Complementary and alternative medicines

Which CAMs can be used for mental health problems?

Many treatments have been used, some more successfully than others. Your choice should be guided by their safety and effectiveness. If they are safe and do not interfere with other treatments, then anything that makes you feel good can be used.

How good are they?

Very little research has been done into these treatments. Research is expensive and many of the studies are too small to give a clear answer. Most research has been done on treatments for depression, anxiety and insomnia.

Finding an expert can be difficult.

Your doctor, nurse or pharmacist can give you some guidance, or may be able to suggest someone who knows more.

It's best to choose a CAM therapist with a recognised qualification, who is member of a regulated society.  

See Finding a practitioner below.

• Keep an open mind about the different options available.
• If in doubt, seek advice from your doctor, nurse or pharmacist.
• Tell the therapist about any illness, seizures or allergies, or if you plan to become pregnant or breast-feed.
• Discuss your concerns about conventional treatments.
• Ask about your therapist’s qualification and experience.
• Ask about the side-effects of treatment.
• Seek medical advice if you experience unusual symptoms.
• Make special time for your treatment sessions.

Acupuncture involves piercing the skin with fine needles. There are two types:

• Traditional Chinese acupuncture involves placing the needles along assumed energy channels or ‘meridians’. This is done in order to restore a disturbed energy balance which is theoretically responsible for illness.
• The Western medical approach uses similar techniques without using the energy concept. In the West, acupuncture is mainly used as a treatment for pain. Its use for mental health problems is still in its infancy

How is the strength of acupuncture determined?

The dose of acupuncture can be varied by the needle sites, the depth and duration of insertion, the number of needles and the number of sessions. The dose can also be increased by manual stimulation of the needles, or electrical stimulation. This is where the dose is increased by running a small electric current through the needles. Moxibustion is when the needles are heated by burning mugwort.

Which mental health problems can be treated with acupuncture?

Anxiety, depression, stress and insomnia can all be treated. If you don’t feel an improvement after several sessions, or your symptoms become severe, you should seek medical help.

How well does it work?

Anxiety

Acupuncture seems to reduce anxiety. Most research has studied its effect on conditions such as tooth extraction, withdrawal from alcohol addiction, and diseases such as cancer. It can help calm people down in these situations.

Depression

We don't really know whether it works, as only a few small studies have been done and the results are conflicting. Acupuncture could possibly be combined with antidepressants in some cases.  Electro-acupuncture may be the most effective method. This seems to have a similar effect on muscles as exercise, which has been shown to improve mood.

Stress

Anxiety, agitation and low mood may be improved.

Insomnia

About 1 in 10 people feel tired after acupuncture. It comes as no surprise that acupuncture has been used to treat insomnia, and some studies suggest that it may work. The main drawback is that the insomnia may come back once the treatment is stopped.

What about addiction and acupuncture?

Acupuncture is used to treat withdrawal symptoms, but on its own does not seem to help people overcome their addiction to smoking, drinking or drugs. More research needs to be done to understand how acupuncture could help people with addiction problems.

Side-effects of acupuncture

If you are sensitive to pain, or if you have fibromyalgia or chronic fatigue with muscle pain, it may not help you. This is because your pain sensitivity could make the treatment uncomfortable or painful. However, one recent trial has shown that it may reduce pain in fibromyalgia.

Most people get very few side-effects. Some needle points require more caution than others, for instance, those in the chest.

Common side-effects include bruising, bleeding and pain. Some people can faint which is why the first session should be conducted lying down.

Some people can also become very tired. If this happens to you, then do not drive after the sessions. Similarly, you should not drive to the first session in case this happens to you.

Infection can occur, but since acupuncture needles are only used once, this is unlikely. Some people get anxious or have a strong emotional reaction to the treatment.

If this happens during the session, it might be best to stop and discuss what happened. Sometimes it can help to simply lower the dose. Tell your acupuncturist if you may be pregnant.

Are there serious side-effects?

