Often referred to as 'complementary' or 'alternative' medicine, natural therapy is a popular system of health care used separately to, or in conjunction with, conventional medicine. The Cochrane Collaboration states "complementary medicine is diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole by satisfying a demand not met by orthodox, or by diversifying the conceptual frameworks of medicine". Natural therapies include the use of herbal medicines, acupuncture, homeopathy, hypnotherapy, relaxation therapy and others.

Forty percent of the US adult population in 1998 used at least one natural therapy for one year. It appears to be most popular with patients suffering from chronic conditions. Generally speaking, people will opt to use natural therapies because these therapies are thought to have fewer or no adverse effects and because they want to leave no option untried. It has also been said that natural therapies offer the patient more control because they are less authoritarian and more empowering.

Natural therapies which are often used in psychiatric practice to treat psychiatric symptoms may produce changes in mood, thinking or behavior as a side effect, or interact with psychiatric medications. Unfortunately, scientific research about these therapies is inadequate to permit definite conclusions about the efficacy or safety of most natural therapies, despite countless reports and anecdotal testaments.

Herbal medicine

Herbal medicine (phytotherapy) involves the treatment of illness with plants, parts of plants or plant extracts. It has a long history of use in medicine, with many modern drugs having botanical sources. In Australia, the US and the UK, phytotherapy is left largely to naturopaths or herbalists. However, herbal medicine is an integral part of orthodox prescribing in continental Europe as well as in Eastern Asia.

Each plant contains a whole array of different compounds so it can be difficult to define which of these, and how many, contribute to which pharmacological effect. Books on complementary and alternative medicine claim a variety of plants to be helpful in depression. Examples of these include wild oats, lemon balm, ginseng, wood betony, basil and St John's Wort. However, it is only for the herb St John's Wort that a substantial body of evidence exists.

There are only scattered references in the ethnobotanical literature to plants used by indigenous peoples to treat depression. In China, herbal remedies are often used in combination with conventional western drug therapy. However, only few trials, usually of poor methodological quality, have investigated Chinese herbal therapies for depression. A similar situation exists in Japan where traditional herbal mixtures are used for depression, however, their effects have not yet been scientifically tested.

St John's Wort

St John's Wort is commonly used as an antidepressant. Earlier scientific evidence suggested that it is very effective, particularly in mild to moderate depression, and that it is comparable with conventional drug treatment. However, more recent investigation into this antidepressant effect has produced conflicting results. In a very recent study conducted from Vanderbilt University in the USA and published in the Journal of the American Medical Association, it was reported that St John's Wort was NOT significantly better after 8 weeks than placebo in the treatment of recruited subjects suffering from at least 4 weeks of major depression.

A more definitive picture as to the efficacy of this agent in the treatment of depression may become available upon completion of a larger and very rigorous three-year study by the National Institute of Mental Health (NIMH, Washington DC) which is undertaking blind comparisons of three treatment groups taking placebo, St. John's Wort and a prescription antidepressant respectively.

There seem to be fewer adverse effects to be seen with St John's Wort than with conventional antidepressants. Some side effects which do occur include photodermatosis, delayed hypersensitivity, gastrointestinal tract upset, dizziness, dry mouth, sedation, restlessness and constipation. There does not appear to be significant adverse effects on cardiac conduction. New data suggests that St John's Wort interferes with hepatic and renal clearance of many chemical agents, thus resulting in unanticipated elevations in the blood levels of other pharmaceutical substances. This is a potentially dangerous situation in people who have to take other drugs and requires careful monitoring by a health professional. The long-term use and efficacy of St John's Wort in severe depression cannot be determined mainly due to inadequate data. This situation should change fairly rapidly because several major studies are now being conducted.

Ginkgo Biloba

Ginkgo Biloba is commonly used in combination with antidepressants in the treatment of antidepressant-induced sexual dysfunction. Ginkgo is a deciduous tree that has been recognized for over two thousand years in China and Japan as a medicinal plant. The medicinal properties of the leaves, either used in a tea infusion or having an extract distilled from them, have been identified and promoted by herbalists. Ginkgo Biloba been used in the treatment of a variety of ailments, including depression in the elderly. The nuts of the tree have been used to treat digestive complaints and recurrent bedwetting in the young. Recent studies show that side effects do not appear to be a prominent problem, however, there have been reports of mild gastro-intestinal problems and headaches.

Acupuncture

Acupuncture originated in China, Japan and other Eastern countries as part of an ancient system of healing. The earliest records of acupuncture date back over 2,000 years and today there are over 3,000,000 practitioners worldwide. While the majority of these practice in Eastern Asia, the last 50 years has seen an increase in acupuncturists in the Western world.

The practice of acupuncture is thought to have begun with the discovery that the stimulation of specific areas on the skin affects the functioning of certain organs of the body. It has evolved into a system of medicine believed to restore and maintain health as a result of the effects of stimulation produced by the insertion of fine needles into acupuncture points just beneath the body surface.

Taoist theories of acupuncture state that there are two types of 'energies' that flow in 'meridians' throughout the body and that an imbalance of these energies constitutes illness. By inserting needles into specific points along these meridians, it is believed that the imbalance is corrected and health restored. Western theories on acupuncture, however, attribute its alleged benefits to neurophysiological and related psychological effects.

Normally, acupuncture is carried out in specialized clinics by doctors, or more commonly, by qualified therapists. During acupuncture treatment, needles are either inserted for a second or two, or left in place for up to 20-30 minutes, depending on the effect required. There may be a heavy sensation in the limbs and a pleasant feeling of relaxation during this time.

