Supplementary appendix - The Lancet

Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Thirthalli J, Zhou L, Kumar K, et al. China–India Mental Health Alliance. Traditional, complementary, and alternative medicine approaches to mental health care and psychological wellbeing in India and China. Lancet Psychiatry 2016; published online May 18. http://dx.doi.org/10.1016/S2215-0366(16)30025-6.

Appendix 1 “Registered Medical Practitioners” (RMPs) of India: The term “Registered medical practitioners” (RMP) is used to denote non-formally trained healthcare providers who provide a mix of AYUSH and biomedical treatments. The origin of the term RMP dates to 1933, when the colonial government introduced a system of provision of state registration for unqualified people with successful medical practice for ten years or evidence of apprenticeship with experienced practitioners1. Today, although only MBBS/BDS or AYUSH-qualified doctors are legally permitted to register and practice medicine, the term RMP has persisted. Some RMPs have acquired degrees and diplomas from non-authentic sources2,3. A number of them have taken to the practice of medicine after having acquired experience in the healthcare field as traditional birth attendants or assistants to qualified physicians. They account for about half of healthcare providers 4. As they provide affordable, around the clock, fast, friendly care and as they are located nearby, they have a fair degree of acceptance by the community; further, they permit deferred payment or payment in kind5, which contributes to their popularity among the poor. Prescription practices of the RMPs 6 and symptom profile of patients that seek treatment with them7 suggest that a large number of those with mental disorders consult them. Case studies suggest patients visit RMP with the same types of symptoms they present to formally trained practitioners, and in many cases believe them to be just as competent for common illnesses.

1

Appendix 2 Dawa aur dua: The fusion of medicine and prayer8: Sayyad Ali Mira Dattar dargah is a Muslim Shrine in Unava village in the state of Gujarat, India. The dargah has visitors from around the world, irrespective of caste, creed and religion. A large proportion of these have a variety of mental disorders. In a first-of-its-kind initiative, the state government, an NGO called Altruist and trustees of the dargah have come together to provide psychiatric care for them. The basic idea of not antagonizing the beliefs of the individuals who seek help there and of providing psychiatric care closely working with their faith seem to have been successful. The faith-healers at the shrine have been trained by the members of the NGO to identify mental illnesses. After providing religious care for those with psychiatric problems, the faith-healers direct them to the psychiatric outpatient clinic, which is located inside the dargah. Psychiatrists and psychologists have been providing medical and psychological care respectively since 2008. On an average, 15 – 20 patients receive the fusion of care in this center daily. The successful collaboration between the faith-healers and biomedical specialists has encouraged similar experiments elsewhere9.

Psychiatrist working with the faith-healers in Tamil Nadu

2

References: 1.

George A, Iyer A. Unfree markets: socially embedded informal health providers in northern

Karnataka, India. Social science & medicine 2013; 96: 297-304. 2.

Ashtekar S, Mankad D. Who cares? Rural health practitioners in Maharashtra. Economic and

Political Weekly 2001 Feb 3 - 10: 448 - 53. 3.

Kumar R, Jaiswal V, Tripathi S, Kumar A, Idris M. Inequity in health care delivery in India: the

problem of rural medical practitioners. Health Care Analysis 2007; 15(3): 223-33. 4.

Sudhinaraset M, Ingram M, Lofthouse HK, Montagu D. What is the role of informal healthcare

providers in developing countries? A systematic review. PloS one 2013; 8(2): e54978. 5.

May C, Roth K, Panda P. Non-degree allopathic practitioners as first contact points for acute

illness episodes: insights from a qualitative study in rural northern India. BMC health services research 2014; 14(1): 182. 6.

Ecks S, Basu S. “We Always Live in Fear”: Antidepressant Prescriptions by Unlicensed Doctors

in India. Culture, Medicine, and Psychiatry 2014; 38(2): 197-216. 7.

Rao P. Profile and practice of private medical practitioner in rural India. Health and population

2005; 28(1). 8.

Hamlai M. Dava & Dua Program. http://thealtruist.org/dava-dua-program/ (accessed May 10,

2016). 9.

The Hindu. Dawa-dua programme gaining momentum. Feb 20, 2014.

http://www.thehindu.com/todays-paper/tp-national/tp-tamilnadu/dawadua-programme-gaining-moment um/article5708147.ece (accessed May 10, 2016).

3

Supplementary table-1: State-wise distribution of AYUSH practitioners Distribution of Average

Distribution of

Distribution of

Distribution

Distribution of

average

number

Distribution of

AYUSH

AYUSH

of

average admission

Distribution of

admission

of

AYUSH

registered

practitioners

AYUSH

capacity to

AYUSH

capacity to

State / Union

beds per

dispensaries

practitioners in

per 10 million

undergradu

undergraduate

postgraduate

post-graduate

Territory

hospital

in India

India (%)

population

ate colleges

institutions

Colleges

institutions (%)

A & N islands

5

Andhra Pradesh

58

Arunachal Pradesh

11

Assam

51

Bihar

119

Chandigarh

40

Chhattisgarh

48

Delhi

132

Goa

0

Gujarat

51

Haryana

68

Himachal pradesh

21

J&K

38

Jharkhand

70

Karnataka

49

3%

5.6

6497

15%

14.00%

21%

23.60%

Kerala

31

6%

4.6

9940

5%

4.10%

6%

6.00%

3%

3.1

2624

1%

1.00%

2%

1.20%

1972 0.40% 9%

18.2

4% 1.4

12129

5%

4.60%

2%

1656

1.60%

5680

1.30%

3%

7.10%

4%

1.70% 0.50%

7689 3%

5.8

6704

1.8

4933

4%

6%

2.20%

1.50%

8391

1.20%

3892

4

Madhyapradesh

30

7%

8.5

8168

8%

9.40%

5%

3.00%

Maharashtra

89

2%

18.4

11550

23%

25.30%

34%

37.20%

Manipur

15

Meghalaya

10

Mizoram

10

Odisha

65

5%

1.9

3183

2%

1.40%

1%

Puducherry

0

Punjab

0

3%

1.4

3526

3%

3.10%

Rajasthan

11

15%

2.3

2380

4%

4.30%

2%

4.00%

Tamil Nadu

9

4%

4.4

4330

6%

5.50%

3%

4.10%

Tripura

15

Uttar pradesh

6

8%

12.2

4264

8%

6.60%

7%

5.00%

Uttarakhand

5

West Bengal

73

8%

6.3

3%

3.00%

2%

1.70%

Others

0

16%

4.1

11%

6.30%

8%

6.90%

1.40%

2547 4910

5

Supplementary table-2: Number of consultations in government-run AYUSH centers for different conditions in 2013-14 Sl.No.

System

Names of included conditions

No. of

Percentage

patients 1.

Cardiovascular system

Heart Disease/Cardiovascular

31669

0.11%

583996

2.03%

Hypertension/heart 2.

Head and Neck

1.

Dental Disease

2.

ENT

3.

Eye diseases

4.

Shiroroga (Diseases of head including headaches)

5.

Sinusitis

6.

Tonsilitis

3.

Endocrine

Endocrine disorders

227

0.00079%

4.

Gastro intestinal system

1. Acid Peptic Disease

6218474

21.62%

5965695

20.75%

319297

1.11%

2. Amlapitta (gastritis) 3. Amoebiasis 4. Constipation 5. Diarrhoea 6. Gastric ulcer etc 7. Kabj (Constipation) 8. Gastrointestinal system 9. Hepatitis 10. Intestinal infections 11. Loss of appetite 12. Pravahika 13. Typhoid 14. Udara 15. Vomiting 16. Worms (Parasitic infestations) 5.

General

1. Anaemia 2. Fever/General 3. General debility 4. Obesity 5. Others

6.

Genito urinary/Genito

1. Genito-rectal

rectal

2. Genito-Urinary Diseases 3. Sexually Transmitted diseases (STD) 6

4. Urinary system 7.

Gynaecology

Female disorders

1369182

4.76%

8.

Metabolic disorders

1. Diabetes/HTN

64846

0.23%

2. Metabolic disorder 9.

Nervous system

Nervous system

444823

1.55%

10.

Orthopaedic and

1. Amavata (Rheumatoid Arthritis)

3735655

12.99%

Musculoskeletal

2. Arthritis (Osteoarthritis)

(including nervous

3. Avabahuka (frozen shoulder and

system complaints)

related disorders) 4. Backache 5. Chickungunya 6. Knee pain 7. Musculokeletal & connective tissue 8. Orthopedic 9. Paralysis 10. Myalgia 11. Spondylosis 12. Vatakantaka (ankle and heel sprains/calcaneal spur) 13. Vatavyadhi (Nervous system disorders) 14. Sciatica

11.

Paediatrics

Paediatrics

9944

0.03%

12.

Psychology

Psychiatric diseases

1911

0.007%

13.

Respiratory diseases

1. Asthma

5757855

20.03%

3299721

11.48%

661318

2.30%

2. Bronchitis 3. Common cold 4. Cough 5. Respiratory system 14.

Skin

1. Kandu (diseases characterized by urticaria) 2. Skin and subcutaneous 3. Vitiligo

15.

Surgical & Ano-rectal

1. Calculi 2. Lipoma 3. Piles/fistula 4. Shalya roga (Diseases requiring surgery) 5. Warts Total

28749613

7

8

Supplement Table 3: Systematic Reviews and Meta-analyses on the Effectiveness of Acupuncture on Mental Illnesses Referenc

Studies

e

Comparisons

Results

Author’s conclusions

Vascular mild

Acupuncture alone

Cognitive

The methodological quality of all included trials

The current clinical evidence

cognitive

or combined with

function training,

was unclear and/or they had a high risk of bias.

is not of sufficient quality for

impairment

cognitive function

rehabilitation,

Meta-analysis showed acupuncture in conjunction

wider application of

training, or

medication

with other therapies could significantly improve

acupuncture to be

rehabilitation, or

Mini-Mental State Examination scores (mean

recommended for the

medication

difference 1.99, 95% CI 1.09 to 2.88, random

treatment of vascular mild

model, p placebo acupuncture,

relaxation, and techniques to

training,

placebo

no treatment. The RCT compared lavender oil scent

increase patients’ sense of

benzodiazepine

acupuncture, no

with no scent shower dental anxiety did not differ

control over dental care are

premedication,

treatment

between conditions, and state anxiety was lower in

also efficacious but perform

lavender scent condition.

best when combined with

music distraction, hypnotherapy,

repeated, graduated

acupuncture (1

exposure. Other

RCT), nitrous oxide

interventions require further

12

Guo XX (2008)

Dementia

study in randomized trials

use of lavender oil

before conclusions about

scent (1 RCT)

their efficacy are warranted.

Acupuncture

11

Huang

13 RCTs

YF (2011)

22 RCTs

sedation, and the

12

Western

Only two out of the 22 RCTs are of high quality

Acupuncture therapy is

medications

based on Jadad score. Meta-analysis was performed

effective on dementia

based on 19 trials. The total OR is 3.72 [95%CI

according to the domestic

2.73 to 5.07]. The funnel plot was a proximately

clinical literatures. However,

symmetry, which indicated that the curative effect

the quality of the studies

of acupuncture groups was better than the control

needs further improving and

groups (Z= 8.32, P < 0.0001).

increasing.

Meta-analyses showed that the effective rate in the

Acupuncture was a relative

Perimenopausal

Acupuncture, alone

Antidepressants

depression

or plus

acupuncture combined with western medicine

safe method with few

antidepressants

group was higher when compared with western

adverse reactions. In

medicine [OR=1.01, 95%CI 1.38, 5.51] and also

combination with western

the cure rate [OR=2.91, 95%CI 1.82, 4.65]. As for

medicine, acupuncture in the

acupuncture compared with western medicine, no

treatment of perimenopausal

significant difference was noted in effective rate

depression reducing HAMD

[OR=1.08, 95%CI 0.64, 1.83], cure rate [OR=1.04,

rate shown potentially valid

95%CI 0.70, 1.56] and the HAMD score at week 2

tendency, while acupuncture

[WMD=-0.35, 95%CI -3.43, 2.72]; at week 4

compared to western

[WMD=0.01, 95%CI -1.96, 1.98]; at week 6

medicine therapy showed no

[WMD=-0.19, 95%CI -2.57, 2.18]. GRADE

statistical difference. Further

evidence classification is very low. The incidence

researches were required to

of adverse events of acupuncture (1.5%) was lower

define the role of

than western medicine group (12.5%).

acupuncture in the treatment

13

of perimenopausal depression neurosis. Jorm AF (2004)

13

Not

Anxiety

34 treatments

Placebo in most

108 treatments were identified and grouped under

The treatments with the best

reported

disorders or

groups under 4

studies, western

the categories of medicines and homoeopathic

evidence of effectiveness are

participants with

categories:

medicines in a

remedies, physical treatments, lifestyle, and dietary

kava (for generalised

anxiety

medicines and

few studies

changes. We give a description of the 34 treatments

anxiety), exercise (for

symptoms

hemoeopathic

(for which evidence was found in the literature

generalised anxiety),

remedies, physical

searched), the rationale behind the treatments, a

relaxation training (for

treatments,

review of studies on effectiveness, and the level of

generalised anxiety, panic

lifestyle, and

evidence for the effectiveness studies.

disorder, dental phobia and

dietary changes

test anxiety). There is more limited evidence to support the effectiveness of acupuncture, music, autogenic training and meditation for generalised anxiety

Jorm AF (2006)

14

Not

Children or

A variety of

reported

adolescents with

Not reported

Relevant evidence was available for glutamine,

Given that antidepressant

complementary and

S-adenosylmethionine, St John’s wort, vitamin C,

medication is not

depressive

self-help treatments

omega-3 fatty acids, light therapy, massage, art

recommended as a first line

disorder or

including herbs,

therapy, bibliotherapy, distraction techniques,

treatment for children and

elevated

homeopathy,

exercise, relaxation therapy and sleep deprivation.

adolescents with mild to

depressive

acupuncture, Tai

However, the evidence was limited and generally of

moderate depression, and

symptoms

chi, yoga, etc

poor quality. The only treatment with reasonable

that the effects of

supporting evidence was light therapy for winter

psychological treatments are

14

depression.

modest, there is a pressing need to extend the range of treatments available for this age group.

