Q. I have mild depression, but I'm concerned about side effects of taking drugs for my condition. What else can I do?

A. While prescription antidepressant drugs are useful for severe depression, they appear to be no better than a placebo in the treatment of mild to moderate depression. Researchers came to this conclusion after reviewing research and data from numerous sources from 1980 to 2009, as reported in the Jan. 6 Journal of the American Medical Association. The lack of clear efficacy of modern pharmaceuticals suggests that other approaches should be considered in cases of mild to moderate depression.

Depression affects more than 14 million American adults every year. There are many possible causes of depression, and identifying the cause is an important key to treating it. Possible causes of depression include:

• Medication: such as medication for blood pressure, sleep, anxiety, cancer, pain, autoimmune disease, cholesterol, acid reflux, corticosteroids and others.

• Hormone changes: such as low thyroid, menopause, pre-menstrual syndrome, hormone treatment, pregnancy.

• Unresolved emotional trauma: such as childhood or spouse abuse.

• Situational: such as job stress, loss of job, divorce, death of relative or friend, bad evaluation or grades, stress of caregiving, money problems or other unexpected life changes.

• Illness: such as stroke, diabetes, anemia, cancer, heart disease, autoimmune disease, hypothyroidism, Parkinson's disease, Alzheimer's disease, sleep apnea.

• Dietary: such as alcohol, caffeine, sugar, unbalanced diet, nutritional deficiency, junk food.

• Drug abuse: such as using methamphetamine, cocaine, marijuana, hallicinogenics and others.

• Lifestyle factors: such as lack of sleep or lack of social contact.

The first approach should be to deal with the above issues. Then, there are numerous alternative treatments for depression but few have a great deal of published research on their effectiveness . They may be worth trying, nonetheless, because unlike using pharmaceuticals, their side effects are few. Treatments that have some documented efficacy include but are not limited to the following:

• Exercise — a number of studies suggest that a brisk walk or aerobic activity for 30 minutes a day may be very helpful. Qigong, tai chi and yoga may also be useful.

• Acupuncture — The World Health Organization lists depression among the conditions for which acupuncture is effective, but there is little solid research.

• Herbs — 5HTP, ginkgo, St. John's wort all have some supporting research but recently one controversial study indicated that St. John's wort is no better than a placebo.

• Supplements: Vitamin B6 (folic acid), vitamin D, iron and B12 may be useful if there is a deficiency.

The following have some anecdotal or traditional support but have not been studied thoroughly enough to have documented efficacy: Chinese herbal medicine; Ayurvedic herbal medicine; nutrition therapy; light therapy; music therapy; EFT (emotional freedom technique); positive affirmations; laughter therapy; healthy relationships, including with pets; and family and social support.

Because the cause or causes of depression may be complex, a whole-person approach may be the most effective. Because pharmaceuticals and physical illness may be involved, talking to your medical doctor is a good start. Working with a psychologist, psychiatrist or medical doctor with a whole-person perspective may be a good next step.

Elizabeth Chen-Christenson, a medical doctor and licensed acupuncturist, practices family medicine, integrative medicine and Chinese medicine at the Department of Complementary and Alternative Medicine clinic at the John A. Burns School of Medicine, University of Hawai'i-Mānoa. Reach her at 692-0908.