Effectiveness of complementary and self-help treatments for depression

Anthony F Jorm, Helen Christensen, Kathleen M Griffiths and Bryan Rodgers
Med J Aust 2002; 176 (10): 84.


Objectives: To review the evidence for the effectiveness of complementary and self-help treatments for depression.

Data sources: Systematic literature search using PubMed, PsycLit, the Cochrane Library and previous review papers.

Data synthesis: Thirty-seven treatments were identified and grouped under the categories of medicines, physical treatments, lifestyle, and dietary changes. We give a description of each treatment, the rationale behind the treatment, a review of studies on effectiveness, and the level of evidence for the effectiveness studies.

Results: The treatments with the best evidence of effectiveness are St John's wort, exercise, bibliotherapy involving cognitive behaviour therapy and light therapy (for winter depression). There is some limited evidence to support the effectiveness of acupuncture, light therapy (for non-seasonal depression), massage therapy, negative air ionisation (for winter depression), relaxation therapy, S-adenosylmethionine, folate and yoga breathing exercises.

Conclusion: Although none of the treatments reviewed is as well supported by evidence as standard treatments such as antidepressants and cognitive behaviour therapy, many warrant further research.

Please login with your free MJA account to view this article in full

  • Anthony F Jorm1
  • Helen Christensen2
  • Kathleen M Griffiths3
  • Bryan Rodgers4

  • Centre for Mental Health Research, The Australian National University, Canberra, ACT.



We thank the following people for their help with this project: Trish Jacomb, Betty Kitchener, Ailsa Korten, Jo Medway, Ruth Parslow, Claire Kelly.