Kalavap

6 RCTs

Insomnia

alli R

and 13

(2007)

15

Acupuncture

No control or no

Despite the limitations of the reviewed studies, all

Acupuncture may be useful

(information

treatment or

of them consistently indicate significant

in the treatment of insomnia

other

about primary

diazepam

improvement in insomnia with acupuncture.

associated with other

studies

or secondary

psychiatric (major

insomnia were

depression, anxiety

not available)

disorders, etc.) and or medical conditions, however, the available data is not strong.

Lee MS (2009)

16

13 RCTs

Schizophrenia

Acupuncture alone

Antipsychotics

The methodological quality was generally poor and

These results provide limited

or combined with

alone or

there was not a single high quality trial. One RCT

evidence for the

antipsychotics

combined with

reported significant effects of electroacupuncture

effectiveness of acupuncture

sham acupuncture

(EA) plus drug therapy for improving auditory

in treating the symptoms of

hallucinations and positive symptom compared

schizophrenia. However, the

with sham EA plus drug therapy. Four RCTs

total number of RCTs, the

showed significant effects of acupuncture for

total sample size and the

response rate compared with antipsychotic drugs

methodological quality were

(RR: 1.18, 95%CI: 1.03–1.34). Seven RCTs

too low to draw firm

showed significant effects of acupuncture plus

conclusions.

antipsychotic drug therapy for response rate compared with antipsychotic drug therapy (RR:

15

1.15, 95% CI: 1.04–1.28). Lee MS (2009)

3 RCTs

17

Alzheimer’s

Electroacupuncture

Nimodipine,

The methodological quality of the trials was poor.

The existing evidence does

disease

alone or plus herbs

herbs,

Results of two RCTs on cognitive function

not demonstrate the

or perphenazine

Hupperzine,

suggested no significant effect in favour of


psychological

acupuncture. One RCT reported favourable effects

for AD

consultation,

of drug therapy compared with acupuncture for

perphenazine

activities of daily living, while the other failed to so. The meta-analysis of these data showed significant effects of drug therapy compared with acupuncture (WMD -1.29; 95% CIs: -1.77 to -0.80).

Leo RJ (2007)

9 RCTs

18

Depressive

Acupuncture alone

Wait list, sham

The Jadad scores of five out of the nine RCTs were

Despite the findings that the

disorder or

or combined with

acupuncture,

lower than 2. The odds ratios derived from

odds ratios of existing

individuals with

antidepressants

needling of true

comparing acupuncture with control conditions

literature suggest a role for

depressive

acupuncture

within the RCTs suggests some evidence for the


symptoms

points unrelated

utility of acupuncture in depression. General trends

of depression, the evidence

to the prevailing

suggest that acupuncture modalities were as

thus far is inconclusive.

depression,

effective as antidepressants employed for treatment

antidepressants,

of depression in the limited studies available for

massage

comparison. However, placebo acupuncture treatment was often no different from intended verum acupuncture.

Leung MCP (2013)

19

3 human

Stroke and

Acupuncture

Sham acupuncture

studies and

vascular

studies with greater

9 animal

dementia

statistical power are needed

16

The results of human studies were inconsistent.

Further high-quality human

studies

to determine the effectiveness of acupuncture and an optimal protocol.

Li XH (2012)

20

14 RCTs

Post-stroke

for needle

depression

1) Needle

Antidepressants

1) Six out of the 14 RCTs are of high quality

acupuncture;

This research preliminarily

based on Jadad scores. Meta-analysis showed

evinces that acupuncture

acupunctur

2) Electro-acupun

that comparing to antidepressants, needle

therapy and combined

e; 13 RCTs

cture (EA);

acupuncture treatment for PSD was more

acupuncture with

effective at the end of 6 weeks (OR=3.03, 95%

antidepressants are more

CI 1.32, 6.94).

effective than the use of

for

3) Acupuncture

electro-acu

plus

puncture;

antidepressants

2) Five out of 13 RCTs are of high quality based

antidepressants alone.

29 RCTs

on Jadad scores. Meta-analysis showed that the

However, the quality of

for

EA improved stroke patients with depression

researches are low.

Acupunctu

more effective than fluoxetine (OR=1.94,

re plus

95%CI 1.12, 3.36).

antidepress

3) Three trials out of 29 RCTs are high quality

ants

based on Jadad scores. Meta-analysis showed that patients suffered from PSD treated with EA together with fluoxetine improved much better than those merely treated with fluoxetine (WMD= -2.50, 95%CI -3.40 to -1.60).

Lin JG (2012)

10 RCTs 21

Opiate addiction

Acupuncture

No treatment,

The majority agreed on the efficacy of acupuncture

Cannot establish the efficacy

Sham

as a strategy for the treatment of opiate addiction.

of acupuncture in the

acupuncture,

treatment of opiate addiction

western medicines

because the majority of these studies were classified as

17

having low quality. Liu TT (2009)

11 RCTs

Opiate addiction

22

Acupuncture

Opioid agonists

Jadad score of each of the 11 included RCTs was 2.

This meta-analysis suggests

combined with

alone

Withdrawal-symptom scores were lower in

that acupuncture combined

opioid agonist

combined treatment trials than in agonist-alone

with opioid agonists can

treatment

trials on withdrawal days 1, 7, 9, and 10. Combined

effectively be used to

treatment also produced lower reported rates of side

manage the withdrawal

effects and appeared to lower the required dose of

symptoms. One limitation of

opioid agonist. There was no significant difference

this meta-analysis is the poor

on relapse rate after 6 months.

quality of the methodology of some included trials.

Ma TM (2007)

6 RCTs

23

Anxiety

Acupuncture

disorders

Medication, not

Homogeneity test was made among the trials and

The Meta analysis results

specifically

no significant difference between the acupuncture

was a trend in favor of

described

and non-acupuncture groups. Fixed effect model

acupuncture effectiveness. It

was used. ORP =1.76, 95% CI (1.34 to 2.32), there

seems no serious adverse

was significant difference between the acupuncture

reactions have been found.

group and medicine group as the interventions used

But there was no sufficient

to treat anxiety while there was no difference

reliable evidence due to the

between the two group on the influence in HAMA.

low quality of the trials and possible publication bias. Further randomized, double blind controlled trials are needed.

Meeks

33 RCTs

TW (2007)

24

Late-life

Various

Placebo, wait list,

67% of the 33 included studies were positive.

Most studies have substantial

depression,

complimentary and

treat as usual,

Positive studies have lower quality than negative

methodological limitation. A

anxiety, and

alternative

sham

studies.

few well-conducted studies

18

sleep

medicines including

acupuncture/acupr

suggested therapeutic

disturbance

yoga, Tai chi,

essure, western

potential of mind-body

Qigong, meditation,

medications

interventions for sleep

single herbs,

disturbance, acupressure for

Chinese herb

sleep and anxiety.

formulae, acupuncture, acupressure, etc Mills EJ (2005)

9 RCTs

25

Cocaine

Acupuncture

dependence

Relaxation,

The pooled odds ratio estimating the effect of

This systematic review and

anti-craving

acupuncture on cocaine abstinence at the last

meta-analysis does not

medication and

reported time-point was 0.76 (95% CI, 0.45 to 1.27,

support the use of

brainwave

P = 0.30, I2 = 30%, Heterogeneity P = 0.19).

acupuncture for the treatment

modification,

of cocaine dependence.

psychosocial treatment Mukaino

6 RCTs

Y (2005)

Depressive

Acupuncture alone

Sham

The evidence is inconsistent on whether manual

The evidence from

disorders

or combined with

acupuncture,

acupuncture is superior to sham, and suggests that

controlled trials is

antidepressants

waiting list,

acupuncture was not superior to waiting list.

insufficient to conclude

antidepressants

Evidence suggests that the effect of

whether acupuncture is an

electroacupuncture may not be significantly

effective treatment for

different from antidepressants, weighted mean

depression, but justifies

difference -0.43(95% CI -5.61 to 4.76).

further trials of

26

electroacupuncture. Pilkingto nK

10 RCTs

Generalised anxiety disorder

Acupuncture

Sham

Positive findings are reported for acupuncture in the

Overall, the promising

acupuncture, drug

treatment of generalised anxiety disorder or anxiety

findings indicate that further

19

(2007)27

Rathbon

or anxiety

5 RCTs

neurosis but there is currently insufficient research

research is warranted in the

neurosis or

evidence for firm conclusions to be drawn. There is

form of well designed,

perioperative

some limited evidence in favour of acupuncture in

adequately powered studies.

anxiety

perioperative anxiety.

Schizophrenia

eJ (2005)

28

therapy

Acupuncture alone

Antipsychotics

BPRS endpoint data (short term) favoured the

We found insufficient

or combined with

alone

combined acupuncture and antipsychotic group

evidence to recommend the

(WMD -4.31 CI -7.0 to -1.6), although

use of acupuncture for

dichotomised BPRS data ’not improved’

people with schizophrenia.

confounded this outcome with equivocal data.

The numbers of participants

antipsychotics

and the blinding of acupuncture were both inadequate. Ravindra

Not

Mood and

Physical therapies

Placebo

In unipolar depression, there is Level 2 evidence for

While several CAM

n AV

reported

anxiety

including Yoga and

alone/placebo

Free and Easy Wanderer Plus (FEWP), and Level 3

therapies show some

disorders

acupuncture; herbal

plus western

for exercise and yoga. In bipolar depression, there

evidence of benefit as

remedies;

medicines/sham

is evidence of Level 3 for FEWP. In anxiety

augmentation in depressive

Nutraceuticals

acupuncture

conditions, exercise augmentation has Level 3

disorders, such evidence is

support in generalized anxiety disorder and panic

largely lacking in anxiety

disorder.

disorders. The general dearth

(2013)

29

of adequate safety and tolerability data encourages caution in clinical use. Robinso

1 RCT and

A variety of

Shiatsu or

Sham points, care

Category 2 evidence was present for anxiety related

Evidence is improving in

nN

8 others

conditions

acupressure

as usual

to surgery. Fairly good evidence existed for

quantity, quality and

for

including pain,

agitation in dementia compared to control, although

reporting, but more research

(2011)

30

20

Shiatsu; 8

dementia, stress,

generalisability was limited by small sample size,

is needed, particularly for

MA/SR,

anxiety, sleep

lack of control, and high attrition.

Shiatsu, where evidence is

39 RCTs,

problems, etc.

poor. Acupressure may be

and 24

beneficial for pain, nausea

other

and vomiting and sleep.

studies for acupressur e Sarris J (2011)

20 RCTs

Insomnia

31

Acupuncture,

Sham

There was evidentiary support in the treatment of

Future researchers are urged

acupressure, natural

acupuncture,

chronic insomnia for acupressure (d =1.42-2.12),

to use acceptable

pharmacotherapies,

sleep hygiene

Tai chi (d= 0.22-2.15), yoga (d= 0.66-1.20), mixed

methodology, including

Tai chi, Yoga

device, placebo,

evidence for acupuncture and L-tryptophan, and

appropriate sample sizes and

health education,

weak and unsupportive evidence for herbal

adequate controls.

exercise, wait list,

medicines such as valerian.

western medicines Sarris J (2012)

32

14 RCTs

Obsessive

Nutrients, herbal

Placebo, western

In OCD, tentative evidentiary support was found

While several studies were

compulsive

medicines,

medicines, wait

for mindfulness meditation (d=0.63),

positive, these were

disorder,

acupuncture,

list, mindfulness

electroacupuncture (d=1.16), and kundalini yoga

un-replicated and commonly

trichotillomania

mindfulness

meditation,

(d=1.61). Better designed studies using the nutrient

used small samples. This

meditation, Yoga,

decoupling

glycine (d=1.10), and traditional herbal medicines

precludes firm confidence in

relaxation, alone or

milk thistle (insufficient data for calculating d) and

the strength of clinical effect.

as adjunct treatment

borage (d=1.67) also revealed positive results. A study showed that N-acetylcysteine (d=1.31) was effective in TTM. Mixed evidence was found for myo-inositol (mean d=0.98). St John's wort, EPA,

21

and meridiantapping are ineffective in treating OCD. Shen X (2014)

30 RCTs

Schizophrenia

33

Acupuncture alone

Standard dose

When acupuncture plus standard antipsychotic

All studies were at moderate

or combined with

antipsychotics,

treatment was compared with standard

risk of bias. Limited

standard, low dose

herbs, electric

antipsychotic treatment alone, people were at less

evidence suggests that

antipsychotics or

compulsive

risk of being ’not improved’ (n = 244, 3 RCTs,

acupuncture may have some

herbs

therapy

medium-term RR 0.40 CI 0.28 to 0.57, very low

antipsychotic effects as

quality evidence). When acupuncture was added to

measured on global and

low dose antipsychotics and this was compared

mental state with few

with standard dose antipsychotic drugs, relapse was

adverse effects.

less in the experimental group (n = 170, 1 RCT, long-term RR 0.57 CI 0.37 to 0.89, very low quality evidence) but there was no difference for the outcome of ’not improved’. When acupuncture was compared with antipsychotic drugs of known efficacy in standard doses, there were equivocal data for outcomes such as ’not improved’ using different global state criteria. Smith

30 RCTs

CA (2010)

34

Depression

Acupuncture, alone

Sham

There was a high risk of bias in the majority of

Insufficient evidence to

or combined with

acupuncture, no

trials. There was insufficient evidence of a

recommend the use of

antidepressants

treatment, wait

consistent beneficial effect from acupuncture

acupuncture for people with

list,

compared with a wait list control or sham

depression.

pharmacological

acupuncture control. Two trials found acupuncture

treatment, other

may have an additive benefit when combined with

structured

medication compared with medication alone. A

22

psychotherapies,

subgroup of participants with depression as a

standard care

co-morbidity experienced a reduction in depression with manual acupuncture compared with SSRIs. The majority of trials compared manual and electro acupuncture with medication and found no effect between groups.

