Abstract

BackgroundUp to 50% of individuals diagnosed with depression are known to use complementary and alternative medicine (CAM). The aim of this study was to identify the quantity and assess the quality of CAM recommendations in clinical practice guidelines for the treatment and/or management of depression in adults using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.MethodsA systematic review was conducted to identify depression guidelines. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible guidelines published by non-profit agencies on treatment of depression for adults were assessed with the AGREE II instrument twice, once for the overall guideline and once for the CAM sections.ResultsFrom 931 unique search results, 19 guidelines mentioned CAM, of which 16 made CAM recommendations. Scaled domain percentages from highest to lowest were as follows (overall, CAM section): clarity of presentation (87.0, 66.1%), scope and purpose (80.9, 77.6%), stakeholder involvement (62.0, 44.3%), editorial independence (61.6, 61.6%), rigour of development (58.0, 52.0%), and applicability (42.2, 25.4%). Quality varied within and across guidelines. Only 1 of 16 guidelines was recommended without modifications for both its overall and CAM sections by both appraisers.ConclusionsThere are multiple depression guidelines containing CAM recommendations available and there are a comprehensive set of CAM therapy options for depression. The quality of guidelines varied within and across guidelines and the quality of CAM recommendations was generally lower than the overall recommendations in the guidelines for all domains except editorial independence. Generally, characteristics of guidelines, including the year of publication and region of development varied across the guidelines irrespective of quality. Guidelines with higher AGREE II scores can serve as a guide to facilitate communication between patients and medical professionals regarding CAM use for depression, while guidelines with lower scores could be improved in future updates using the AGREE II instrument as a guide.

Highlights

  • Up to 50% of individuals diagnosed with depression are known to use complementary and alternative medicine (CAM)

  • There are multiple depression guidelines containing CAM recommendations available and there are a comprehensive set of CAM therapy options for depression

  • Guidelines with higher AGREE II scores can serve as a guide to facilitate communication between patients and medical professionals regarding CAM use for depression, while guidelines with lower scores could be improved in future updates using the AGREE II instrument as a guide

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Summary

Introduction

Up to 50% of individuals diagnosed with depression are known to use complementary and alternative medicine (CAM). Depression is classified based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD) [4, 5] It is defined by the intensity and persistence of symptoms such as a reduction in mood, hopelessness, fatigue, a loss of interest in almost all activities, appetite or weight changes, and a decrease in activity, manifesting close to every day for a minimum of 2 weeks, where the depressive episodes are not associated with or a result of another medical condition or a substance or drug [3, 5]. According to the National Center of Complementary and Integrative Health (NCCIH), CAM is a diverse set of therapeutic forms or “health care approaches that are not typically part of conventional medical care or that may have origins outside of usual Western practice”

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