Substance Abuse & Mental Health Services Administration

CMHS Consumer Affairs E-News
March 21, 2003, Vol. 03-18

PERCEIVED BENEFITS OF ALTERNATIVE HEALTH CARE PRACTICES

The following study was supported by a grant jointly funded by the National Institute on Disability and Rehabilitation Research and the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration.

USE OF ALTERNATIVE HEALTH CARE PRACTICES BY PERSONS WITH SERIOUS MENTAL ILLNESS: PERCEIVED BENEFITS
Z. Russinova, N. J. Wewiorski, & D. J. Cash

American Journal of Public Health, Volume 92, Number 10, 2002

Abstract

Examined the perceived benefits of alternative health care practices by individuals with serious mental illness. 157 individuals (mean age 46.6 yrs) with bipolar disorder, schizophrenia spectrum disorder, or depressive disorder who reported mental health benefits from alternative health care practices completed surveys concerning the benefits of alternative practice. Results show that some subjects (Ss) seemed to benefit from a variety of alternative practices, including body-manipulation modalities such as massage and chiropractic. More frequently used practices included meditation, massage, yoga, and guided imagery. Religious or spiritual activities such as prayer, worship attendance, and religious or spiritual reading were commonly practiced and reported as beneficial. Alternative practices promoted the recovery process beyond the management of emotional and cognitive impairment by also enhancing social interaction, spirituality, and self-functioning.

Excerpt

Perceived benefit has been identified as an important factor influencing the decision to use alternative medicine for various health problems. Although research examining the use of alternative health care practices in the treatment of psychiatric disorders has been increasing, little is known about the specific benefits experienced by users with mental illness. A few studies have attempted to address this issue by having respondents assess the extent to which a given practice was experienced as helpful. This report presents preliminary findings on the perceived benefits of alternative health care practices used by adults with serious mental illness (SMI) who participated in a larger exploratory study on the role of such practices in mental health recovery.

TREATMENT FOR MINOR DEPRESSION

In a new approach to research on minor depression, the National Institutes of Health (NIH) has launched a four-year study to determine the safety and effectiveness of St. John's wort, a common herbal supplement, and citalopram, a standard antidepressant, compared to placebo.

The trial is being conducted at three sites. A total of 300 participants with minor depression will be randomly assigned a standardized extract of St. John's wort (Hypericum perforatum), citalopram, or placebo in a twelve-week double-blind trial. Researchers will assess changes in patients' symptoms, functioning, and quality of life. Those who show no improvement will receive the active treatment they hadn't been assigned before, while patients with improved symptoms will take their assigned treatment for another 14 weeks for a total of 26 weeks.

The more than $4 million collaborative study is funded by the National Institute of Mental Health (NIMH), the National Center for Complementary and Alternative Medicine (NCCAM), and the Office of Dietary Supplements (ODS).

Minor depression is a common disorder that may impair a person's functioning and quality of life and is a serious risk factor for major depression. Yet it is underdiagnosed and undertreated. The study addresses a need for definitive data on therapy for this significant health problem.

Patients with minor depression who seek treatment from family doctors are often treated with prescription antidepressants, if their mood disorder is diagnosed at all. Many people use St. John's wort without consulting a physician. This study will help determine how the herbal agent and the antidepressant fit in the overall management of the disorder.

"If the trial demonstrates that citalopram or St. John's wort benefits patients with minor depression, it will expand our understanding of this underrecognized mood disorder and offer new evidence-based treatment recommendations for either primary care or mental health clinicians," explained Matthew Rudorfer, M.D., Associate Director of Treatment Research, Division of Services and Intervention Research, NIMH.

"There is high public interest in herbal remedies for depression," according to Stephen E. Straus, M.D., NCCAM Director. "Our intent is to study St. John's wort for the spectrum of depressive conditions for which the public considers its use. This new study extends our earlier research efforts from the more serious form of depression to a clinically less serious one, yet one that is, in fact, of considerable public health significance," he said.

Men and women age 18 to 85 who meet diagnostic criteria for minor depression are eligible to participate. They must have experienced depressive symptoms for at least 6 months but less than 2 years continuously without meeting criteria for a major depressive episode or dysthymia within the past year. Additional exclusionary criteria include other mental disorders, such as schizophrenia, bipolar disorder, anxiety and substance use disorders. Individuals with some active physical illnesses, such as cardiovascular, renal, respiratory, endocrine, neurological, or blood diseases also are not eligible for the study.

Participants are interviewed at an initial screening visit, during the initial two-week period when they are withdrawn from all psychotropic medications, at baseline, and every two weeks thereafter during the study. At the screening visit, Week 12, and Week 20, patients will undergo a complete blood count with laboratory tests. Well validated scales will be used to assess symptoms, dysfunction, and well-being.

Minor depression affects about 7.5 percent of Americans during their lifetime. Although there is broad knowledge about the scope of suffering and disability due to major depressive disorder, less is known about the day-to-day struggles faced by people with minor depression. Its symptoms are the same as those of major depression, though fewer in number and causing less impairment. They include:

• Either a depressed mood most of the day, nearly every day
• Or a markedly diminished interest or pleasure in daily activities
• Plus two to four of the following symptoms:
  • Significant weight loss or gain, or decrease or increase in appetite
  • Disturbance in sleep pattern
  • Noticeable agitation or slowness
  • Fatigue or loss of energy
  • Inappropriate feelings of worthlessness or guilt
  • Diminished ability to concentrate, indecisiveness
  • Recurrent thoughts of death or suicide
• Symptoms must last at least 6 months but less than 2 years continuously.

Trials are being conducted in:

Boston, Massachusetts, at Massachusetts General Hospital. Andrew A. Nierenberg, M.D., is the principal investigator. The coordinator is Megan Hughes at 617-726-3129; mhughes3@partners.org.

Los Angeles, California, at Cedar Sinai Medical Center. Mark Rapaport, M.D., is the principal investigator. The coordinator is Rachel E. Maddux at 310-423-4473; rmaddux@ucsd.edu.

Pittsburgh, Pennsylvania, at the University of Pittsburgh. Robert Howland, M.D., is the principal investigator. The coordinator is Michael Lightfoot at 412-624-5035; lightfoot@msx.upmc.edu.

For more information, contact http://www.ClinicalTrials.gov. NIMH Web site: http://www.nimh.nih.gov.

NIMH, NCCAM, and ODS are part of the National Institutes of Health (NIH), the Federal Government's primary agency for biomedical and behavioral research. NIH is a component of the U. S. Department of Health and Human Services.