Yoga
Yoga is a complex mind–body intervention involving spiritual practice, physical activity, breathing exercises and meditation [669, 670]. Although the traditional goal of yoga is to unite body, mind, and spirit and achieve self-awareness, yoga has become a popular method of maintaining physical and mental health [669-671]. Yoga practice commonly involves postures to improve strength and flexibility, breathing exercises to focus the mind and assist with relaxation, and meditation to calm the mind [671]. Research has demonstrated that yoga can assist with the improvement of co-occurring mental health symptoms in patients with physical conditions such as cancer [672, 673], menopausal symptoms [674], and pain [675].
Several systematic reviews have been conducted to assess the efficacy of yoga as an intervention for depression. These studies have found limited to moderate support for short-term improvements in severity of depression in yoga with meditation-based practice (rather than exercise-based practice) [676-679]. Only one study has examined the effect of yoga breathing (Sudarshana Kriya Yoga) on depressive symptoms among people with alcohol dependence [680]. This study found that the yoga intervention was associated with reduced depressive symptoms compared to the control group. Although the effectiveness of yoga as a treatment for people with comorbid AOD and depressive disorders needs further investigation, these findings indicate that yoga may be considered as an additional treatment for clients with comorbid depression.
Omega-3
There has been much research conducted examining the relationship between omega-3 and depressive disorders, with some evidence that omega-3 fatty acids (primarily found in fish and seafood) are associated with lower rates of depression [681-688]. Although several studies support omega-3 supplementation as an antidepressant for people with depression alone, the role of omega-3 in people with comorbid AOD use and depression has not been rigorously examined.
Research that has included people with comorbid AOD use has been largely focused on aggression, anger, and co-occurring depression. Animal studies have found evidence of associations between omega-3 deficiencies and increased aggressive and depressive behaviours [689]. Beier and colleagues found reduced omega-3 levels among people with comorbid major depression and AOD use, indicating that omega-3 may be used as a therapeutic approach for people with depression and AOD use, and particularly those with aggressive symptoms [690]. Another placebo-controlled study of people with AOD abuse who had histories of aggression and legal problems found that anger improved with omega-3 supplementation [691, 692]. Other studies have also examined the relationship between omega-3 supplementation, depression, and co-occurring anger, aggression, hostility, and impulsivity, but have not included comorbid substance use [693-695]. Although these studies found that omega-3 supplementation improved depression and aggression [693, 694], Beier and colleagues suggest that AOD use (which was not measured) may have played an important underlying role [690].
St John’s Wort
St John’s Wort is the common name for the plant Hypericum perforatum, the extracts of which are commonly used to treat depression, sometimes in order to avoid the side-effects involved with prescription medication [696]. A systematic review of studies examining the efficacy of St John’s Wort found significantly greater reductions in mild to moderate symptoms of depression among those taking St John’s Wort compared to placebo [697]. However, the efficacy of St John’s Wort compared to antidepressants is not known. The long-term side effects, particularly among pregnant women, are also unknown.
Although there is some evidence of efficacy in mild to moderate depression, the use of St John’s Wort has been shown to have significant interactions with a range of other medications, including SSRIs and related drugs, oral contraceptives, some anticoagulants, and some cardiac medications [698]. Further, the use of St John’s Wort among people with comorbid AOD and depressive disorders has not been examined. As such, AOD workers should ask their clients specifically about their use of St John’s Wort and other complementary medicines, taking note of the potential for interactions between medications.