  • 1. Andrews G, Hall W, Teesson M, Henderson S. The mental health of Australians. Canberra: Mental Health Branch, Commonwealth Department of Health and Aged Care, 1999.
  • 2. Mathers C, Vos T, Stevenson C. The burden of disease and injury in Australia. Australian Institute of Health and Welfare. Canberra: AIHW, 1999. Available at: <>.
  • 3. Judd LL, Akiskal HS, Paulus MP. The role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder. J Affect Disord 1997; 45: 5-18.
  • 4. Andrews G, Sanderson K, Slade T, Issakidis C. Why does the burden of disease persist? Relating the burden of anxiety and depression to effectiveness of treatment. Bull World Health Organ 2000; 78: 446-454.
  • 5. Jorm AF, Korten AE, Jacomb PA, et al. "Mental health literacy": a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med J Aust 1997; 166: 182-186.
  • 6. Jorm AF, Medway J, Christensen H, et al. Public beliefs about the helpfulness of interventions for depression: effects on actions taken when experiencing anxiety and depression symptoms. Aust N Z J Psychiatry 2000; 34: 619-626.
  • 7. MacLennan AH, Wilson DH, Taylor AW. Prevalence and cost of alternative medicine in Australia. Lancet 1996; 347: 569-573.
  • 8. Kessler RC, Soukup J, Davis RB, et al. The use of complementary and alternative therapies to treat anxiety and depression in the United States. Am J Psychiatry 2001; 158: 289-294.
  • 9. Unützer J, Klap R, Sturm R, et al. Mental disorders and the use of alternative medicine: results from a national survey. Am J Psychiatry 2000; 157: 1851-1857.
  • 10. Griffiths K, Christensen H. The quality of web-based information on the treatment of depression. BMJ 2000; 321: 1511-1515.
  • 11. Ernst E, Rand JI, Stevinson C. Complementary therapies for depression. Arch Gen Psychiatry 1998; 55: 1026-1032.
  • 12. Fugh-Berman A, Cott JM. Dietary supplements and natural products as psychotherapeutic agents. Psychosom Med 1999; 61: 712-728.
  • 13. Wong HC, Smith M, Boon HS. Herbal remedies in psychiatric practice. Arch Gen Psychiatry 1998; 55: 1033-1044.
  • 14. Muskin PR. Complementary and alternative medicine and psychiatry. Washington DC: American Psychiatric Press, 2000.
  • 15. National Health and Medical Research Council. How to use the evidence: assessment and application of scientific evidence. Canberra: NHMRC, 2000.
  • 16. Lingaerde O, Foreland AR, Magnusson A. Can winter depression be prevented by Ginkgo biloba extract? A placebo-controlled trial. Acta Psychiatr Scand 1999; 100: 62-66.
  • 17. Levine J, Panchalingam K, Rapoport A, et al. Increased cerebrospinal fluid glutamine levels in depressed patients. Biol Psychiatry 2000; 47: 586-593.
  • 18. Cocchi R. Antidepressive properties of l-glutamine: preliminary report. Acta Psychiatr Belg 1976; 76: 658-666.
  • 19. Kleijnen J, Knipschild P, Ter Riet G. Clinical trials of homeopathy. BMJ 1991; 302: 316-323.
  • 20. Lee JR, Hopkins V. What your doctor may not tell you about menopause. New York: Warner Books, 1996.
  • 21. Lawrie TA, Herxheimer A, Dalton K. Oestrogens and progestogens for preventing and treating postnatal depression [Cochrane review]. In: The Cochrane Library. Issue 2, 2000. Oxford: Update Software.
  • 22. Van der Meer YG, Loendersloot EW, Van Loenen AC. Effects of high-dose progesterone in post-partum depression. J Psychosom Obstet Gynaecol 1984; 3: 67-68.
  • 23. Granger A, Underwood M. Review of the role of progesterone in the management of postnatal mood disorders, J Psychosom Obstet Gynaecol 2001; 22: 49-55.
  • 24. Altshuler LL, Hendrick V, Parry B. Pharmacological management of premenstrual disorder. Harv Rev Psychiatry 1995; 2: 233-245.
  • 25. Beckmann H, Athen D, Olteanu M, Zimmer R. dl-Phenylanlanine versus imipramine: a double-blind study. Arch Psychiatr Nervenkr 1979; 227: 49-58.
  • 26. Giannini AJ, Sternberg DE, Martin DM, Tipton KF. Prevention of late luteal phase dysphoric disorder symptoms with dl-phenylalanine in women with abrupt β-endorphin decline: a pilot study. Ann Clin Psychiatry 1989; 1: 259-263.