Acupuncture involves needles, so it is possible to pierce organs, nerves and blood vessels.

In the worst case, needling over the chest or back could pierce the heart or lungs. Skilled therapists would avoid such injuries.

However, if you get breathing difficulties after needling of the chest and upper back, you should consult a doctor immediately and explain that you had acupuncture.

Ear acupuncture

Ear acupuncture, or auriculotherapy, involves inserting very fine needles into the surface of the ears.

The needles are never inserted into the openings of the ear. Since ears are prone to infections, the skin area should be cleaned and disinfected. Ear acupuncture has been used to treat addiction and pain.

Some people use needles which stay in the ear, sometimes for up to two weeks. These needles are more prone to infection, and people who suffer from heart valve disease must never use them.

People who are treated with steroids, or have diabetes, also have a higher risk of infection.

TENS is short for Transcutaneous Electrical Nerve Stimulation. Electrodes are placed on the skin, so no needles are used. TENS is mainly used as a treatment for pain.

This is based on the healing properties of plant oils.

These oils are diluted in a 'carrier oil'.  The oils are commonly used in oil burners, in bath water, or massaged into the skin. 

The aroma of the essential oil evaporates and stimulates the sense of smell. An aromatherapy massage is based on techniques to relieve tension and improve circulation.

Practitioners believe this allows oil molecules to be absorbed into the blood stream during massage, and then passed through the body to the nervous system.

People use aromatherapy for relaxation, sleep improvement, pain relief and to help depression.

Its effects are weak, so it is best to use it in conjunction with conventional treatments.

Aromatherapy is safe, but some oils should not be used if you are pregnant or have epilepsy, or in babies and young children.

Some oils can lead to allergies or increased sensitivity to light.

Homeopathy uses the principle of 'like to cure like'. This involves using extremely diluted substances to avoid toxicity.

The medicines may be so diluted that very few, or no, molecules of the original substance are present in the tablets or solutions taken.

Homeopathic medicines are prepared from minerals, plants and animal substances. The more diluted the solution, the stronger the 'claimed' effect. This is one of the most controversial aspects of homeopathy.

There is a lot of scepticism about the effectiveness of homeopathy, and using it as a substitute for conventional treatments is unwise.

However, some people find it helps to combine homeopathic and conventional medicines. Homeopathic remedies are very safe because they are highly diluted.

Yoga is a technique which is more than 5,000 years old.

'Yoga' means 'union' in Sanskrit. It uses spiritual and physical exercises to heal mind and body.

The exercises need to be adapted to suit the person. Yoga can have a calming and relaxing effect, and reduce agitation.

It may be useful for anxiety and stress. Yoga has also been tested as a treatment of depression and epilepsy, but the findings are inconclusive.

Biofeedback is a technique where bodily functions which are usually ignored, or perceived as automatic, are monitored in order to control them.

These functions include heart or breathing rate, blood pressure, sweating and muscle tension.

Monitors are attached to measure and provide feedback of the chosen function. It can be used for agitation, anxiety and stress, but it is difficult to draw firm conclusions about its effectiveness.

One of the main criticisms is that it is costly and similar effects can be achieved through meditation or relaxation.

Relaxation is usually used to reduce agitation and arousal. One technique is progressive muscle relaxation.

This involves tensing and relaxing different muscle groups. It is useful for problems associated with muscle tension, and can help in anxiety and asthma. Sessions take about 20 minutes.

The exercises need to be done every day to work. Autogenic training is another technique and involves autosuggestion to control breathing, heart rate and muscle tone.

 'Reiki' relates to spiritual life force and energy. Reiki therapists claim to channel energy from their hands to the client which leads to healing.

Advanced reiki therapy involves healing from a distance. Reiki therapy is controversial. If reiki is not successful, some therapists may claim that this is because the client was blocking the energy.

This could result in people wrongly blaming themselves for the therapy not working. The evidence for reiki being effective is poor.

