Publisher's Synopsis
Posttraumatic stress disorder (PTSD) is an anxiety disorder, and the disorder most frequently associated with combat exposure. An anticipated consequence of our troops' prolonged deployments in Iraq and Afghanistan is an increased incidence of PTSD among returning Veterans. The VA is committed to providing cutting-edge, evidence-based treatment for all Veterans, including those seeking PTSD-related services. Complementary alternative medicine (CAM) interventions are widely requested and used by mental health consumers, including Veterans and active duty personnel. CAM treatments are perceived to be less invasive and to have fewer side effects than traditional therapies and, in some cases, may be more congruent with individual treatment preference. VA is committed to expanding the evidence base and breadth of PTSD-related services available to Veterans. To this end, there is growing interest in applications of CAM. This evidence report was commissioned to examine the efficacy of CAM therapies for the treatment of PTSD. The Durham Evidence-based Synthesis Program (ESP) Center completed a systematic review, Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder, that included studies of patients with PTSD. In response to a preliminary presentation, stakeholders and attendees requested the review be extended to other disorders related to, or often comorbid with, PTSD. This supplemental report examines CAM therapies for other anxiety diagnoses and depression to better ascertain the potential for CAM therapies in the treatment of PTSD. The National Vietnam Veterans Readjustment Study found that 98.9 percent of Veterans with PTSD reached criteria for a lifetime comorbid psychiatric diagnosis, suggesting that the co-occurrence of PTSD with other psychiatric diagnoses is a ubiquitous phenomenon. Almost half of men (47.9%) and women (48.5%) in the general population with PTSD meet criteria for major depressive episode. Of the other anxiety disorders, generalized anxiety disorder (GAD) and social phobia are the most likely to co-occur with both PTSD and major depressive disorder (MDD). Further support for the interrelationship of these disorders is the recommendation for Diagnostic and Statistical Manual of Mental Disorders, 5th edition to reclassify the "emotional (or internalizing) disorders," to include GAD, unipolar depression, panic disorder, phobic disorders, obsessional states, dysthymic disorders, PTSD and somatoform disorders. In addition, a shared association with abnormalities in the 5-HT transporter gene provides a potential mechanism to explain the clinical observation that antidepressants are effective for a variety of anxiety disorders. Since these disorders share symptoms, possible causative mechanisms, and common psychological and pharmacologic treatments, it is plausible that CAM therapies shown to be effective for depression or an anxiety disorder may be effective for PTSD. CAM refers to a group of healing techniques not traditionally practiced by Western-trained physicians but traditionally used in the medical systems of other parts of the world. The National Center for Complementary and Alternative Medicine in the National Institutes of Health has proposed a classification system for CAM therapies that includes natural products (e.g., dietary supplements, herbal remedies), mind-body medicine (e.g., meditation, acupuncture), manipulative and body-based practices (e.g., spinal manipulation, massage), whole medical systems (e.g., traditional Chinese or Ayurvedic medicine), and other alternative practices (e.g., light or movement therapy).This supplemental report examines the evidence base for mind-body medicine, manipulative and body-based practices, and movement or energy therapies in the treatment of depressive disorders and anxiety disorders other than PTSD.