Sniezek

6 RCTs

DP (2013)

35

Women with

Acupuncture alone

Counseling , sham

The quality of research varied heavily. There was a

Overall, there is a lack of

depressive or

or combined with

acupuncture,

significant difference between acupuncture and at

high-quality research on the

anxiety

counseling

nonspecific

least one control in all six trials.


disorders

acupuncture alone

for treating anxiety and

or plus massage,

depression in women. With

patient education

respect to six reviewed studies, there is high-level evidence to support the use of acupuncture for treating major depressive disorder in pregnancy.

Stub T (2011)

36

4 SRs and

Depressive

26 RCTs

disorders

Acupuncture

Sham

The methodological quality of the trial reports was

Current evidence from this

acupuncture,

generally low. A significant beneficial effect was

meta-analysis of randomized

antidepressants,

found for acupuncture in improvement of

trials shows that acupuncture

massage, wait list,

depression compared to pooled control measured by

is effective in reducing

non-specific

Hamilton Rating Scale for Depression

severity of depression and

acupuncture

(WMD−3.10, 95% CI−4.91 to−1.99). Subgroup

that TCM- and electro

analysis suggested that electro-acupuncture

acupuncture may have

(WMD−0.68, 95% CI−1.49 to 0.13) and TCM

similar effect as current usual

23

acupuncture (WMD 0.79, 95% CI−0.93 to 2.52),

care. More rigorous trials are

were not statistically different from medication.

needed and long-term effects should be investigated if acupuncture is to be recommended for clinical use.

Thachil

7 SRs, 9

Depressive

Herbs, nutritional

Placebo,

Grade 1 evidence on the use of St. John's wort,

None of the CAM studies

AF

RCTs, and

disorders

therapy,

antidepressants,

Tryptophan/5-Hydroxytryptophan, S-adenosyl

show evidence of efficacy in

acupuncture,

psychotherapy

methionine, Folate, Inositol, Acupuncture and

depression according to the

exercise, complex

Exercise in Depressive disorders, none of which

hierarchy of evidence. The

homeopathy, yoga,

was conclusively positive. We found RCTs at the

RCT model and the

traditional Chinese

Grade 2 level on the use of Saffron, Complex

principles underlying many

medicine

Homoeopathy and Relaxation training in

types of CAM are dissonant,

Depressive disorders, all of which showed

making its application in the

inconclusive results. Other RCTs yielded

evaluation of those types of

unequivocally negative results. Studies below this

CAM difficult.

(2007)

37

3 others

level yielded inconclusive or negative results. Tian TT (2012)

8 RCTs

38

Alzheimer’s

Acupuncture

disease (AD)

Nimodipine,

Meta-analysis showed significant differences in

Inconclusive due to low

Huperzine A,

acupuncture vs. Huperzine A (WMD=-0.81, 95%

quality and small sample size

Almitrine and

CI -1.02 to -0.59), acupuncture vs. donepezil

of the reviewed trials.

Raubasine,

(WMD=-1.42, 95%CI -2.32 to -0.52), acupuncture

donepezil,

vs. Oxygen (WMD=4.85, 95%CI 4.62 to 5.08),

Oxygen

while no significant differences were found in other comparisons.

Wahbeh

17 RCTs

Posttraumatic

Complementary

Waitlist, CBT,

Scientific evidence of benefit for posttraumatic

24

Several complementary and

H (2014)

39

and 16

stress disorder

medicine including

supportive

stress disorder was strong for repetitive transcranial

alternative medicine

other

(PTSD)

acupuncture,

counseling,

magnetic stimulation and good for acupuncture,

modalities may be helpful for

meditation, yoga,

medication,

hypnotherapy, meditation, and visualization.

improving posttraumatic

etc

psychotherapy,

Evidence was unclear or conflicting for

stress disorder symptoms.

massage, EMDR,

biofeedback, relaxation, Emotional Freedom and

Future research should

exposure, placebo

Thought Field therapies, yoga, and natural

include larger, properly

products.

randomized, controlled trials

studies

with appropriately selected control groups and rigorous methodology. Wang H (2008)

Wang L (2008)

8 RCTs

Depression

Acupuncture

Sham acupuncture

40

41

14 RCTs

Depressive

Acupuncture

Antidepressants

disorder

25

Our results confirmed that acupuncture could

Although this meta-analysis

significantly reduce the severity of depression. The

might be discounted due to

pooled standardized mean difference of the

the low quality of individual

‘Improvement of depression’ was −0.65 (95% CI

trials, it supported that

−1.18, −0.11) by random effect model. However,

acupuncture was an effective

no significant effect of active acupuncture was

treatment that could

found on the response rate (RR 1.32, 95% CI 0.83

significantly reduce the

to 2.10) and remission rate (RR 1.30, 95% CI 0.57

severity of disease in the

to 2.95).

patients with depression.

Only four of the trials used double blind method.

Both acupuncture and

Meta-analysis indicated that there was no

medication possibly are

significant difference between the effective rates of

effective for depression with

acupuncture treatment and medication, and

good safety. However,

acupuncture treatment was better than

because of lower

Amitriptyline in improvement of HAMD scores,

methodological quality of the

White A (2006)

42

but no significant differences as compared with

trials, this conclusion needs

other drugs.

further be confirmed.

13

Nicotine

Ear acupuncture,

Psychotherapy

Combining ten studies showed auricular

Auricular acupuncture

controlled

dependence

alone or plus

plus illustration or

acupuncture at ‘correct’ points to be more effective

appears to be effective for

psychotherapy or

medication, sham

than control interventions, odds ratio 2.24 (95% CI

smoking cessation, but the

counselling

ear acupuncture,

1.61, 3.10). Comparisons of three higher quality

effect may not depend on

‘incorrect point’

studies suggest that ‘correct’ and ‘incorrect’ point

point location. This calls into

acupuncture,

acupuncture is no different (odds ratio 1.22, CI

question the somatotopic

hypnosis, advice

0.72, 2.07); and two studies showed that ‘incorrect’

model underlying auricular

point acupuncture may be more effective than other

acupuncture and suggests a

interventions (odds ratio 1.96, CI 1.00, 3.86).

need to re-evaluate sham

studies

controlled studies which have used ‘incorrect’ points. White

38 RCTs

AR (2014)

43

Nicotine

acupuncture,

no intervention,

Based on three studies, acupuncture was not shown

Although pooled estimates

dependence

acupressure, laser

sham acupuncture

to be more effective than a waiting list control for

suggest possible short-term

stimulation or

or acupressure,

long term abstinence, with wide confidence

effects there is no consistent,

electrostimulation

nicotine

intervals and evidence of heterogeneity (RR 1.79,

bias-free evidence that

replacement

95%CI 0.98 to 3.28). Compared with sham

acupuncture, acupressure, or

therapy,

acupuncture, the RR for the short-term effect of

laser therapy have a

psychological

acupuncture was 1.22 (95%CI 1.08 to 1.38), and for

sustained benefit on smoking

intervention

the long-term effect was 1.10 (95%CI 0.86 to 1.40).

cessation for six months or

Acupuncture was less effective than nicotine

more. However, lack of

replacement therapy. There was no evidence that

evidence and methodological

acupuncture is superior to psychological

problems mean that no firm

interventions in the short- or long-term. There is

conclusions can be drawn.

26

limited evidence that acupressure is superior to

Electrostimulation is not

sham acupressure for short-term outcomes (RR

effective for smoking

2.54, 95% CI 1.27 to 5.08), but no trials reported

cessation.

long-term effects. The pooled estimate for studies testing continuous auricular stimulation suggested a short-term benefit compared to sham stimulation (RR 1.69, 95%CI 1.32 to 2.16); subgroup analysis showed an effect for continuous acupressure (RR 2.73, 95%CI 1.78 to 4.18) but not acupuncture with indwelling needles (RR 1.24, 95%CI 0.91 to 1.69). At longer follow-up the CIs did not exclude no effect (RR 1.47, 95% CI 0.79 to 2.74). The combined evidence on electrostimulation suggests it is not superior to sham electrostimulation (short-term abstinence: RR 1.13, 95% CI 0.87 to 1.46; long-term abstinence: RR 0.87, 95% CI 0.61 to 1.23). Xie YY (2014)

17 RCTs

44

Vascular

Acupuncture plus

dementia

traditional Chinese

Nor reported

Response rate in acupuncture plus herbs was better

Acupuncture plus herbs is a

than in other treatment.

potentially effective

herb formulae

approach for the treatment of vascular dementia. However, the quality of included trials was low.

Xiong J (2009)

45

9 RCTs

Depression

Acupuncture

Antidepressants

neurosis

27

Meta-analyses showed that the total effective rate in

Acupuncture is not inferior

the acupuncture group was similar when compared

to western medicine, and it is

with Dailixin (RR= 1.01, 95%CI 0.82 to 1.23) on

worth noting that

20 d, fluoxetine (RR= 1.06, 95%CI 0.82 to 1.37) at

acupuncture is associated

week 8, but showing difference between

with few adverse reactions.

acupuncture and fluoxetine (RR= 1.15, 95CI 1.07

Further large-scale trials are

to 1.22) at week 12. As for the HAMD score, no

required to define the role of

significant difference was noted between


acupuncture and Dailixin (WMD= 0.45, 95%CI –

of depression neurosis.

2.47 to 3.37) at 20 d, or amitriptyline at week 6, or fluoxetine on 30 d, and weeks 4, 8, 12; there was a difference between acupuncture and amitriptyline observed at week 1 (WMD= – 2.67, 95%CI – 4.38 to – 0.96) and week 2 (WMD= – 2.18, 95%CI – 3.28 to – 1.08). In terms of the SDS scores, significant difference was found between acupuncture and fluoxetine (WMD= – 4.26, 95%CI – 6.67 to – 1.85) at week 6, but no difference at week 4 and 12. Xiong J (2010)

46

20 RCTs

Post-stroke

Acupuncture

Antidepressants

depression

28

Meta-analyses showed that the total effective

Acupuncture is not inferior

according with 24 HAMD score rate in the

to western medicine, and it is

acupuncture group was different when compared

worth noting that

with fluoxetine (RR=1.15, 95% CI 1.07 to 1.24) at

acupuncture is associated

week 8, but showing similar results between

with few adverse reactions.

acupuncture and fluoxetine at weeks 4 and 6. The

Further large-scale trials are

total effective according with 17 HAMD score rate

required to define the role of

in the acupuncture group was similar when


compared with fluoxetine or amitriptyline. As for

of post stroke depression.

the 24 HAMD score，no significant difference was noted between acupuncture and fluoxetine at weeks 2, 6, 8, and 24; difference between acupuncture and fluoxetine observed at week 1 (WMD=-3.80, 95%CI -7.64 to 0.04) and week 4 (WMD=-1.34, 95%CI -2.67 to -0.02); no difference between acupuncture and amitriptyline/diapazem. As for the 24 HAMD score, significant difference was noted between acupuncture and fluoxetine at week 4 (WMD=-1.15, 95%CI -2.01 to -0.30), but showing similar results at weeks 2 and 6, as well as acupuncture and amitriptyline. In terms of the SDS scores, significant differences were noted between acupuncture and fluoxetine or amitriptyline. Xu Y (2014)

20 RCTs 47

Post-stroke

Acupuncture

Western medicine

Only two trials are of high quality based on Jadad

Meta-analysis showed that

depression

scores. Comparing to the Western medicine,

the acupuncture treatment of

(PSD)

acupuncture showed better recovery rates [OR

PSD in cure rate, efficiency

=1.43, 95%CI 1.16 to 1.77], effectiveness

and improve the HAMD

[OR=2.36, 95%CI 1.84 to 3.03)], and improved

score is better than western

HAMD score [SMD=-0.42, 95%CI -0.52, -0.32].

medicine. Higher quality,

Meta-analysis showed that the cumulative PSD

larger sample randomized

acupuncture treatment in the cure rate, efficiency

controlled trials are

and improving HAMD scores were better than

warranted.

western medicine, but its detection by time and

29

sample volume trends, found that stability is not high. Yeung

40 RCTs

Insomnia

WF 48

(2012)

acupressure,

Music therapy,

Only nine studies scored three or more by the Jadad

Owing to the methodological

reflexology, and

waitlist, no

scale, and all had at least one domain with high risk

limitations of the studies and

auricular

treatment, western

of bias. Meta-analyses of the moderate-quality

equivocal results, the current

acupressure, alone

medications,

RCTs found that acupressure as monotherapy fared

evidence does not allow a

or combined with

sham acupuncture

marginally better than sham control. Studies that

clear conclusion on the

herbs or western

compared auricular acupressure and sham control

benefits of acupressure,

medications

showed equivocal results. It was also found that

reflexology, and auricular

acupressure, reflexology, or auricular acupressure

acupressure for insomnia.

as monotherapy or combined with routine care was significantly more efficacious than routine care or no treatment. Yue SJ (2009)

6 RCTs 49

Generalized

Acupuncture

Antidepressants

The response rates between acupuncture and

Our review indicated that

anxiety disorder

antidepressants did not show significant difference

acupuncture might have

(GAD)

in all included three trials, while the adverse events

similar effect and less

in acupuncture group were significantly less in two

adverse events comparing to

trials.

antidepressants in treating patients with GAD. However, the quality of included trials was low.

