Preparation for Child Psych PRITE and Boards
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Introduction

While alternative medicine is frequently defined as healing practice not supported by scientific evidence, the purpose of this article is to gather scientific evidence for treatments that are outside the mainstay Western psychiatric practice.


Depression

Omega-3 fatty acids

Omega-3 fatty acids have a clear role in treatment augmentation of mood and psychotic disorders. A review of evidence can be found here.

SAM-E

Folate and derivatives

L-methylfolate is metabolized from dietary folate, and is necessary for the synthesis of serotonin, norepinephrine, and dopamine

In two randomized, placebo controlled trials, it was found that "adjunctive L-methylfolate at 15 mg/day may constitute an effective, safe, and relatively well tolerated treatment strategy for patients with major depressive disorder who have a partial response or no response to SSRIs" (not effective at 7.5mg/day). (Papakostas, 2012)

Of note, the dose studied here is much higher that the dose recommended to pregnant women for prevention of neural tube defects (1-4mg/day), or the dose used in management of alcohol withdrawal (1mg/day). Deplin is a comercial preparation of high-dose l-methylfolate (7.5mg and 15mg tabs) and allows convinient dosing. This convinience comes with a price tag of about $60/mo, not extremely expensive, but immodest for a vitamin.

Curcumin

Curcumin is the main ingridient of tumeric
In an 8-week trial, 56 adults with major depressive disorder were randomly assigned to curcumin 500mg twice a day, or placebo. From weeks 4 to 8, curcumin was significantly more effective than placebo in improving several mood-related symptoms, particularly in patients with atypical depression. (Lopresti, 2014)

References

Papakostas GI, Shelton RC, Zajecka JM, et.al. L-methylfolate as adjunctive therapy for SSRI-resistant major depression: results of two randomized, double-blind, parallel-sequential trials. Am J Psychiatry. 2012 Dec 1;169(12):1267-74

Lopresti AL, Maes M, Maker GL, Hood SD, Drummond PD. Curcumin for the treatment of major depression: A randomised, double-blind, placebo controlled study. J Affect Disord. 2014 Oct;167:368-75