  • 27. Bottiglieri T, Hyland K. S-Adenosylmethionine levels in psychiatric and neurological disorders: a review. Acta Neurol Scand 1994; 154 Suppl: 19-26.
  • 28. Bressa GM. S-Adenosyl-1-methionine (SAMe) as antidepressant: meta-analysis of clinical studies. Acta Neurol Scand 1994; 154: 7-14.
  • 29. Cesarin P. Therapeutic goods regulations. Commonwealth of Australia Gazette 2001: S295. Canberra.
  • 30. Nathan P. The experimental and clinical pharmacology of St John's wort (Hypericum perforatum L.). Mol Psychiatry 1999; 4: 333-338.
  • 31. Linde K, Mulrow CD. St John's wort for depression [Cochrane review]. Issue 1, 2002. Oxford: Update Software.
  • 32. Kim HL, Streltzer J, Goebert D. St John's wort for depression: a meta-analysis of well defined clinical trials. J Nerv Ment Dis 1999; 187: 532-538.
  • 33. Harrer G, Schmidt U, Kuhn U, Biller A. Comparison of equivalence between the St John's wort extract LoHyp-57 and fluoxetine. Arzneimittelforschung 1999; 49: 289-296.
  • 34. Brenner R, Azbel V, Madhusoodanan S, Pawlowska M. Comparison of an extract of hypericum (LI 160) and sertraline in the treatment of depression: a double-blind, randomized pilot study. Clin Ther 2000; 22: 411-419.
  • 35. Schrader E. Equivalence of St John's wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mild-moderate depression. Int Clin Psychopharmacol 2000; 15: 61-68.
  • 36. Shelton RC, Keller MB, Gelenberg A. Effectiveness of St John's wort in major depression: a randomized controlled trial. JAMA 2001; 285: 1978-1986.
  • 37. Therapeutic Goods Administration. St John's Wort Information sheet for health care professionals. 2000. <h>. Accessed 20 December 2001.
  • 38. Benton D, Cook R. The impact of selenium supplementation on mood. Biol Psychiatry 1991; 29: 1092-1098.
  • 39. Gelenberg AJ, Wojcik JD, Falk WE, et al. Tyrosine for depression: a double-blind trial. J Affect Disord 1990; 19: 125-132.
  • 40. Hutto BR. Folate and cobalamin in psychiatric illness. Compr Psychiatry 1997; 38: 305-314.
  • 41. Morishita S, Sonohara M, Murakami H, et al. Vitamin E treatment of prolonged depression: a report of nine cases. Int Med J 2000; 7: 33-36.
  • 42. Stumpf WE, Privette TH. Light, vitamin D and psychiatry. Role of 1,25 dihydroxyvitamin D3 (soltriol) in etiology and therapy of seasonal affective disorder and other mental processes. Psychopharmacology 1989; 97: 285-294.
  • 43. Gloth FM, Alam W, Hollis B. Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder. J Nut Health Aging 1999; 3: 5-7.
  • 44. Coppen A, Bailey J. Enhancement of the antidepressant action of fluoxetine by folic acid: a randomised, placebo controlled trial. J Affect Disord 2000; 60: 121-130.
  • 45. Godfrey PSA, Toone BK, Cawrney MWP, et al. Enhancement of recovery frompsychiatric illness by methylfolate. Lancet 1990; 336: 392-395.
  • 46. Coppen A, Chaudhry S, Swade C. Folic acid enhances lithium prophylaxis. J Affect Disord 1986; 10: 9-13.
  • 47. Passeri M, Cucinotta G, Abate G. Oral 5'-methyltetrahydrofolic acid in senile organic mental disorders with depression: Results of a double-blind multicentre study. Aging Clin Expt Res 1993; 51: 63-71.
  • 48. Guaraldi GP, Fava M, Mazzi F, La Greca P. An open trial of methyltetrahydrofolate in elderly depressed patients. Ann Clin Psychiatry 1993; 5: 101-105.
  • 49. Di Palma C, Urani R, Agricola R, et al. Is methylfolate effective in relieving major depression in chronic alcoholics? A hypothesis of treatment. Curr Ther Res Clin Exp 1994; 55: 559-568.
  • 50. Bell IR, Edman JS, Morrow FD, et al. Vitamin B1, B2 and B6 augmentation of tricyclic antidepressant treatment in geriatric depression with cognitive dysfunction. J Am Coll Nutr 1992; 11: 159-163.
  • 51. Oren DA, Teicher MH, Schwartz PJ, et al. A controlled trial of cyanocobalamin (vitamin B12) in the treatment of winter seasonal affective disorder. J Affect Disord 1994; 32: 197-200.