Zhang B (2014)

50

16 RCTs

Opioid addiction

Acupuncture

Sham

Four studies from Western countries did not report

This review and

acupuncture,

any clinical gains in the treatment of psychological

meta-analysis could not

drug, methadone,

symptoms associated with opioid addiction. 10 of

confirm that acupuncture

placebo,

12 studies from China have reported positive

was an effective treatment

30

Zhang

15

GC (2012)

Post-stroke

Acupuncture

Buprenorphine,

findings regarding the use of acupuncture to treat

for psychological symptoms

no treatment

the psychological symptoms associated with opioid

associated with opioid

addiction. The methodological quality of the

addiction. However,

included studies was poor. The meta-analysis

considering the potential of

indicated that there was a significant difference

acupuncture demonstrated in

between the treatment group and the control group

the included studies, further

for anxiety and depression associated with opioid

rigorous randomized

addiction, although groups did not differ on opioid

controlled trials with long

craving.

follow up are warranted.

All included trials were of low to moderate quality.

Acupuncture has a higher

Comparison between the acupuncture group and the

curative rate than Western

Western medicine group for the curative rate on

medicine in treating

PSD revealed an OR of 1.48, 95% CI = [1.11 1.97].

post-stroke depression.

Antidepressants

depression 51

Comparison of obviously effective rate shows that OR=1.39, 95% CI=[1.08 1.80]. Comparison of effective rate shows that OR=0.83, 95% CI=[0.63 1.09]. Zhang J (2014)

52

17 RCTs

Post-stroke

Filiform needle

Antidepressant

Meta-analysis showed that after 4 weeks of

Therapeutic effects of

depression

acupuncture

drugs

treatment, clinical effective rate was better in

filiform needle acupuncture

patients treated with acupuncture than those treated

were better than those of

with antidepressants (RR=1.11, 95%=1.03-1.21).

antidepressant drugs.

At 6 weeks, clinical effective rates were similar. At 2 weeks after acupuncture, Hamilton Depression Scale was lower than in antidepressants group (mean difference=-2.34, 95% CI -3.46 to -1.22). At

31

4 weeks, scores were similar. Zhang ZJ (2010)

53

35 RCTs

Depressive

Acupuncture alone

Sham acupuncture

The efficacy of acupuncture as monotherapy was

Acupuncture therapy is safe

with Jadad

disorders

or combined with

or antidepressants

comparable to antidepressants alone in improving

and effective in treating

scores >3

including major

antidepressants

alone

clinical response and alleviating symptom severity

MDD and PSD, and could be

depressive

of MDD, but not different from sham acupuncture.

considered an alternative

disorder and

No sufficient evidence favored the expectation that

option for the two disorders.

post-stroke

acupuncture combined with antidepressants could

The efficacy in other forms

depression

yield better outcomes than antidepressants alone in

of depression remains to be

treating MDD. Acupuncture was superior to

further determined.

antidepressants and waitlist controls in improving both response and symptom severity of PSD. The incidence of adverse events in acupuncture intervention was significantly lower than antidepressants. Zhong BL (2008)

54

7 RCTs

Depressive

with Jadad

disorders

scores >4

Acupuncture

Waitlist, sham

In one study, there was a statistically significant

Based on current evidence,

acupuncture,

difference between acupuncture and waitlist groups

acupuncture is a promising

antidepressants

on the Hamilton Rating Scale for Depression

treatment for depress ion.

(HAMD) score (WMD = - 4.79, 95% CI : - 6.17,

Electroacupuncture for major

-3.14) ; In another study, no statistically significant

depressive disorder and

difference was found between electroacupuncture

acupuncture combined with

and fluoxetine groups (WMD = - 1.15, 95% CI: -

auricular acupuncture for

4.24, 1.94); In the other two studies, no statistically

depressive neuros is have the

significant difference was found between

same effectiveness as

acupuncture combined with auricular acupuncture

fluoxetine. The safety of

and fluoxetine groups on the HAMD score (WMD

acupuncture is good with

32

= - 0.87, 95% C I: - 2.08, 0.35).

slight and transient adverse effect. More follow-up studies are needed for evaluating the long-term effect of acupuncture for depression.

33

Supplement Table 4: Systematic Reviews and Meta-analyses on the Effectiveness of Traditional Chinese Herbs on Mental Illnesses Referenc

Studies

e

Interventions

Comparisons

Results


treated

Butler L (2013)

Conditions

55

5 SRs and

Depressive

Chinese Herb

Antidepressants,

The mean Jadad score of 8 trials was 2.4 (out of 5)

Despite promising results,

8 RCTs

disorders

formulas, alone or

alone or plus

and 3 trials scored more than 3. Positive results

particularly for Xiao Yao San

plus antidepressants

placebo herbs

were reported: no significant differences from

and its modifications, the

or placebo

medication, greater effect than medication or

effectiveness of Chinese herbal

antidepressants

placebo, reduced adverse event rates when

medicine in depression could

combined or compared with antidepressants.

not be fully substantiated based on current evidence.

Chen DF (2010)

56

61 RCTs

Alzheimer’s

Chinese Herb

Cholinesterase

The results of meta-analysis of AD showed that in

Generally speaking, the quality

for

disease,

formulas

Inhibitors,

the comparison with Cholinesterase Inhibitors, the

of clinical research literature of

Alzheimer’

vascular

metabolic

TCM is not better than the Cholinesterase Inhibitors

Chinese Medicine in treatment

s disease;

dementia

enhancement

in the standards of the MMSE’s increased score

with AD and VD is not

335 RCTs

[OR=0.78, 95%Cl 0.53, 1.13], the percentage of

satisfactory, which need to be

for

MMSE’s increased score [OR=1.41, 95%Cl 0.80,

enhanced further. The results of

vascular

2.48] and the difference of MMSE’s scores before

meta-analysis show that the

dementia

and after treatment [WMD=-0.17, 95%Cl -2.76 to

curative effect of Chinese

0.56)]. In the comparison with the drugs of

Medicine in treatment with AD

Metabolic enhanced, the TCM is better than the

is not better than the

drugs of Metabolic enhanced in the standard of the

Cholinesterase Inhibitors, and

effectiveness of traditional Chinese medical

the effect of Chinese Medicine

syndrome [OR=2.60, 95%Cl 1.35, 5.00], but in the

is better than the drugs of

standard of the difference of MMSE’s scores before

Metabolic in treatment with AD

34

and after treatment [WMD=1.97, 95%Cl -0.39,

and VD.

4.33], the TCM is not better than the drugs of Metabolic enhanced. The results of meta-analysis of VD showed that the TCM is better than the drugs of Metabolic enhanced in the standards of the difference of MSSE’s scores before and after treatment [WMD=0.96, 95%CI 0.13, 1.78], the therapeutic indices which is counted by the scores of TCM symptoms [OR=1.68, 95%CI 1.25, 2.26] and the effectiveness of traditional Chinese medical syndrome; but in the standards of the percentage of MMSE’s increased score [OR=1.32, 95%Cl 0.98, 1.77], the difference of BBS’s scores before and after treatment [WMD=0.21, 95%Cl -0.17, 0.59] and the difference of ADL’s scores before and after treatment [WMD=0.28, 95%Cl -0.55, 1.11], the TCM is not better than the drugs of Metabolic enhanced. Guo Q (2014)

12 RCTs 57

Vascular

Chinese Herb

Western

Chinese herb, alone or plus western medications,

Chinese herbs for the treatment

dementia

formulas, alone or

medications

showed better response rate than western

of vascular dementia is better

plus western

medications (95% CI 1.20 to 1.51), and higher

than Western medicine alone.

medications

MMSE scores (95% CI 1.33 to 2.40).

However, further large, rigorously designed trials are warranted due to the insufficient

35

methodological rigor seen in the trials included in this study. Jun JH (2014)

13 RCTs 58

Depressive

GanmaiDazao

disorders

Antidepressants

All of the included RCTs had a high risk of bias

This systematic review and

(GMDZ) decoction,

across their domains. Three RCTs failed to show

meta-analysis failed to provide

alone or plus

favorable effects of GMDZ decoction on response

evidence of the superiority of

antidepressants

rate or HAMD score in major depression. One RCT

GMDZ decoction over

showed a beneficial effect of GMDZ decoction on

anti-depressant therapies for

response rate in post-surgical depression, while

major depression, post-surgical

another failed to do so. Two studies showed

depression, or depression in the

favorable effects on response rate in post-stroke

elderly, although there was

depression, while another two failed to do so. A

evidence of an effect in

meta-analysis, however, showed that GMDZ

post-stroke depression. The

decoction produced better response rates than

quality of evidence for this

anti-depressants in post-stroke depression (RR:

finding was low, however,

2

1.17, I = 15%). One trial failed to show any

because of a high risk of bias.

beneficial effects of GMDZ decoction on response rate or HAMD score in depression in an elderly sample. Two trials tested GMDZ decoction in combination with anti-depressants but failed to show effects on response rate in major depression, while another did show beneficial effects on response rate in post-stroke depression. Kou MJ (2012)

59

7 RCTs

Depression

Integrated

Western medicine

The included trials had generally low

Integrated traditional and

traditional and

alone

methodological quality. Meta-analysis showed,

Western medicine for treatment

compared with Western medicine alone, integrated

of depression is better than

Western medicine

36

traditional and Western medicine based on

Western medicine alone.

syndrome differentiation could improve the effect

However, further large,

of treatment represented by the HAMD

rigorously designed trials are

[WMD=-2.39, CI (-2.96,-1.83)]. There were no

warranted due to the insufficient

reported serious adverse effects that were related to

methodological rigor seen in the

integrated traditional and Western medicine based

trials included in this study.

therapies in these trials. Liu TT (2009)

21 RCTs

60

Heroin

Eighteen Chinese

α2-adrenergic

Of the 21 studies, 10 were judged high in quality.

Our meta-analysis suggests that

addiction

herb formulas as

agonists, opioid

For withdrawal symptoms score relieving during

Chinese herbal medicine is an

monotherapy

agonists

the 10-day observation, Chinese herbal medicine

effective and safety treatment

was superior to α2-adrenergic agonists in relieving

for heroin detoxification. And

opioid-withdrawal symptoms during 4–10 days

more work is needed to

(except D8) and no difference was found within the

determine the specific effects of

first 3 days. Compared with opioid agonists,

specific forms of Chinese herbal

Chinese herbal medicine was inferior during the

medicine.

first 3 days, but the difference became nonsignificant during days 4–9. Chinese herbal medicine has better effect on anxiety relieving at late stage of intervention than α2-adrenergic agonists, and no difference with opioid agonists. Man SC (2008)

61

16 RCTs

Alzheimer’s

Herbal medicine

Placebo, or

Out of the 15HM monotherapy studies, 13 reported

Herb medicine can be a safe,

disease

(HM), single herb

orthodox

HM to be significantly better than OM or placebo;

effective treatment for AD,

or herbal formula,

medications

one reported similar efficacy between HM and OM.

either alone or in conjunction

alone or plus

Only the HM adjuvant study reported significant

with orthodox medications.

orthodox

efficacy. No major adverse events for HM were

However, methodological flaws

37

medications (OM) May BH (2009)

13 RCTs

Dementia

62

reported and HMs were found to reduce the adverse

limited the extent to which the

effects arising from OM.

results could be interpreted.