Therapeutic touch is a concept related to Reiki, but there is no distance healing.

This treatment works on the principle that specific points in the feet, hands and ears represent certain body systems or organs.

Illness is seen as a sign that the person is out of balance, and that energy flows are disturbed.

By applying pressure point massage, the energy flows and balance is restored. Reflexology can give a sense of well-being and relaxation and it may be help in stress, anxiety and poor sleep.

If symptoms are severe, reflexology may not work. In such cases, it still can be a useful additional treatment.

Finding a well-trained practitioner can be difficult. You can ask your doctor or mental health professional to suggest a qualified practitioner.

Acupuncture

The British Medical Acupuncture Society trains doctors and health care professionals.

The British Acupuncture Council represents non-medically qualified practitioners trained in traditional Chinese acupuncture.

Aromatherapy

The Aromatherapy Council has a national register of aromatherapists who meet the agreed national standards for training, professional skills, behaviour and health.

Homeopathy

The website for the British Homeopathic Association has a register of medically qualified homeopaths.  

The Royal London Hospital for Integrated Medicine, formerly The Royal London Homeopathic Hospital, has been part of the NHS from its beginnings in 1949. The hospital offer a whole range of other complementary and alternative medicines.

Hypnosis

The National Council for Hypnotherapy represents over 700 practitioners within the United Kingdom.

The British Institute of Hypnotherapy is an association of hypnotherapists, Psychotherapists, and neuro-linguistic programming practitioners.

The General Hypnotherapy Register is the registering agency for the General Hypnotherapy Registering Council.

All three organisations offer accreditation and operate a code of practice as well as grievance and complaints procedures.

Reiki

All members of the UK Reiki Federation of practitioners and teachers, have undersigned to the Federation’s code of ethics, have Reiki insurance and hold Reiki certificates.

Reflexology

The Association of Reflexologists is the foremost aspirational and independent Professional Association for reflexology in the UK since 1984, providing benefits, advice and guidance to reflexologists and working with other external bodies and advisory groups to promote the highest standards in the profession. 

Yoga

The British Wheel of Yoga is recognised by the Sports Council as the national governing body for yoga in Great Britain. 

It represents the UK at the European Federation of National Yoga Organisations and offers a training and accreditation programme for professional qualifications.

BWY also accredits other organisations’ training programmes.

MedlinePlus:

This is a website run by the US National Institute of Health. The homepage has a search option allowing you to type in different keywords, to enable you to retrieve the information you want.

Typing the keyword “alternative medicine” or “drug information” will direct you to the relevant sites. Navigating with the buttons on the top of the menu will help you to find what you are looking for.

National Center for Complementary and Integrative Health / National Institutes of Health:

This website from the US offers very comprehensive information on complementary medicines. It is easy to surf.

Of particular interest is the clinical trial register, which gives an overview of the evidence base collated in the US.

Obviously this needs to complemented with information from other clinical trial databases, such as the Cochrane collaboration. Click on “news and events” for important safety updates.

Mayo Clinic – complementary and integrative medicine:

An American website that offers a wealth of information on all sorts of complementary alternative medicines.

NHS – Complementary and alternative medicine:

This website is very helpful to get information on all aspects of complementary and alternative medicines, ranging from individual treatment to regulation of medicines and how to find a practitioner.

Quackwatch: 

Quackwatch is “a non-profit corporation whose purpose is to combat health-related frauds, myths, fads, fallacies, and misconduct."

Its primary focus is on quackery-related information that is difficult or impossible to get elsewhere.

This website can be very helpful to consult when rather unusual treatments are suggested, particularly if high fees are to be paid in advance.

Some people may find the website too provocative and over-sceptical towards complementary medicines.

Click onto the “cheers and jeers” section to get a flavour of the site.

This information was produced by the Royal College of Psychiatrists' Public Education Editorial Board.

• Author: Dr Ursula Werneke
• Editor: Dr Philip Timms

The  contents reflect the best available evidence at the time of writing.