  • 52. Kendell KE, Schnurr PP. The effects of vitamin B6 supplementation on premenstrual symptoms. Obstet Gynecol 1987; 70: 145-149.
  • 53. Benton D, Donohoe RT. The effects of nutrients on mood. Public Health Nutr 1999; 2: 403-409.
  • 54. Wyatt KM, Dimmock PW, Jones PW, Shaughn O'Brien PM. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ 1999; 318: 1375-1381.
  • 55. Hoes MJAJM, Sijben N. Xanthurenic acid in depression. J Orthomolec Med 1987; 2: 129-136.
  • 56. Adams PW, Rose DP, Folkard J, et al. Effect of pyridoxine hydrochloride (vitamin B6) upon depression associated with oral contraception. Lancet 1973; 1: 899-904.
  • 57. Cocchi P, Silenzi M, Clabri G, Salvi G. Antidepressant effect of vitamin C. Pediatrics 1980; 65: 862.
  • 58. Han JS. Electroacupuncture: an alternative to antidepressants for treating affective diseases? Int J Neurosci 1986; 29: 79-92.
  • 59. Allen JJB, Schnyer RN, Hitt SK. The efficacy of acupuncture in the treatment of major depression in women. Psychol Sci 1998; 9: 397-401.
  • 60. Röschke J, Wolf C, Müller MJ, et al. The benefit of whole body acupuncture in major depression. J Affect Disord 2000; 57: 73-81.
  • 61. Luo H, Meng F, Jia Y, Zhao X. Clinical research on the therapeutic effect of the electroacupuncture treatment in patients with depression. Psychiatry Clin Neurosci 1998; 52: S338-S340.
  • 62. Terman M, Terman JS. Treatment of seasonal affective disorder with high-output negative ionizer. J Altern Complement Med 1995; 1: 87-92.
  • 63. Terman M, Terman JS, Ross DC. A controlled trial of timed bright light and negative air ionization for treatment of winter depression. Arch Gen Psychiatry 1998; 55: 875-882.
  • 64. Wirz-Justice A, Graw P, Kräuchi K, et al. 'Natural' light treatment of seasonal affective disorder. J Affect Disord 1996; 37: 109-120.
  • 65. Wirz-Justice A. Beginning to see the light. Arch Gen Psychiatry 1998; 55: 861-862.
  • 66. Avery DH, Eder DN, Bolte MA, et al. Dawn simulation and bright light in the treatment of SAD: a controlled study. Biol Psychiatry 2001; 50: 205-216.
  • 67. Wileman SM, Eagles JM, Andrew JE, et al. Light therapy for seasonal affective disorder: randomised controlled trial. Br J Psychiatry 2001: 178: 311-316.
  • 68. Lee TMC, Chan CCH. Dose–response relationship of phototherapy for seasonal affective disorder: a meta analysis. Acta Psychiatr Scand 1999; 99: 315-323.
  • 69. Kripke DF. Light treatment for nonseasonal depression: speed, efficacy, and combined treatment. J Affect Disord 1998; 49: 109-117.
  • 70. Field T. Massage therapy effects. Am Psychol 1998; 53: 1270-1281.
  • 71. Field T, Morrow C, Valdeon C, et al. Massage reduces anxiety in child and adolescent psychiatric patients. J Am Acad Child Adolesc Psychiatry 1992; 31: 125-131.
  • 72. Field T, Grizzle N, Scafidi F, Schanberg S. Massage and relaxation therapies' effects on depressed adolescent mothers. Adolescence 1996; 31: 903-911.
  • 73. Zand J. The natural pharmacy: herbal medicine for depression. In: Strohecker J, Strohecker NS, editors. Natural healing for depression. New York: Perigee, 1999.
  • 74. Komori T, Fujiwara R, Tanida M, et al. Effects of citrus fragrance on immune function and depressive states. Neuroimmunomodulation 1995; 2: 174-180.
  • 75. Cuipers P. Bibliotherapy in unipolar depression: a meta-analysis. J Behav Ther Exp Psychiatry 1997; 28: 139-147.
  • 76. Jamison C, Scogin F. The outcome of cognitive bibliotherapy with depressed adults. J Consult Clin Psychol 1995; 63: 644-650.
  • 77. Ackerson J, Scogin F, McKendree-Smith N, Lyman RD. Cognitive bibliotherapy for mild and moderate adolescent depressive symptomatology. J Consult Clin Psychol 1998; 66: 685-690.
  • 78. Scogin F, Floyd M, Jamison C, et al. Negative outcomes: what is the evidence on self-administered treatments? J Consult Clin Psychol 1996; 64: 1086-1089.
  • 79. Lewinsohn PM, Munoz RF, Youngren M-A, Zeiss AM. Control your depression. New York: Prentice Hall, 1986.
