1 Complimentary and Alternative Treatment Modalities for Major Depression Kayla Lowery Division of Nursing, Baptist Health Sciences University NSG307: Essentials of Professional Nursing Laritha Hill Sweet, PhD, RN October 21, 2022 2 Complimentary and Alternative Treatment Modalities for Major Depression Depression affects millions of people a year and is one of the most common diseases in the United States (Fava and Kendler, 2000). Depression has many severe symptoms that affect a person’s mind and body, including mood and the healing process. Depression increases the risk of suicide which is detrimental, so it is essential to identify and cure it (Holman et al., 2019a). Two different treatment practices are used to treat patients: complementary and alternative medicine (CAM) and conventional medicine. This paper will focus on what CAM is including a description of conventional medicine, what major depression is, the different CAM and conventional medical treatments for major depression, and what treatment I recommend. Complementary and Alternative Medicine Complementary and alternative medicine (CAM) is a broad healthcare resource field that consists of "systems, practices, and products that are not generally considered to be part of conventional medicine" (Freeman, 2009, p. 4). For people to fully understand CAM, people should first understand conventional medicine. Dalen (1998) defines conventional medicine as "medical interventions that are taught extensively at US medical schools and generally provided at US hospitals" (p. 2179). Treatments that are considered conventional modalities are pharmacological medications, radiation, and surgery (National Cancer Institute, n.d.). Despite complementary and alternative modalities being classified together in a category, complementary modalities and alternative modalities both have distinct differences in their meaning. Complementary modalities are medical treatments that are used in collaboration with conventional medicine. Alternative modalities are best described as treatments that are used independently of conventional medicine. Treatments considered to be CAM include acupuncture, chiropractic, homeopathy, yoga, spiritual guidance, and herbal supplements (Holman et al., 2019b). To further explain these forms of CAM, acupuncture is using needles punctured into pressure points of the body to impair body function and replace medical anesthesia (Slomski and 3 DeAngelo, 2022). Chiropractic is the use of hands that align the skeleton into the correct placement to relieve pain and pressure. Yoga is a form of body movement that influences body strength and encourages mental and spiritual strength. Herbal supplements are natural substances and chemicals from plants with healing properties. The illness the patient suffers from determines the CAM treatment the patient will use; for example, music therapy would be used with a person with Alzheimer's disease to promote concentration (Holman et al., 2019b). CAM benefits the patient because it focuses on the person as a whole and continues to grow as a preferred treatment option (Holman et al., 2019b). Major Depression Major depressive disorder (MDD) is a form of depression that is the most severe and is categorized as a depression that does not change shifts of mood from mania back to depression (Holman et al., 2019a). MDD is distinguished from other forms of depression because it lasts more than two weeks and presents with more than four symptoms. Symptoms can include significant weight changes within a month, thoughts of suicide, anxiety, depressed mood, sleeping issues, indecisiveness, and motor activity that is not consistent with normal personal behavior (Holman et al., 2019a). Signs that would be noticeable in others would be poor hygiene, social isolation, and delayed speech response (Holman et al., 2019a). MDD is very common, and Hasin et al. (2018) found that in a lifetime, 20% of people in the United States would have or do suffer from MDD. MDD is more likely to be exhibited in people between the ages of 40-49 and women (Hasin, 2018). Many psychological, social, and physiological determinants contribute to the risks of MDD, like family history of depression, medical illnesses, and childhood trauma (Holman et al., 2019a). MDD significantly negatively impacts the person mentally, physically, and socially, along with an increased risk of suicide, making diagnosing and treating MDD essential. 4 CAM and Conventional Medical Treatments for MDD Many CAM and conventional medical treatments are used to treat MDD. Two CAM treatments are exercise and St. John's wort, and both come highly recommended to treat MDD (Ravindran et al., 2016). The first CAM treatment is exercise; exercise's goal is to improve health through the act of physical activity and was found to be effective because of the biological benefits that exercise promotes. Changes that the body exhibits through exercise are an increase in endorphins, a decrease in cortisol, and an increase in self-esteem (Ravindran et al., 2016). The recommended duration to experience efficacy is 8-9 weeks. There are no harmful side effects of exercise, but it is essential to know that its benefits may not be as practical for aggressive MDD (Ravindran et al., 2016). The second CAM treatment recommended is St. John's wort, derived from a plant called Hypericum perforatum (Holman et al., 2019a). The herbal medicine's properties are successful because of the effect it has on the serotonin receptors, which also poses a risk because serotonin syndrome can occur if taken with other medications (Ravindran et al., 2016). Therefore, it is essential to report the use of St. John's wort to the medical provider to avoid these risks. The recommended duration to experience efficacy is 4-12 weeks, depending on the dose (Ravindran et al., 2016). Although St. John's wort is an all-natural product, it does pose some adverse side effects like tachycardia and GI distress (Holman et al., 2019). Two conventional medical treatments used to treat MDD are selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (Holman et al., 2019). The first conventional treatment, SSRIs, is the most recommended treatment for MDD (Holman et al., 2019). SSRIs are responsible for increasing the uptake of serotonin in the brain (Holman et al., 2019). It may take 4-6 weeks for the medication to take effect, and it should not be stopped abruptly (Holman et al. 2019). Side effects may include serotonin syndrome, sexual dysfunction, urinary retention, constipation, and dry mouth (Holman et al., 2019). The second recommended conventional treatment for MDD is serotonin norepinephrine reuptake inhibitors, which affect serotonin, norepinephrine, and dopamine. Serotonin norepinephrine reuptake inhibitors 5 have fewer side effects than the alternative option of conventional medicine, which are headache, vertigo, insomnia, and constipation. The results of this medication would also take 4-6 weeks to take effect. Recommendation I would recommend exercise as the leading option from the treatments I have mentioned in this paper. I would choose exercise first because it has no harmful side effects but benefits the body and mind; for example, it improves body movement and reduces cardiovascular disease and diabetes. Exercise's only downfall is that it may not be as effective for more severe MDD. I would then recommend a conventional medicine like serotonin norepinephrine reuptake inhibitors because they have less severe side effects, unlike SSRIs that may cause serotonin syndrome, which is fatal. Conclusion In conclusion, MDD is a depressive disorder that has severe effects on the body and mind. Many people in the United States suffer from MDD, and many leading treatments help combat this mental disorder. Treatments for MDD include CAM and conventional medicine options that are very effective in treating MDD. Because of the harmful effects of conventional medicine, I recommend a CAM treatment over conventional medicine, but in severe cases, I would choose a medication to help combat MDD. 6 References Dalen, J. E. (1998). “Conventional” and “unconventional” medicine: Can they be integrated? Arch Intern Med, 158(20), 2179-2181. https://doi.org/10.1001/archinte.158.20.2179 Fava, M., & Kendler, K. S. (2000). Major depressive disorder. Neuron, 28(2), 335-341. https://doi.org/10.1016/S0896-6273(00)00112-4 Freeman, M. P. (2009). Complementary and alternative medicine (CAM): Considerations for the treatment of major depressive disorder. The Journal of Clinical Psychiatry, 70(5), 4-6. https://doi.org/10.4088/jcp.8157su1c.01 Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, J., Stohl, M., & Grant, B. F. (2018). Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry, 75(4), 336-346. https://doi.org/10.1001/jamapsychiatry.2017.4602 Holman, H. C., Williams, D., Sommer, S., Johnson, J., Ball, B. S., McMichael, M. G., and Assessment Technologies Institute (Contributors). (2019a). Rn mental health nursing: Review module (11th ed.). 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