Complementary and alternative treatments for late-life depression, anxiety, and sleep disturbance : A review of randomized controlled trials

• Published in: The journal of clinical psychiatry Vol. 68; no. 10; pp. 1461 - 1471
• Main Authors: MEEKS, Thomas W, WETHERELL, Julie L, IRWIN, Michael R, REDWINE, Laura S, JESTE, Dilip V
• Format: Journal Article
• Language: English
• Published: Memphis, TN Physicians Postgraduate Press 01-10-2007
• Subjects: Adult and adolescent clinical studies; Anxiety Disorders - diagnosis; Anxiety Disorders - psychology; Anxiety Disorders - therapy; Biological and medical sciences; Complementary Therapies - methods; Depression; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - psychology; Depressive Disorder, Major - therapy; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Humans; Medical sciences; Mood disorders; Nervous system (semeiology, syndromes); Neurology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Randomized Controlled Trials as Topic; Sleep Wake Disorders - diagnosis; Sleep Wake Disorders - psychology; Sleep Wake Disorders - therapy; Human; Mood disorder; Affect affectivity; Nervous system diseases; Treatment; Sleep disorder; Controlled therapeutic trial; Depression; Anxiety; Review; Neurological disorder; Elderly
• ISSN: 0160-6689; 1555-2101
• DOI: 10.4088/JCP.v68n1001

We reviewed randomized controlled trials of complementary and alternative medicine (CAM) treatments for depression, anxiety, and sleep disturbance in nondemented older adults.
We searched PubMed (1966-September 2006) and PsycINFO (1984-September 2006) databases using combinations of terms including depression, anxiety, and sleep; older adult/elderly; randomized controlled trial; and a list of 56 terms related to CAM.
Of the 855 studies identified by database searches, 29 met our inclusion criteria: sample size >or= 30, treatment duration >or= 2 weeks, and publication in English. Four additional articles from manual bibliography searches met inclusion criteria, totaling 33 studies.
We reviewed identified articles for methodological quality using a modified Scale for Assessing Scientific Quality of Investigations (SASQI). We categorized a study as positive if the CAM therapy proved significantly more effective than an inactive control (or as effective as active control) on at least 1 primary psychological outcome. Positive and negative studies were compared on the following characteristics: CAM treatment category, symptom(s) assessed, country where the study was conducted, sample size, treatment duration, and mean sample age.
67% of the 33 studies reviewed were positive. Positive studies had lower SASQI scores for methodology than negative studies. Mind-body and body-based therapies had somewhat higher rates of positive results than energy- or biologically-based therapies.
Most studies had substantial methodological limitations. A few well-conducted studies suggested therapeutic potential for certain CAM interventions in older adults (e.g., mind-body interventions for sleep disturbances and acupressure for sleep and anxiety). More rigorous research is needed, and suggestions for future research are summarized.