Herb Medicine

Placebo, no

Meta-analyses found HM more effective than no

Due to the small sample size for

(HM) including

treatment,

treatment or placebo and at least equivalent to

each herbal preparation, some

Melissa officinalis,

pharmacologic

control interventions, although the overall effect

methodological weaknesses and

Salvia officinalis,

intervention

was small. No severe adverse events were reported.

lack of longer term follow-up,

and various Chinese

there is a need for further

herbs formulae.

multi-center studies with large

Ginkgo biloba was

sample sizes.

excluded. May BH (2009)

10 RCTs

63

Mild cognitive

Eight types of

Placebo, no

This review found an overall benefit on some

The evidence for efficacy of

impairment

Chinese herbs

treatment,

outcome measures for the eight CHMs involved in

these herbs in MCI and AAMI

(MCI) and age

formulae. Ginkgo

pharmacologic

the 10 RCTs but methodological and data reporting

remains inconclusive.

associated

biloba was

intervention

issues were evident.

memory

excluded.

impairment (AAMI) Meeks

33 RCTs

TW (2007)

24

Late-life

Various

Placebo, wait list,



depression,

complimentary and

treat as usual,



anxiety, and

alternative

sham

studies.


sleep

medicines including

acupuncture/acupr

suggested therapeutic potential

disturbance

yoga, Tai chi,

essure, western

of mind-body interventions for

Qigong, meditation,

medications

sleep disturbance, acupressure

single herbs,

for sleep and anxiety.

Chinese herb

38

formulae, acupuncture, acupressure, etc Qin X (2013)

31 RCTs 64

Vascular

Chinese herbal

Placebo, western

Patients in the treatment group showed better

Chinese herbal medicine

Dementia

medicines

medicine

outcome than those in the control group

appears to be safer and more

(Mini-Mental State Examination scores, WMD =

effective than control measures

2.83; 95%CI: 2.55–3.12; Hasegawa Dementia Scale

in the treatment of vascular

scores, WMD = 2.41, 95%CI: 1.48–3.34).

dementia. However, the included trials were generally low in quality.

Rathbon

7 RCTs

Schizophrenia

eJ (2007)

65

Ginkgo biloba or

antipsychotics

Results tended to favour combination treatment

Beneficial effects of combining

Herbs, alone or

compared with antipsychotic alone (Clinical Global

herbs were indicated. Study

combined with

Impression ‘not improved/worse’ RR=0.19, 95% CI

sizes were generally small and

antipsychotics

0.1-0.6; Brief Psychiatric Rating Scale ‘not

pooled data were typically

improved/worse’ RR=0.78,95% CI 0.5-1.2; Scale

derived from one or two studies.

for the Assessment of Negative Symptoms ‘not

All outcomes, therefore, were

improved/worse’ RR=0.87,95% CI 0.7-1.2; Scale

underpowered.

for the Assessment of Positive Symptoms ‘not improved/worse’ RR=0.69, 95% CI 0.5-1.0. Ravindra

Not

Mood and

Physical therapies

Placebo alone,


While several CAM therapies

n AV

reported

anxiety

including Yoga and

placebo plus


show some evidence of benefit

disorders

acupuncture; herbal

western


as augmentation in depressive

remedies;

medicines, sham



Nutraceuticals

acupuncture




disorders. The general dearth of

(2013)

29

39

disorder.

adequate safety and tolerability data encourages caution in clinical use.

Shu JZ (2010)

9 RCTs 66

Vascular

Bu Yang Huan Wu

Western

BYHWD was more effective than Western

The general efficacy results of

dementia

Decoction,

medications

medicine in the treatment of vascular dementia. The

BYHWD treating vascular

summary OR was 1.71 (95% CI 1.15 to 2.53); the

dementia is not clinical

therapeutic effect of BYHWD was better than

significance because there is

Western medicine in improving the MMSE and

heterogeneity. BYHWD was

HDS score. The summary WMD was 1.60 (95% CI

more effective than western

0.16 to 3.03) and 2.98 (95% CI 2.34 to 3.62); there

medicine in improving the

were no obvious adverse reactions.

MMSE and HDS score, but

BYHWD

need more high-quality research in order to increase the strength of the evidence. Thachil

7 SRs, 9

Depressive

Herbs, nutritional

Placebo,


None of the CAM studies show

AF

RCTs, and

disorders

therapy,

antidepressants,


evidence of efficacy in

acupuncture,

psychotherapy



exercise, complex


hierarchy of evidence. The RCT

homeopathy, yoga,


model and the principles

traditional Chinese


underlying many types of CAM

medicine


are dissonant, making its


application in the evaluation of


those types of CAM difficult.

(2007)

37

3 others

unequivocally negative results. Studies below this level yielded inconclusive or negative results.

40

Wang

10 RCT

Y(2012)

Depression

6

7

Chaihu-Shugan-San

antidepressants

All studies were of poor methodological quality

The present work supported that

(CSS), alone or

alone

(Jadad score≤3) and are at high risk of bias.

CSS was effective and safe in

combined with

Meta-analyses revealed that CSS in combination

treating depressed patients.

antidepressants

with antidepressant drugs treatment significantly

More full-scale randomized

improved depressive symptoms (WMD=−3.56;

clinical trials with reliable

95% CI −5.09 to −2.03) and significantly increased

designs are recommended to

effective rate (OR = 3.31; 95% CI 1.80–6.10) and

further evaluate the clinical

recovery rate (OR = 2.32; 95% CI 1.61–3.34)

benefit and long-term

compared with antidepressant drugs therapy. In

effectiveness of CSS for the

addition, the efficacy of CSS as monotherapy was

treatment of depression.

significantly better than antidepressants in improving depressive symptoms (WMD=−3.09; 95% CI −5.13 to −1.06) and in creasing effective rate (OR = 2.61; 95% CI 1.23–5.53). CSS was comparable to antidepressants in increasing recovery rate (OR = 1.83; 95% CI 0.84–3.98). Wu KG (2013)

13 RCTs

68

Generalized

Chinese herb

Antidepressants,

Only three studies in the 13 included studies had a

The information currently

anxiety disorder

formulae

anxiolytic

Jadad score of 3 or higher. Meta-analysis showed

available can support the

medications

the efficiency rate [OR=0.98, 95%CI 0.66 to 1.44,

opinion that the Chinese

P=0.90], HAMA score after the end of the trial

medicinal herbs treatment and

[MD=-0.52, 95%CI -1.38 to 0.33), P=0.23].

western medicine treatment provide the same clinical efficacy in generalized anxiety disorders.

Wu KG

8 RCTs

Depressive

Chinese herb

Antidepressants

As for the total effective rate, there is no statistical

41

Based on the existing evidence,

(2013) 69

disorders

formulae

difference between treatment group and control

some Chinese herbal medicines

group in the 4 trials comparing with Fluoxetine

for treating depression appeared

(OR=1.04, 95%CI 0.74 to 1.46, P=0.84), in the 2

efficacious. However, due to the

trials comparing with Paroxetine (OR=0.57,

lack of stronger evidence, we

95%CI=0.16 to 2.08, P=0.40), in the 1 trial

cannot recommend any kind of

comparing with Venlafaxine (OR=0. 57, 95%

Chinese medical herbal

CI=0.22 to 1.50, P=0.26), and in the 1 trial

fomulation as an effective

comparing with Mapmtiline (OR=0.23,

remedy for depression.

95%CI=0.02 to 2.22, P=0.21). As for HAM-D scaling rate, neither 6 trials with treatment for 6 weeks nor 1 trial for 12 weeks appear statistical differences between treatment group and control group (MD=0.18, 95%CI=-0.89 to 1.24, P=0.74; MD=0.75, 95%CI=-0.56 to 2.06, P=0.26). Xu EP (2013)

19 RCTs 70

Depressive

Chinese herb

disorders

formulae

Antidepressants

Only 4 included trials had a Jadad score of 3 or

The curative effect of traditional

higher.

Chinese medicine and Western

The results of meta-analysis suggest that

there was no statistical significant difference in the

medicine treatment of

response rates between Chinese medicine

depression seems similar, but

intervention group and the control group.

into the quality of design document is low，

Yang M (2014)

71

21 RCTs

Alzheimer’s

Natural medicines

Placebo,

Apart from Ginkgo, other treatments had minimal

Our results suggest that Ginkgo

disease

including several

donepezil

benefits and/or the methodological quality was

may help established AD

single herbs and

poor. In one RCT, Fuzhisan, a Chinese herbal

patients with cognitive

Fuzhisan (Chinese

formula, was reported to significantly improve

symptoms but cannot prevent

42

herbs formula)

ADAS-Cog scores, NPI scores and the regional

the neurodegenerative

cerebral metabolic rate of glucose consumption

progression of the disease.

(rCM-Rglc), which suggests that Fuzhisan treatment may have a positive effect on cognition, behavior functions, and rCM-Rglc in mild-to-moderate AD patients. Yeung

296 RCTs

WF (2014)

Depressive

Chinese single

Placebo,

21 RCTs with a Jadad score >3 out of 296 RCTs

Despite the overall positive

disorders

herbs or herbal

antidepressants

were included. Meta-analyses showed that CHM

results, due to the small number

formulas, alone or

alone or plus

monotherapy was better than placebo and as

of studies with sufficient


placebo herbs

effective as antidepressants in reducing Hamilton

methodological quality, it is

or plus placebo

Depression Rating Scale (HDRS) score (CHM vs.

premature to accurately

antidepressants

placebo: mean difference: -7.97, 95% CI: -10.25 to

conclude the benefits and risks

-5.70, 2 studies; CHM vs. antidepressants: mean

of CHM for depression.

72

difference: 0.01, 95% CI: -0.28 to 0.30, 7 studies). Yeung

10 RCTs

WF (2014)

73

Depression

GanmaiDazao

Antidepressants

Methodological quality was generally low. Pooled

The overall results suggest that

(GMDZ) decoction,

alone

analysis of 5 studies which compared GMDZ with

GMDZ has few side effects and

alone or plus

antidepressants showed that GMDZ was

the potential as an

antidepressants

significantly more efficacious than antidepressants

antidepressant. Adding GMDZ

in effective rate (risk ratio: 1.14, 95%CI: 1.02 to

to antidepressants reduces side

1.27), but comparable in Hamilton Depression

effects and enhances efficacy of

Rating Scale score. The other 5 studies which

antidepressants. However, due

compared GMDZ plus antidepressants with

to the small number of studies

antidepressants alone, there was no significant

and their limitations, further

difference in effective rate (risk ratio: 1.24, 95%CI:

studies with better

0.99 to 1.55), but the end-point HDRS score was

methodological quality and

43

significantly lower in GMDZ antidepressants

more comprehensive safety

combination (mean difference: -4.25, 95%CI:

assessment are needed to

-6.50 to -2.00).

determine the benefits and risks of GMDZ in the treatment of depression.

Zhang X (2014)

7 RCTs

74

Major

Shuganjieyu

Placebo or

Shuganjieyu capsule was superior than placebo in

Shuganjieyu capsule is superior

depressive

capsule, alone or

venlafaxine

terms of response rate (RR=2.42, 95% CI: 1.55–

to placebo in terms of overall

disorder

combined with

3.79), remission rate (RR=4.29, 95% CI: 1.61–

treatment effectiveness and

venlafaxine

11.45), the scores of the mean change from baseline

safety. Both response rate and

of the HAM-D17 (MD=-4.17, 95% CI: -5.61

remission rate among patients

to-2.73) and from baseline of traditional Chinese

treated with the combination of

medicine (TCM) syndrome score scale scores

Shuganjieyu plus venlafaxine

(MD=-6.00, 95% CI:-8.25 to-3.75). In addition,

were significantly higher than

Shuganjieyu plus venlafaxine had a significantly

those treated with venlafaxine

higher response rate (RR=1.56, 95% CI: 1.29–1.88)

alone. Due to the considerable

and was superior in terms of the scores of the mean

risk of bias in majority of trials,

change from baseline of the treatment emergent

recommendations for practice

symptoms scale scores (MD=-0.74, 95% CI: -1.12

should be cautious.

to -0.35) than venlafaxine alone. Zhang Y (2014)

75

8 RCTs

Depressive

Traditional Chinese

Conventional

Only one study was of high quality (Jadad

There is evidence that TCM

and 2

disorder or

medicine combined

drug

score=3). The pooled results revealed that TCM

may be beneficial to the

controlled

symptoms of

with conventional

combined with conventional drugs significantly

treatment of depression in

clinical

patients with

drug

improved the total scores of the unified Parkinson’s

Parkinson’s disease in spite of

trials

Parkinson’s

disease rating scale (WMD =-7:35, 95% CI: -11.24

the methodological weakness of

disease

to -3.47) and the score of the Hamilton rating scale

the included studies.

44

for depression (HAM-D) (WMD=-4:19, 95% CI: -5.14 to -3.24) compared with conventional drug, respectively. Zhao H (2014)

76

9 RCTs

Dementia

Chinese herb

Western

The Jadad score of 9 studies ranged from 1 to 2. By

The effect of the TCM purging

formulae

medications

the analysis of meta display, it was better for

turbidity method of

treatment with the TCM purging turbidity method

detoxification therapy in

of detoxification than pure western medicine

patients with dementia，in the

dementia. Overall curative effect, for the summary

overall efficiency but reducing

OR=2. 85 ( 95% CI 1. 80 to 4. 51 ), difference had

the ADL score, it may be better

statistical significance ( P＜0. 0001) ; to improve

treatment to the overall curative

the ADL score, the effect of pure western medicine

effect, but it may be worse than

was better than the TCM purging turbidity method

the pure western medicine

of detoxification with WMD－4. 03 ( 95% CI -5.