  • 80. Burns DD. Feeling good: the new mood therapy. New York: Morrow, 1980.
  • 81. Stewart NJ, McMullin LM, Rubin LD. Movement therapy with depressed inpatients: a randomized multiple single case design. Arch Psychiatr Nurs 1994; 8: 22-29.
  • 82. North TC, McCullagh P, Tran ZV. Effect of exercise on depression. Exerc Sport Sci Rev 1990; 18: 379-415.
  • 83. Craft LL, Landers DM. The effect of exercise on clinical depression and depression resulting from mental illness: a meta-analysis. J Sport Exerc Psychol 1998; 20: 339-357.
  • 84. Lawlor DA, Hopker SW. The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. BMJ 2001; 322: 1-8.
  • 85. Martinsen EW, Medhus A, Sandvik L. Effects of aerobic exercise on depression: a controlled study. BMJ 1985; 291: 109.
  • 86. Veale D, Le Fevre K, Pantelis C, et al. Aerobic exercise in the adjunctive treatment of depression: a randomized controlled trial. J R Soc Med 1992; 85: 541-544.
  • 87. Klein MH, Greist JH, Gurman AS. A comparative outcome study of group psychotherapy vs. exercise treatments for depression. Int J Mental Health 1985; 13: 148-177.
  • 88. McCann L, Holmes DS. Influence of aerobic exercise on depression. J Pers Soc Psychol 1984; 46: 1142-1147.
  • 89. Doyne EJ, Ossip-Klein DJ, Bowman ED, et al. Running versus weight lifting in the treatment of depression. J Consult Clin Psychol 1987; 55: 748-754.
  • 90. McNeil JK, LeBlanc E, Joyner M. The effect of exercise on depressive symptoms in the moderately depressed elderly. Psychol Aging 1991; 6: 487-488.
  • 91. Singh NA, Clements KM, Fiatarone MA. A randomized controlled trial of progressive resistance training in depressed elders. J Gerontol A Biol Sci Med Sci 1997; 52A: M27-35.
  • 92. Pinchasov BB, Shurgaja AM, Grishchin OV, Putilov AA. Mood and energy regulation in seasonal and non-seasonal depression before and after midday treatment with physical exercise or bright light. Psychiatry Res 2000; 94: 29-42.
  • 93. Blumenthal JA, Babyak MA, Moore KA, et al. Effects of training on older patients with major depression. Arch Intern Med 1999; 159: 19-26.
  • 94. Babyak M, Blumenthal JA, Herman S, et al. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med 2000; 62: 633-638.
  • 95. Singh NA, Clements KM, Singh MA. The efficacy of exercise as a long-term antidepressant in elderly subjects: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2001; 56A: M497-M504.
  • 96. Greyson B. Distance healing of patients with major depression. J Sci Exploration 1996; 10: 447-465.
  • 97. Field T, Martinez A, Nawrocki T. Music shifts frontal EEG in depressed adolescents. Adolescence 1998; 33: 109-116.
  • 98. Lai YM. Effects of music listening on depressed women in Taiwan. Issues Ment Health Nurs 1999; 20: 229-246.
  • 99. Chen X. Active music therapy for senile depression. Chung Hua Shen Ching Ching Shen Ko Tsa Chih 1992; 25: 252-253 (in Chinese).
  • 100. Zisselman MH, Rovner BW, Shmuely Y, Ferrie P. A pet therapy intervention with geriatric psychiatry inpatients. Am J Occup Ther 1996; 50: 47-51.
  • 101. Barker SB, Dawson KS. The effects of animal-assisted therapy on anxiety ratings of hospitalised psychiatric patients. Psychiatr Serv 1998; 49: 797-801.
  • 102. Folse EB, Minder CC, Aycock MJ, Santana RT. Animal-assisted therapy and depression in adult college students. Anthrozoos 1994; 7: 188-194.
  • 103. Zeiss AM, Lewinsohn PM, Munoz RF. Nonspecific improvement effects in depression using interpersonal skills training, pleasant activity schedules, or cognitive training. J Consult Clin Psychol; 47: 427-439.
  • 104. Biglan A, Craker D. Effects of pleasant-activities manipulation on depression. J Consult Clin Psychol 1982; 50: 436-438.
  • 105. Reynolds WM, Coats KI. A comparison of cognitive-behavioral therapy and relaxation training for the treatment of depression in adolescents. J Consult Clin Psychol 1986; 54: 653-660.
