin A preparations META PLB (n=10): improves depressive symptoms in patients with clearly defined depression or bipolar affective disorder. [...]it is not possible to discuss treatments of any kind in absolute terms; one can only derive likelihoods. Since it is not possible to infer from summary statistics to an individual, a patient-against all odds-may derive benefit or harm from a treatment, even if the majority of patients do not.