45

than the pure western medicine

treatment to improve the ADL score, and more high quality

14 to -2. 93) , and difference was statistically

studies are still needed to

significant ( P ＜ 0. 00001).

increase evidence.

Supplement Table 5: Systematic Reviews and Meta-analyses on the Effectiveness of Qigong and Tai chi on Mental Illnesses Referenc

Studies

e

Comparisons

Results


Patients with

A variety of

Wait list,

74% of these selected quality papers demonstrated

The use of evidence-based

depressive

mind-body

psychotherapy,

positive effects on the improvement of depressive

mind-body therapies can

disorders or

practices including

education,

symptoms. All mind-body modalities included in

alleviate depression severity.

other conditions

yoga, meditation,

supportive

the study had at least one positive study.

They could be used with

and elevated

relaxation, Tai chi,

counseling, ECT,

established psychiatric

depressive

Qigong, etc

antidepressants,

treatments of therapy and

exercise,

medications.

treated

D’Silva

54 trials

S (2012)

Interventions

Conditions

77

symptom

treatment as usual Jorm AF (2006)

14

Not

Children or

A variety of

reported

adolescents with

Not reported



complementary and


medication is not recommended

depressive



as a first line treatment for

disorder or

including herbs,


children and adolescents with

elevated

homeopathy,


mild to moderate depression,

depressive

acupuncture, Tai


and that the effects of

symptoms

chi, yoga, etc




modest, there is a pressing need

depression.

to extend the range of treatments available for this age group.

Kim SH (2013)

78

6 RCTs and 10

PTSD

Mind-body

Thermal

Most of the studies have small sample size, but

Mind-body practices are

practices including

biofeedback,

findings from the 16 publications reviewed here

increasingly employed in the

46

other

yoga, meditation,

narrative exposure

suggest that mind-body practices are associated

treatment of PTSD and are

studies

Qigong, Tai chi, etc

therapy, wait list

with positive impacts on PTSD symptoms.

associated with positive impacts

Mind-body practices incorporate numerous

on stress-induced illnesses such

therapeutic effects on stress responses, including

as depression and PTSD in most

reductions in anxiety, depression, and anger, and

existing studies.

increases in pain-tolerance, self-esteem, energy levels, ability to relax, and ability to cope with stressful situations. Meeks

33 RCTs

TW (2007)

24

Late-life

Various

Placebo, wait list,



depression,

complimentary and

treat as usual,



anxiety, and

alternative

sham

studies.


sleep

medicines including

acupuncture/acupr


disturbance

yoga, Tai chi,

essure, western


Qigong, meditation,

medications


single herbs,


Chinese herb formulae, acupuncture, acupressure, etc NG BHP (2009)

79

26 RCTs

Chronic

Qigong

No treatment,

Qigong may have some effects in decreasing

In view of its safety, minimal

conditions

placebo,

depression with a weighted mean difference of 0.90

cost, and potential clinical

including 1

conventional

(1.08-0.71), but most of the studies have obvious

benefit, the authors support that

RCT for heroin

theray

methodological limitations.

health qigong can be advocated

addict, and 1

as an adjunctive therapy for

RCT for

elderly with chronic conditions.

47

depression Oh B

10 RCTs 80

(2013)

Depressive

Qigong alone or

Educational

Four studies reported positive results of the Qigong

While the evidence suggests the

disorder or

combined with

support group,

treatment on depression; two reported that Qigong

potential effects of Qigong in

symptoms

mindfulness

standard care,

effect on depression was as effective as physical

the treatment of depression, the

meditation or

exercises,

exercise. One study reported that Qigong was

review of the literature shows

standard care

newspaper

comparable to a conventional rehabilitation

inconclusive results.

reading, no

program, but the remaining three studies found no

intervention,

benefits of Qigong on depression.

lecture Rogers

36 RCTs

C (2009)

81

Older adults

Qigong (QG) or Tai

Wait list, usual

Five studies evaluated the effect of TC&QG on

Significant improvement in

with variety of

chi (TC)

care,

depression. Two studies reported significant

clusters of similar outcomes

conditions

hydrotherapy,

reductions in depression: one compared QG to

indicated interventions utilizing

including

health education,

newspaper reading and one compared TC to

TC&QG may help older adults

depression

stretching control,

wait-list control.

improve physical function and

newspaper

reduce blood pressure; fall risk;

reading, aerobic

and depression.

exercise, etc Rosenba

39 RCTs, 2

um S (2014)

82

Mental illnesses

Physical activity

Usual care, social

Meta-analysis revealed a large effect of physical

Physical activity reduced

on Tai chi

intervention

support, wait list,

activity on depressive symptoms (SMD=0.80),

depressive symptom in people

and 1 on

including Tai chi

placebo, health

schizophrenia symptoms (SMD=1.0), a small effect

with mental illness, reduced

Yoga

and Yoga

education

for anthropometry (SMD=0.24), and moderate

symptoms of schizophrenia and

effects were found in aerobic capacity (SMD=0.63)

improved anthropometric

and quality of life (SMD=0.64).

measures, aerobic capacity, and quality of life among people with mental illness.

48

Sarris J (2011)

20 RCTs

Insomnia

31

Acupuncture,

Sham


Future researchers are urged to


acupuncture,


use acceptable methodology,

pharmacotherapies,

sleep hygiene


including appropriate sample

Tai chi, Yoga

device, placebo,


sizes and adequate controls.

health education,




western medicines Sharma

8 RCTs

Healthy

Tai chi, alone or

Exercise,

Statistically significant results of anxiety reduction

Despite the limitations of not all

M

and 9 other

individuals and

combined with drug

rehabilitation,

were reported in 12 of the studies reviewed.

studies using randomized

studies

patients with

therapy

health education,

controlled designs, having

various

neutral reading,

smaller sample sizes, having

conditions

wait list, no

different outcomes, having

including

control, drug

nonstandardized tai chi

anxiety and

therapy alone

interventions, and having

(2015)

83

mood disorders

varying lengths, tai chi appears to be a promising modality for anxiety management.

Tsang

12 RCTs

HWH (2008)

84

Individuals with

Exercise including

Antidepressants,

The results based on 12 RCTs indicated that both

We recommend that more

depressive

yoga, Qigong, and

usual care, wait

the mindful and nonmindful physical exercises

well-controlled studies have to

disorders or

Tai chi, alone or

list, newspaper

were effective in their short-term effect in reducing

be conducted in the future to

elevated

combined with

reading, modified

depression levels or depressive symptoms.

address the short- and long-term

depressive

antidepressants

ECT

However, most of studies had methodological

effects of physical exercise on

problems that only small sample size was used, and

alleviating depression.

symptoms

the maintenance effects of physical exercise were not reported.

49

Wang C (2010)

85

17 RCTs

Healthy

and 23

Tai chi

Attention control,

21 of 33 randomized and nonrandomized trials

Tai Chi appears to be associated

individuals and

exercise,

reported that Tai Chi significantly increased

with improvements in

other

patients with

relaxation, wait

psychological well-being including reduction of

psychological well-being

studies

chronic

list, hydrotherapy,

stress (effect size [ES], 0.66; 95% confidence

including reduced stress,

conditions

health education,

interval [CI], 0.23 to 1.09), anxiety (ES, 0.66; 95%

anxiety, depression and mood

including

psychosocial

CI, 0.29 to 1.03), and depression (ES, 0.56; 95%

disturbance, and increased

depression and

support therapy,

CI, 0.31 to 0.80), and enhanced mood (ES, 0.45;

self-esteem. Definitive

dementia

neutral reading

95% CI, 0.20 to 0.69) in community-dwelling

conclusions were limited due to

healthy participants and in patients with chronic

variation in designs,

conditions. Seven observational studies with

comparisons, heterogeneous

relatively large sample sizes reinforced the

outcomes and inadequate

beneficial association between Tai Chi practice and

controls. High-quality,

psychological health.

well-controlled, longer randomized trials are needed to better inform clinical decisions.

Wang

12 RCTs

CW (2013)

86

Patients with

Qigong, alone or

Psychotherapy,

The results of meta-analyses suggested a beneficial

Qigong may be potentially

mood disorders,

combined with

wait list, exercise,

effect of qigong on depressive symptoms when

beneficial for management of

or chronic

drugs

usual care, drugs,

compared to waiting-list controls or usual care only

depressive symptoms, but the

disease patients

newspaper

(SMD= −0.75; 95% CI, −1.44 to −0.06), group

results should be interpreted

with elevated

reading, mindful

newspaper reading (SMD= −1.24; 95% CI, −1.64 to

with caution due to the limited

depressive

relaxation

−0.84), and walking or conventional exercise

number of RCTs and associated

(SMD= −0.52; 95% CI, −0.85 to −0.19), which

methodological weaknesses.

symptoms

might be comparable to that of cognitive-behavioral therapy (𝑃 = 0.54). Available evidence did not suggest a beneficial effect of qigong exercise on

50

anxiety symptoms. Wang D (2014)

22 RCTs

87

Substance use

Physical exercise

No exercise,

The results indicated that physical exercise can

The moderate and

disorders

including Tai chi,

standard

effectively increase the abstinence rate (OR = 1.69

high-intensity aerobic exercises,

including

Qigong, and Yoga

treatment,

(95% CI: 1.44, 1.99)), ease withdrawal symptoms

designed according to the

alcohol, drug

educational

(SMD =21.24 (95% CI: 22.46, 20.02)), and reduce

Guidelines of American College

and nicotine

meeting, no

anxiety (SMD =20.31 (95% CI: 20.45, 20.16)) and

of Sports Medicine, and the

intervention,

depression (SMD = 20.47 (95% CI: 20.80, 20.14)).

mind-body exercises can be an

CBT, wellness

The physical exercise can more ease the depression

effective and persistent

sessions, care as

symptoms on alcohol and illicit drug abusers than

treatment for those with SUD.

usual, sham

nicotine abusers, and more improve the abstinence

Qigong

rate on illicit drug abusers than the others. Similar treatment effects were found in three categories: exercise intensity, types of exercise, and follow-up periods.

Wang F (2013)

88

14 RCTs

Healthy

and 1

Qigong

Wait list, lecture,

The most frequently reported psychological

Preliminary evidence suggests

individuals or

placebo, exercise,

benefits were decreased depressive symptoms and

that Qigong may have positive

quasi-expe

patients with

health education,

improved mood, reported in seven studies. Anxiety

effects on psychological

riment

chronic

usual care, group

decreased significantly for participants practicing

well-being among patients with

conditions

therapy,

Qigong compared to an active exercise group.

chronic illnesses. However the

including

newspaper

Meta-analyses were conducted in three studies of

published studies generally had

depression

reading

patients with type II diabetes, which suggested that

significant methodological

Qigong was effective in reducing depression and

limitations.

anxiety. Wang F (2014)

89

37 RCTs

Healthy

Tai chi, alone or

Routine

The studies in this review demonstrated that tai chi

In spite of the positive

and 5

individuals or

combined with

medication, wait

interventions have beneficial effects for various

outcomes, the studies to date

51

quasi-expe

patients with

riment

routine medication

list, exercise,

populations on a range of psychological well-being

generally had significant

chronic

health education,

measures, including depression, anxiety, general


conditions

psychosocial

stress management, and exercise self-efficacy.

More RCTs with rigorous

including

support, sham

Meta-analysis was performed on three RCTs that

research design are needed to

depression

exercise,

used depression as an outcome measure (ES=-5.97;

establish the efficacy of tai chi

95 % CI=-7.06 to-4.87).

in improving psychological well-being and its potential to be used in interventions for populations with various clinical conditions.

Wang

15 RCTs

WC (2009)

90

Healthy

Tai chi

No treatment,

Eight were high quality trials. Tai Chi intervention

It is still premature to make any

individuals or

health education,

was found to have a significant effect in 13 studies,

conclusive remarks on the effect

patients with

walking,

especially in the management of depression and

of Tai Chi on psychosocial

chronic

meditation and

anxiety. However, significant findings were shown

well-being.

conditions

reading

in only six high quality studies. Moreover,

including

significant between group differences after Tai Chi

depression

intervention was demonstrated in only one high quality study. Two high quality studies in fact found no significant Tai Chi effects.

Wayne

11 RCTs

Individuals aged

Tai chi, along or

No intervention,

Overall quality of RCTs was modest.

