19 November 2007

No alternative therapy for gran

While some alternative remedies show promise for older adults' sleep problems, depression and anxiety, the jury is still out on most.

While some alternative remedies show promise for older adults' sleep problems, depression and anxiety, the jury is still out on most, according to a new research review.

In an analysis of 33 clinical trials, researchers found that two thirds of the studies showed benefits from various alternative remedies used to treat depression, anxiety and sleep disturbances.

Particularly promising were certain "mind-body" approaches, such as tai chi and relaxation exercises, in the treatment of sleep problems.

In general, however, many of the studies suffered from flaws in their design, and this was particularly true of those that had positive results, the researchers report in the Journal of Clinical Psychiatry.

In particular, no "biologically based" therapy - including herbs, vitamins and hormones - has been proven safe and effective for any of these conditions in older adults, said lead researcher Dr Thomas W. Meeks, an assistant clinical professor of psychiatry at the University of California, San Diego.

More studies needed
More studies of alternative remedies, specifically focusing on older adults, are necessary, according to Meeks and his colleagues. The number of older Americans with mental health conditions is "increasing exponentially", they note, as is consumers' interest in alternatives to conventional medicine.

For their review, the researchers combed the medical literature for clinical trials testing various alternative therapies for depression, anxiety and sleep disturbances. They found 33 clinical trials that involved at least 30 patients and lasted at least two weeks.

Overall, 10 of 12 studies on mind-body therapies - including tai chi and relaxation exercises - found benefits, particularly for insomnia.

Mind-body therapies are a "reasonable alternative" for older adults with insomnia who cannot or don't want to take sedative medication, Meeks told Reuters Health. He noted that components of relaxation therapy are used in cognitive behavioural therapy, a mainstream treatment for insomnia.

However, Meeks added, certain mind-body approaches, like tai chi and yoga, require physical exertion, so older adults should get an OK from their doctor before trying them.

Mind-body therapies also "hold promise" for depression and anxiety, according to Meeks, but more studies are necessary. Of the mind-body trials in his team's review, none focused primarily on treating older adults' anxiety symptoms.

When it came to herbal remedies and other supplements - such as St. John's wort for depression, and melatonin for sleep problems - the results were inconsistent. According to the researchers, less than half of these trials yielded positive results.

Older adults who do want to try an alternative remedy should first talk with their doctor, Meeks advised. Herbs and other biological therapies, for example, can potentially interact with any medications a person may be taking.

Some doctors may not be knowledgeable about a given alternative therapy, Meeks noted, but they should at least be willing to have a conversation about it.

"Open, honest communication is key to a doctor-patient relationship," he said.

SOURCE: Journal of Clinical Psychiatry, October 2007. - (Amy Norton/Reuters Health)

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