  • 106. Kahn JS, Kehle TJ, Jenson WR, Clark E. Comparison of cognitive-behavioural, relaxation, and self-modeling interventions for depression among middle-school students. School Psychol Rev 1990; 19: 196-211.
  • 107. Broota A, Dhir R. Efficacy of two relaxation techniques in depression. J Pers Clin Stud 1990; 6: 83-90.
  • 108. Mclean PD, Hakstian AR. Relative endurance of unipolar depression treatment effects: longitudinal follow-up. J Consult Clin Psychol 1990; 58: 482-488.
  • 109. Murphy GE, Carney RM, Knesevich MA, et al. Cognitive behaviour therapy, relaxation training, and tricyclic antidepressant medication in the treatment of depression. Psychol Rep 1995; 77: 403-420.
  • 110. Bowers WA. Treatment of depressed in-patients. Cognitive therapy plus medication, relaxation plus medication, and medication alone. Br J Psychiatry 1990; 156: 73-78.
  • 111. Khumar SS, Kaur P, Kaur S. Effectiveness of shavasana on depression among university students. Indian J Clin Psychol 1993; 20: 82-87.
  • 112. Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, et al. Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine. J Affect Disord 2000; 57: 255-257.
  • 113. Brown SA, Schuckit MA. Changes in depression among abstinent alcoholics. J Stud Alcohol 1988; 49: 412-417.
  • 114. Davidson KM. Diagnosis of depression in alcohol dependence: changes in prevalence with drinking status. Br J Psychiatry 1995; 166: 199-204.
  • 115. Neff JA, Husaini BA. Life events, drinking patterns and depressive symptomatology: the stress buffering role of alcohol consumption. J Stud Alcohol 1982; 43: 301-318.
  • 116. Pearlin LI, Radaburgh CW. Economic strains and the coping functions of alcohol. AJS 1976; 82: 652-663.
  • 117. Power C, Rodgers B, Hope S. U-shaped relation for alcohol consumption and health in early adulthood and implications for mortality [letter]. Lancet 1998; 352: 877.
  • 118. Lipton RI. The effect of moderate alcohol use on the relationship between stress and depression. Am J Public Health 1994; 84: 1913-1917.
  • 119. Rodgers B, Korten AE, Jorm AF, et al. Non-linear relationships in associations of depression and anxiety with alcohol use. Psychol Med 2000; 30: 421-432.
  • 120. Baum-Baicker C. The psychological benefits of moderate alcohol consumption: a review of the literature. Drug Alcohol Depend 1985; 15: 305-322.
  • 121. Peele S, Brodsky A. Exploring psychological benefits associated with moderate alcohol use: a necessary corrective to assessments of drinking outcomes? Drug Alcohol Depend 2000; 60: 221-247.
  • 122. Christensen L, Burrows R. Dietary treatment of depression. Behav Ther 1990; 21: 183-193.
  • 123. Lee MA, Flegel P, Greden JF, Cameron OG. Anxiogenic effects of caffeine on panic and depressed patients. Am J Psychiatry 1988; 145: 632-635.
  • 124. Hibbeln JR. Fish consumption and major depression. Lancet 1998; 351: 1213.
  • 125. Maidment ID. Are fish oils an effective therapy in mental illness — an analysis of the data? Acta Psychiatr Scand 2000; 102: 3-11.
  • 126. Stoll AL, Severus E, Freeman MP. Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Arch Gen Psychiatry 1999; 56: 407-412.
  • 127. US Agency for Health Care Policy and Research. Depression in primary care: volume 2. Treatment of major depression. (Clinical practice guideline no. 5) Rockville, MD: US Department of Health and Human Services, 1993. (AHCPR Publication No. 93-0551.)
  • 128. Williams JW, Mulrow CD, Chiqutte E, et al. A systematic review of newer pharmacotherapies for depression in adults: evidence report summary. Ann Intern Med 2000; 132: 743-756.
  • 129. Gloaguen V, Cottraux J, Cucherat M, Blackburn IM. A meta-analysis of the effects of cognitive therapy in depressed patients. J Affect Disord 1998; 49: 59-72.
  • 130. Jorm AF, Christensen H, Griffiths KM, et al. Help for depression: what works (and what doesn't). Canberra: Centre for Mental Health Research, 2001.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.