Tai Chi shows potential to

PM

and 9 other

60 and over

plus

exercise, social

Meta-analyses of outcomes related to executive

enhance cognitive function in

studies

(with the

antidepressants, or

interaction, health

function in RCTs of cognitively healthy adults

older adults, particularly in the

exception of one

plus CBT and

education,

indicated a large effect size when Tai Chi was

realm of executive functioning

study) with and

support group

attention control,

compared to non-intervention controls (Hedge’s

and in those individuals without

dance, fall

g=0.90; p=0.043) and moderate effect size when

significant impairment. Larger

(2014)

91

without

52

cognitive

prevention,

compared to exercise controls (Hedge’s g=0.51;

and methodologically sound

impairment.

mahjong, simple

p=0.003). Meta-analyses of outcomes related to

trials with longer follow-up

handicrafts,

global cognitive function in RCTs of cognitively

periods are needed before more

cognition-action,

impaired adults, ranging from mild cognitive

definitive conclusions can be

impairment to dementia, showed smaller but

drawn.

statistically significant effects when Tai Chi was compared to both non-intervention controls (Hedge’s g=0.35; p=0.004) and other active interventions (Hedge’s g=0.30; p=0.002). Wu Y (2013)

92

6

Healthy

interventio

Tai chi

No exercise,

Four (mini mental status examination, digit span

Tai Chi as a mind-body exercise

individuals or

stretching, low

test backward, visual span test backward, and

has the positive effects on

n and 2

patients with

dosage Tai chi

verbal fluency test) out of nine variables were

global cognitive and memory

cross-secti

mild cognitive

significantly improved after Tai Chi exercise with

functions, and more consistent

onal

impairment

the effect sizes ranged from 0.20 to 0.46 (small to

positive effects were found on

medium).

memory function, especially

studies

verbal working memory.

53

Supplement Table 6: Systematic Reviews and Meta-analyses on the Effectiveness of Homeopathy and Ayuveda Medicine on Mental Illnesses Referenc

Studies

e

Conditions

Interventions

Comparisons

Results


Ayurvedic herbs

Chlorpromazine,

When Ayurvedic herbs were compared with

Ayurvedic medication may

placebo

placebo, mental state ratings were mostly

have some effects for treatment

equivocal. Behaviour seemed unchanged (WMD

of schizophrenia, but has been

Fergus Falls Behaviour Rating 1.14 CI -1.63 to

evaluated only in a few small

3.91). When the Ayurvedic herbs were compared

pioneering trials.

treated

Agarwal

3 RCTs

Schizophrenia

V (2007)

93

with chlorpromazine, people allocated herbs were at greater risk of no improvement in mental state compared to those allocated chlorpromazine (RR 1.82 CI 1.11 to 2.98). Finally, when Ayurvedic treatment is compared with chlorpromazine, it is equally (~10% attrition, n=36, RR 0.67 CI 0.13 to 3.53), but skewed data does seem to favour the chlorpromazine group. Cooper

4 RCTs

KL

and a

(2010)

94

Insomnia

Homeopathy

Placebo

All RCTs involved small patient numbers and were

The limited evidence available

of low methodological quality. None demonstrated

does not demonstrate a

number of

a statistically significant difference in outcomes

statistically significant effect of

other

between groups, although two showed a trend

homeopathic medicines for

studies

favouring homeopathic medicines. A cohort study

insomnia treatment. Existing

reported significant improvements from baseline.

RCTs were of poor quality and

medications

were likely to have been underpowered.

54

Davidso

25 RCTs

n JRT (2011)

95

A variety of

Homeopathy

Placebo

Study quality varied, 6 assessed as good, 9 as fair,

The database on studies of

psychiatric

and 10 as poor. Efficacy was found in the somatic

homeopathy and placebo in

disorders

syndrome group, but not for anxiety or stress. For

psychiatry is very limited, but

including

other disorders, homeopathy produced mixed

results do not preclude the

anxiety

effects. No placebo-controlled studies of depression

possibility of some benefit.

disorders,

were identified.

insomnia, premenstrual syndrome, ADHD, etc Jorm AF (2004)

13

Not

Anxiety

34 treatments

Placebo in most

108 treatments were identified and grouped under

The treatments with the best

reported

disorders or

groups under 4

studies, western

the categories of medicines and homoeopathic

evidence of effectiveness are

participants with

categories:

medicines in a

remedies, physical treatments, lifestyle, and dietary

kava (for generalised anxiety),

anxiety

medicines and

few studies

changes. We give a description of the 34 treatments

exercise (for generalised

symptoms

hemoeopathic

(for which evidence was found in the literature

anxiety), relaxation training (for

remedies, physical

searched), the rationale behind the treatments, a

generalised anxiety, panic

treatments,

review of studies on effectiveness, and the level of

disorder, dental phobia and test

lifestyle, and

evidence for the effectiveness studies.

anxiety). There is more limited

dietary changes

evidence to support the effectiveness of acupuncture, music, autogenic training and meditation for generalised anxiety

Jorm AF (2006)

14

Not

Children or

A variety of

reported

adolescents with

complementary and

Not reported

55





depressive




disorder or

including herbs,



elevated

homeopathy,



depressive

acupuncture, Tai



symptoms

chi, yoga, etc





depression.


Pilkingto

2 RCTs

Depressive

nK

and a number of

(2005)

96

Homeopathy

Diazepam,

Homeopathy showed some benefits in alleviating

The evidence for the

disorders and

fluoxetine,

depressive symptoms in several uncontrolled study.

effectiveness of homeopathy in

symptoms

placebo

depression is limited due to lack

other

of clinical trials of high quality.

studies Pilkingto

8 RCTs

Generalised

nK

and a

anxiety

number of

disorder, test

other

anxiety, and

studies

anxiety related

(2006)

97

Homeopathy

Placebo,

The randomised controlled trials reported

It is not possible to draw firm

benzodiazepines

contradictory results, were underpowered or

conclusions on the efficacy or

provided insufficient details of methodology.

effectiveness of homeopathy for anxiety.

to general conditions Thachil

7 SRs, 9

Depressive

Herbs, nutritional

Placebo,



AF

RCTs, and

disorder

therapy,

antidepressants,



acupuncture,

psychotherapy





(2007)

37

3 others

exercise, complex

56

homeopathy, yoga,



traditional Chinese



medicine







unequivocally negative results. Studies below this level yielded inconclusive or negative results.

57

Supplement Table 7: Systematic Reviews and Meta-analyses on the Effectiveness of Yoga and Meditation on Mental Illnesses Referenc

Studies

e

Comparisons

Results


Yoga or meditation

Waitlist, active

7 RCTs focused on mental illness support the use of

The results support the safety

illnesses

control, no

yoga and meditation as an adjunct or independent

and potential efficacy of

including

treatment,

treatment for mood and anxiety disorders.

meditative practices for treating

treated

Arias AJ (2006)

Interventions

Conditions

20 RCTs

98

A variety of

depressive,

certain illnesses, particularly in

anxiety, and

nonpsychotic mood and anxiety

substance use

disorders. Clear and replicable

disorders

evidence from large, methodologically sound studies is lacking.

Balasubr

Schizophrenia,

Yoga alone or

Waitlist,

Grade B evidence supporting a potential acute

There is emerging evidence

amaniam

depression,

combined with

ayurveda,

benefit for yoga exists in depression (4 RCTs), as

from randomized trials to

M

ADHD, eating

pharmacotherapy

exercise, usual

an adjunct to pharmacotherapy in schizophrenia (3

support popular beliefs about

care

RCTs), in children with ADHD (2 RCTs), and

yoga for depression, sleep

disorder,

Grade C evidence in sleep complaints (3 RCTs).

disorders, and as an

cognitive

RCTs in cognitive disorders and eating disorders

augmentation therapy.

disorder

yielded conflicting results.

Limitations of literature include

(2013)

16RCTs

99

disorder, sleep

inability to do double-blind studies, multiplicity of comparisons within small studies, and lack of replication. Cabral P

10 RCTs

Depression,

Yoga as a

Standard care

The combined analysis of all 10 studies provided a

58

Yoga therapy is an effective

(2011)100

schizophrenia,

complimentary

PTSD, anxiety,

treatment to

depression in

standard care

pooled effect size of -3.25 (95% CI, -5.36 to -1.14).

adjunct treatment for several psychiatric disorders.

alcohol dependence Chiesa A (2010)

101

3

Healthy

Vipassana

neuro-ima

individuals or

meditation (VM)

ging

Treat as usual

Three clinical studies in incarcerated populations

Current studies provided

suggested that VM could reduce alcohol and

preliminary results about

prisoners with

substance abuse but not post-traumatic stress

neurobiological and clinical

studies; 4

alcohol abuse,

disorder symptoms in prisoners. One clinical study

changes related to VM practice.

controlled

substance abuse,

in healthy subjects suggested that VM could

Nonetheless, few and mainly

studies

or PTSD

enhance more mature defenses and copying styles.

low-quality data are available especially for clinical studies.

Cramer H (2013)

102

12 RCTs

Depression

Yoga alone or

Waiting list, ECT,

Three RCTs had low risk of bias. Regarding

Despite methodological

combined with

massage, exercise,

severity of depression, there was moderate evidence

drawbacks of the included

antidepressants

psychotherapy,

for short-term effects of yoga compared to usual

studies, yoga could be

relaxation music,

care (SMD =−0.69; 95% CI−0.99, −0.39), and

considered an ancillary

social support

limited evidence compared to relaxation (SMD

treatment option for patients

group

=−0.62; 95%CI −1.03, −0.22), and aerobic exercise

with depressive disorders and

combined with

(SMD = −0.59; 95% CI −0.99, −0.18). Limited

individuals with elevated levels

antidepressants

evidence was found for short-term effects of yoga

of depression.

alone or

on anxiety compared to relaxation (SMD=−0.79; 95% CI −1.3, −0.26). Subgroup analyses revealed evidence for effects in patients with depressive disorders and in individuals with elevated levels of depression.

59

Cramer

5 RCTs

Schizophrenia

H (2013)

103

Yoga combined

Exercise and/or

Two RCTs had low risk of bias. No evidence was

This systematic review found

with antipsychotics

usual care

found for short-term effects of yoga compared to

only moderate evidence for

or hospital

combined with

usual care on positive or negative symptoms.

short-term effects of yoga on

impatient treatment

antipsychotics or

Moderate evidence was found for short-term effects

quality of life. As these effects

hospital impatient

on quality of life compared to usual care (SMD =

were not clearly distinguishable

treatment

2.28; 95% CI 0.42 to 4.14\). These effects were

from bias and safety of the

only present in studies with high risk of bias. No

intervention was unclear, no

evidence was found for short-term effects on social

recommendation can be made

function. Comparing yoga to exercise, no evidence

regarding yoga as a routine

was found for short-term effects on positive

intervention for schizophrenia

symptoms, negative symptoms, quality of life, or

patients.

social function. Jain FA (2015)

104

18 RCTs

Depressive

Mindfulness-based

Hypnosis,

Studies including patients having acute major

A substantial body of evidence

disorders

cognitive therapy

bibliotherapy,

depressive episodes (n=10 studies), and those with

indicates that meditation

(MBCT), 8studies;

treat as usual,

residual subacute clinical symptoms despite initial

therapies may have salutary

Tai Chi, 3studies;

antidepressants

treatment (n=8), demonstrated moderate to large

effects on patients having

Sudar-shan Kriya

alone or

reductions in depression symptoms within the

clinical depressive disorders

Yoga (SKY),

psychoeducation,

group, and relative to control groups.

during the acute and subacute

2studies; and

pseudo-Yoga,

phases of treatment. Owing to

Patañjali Yoga,

wait list, ECT,

methodologic deficiencies and

2studies; alone or

newspaper

trial heterogeneity, large-scale,


reading, partial

randomized controlled trials

SKY

with well-described comparator

plus

interventions and measures of expectation are needed.

60

Jorm AF (2006)

14

Not

Children or

A variety of

reported

adolescents with

Not reported



complementary and



depressive




disorder or

including herbs,



elevated

homeopathy,



depressive

acupuncture, Tai



symptoms

chi, yoga, etc





depression.


Kim SH (2013)

78

6 RCTs

PTSD

Mind-body

Thermal

Most of the studies have small sample size, but

Mind-body practices are

and 10

practices including

biofeedback,

findings from the 16 publications reviewed here

increasingly employed in the

other

yoga, meditation,

narrative exposure

suggest that mind-body practices are associated

treatment of PTSD and are

studies

Qigong, Tai chi, etc

therapy, wait list

with positive impacts on PTSD symptoms.

associated with positive impacts

Mind-body practices incorporate numerous

on stress-induced illnesses such

therapeutic effects on stress responses, including

as depression and PTSD in most

reductions in anxiety, depression, and anger, and

existing studies.

increases in pain-tolerance, self-esteem, energy levels, ability to relax, and ability to cope with stressful situations. Kirkwoo

6

Anxiety

dG

randomise

(2005)

105

Yoga

Meditation ,

The reporting of study methodology was poor in

Owing to the diversity of

disorders

placebo,

most of the studies, and there were also some

conditions treated and poor

d and 2

including OCD,

relaxation,

methodological inadequacies. The potential for bias

quality of most of the studies, it

nonrandom

anxiety

pseudo-yoga,

is therefore high. All eight studies reported positive

is not possible to say that yoga

61

Krisanap

ised

neurosis,

anxiolytic and

controlled

psychoneurosis,

antidepressant

or anxiety disorders in general.

trials

examine

drugs

However, there are encouraging

2 RCTs

rakornkit

is effective in treating anxiety

anxiety, snake

results, particularly with

phobia

obsessive compulsive disorder.

Anxiety

Yoga plus

electromyography

In one study transcendental meditation showed a

The small number of studies

disorders

anti-anxiety

-biofeedback and

reduction in anxiety symptoms and

included in this review does not

medicines

relaxation

electromyography score comparable with

permit any conclusions to be

therapy,

electromyography-biofeedback and relaxation

drawn on the effectiveness of

Relaxation,

therapy. Another study compared Kundalini Yoga

meditation therapy for anxiety

Mindfulness

(KY), with Relaxation/Mindfulness Meditation.

disorders.

