Complementary and Alternative Treatments for Late-Life Depression, Anxiety, and Sleep Disturbance: A Review of Randomized Controlled Trials

Thomas W. Meeks, MD; Julie L. Wetherell, PhD; Michael R. Irwin, MD; Laura S. Redwine, PhD; Dilip V. Jeste, MD

J Clin Psychiatry 2007;68(10):1461-1471

Article Abstract

Objective: We reviewed randomized controlled trials of complementary and alternative medicine (CAM) treatments for depression, anxiety, and sleep disturbance in nondemented older adults.

Data sources: We searched PubMed (1966-September 2006) and PsycINFO (1984-September 2006) databases using combinations of terms includingdepression, anxiety, and sleep; older adult/elderly;randomized controlled trial; and a list of 56 terms related to CAM.

Study selection: Of the 855 studies identified by database searches, 29 met our inclusion criteria: sample size >= 30, treatment duration >= 2 weeks, and publication in English. Four additional articles from manual bibliography searches met inclusion criteria, totaling 33 studies.

Data extraction: 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.

Data synthesis: 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.

Conclusions: 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.