Research report
Use of prescription medications and complementary and alternative medicines to treat depressive and anxiety symptoms: results from a community sample

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Abstract

Background: Individuals prescribed antidepressants or anxiolytics may replace or augment such medications with complementary and alternative medicines (CAMs). Little is known about the extent to which individuals in the community use CAMs instead of, or in addition to, medications they have been prescribed, for anxiety and depressive symptoms. Method: Information on use of CAMs, antidepressants and anxiolytics was obtained from a community sample of 7485 survey participants from Canberra and environs, Australia. Participants aged 20–24, 40–44, or 60–64 were also provided information on sociodemographic attributes, physical and mental health. Results: 6.29% of participants used only prescription medications to treat their depression or anxiety. 2.28% used only CAMs for this purpose while a further 0.59% reported using both types of treatments. Those using CAMs and those who took prescription medications had comparable levels of mental health problems while CAM users had fewer physical health problems and lower neuroticism. Compared with those taking neither CAMs nor prescribed medication, however, CAM users had more depressive and anxiety symptoms, worse mental health, higher neuroticism and lower levels of mastery. Limitations: Information on use of prescribed and CAMs is self-reported and is subject to the inaccuracies and omissions associated with this method of data collection. Conclusion: We found survey participants used CAMs less frequently than prescription medications to treat their depressive or anxiety symptoms. Nonetheless, medical practitioners should be aware that their patients may use CAMs and seek information about such use to reduce the likelihood of adverse interactions between prescribed medication and CAMs.

Introduction

In selecting medications to treat the common mental disorders of depression and anxiety, the medical practitioner is now able to choose from a wide range of antidepressants and anxiolytics Hickie, 2000, Andrews and Hunt, 1998. Individuals experiencing such depression or anxiety, however, can choose treatments from a much larger array of substances that includes herbal medicines, vitamins, homeopathic and naturopathic remedies (Jorm et al., 2002). Individuals using these types of treatment may choose to take them in place of, or in addition to, any prescribed medications. The criteria by which these complementary and alternative medicines (CAMs) are selected may have less to do with the proven efficacy of treatment or potential side effects and more to do with the perceived ‘naturalness’ of the treatment or the holistic belief system by which it is selected (Astin, 1998). Members of the lay public often view antidepressants, anxiolytics and other prescribed psychotropic medications, as dangerous and addictive Angermeyer and Matschinger, 1996, Benkert et al., 1997, Jorm et al., 1997 and consider CAMs to be more natural and safer (MacLennan et al., 2002), although such attributes are not clearly defined and rarely tested Kaptchuk, 1996, De Smet, 1995.

Use of CAMs overseas and in Australia is widespread MacLennan et al., 2002, Bensoussan, 1999. Those using such substances (and also other forms of complementary health care such as yoga, massage and meditation) are more likely to be female, highly educated and have a holistic orientation to health Astin, 1998, Siahpush, 1999, MacLennan et al., 1996. They are also more likely to have poorer health overall, chronic health problems, and symptoms of anxiety and depression Astin, 1998, Kessler et al., 2001, Wang et al., 2001. Outside Australia, studies have found that those using CAMs to treat their mental health problems are also likely to be obtaining treatment from conventional practitioners Eisenberg, 2002, McFarland et al., 2002, but are unlikely to discuss CAMs with those practitioners Barrett, 2001, Unutzer et al., 2000. Medical practitioners may not take into account their patients' use of CAMs when making treatment decisions. However, CAMs, including those commonly used to treat for anxiety and depressive symptoms, have the potential to cause adverse side effects including neuropsychiatric reactions (Pies, 2000), and to interact with prescribed medications including anxiolytics and antidepressants Drew and Myers, 1997, Ernst, 2002, Izzo and Ernst, 2001, Stevinson et al., 2002. Such factors may well impact on treatment outcomes if not the practitioner's prescribing decisions.

MacLennan et al., 1996, MacLennan et al., 2002 have previously reported on the extent to which Australians living in the community use CAMs for any reason. Other community-based research in Australia has examined the attributes of those using any complementary health treatments (McGregor and Peay, 1996), and the levels of such use in a small rural region (Wilkinson and Simpson, 2001). The extent to which Australians use such substances to treat the common mental health problems of anxiety or depression has not been previously reported.

Examination of this issue was made possible with access to data from the PATH Through Life Project, a large community-based study of 7485 individuals in three age groups, conducted by the Centre for Mental Health Research in Canberra, Australian Capital Territory. Information obtained from PATH participants included sociodemographic factors and also mental and physical health measures. Of relevance to this study, participants provided information on their levels of anxiety and depressive symptoms, and on the personality traits of neuroticism, extraversion and psychoticism and level of mastery. They were also asked about the types and levels of medications they had taken in the last month to help with sleep problems, relieve pain and treat depression and anxiety. Given the high level of co-morbidity of depression and anxiety, this study combined both of these disorders in the analysis. It examined the extent to which participants used prescription medicines or CAMs to treat symptoms of either depression or anxiety, or both problems. It then explored associations between use of such treatments and various mental and physical health and personality characteristics.

Section snippets

Participants

The PATH Through Life Project is a longitudinal survey of residents living in the Australian Capital Territory and the neighbouring town of Queanbeyan, New South Wales. Potential participants were drawn from three age groups: those aged 20–24 years on 1 January, 1999; those aged 40–44 years on 1 January 2000; and those aged 60–64 years on 1 January 2001. Sampling frames for this survey were the Electoral Rolls for Canberra and Queanbeyan, Australia. Registration on these rolls is compulsory for

Results

Of the 7485 PATH participants, 416 (5.56%) reported that, in the month preceding their interview, they had taken prescribed antidepressants while 145 (1.94%) had taken prescribed anxiolytics over that same period. The numbers taking CAMs for depression and for anxiety were 81 (1.08%) and 179 (2.39%), respectively. Given the small numbers using prescribed medication or CAMs for each type of disorder, those taking antidepressants and anxiolytics were combined together as were those taking CAMs

Discussion

This study explored the extent to which people in the community reported that, in the last month, they had used prescription medications or CAMs to treat symptoms of depression and anxiety. 6.29% of respondents reported taking only prescription medications while an additional 2.28% took only CAMs. Less than one percent of participants reported taking both types of treatment. Other Australia-based research against which these findings could be compared is limited. McManus et al. (2000) who

Conclusion

Overall, CAMs are used less frequently than prescription medications to treat symptoms of depression or anxiety. However, use of CAMs is more common in particular groups, for example, middle aged women. Medical practitioners should be aware that their patients may be using such treatments and seek information about such use to reduce the likelihood of adverse interactions between medications they are prescribing and other CAMs their patients may also take.

Acknowledgements

We thank Helen Christensen, Patricia Jacomb, Bryan Rodgers, Karen Maxwell and the team of interviewers from the Centre for Mental Health Research for their assistance with this study.

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