Meditation,

The Yale-Brown Obsessive Compulsive Scale

anti-anxiety

showed no statistically significant difference

medicines as

between groups.

T (2006)

results.

106

usual Meeks

33 RCTs

TW (2007)

24

Late-life

Various

Placebo, wait list,



depression,

complimentary and

treat as usual,



anxiety, and

alternative

sham

studies.


sleep

medicines including

acupuncture/acupr


disturbance

yoga, Tai chi,

essure, western


Qigong, meditation,

medications


single herbs,


Chinese herb formulae, acupuncture,

62

acupressure, etc Mehta P (2010)

107

10 RCTs

Individuals with

Yoga, alone or

Antidepressants,

It was found that majority of the interventions were

Several methodological

and 8 other

depressive

combined with

usual care,

able to significantly reduce depressive symptoms in

limitations were identified in

studies

disorders or

antidepressants or

psychoeducation

the patients under study.

the conduct of the intervention

elevated

psychoeducation

alone or

trials, which future

depressive

combined with

interventions must consider.

symptoms

group hypnosis, supportive therapy, or no control

Meyer

7 RCTs in

Mood disorders,

Yoga, alone or

Waitlist, exercise,

Of 13 randomized, controlled trials of yoga in

These results, although

HB

neurologic

schizophrenia,

combined with

dialectic

patients with psychiatric disorders, 10 found

encouraging, indicate that

(2012)

al

PTSD

antidepressants or

behavioral

significant, positive effects.

additional randomized,

108

disorders

psychoeducation

therapy,

controlled studies are needed to

and 13

psychoeducation,

critically define the benefits of

RCTs in

antidepressants,

yoga for both neurological and

mental

electroconvulsive

psychiatric disorders.

illnesses

therapy Jacobson’s

It appears that yoga-based interventions may have

Variation in the interventions

progressive

potentially beneficial effects on depressive

utilized and in the severity of

(2005)

relaxation,

disorders.

the depression reported was

109

modified ECT, no

encountered in the studies

treatment, partial

located together with a lack of

Yoga, wait list

details of trial methodology.

Pilkingto nK

5 RCTs

Depressive disorders

Yoga

Consequently, the findings must

63

be interpreted with caution. Posadzki

8 RCTs

Alcohol, drug or

Various types of

CBT, waiting list,

Most of these RCTs were small with serious

Although the results of this

P (2014)

nicotine

Yoga alone, or

usual care,

methodological flaws. Seven RCTs suggested that

review are encouraging, large

110

addiction

combined with

watching video,

various types of yoga led to favourable results for

RCTs are needed to better

cognitive

methadone plus

addictions compared to control. One RCT indicated

determine the benefits of yoga

behavioral therapy

psychotherapy,

that methadone plus Yoga had no effect compared

for addiction.

(CBT), or

exercise

with methadone plus psychotherapy.

combined with methadone Ravindra

Not

Mood and

Physical therapies

Placebo


While several CAM therapies

n AV

reported

anxiety

including Yoga and

alone/placebo


show some evidence of benefit

disorders

acupuncture; herbal

plus western


as augmentation in depressive

remedies;

medicines/sham



Nutraceuticals

acupuncture




disorders. The general dearth of

disorder.

adequate safety and tolerability

(2013)

29

data encourages caution in clinical use. Rosenba

39 RCTs, 2

um S (2014)

82

Mental illnesses

Physical activity

Usual care, social

Meta-analysis revealed a large effect of physical

Physical activity reduced

on Tai chi

intervention

support, wait list,

activity on depressive symptoms (SMD=0.80),

depressive symptom in people

and 1 on

including Tai chi

placebo, health

schizophrenia symptoms (SMD=1.0), a small effect

with mental illness, reduced

Yoga

and Yoga

education

for anthropometry (SMD=0.24), and moderate

symptoms of schizophrenia and

effects were found in aerobic capacity (SMD=0.63)

improved anthropometric

and quality of life (SMD=0.64).

measures, aerobic capacity, and quality of life among people

64

with mental illness. Ross A (2010)

10 RCTs

111

Healthy or

Yoga

Exercise

The only RCT in schizophrenia patients showed

The studies comparing the

patients of

benefits of yoga in decreasing psychotic symptoms

effects of yoga and exercise

various

than exercise.

seem to indicate that, in both

conditions

healthy and diseased

including

populations, yoga may be as

schizophrenia

effective as or better than exercise at improving a variety of health-related outcome measures.

Sarris J (2011)

20 RCTs

Insomnia

31

Acupuncture,

Sham


Future researchers are urged to


acupuncture,


use acceptable methodology,

pharmacotherapies,

sleep hygiene


including appropriate sample

Tai chi, Yoga

device, placebo,


sizes and adequate controls.

health education,




western medicines Sarris J (2012)

32

14 RCTs

Obsessive

Nutrients, herbal

Placebo, western

In OCD, tentative evidentiary support was found

While several studies were

compulsive

medicines,

medicines, wait

for mindfulness meditation (d=0.63),

positive, these were

disorder,

acupuncture,

list, mindfulness

electroacupuncture (d=1.16), and kundalini yoga

un-replicated and commonly

trichotillomania

mindfulness

meditation,

(d=1.61). Better designed studies using the nutrient

used small samples. This

meditation, Yoga,

decoupling

glycine (d=1.10), and traditional herbal medicines

precludes firm confidence in the

relaxation, alone or

milk thistle (insufficient data for calculating d) and

strength of clinical effect.

as adjunct treatment

borage (d=1.67) also revealed positive results. A study showed that N-acetylcysteine (d=1.31) was

65

effective in TTM. Mixed evidence was found for myo-inositol (mean d=0.98). St John's wort, EPA, and meridiantapping are ineffective in treating OCD. Thachil

7 SRs, 9

Depressive

Herbs, nutritional

Placebo,



AF

RCTs, and

disorders

therapy,

antidepressants,



acupuncture,

psychotherapy



exercise, complex



homeopathy, yoga,



traditional Chinese



medicine







(2007)

37

3 others

unequivocally negative results. Studies below this level yielded inconclusive or negative results. Tsang

12 RCTs

HWH (2008)

84

Individuals with

Exercise including

Antidepressants,

The results based on 12 RCTs indicated that both

We recommend that more

depressive

yoga, Qigong, and

usual care, wait

the mindful and nonmindful physical exercises

well-controlled studies have to

disorders or

Tai chi, alone or

list, newspaper

were effective in their short-term effect in reducing

be conducted in the future to

elevated

combined with

reading, modified

depression levels or depressive symptoms.

address the short- and long-term

depressive

antidepressants

ECT

However, most of studies had methodological

effects of physical exercise on

problems that only small sample size was used, and

alleviating depression.

symptoms

the maintenance effects of physical exercise were not reported. Uebelac

7 RCTs

Individuals with

Yoga alone or

Progressive

Although results from these trials are encouraging,

Yoga is a good candidate as a

ker LA

and 1

depressive

combined with

relaxation, no

they should be viewed as very preliminary because

possible innovative treatment

66

(2010)112

controlled

disorders or

trial

antidepressants

treatment,

the trials, as a group, suffered from substantial

for depression, but, given the

elevated

psychoeducation,


clear empirical support for other

depressive

ECT, wait list

depression treatments, we need

symptoms

more rigorous research prior to advocating for the routine use of yoga as a treatment.

Vancam

3 RCTs

Schizophrenia

pfort D (2012)

Yoga plus

Exercise or

Lower Positive and Negative Syndrome Scale

Yoga therapy can be an useful

antipsychotics

waiting list, plus

(PANSS) scores were obtained after yoga compared

add-on treatment to reduce

antipsychotics

with exercise or waiting list control conditions.

general psychopathology, and

HRQL increased more significantly after yoga than

positive and negative symptoms

after exercise or waiting list control conditions.

and quality of life.

113

Wahbeh

17 RCTs

Posttraumatic

Complementary

Waitlist, CBT,

Scientific evidence of benefit for posttraumatic

Several complementary and

H

and 16

stress disorder

medicine including

supportive

stress disorder was strong for repetitive transcranial

alternative medicine modalities

other

(PTSD)

acupuncture,

counseling,

magnetic stimulation and good for acupuncture,

may be helpful for improving

meditation, yoga,

medication,

hypnotherapy, meditation, and visualization.

posttraumatic stress disorder

etc

psychotherapy,

Evidence was unclear or conflicting for

symptoms. Future research

massage, EMDR,

biofeedback, relaxation, Emotional Freedom and

should include larger, properly

exposure, placebo

Thought Field therapies, yoga, and natural

randomized, controlled trials

products.

with appropriately selected

(2014)

39

studies

control groups and rigorous methodology. Wang D (2014)

87

22 RCTs

Substance use

Physical exercise

No exercise,

The results indicated that physical exercise can

The moderate and

disorders

including Tai chi,

standard

effectively increase the abstinence rate (OR = 1.69

high-intensity aerobic exercises,

including

Qigong, and Yoga

treatment,

(95% CI: 1.44, 1.99)), ease withdrawal symptoms

designed according to the

educational

(SMD =21.24 (95% CI: 22.46, 20.02)), and reduce

Guidelines of American College

alcohol, drug

67

and nicotine

meeting, no

anxiety (SMD =20.31 (95% CI: 20.45, 20.16)) and

of Sports Medicine, and the

intervention,

depression (SMD = 20.47 (95% CI: 20.80, 20.14)).

mind-body exercises can be an

CBT, wellness

The physical exercise can more ease the depression

effective and persistent

sessions, care as

symptoms on alcohol and illicit drug abusers than

treatment for those with SUD.

usual, sham

nicotine abusers, and more improve the abstinence

Qigong

rate on illicit drug abusers than the others. Similar treatment effects were found in three categories: exercise intensity, types of exercise, and follow-up periods.

68

Supplement Table 8 Summary of Systematic Reviews on the Effect of One Category of TCAM Approach in Treating One Category of Mental Illness in India and China TCM

Mental illnesses

approaches

Acupuncture

Dementia

Alzheimer’s disease

cognitive

Vascular dementia

deficits

19 11

Mild cognitive impairment Nicotine

2,7,42,43

Alcohol

Mixed

of

results from

from low

from high

from low

from high

from low

SRs

high quality

quality

quality

quality

quality

quality

evidences

evidences

evidences

evidences

evidences

evidences

1

results

Mixed

1

1

1

1

1

1

1

5

3

5

1

1

1

1 1

4

3

21,22,50

3

1

11

4

1

1

Subtotal Perimenopausal depression

1

2

Cocaine 5,9,25 Heroin

disorders

Negative results

1

dependence

Depressive

Negative results

1

Subtotal

Acupuncture

Positive results

2

and

Addiction

Positive

17,38

Dementia

Acupuncture

No.

2

2 2

12

Post-stroke

5

1

1

4

depression 20,46,47,51,52

69

1

4

results

Depressive

1

1

45

neurosis

Depressive

9

1

3

5

16

2

9

5

disorders 8,18,26,34,36,40,41,53,54

Subtotal Acupuncture Acupuncture Acupuncture

Insomnia

3,15

Schizophrenia

16,28,33 23,27,49

Anxiety disorders

55,58,59,67,69,70,72-75

Chinese herbs

Depression

Chinese herbs

Dementia

Chinese herbs Qigong and Tai

3 1

3

Dementia56,62,76

3

2

Mild cognitive

1

1

9

8

1

1

1

1

cognitive

Vascular dementia

1

57,64,66

65

Anxiety disorders

1

8

3

disease

68

60

Heroin addiction Depression

3

2

Subtotal Chinese herbs

2

2

and

Schizophrenia

3

61,71

impairment Chinese herbs

2

10

Alzheimer’s

deficits

2

80,86

1

63

1

1

1

2

1

1

2

1

1

Chi Qigong and Tai

Cognitive impairment 91,92

70

Chi Ayuveda

Schizophrenia 93

1

1

Insomnia 94

1

1

Medicine Homeopathy Homeopathy Homeopathy Yoga Yoga Yoga Yoga

Depression

96

1

Anxiety disorders Depression

1

1

1

102,107,109,112

4

4

103,113

2

1

2

1

Schizophrenia

Anxiety disorders Addiction

97

105,106

110

Total

1 1

1 80

1 3

50

1

6

1

19

Note: ‘Positive results’ was defined as consistent results across individual clinical trials or pooled estimates that showed at least one of the following results (based on the authors’ conclusion): 1) equal or superior to a previously established treatment; 2) superior to placebo, waitlist control, or no treatment; 3) a combination of TCAM treatment and an established treatment was better than the established treatment alone. ‘Mixed results’ was defined as inconsistent results across individuals clinical trials while no pooled estimates was provided, or pooled estimates showed inconsistent findings on different outcome measures, different comparisons (i.e. superior to placebo but not as good as an established treatment), or at different timepoints. ‘High quality’ was defined as all individual clinical trials that were analysed to reach the conclusion were of high quality (i.e. Jadad score > 3). *: One of the 79 studies conducted two comparisons, one based on all included RCTs regardless the quality and another based on high quality RCTs only. Therefore, 80 results based on 79 reviews were summarized.

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