Although treatment can sometimes produce rapid results, it more often requires at least 6 to 12 sessions, with beneficial change usually being seen after about 5 treatments.

Aromatherapy

Aromatherapy involves a combination of gentle massage techniques with the inhalation or skin- absorption of essential plant oils. Essential oils are considered to be a condensed form of the vital life essence of aromatic plants and flowers. The ways of administering aromatherapy are by:

• breathing the aromatic vapors using an aroma diffuser or air freshener; and
• absorbing diluted oils through the skin in a bath or during massage.

For thousands of years, it has been believed that these oils have specific therapeutic effects on the body, mind and spirit. However, there is very little if any scientific evidence about the value of aromatherapy in the treatment of mental illness. In particular there have been no randomized studies with large sample groups and so at present it is not possible to draw conclusions about the value of aromatherapy for depression or for any other mental illness.

Homeopathy

Homeopathy is a system of healing which claims to assist the natural tendency of the body to heal itself. It teaches that all symptoms of ill health are expressions of disharmony within the whole person, and that it is the patient who needs treatment and not the disease. In this respect it is not unlike several traditional healing approaches developed in Eastern Asia and India and also has tenets which are similar to those of Western orthodox medicine in its development of the concept of 'holistic medicine'.

Homeopathy was introduced as a different approach to curing the sick by a German doctor, Samuel Hahnemann, in 1796. Like Hippocrates two thousand years earlier he suggested that there were two ways of treating ill health - by the way of opposites and by the way of similars. Take for example a case of insomnia. The way of opposites is to treat this by giving a drug to induce sleep which may be artificial. Improperly administered, this may involve the use of repeated or regular doses of drugs which frequently leads to tachyphylaxis (loss of effect), dependency and sometimes physiological addiction. The way of similars, in the homeopathic way, is to give the patient a minute dose of a substance, such as coffee, which in large doses causes sleeplessness in a healthy person. This is claimed to help the patient to sleep in a healthy way.

Homeopathic remedies are usually administered in the form of tablets, powders or liquids. Instructions usually include that nothing else should be put in the mouth for 20 minutes before or after taking the remedy, not even toothpaste or cigarettes. The homeopath will usually advise the avoidance of coffee, peppermint and preparations containing menthol, eucalyptus and camphor, as these are thought to interfere with the action of the homeopathic remedy.

Homeopathic remedies do not directly cause side effects (although psychological reactions or placebo effects can occur) and addiction does not occur. This is because only a very minute amount of the active ingredient is used in a specially prepared form. Homeopathic practitioners claim to provide homeopathic medicine or remedies that match the individual's symptoms. This is said to take account of each person - his/her individual characteristics emotionally as well as physically. Its scientific status remains obscure in the absence of appropriate trials of efficacy.

Massage therapy

Massage therapy involves methodical 'hands-on' application of mobilization and pressure to the body's soft tissue including muscle and fascia. The supposition that this has therapeutic effect lies in the belief that massage promotes blood and lymph flow locally as well as making muscle and connective tissue supple. Following muscular exertion massage is said to aid in dispelling the build up of lactate that might cause cramps.

The principles of modern-day massage techniques were described over 100 years ago by the creator of Swedish massage called Per Henrik Ling. Massage therapy is an accepted therapeutic practice in most health care systems where it may be used to treat a variety of symptoms including pain, other physical symptoms and even mental symptoms. It has not been shown to have any curative effect in grave or life-threatening medical illnesses but its benefit for people with mental disorders may be as a form of relaxation therapy.

A massage therapist may use one of the many techniques in use today, utilizing an array of different application methods to meet the specific needs of the client. Massage can be used on people of all ages. Sessions vary in time but a full body massage usually lasts about one hour. Massage therapy can also be combined with other therapies, for example, the use of aromatherapy or reflexology where pressure is applied manually to specific reflex points on the feet. Several techniques are below.

Percussion: The use of rhythmic drumming movements over the body part, especially the back.
Trigger point therapy: the use of focal and sustained finger pressure to painful taut areas in the muscle and surrounding tissues referred to as trigger-points. These occur in such conditions as fibromyalgia.

Sports massage: this employs various massage techniques in the sports setting where the goal is to enhance performance as well as augment recuperation from injury (strains, tendonitis) and prevent injury.

Deep tissue massage: Powerful manual strokes of slow rhythm combined with concentrated finger pressure to areas of chronic tension or stiffness. It aims to relieve stiffness and regain flexibility of an area such as a stiff neck or a tight shoulder area.

Petrissage: This involves grasping the tissue group and applying pressure via kneading, rolling, or pressing in an on-off rhythmic manner.

The claimed benefits of massage therapy include:

• decrease in serum cortisol levels, and increases in levels of natural killer cells (which suggests there may be immunological benefits);
• reduction in the intensity of anxiety and depressive symptoms;
• the reduction of pain and stiffness in muscles;
• improvements in joint range and movement;
• assistance with stress management; and
• help in managing work or sport related injuries to soft tissue, including muscles.

Massage should, however, be used with caution. It can aggravate existing swelling and oedema of tissues. Hence, during pregnancy, it is recommended that massage be used only after advice from an obstetrician. Abdominal massage should be avoided in the first three months of pregnancy. Massage should also be avoided:

• where there is a skin infection or open wound;
• following chemotherapy;
• in areas where there is significant bruising or recent bleeding;
• in areas where there has been a recent fracture; and
• during the immediate post-operative period

People who have experienced traumatic sexual abuse may be very uncomfortable with the manual approach used in massage therapy. This obviously precludes some of the benefits massage seeks to achieve, such as a feeling of relaxation, and in these circumstances may be actively rejected.