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Using adjunctive neutraceuticals together with antidepressants can be helpful in reducing depressive symptoms, according to a new systematic review and meta-analysis published in the June 1, 2016 issue of the American Journal of Psychiatry.
An Australian research team analyzed findings of 40 studies encompassing 14 different neutraceuticals and found evidence to support the use of adjunctive S-adenosylmethionine (SAMe), methylfolate, omega-3 (primarily EPA or ethyl-EPA), and vitamin D in order to alleviate symptoms of depression.
Findings regarding omega-3 were particularly robust. Eight double blind RCTs of omega-3, varying in size (from 20 to 122 participants) and in duration (4 to 12 weeks), met inclusion criteria. Of these, 6 studies showed a statistically significant reduction in depression scores for the treatment group, compared to the placebo group, with a significant effect size of 0.61 (P=0.0009). Ten out of 15 datasets found an effect in favor of 1-carbon cycle neutraceuticals (which consist of SAMe, folic acid, methylfolate, B6, and B12).
Creatine and an amino acid combination yielded positive findings in “isolated studies,” and the researchers stated that these products should receive “tentative consideration.”
The investigators noted that further research is needed to clarify whether zinc, vitamin C, or tryptophan (more specifically, 5-HTP, the active precursor of serotonin) could be of value. They concluded that inositol is “unlikely to have any utility as an adjunctive antidepressant agent,” although some research has suggested it may have utility as depression monotherapy.
Studies were tabulated in 4 separate groups: 1-carbon cycle neutraceuticals (consisting of SAMe and folic acid or related forms, such as methylfolate, B6 and B12); omega-3; tryptophan; other neutraceuticals.
All of the investigated supplements have “mechanistic antidepressant activity underpinning their use,” the researchers emphasized. For example, 1-carbon cycle agents are critical in the methylation processes of monoamines. Omega-3 modulates norepinephrine, dopamine, and serotonin reuptake, degradation, synthesis, and receptor binding.
The study was undertaken in response to the “growing recognition that for many people with a depressive disorder, full remission is either short-lived or absent.” The researchers noted that augmentation and combination approaches with pharmaceuticals are often used in clinical practice. Coadministration of neutraceuticals may “provide an effective and safe approach to enhancing antidepressant effects” either by “synergistically augmenting an antidepressant agent” or by providing “a range of additional biological effects.”
Sarris J, Murphy J, Mischoulon D, et al. Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses. Am J Psychiatry. 2016;173(6):575-87.
Natural protocol for depression treatment that includes omega-3s, magnesium, B vitamins, vitamin D, St John’s wort, ginkgo, SAMe, 5-HTP, and ginseng
Depression is a common mental disorder that presents with some or all of the following symptoms: a depressed mood, a loss of interest in things that once brought pleasure, feelings of guilt or low self-worth, disturbed sleep patterns, changes in appetite, a lack of energy, and poor concentration. These symptoms lead to impairments in an individual’s ability to take care of his or her everyday responsibilities and can become chronic or recurrent. According the World Health Organization (WHO), depression is common worldwide, affecting about 121 million people. Untreated depression can lead to suicide, and the WHO estimates that 850,000 people worldwide commit suicide every year. Depression is the leading cause of disability worldwide and was the 4th leading contributor to the global burden of disease for the year 2000, according to the WHO. Their estimates project that depression will rise to 2nd place in the global burden of disease listing by the year 2020. In many patients, mild to moderate depression can be successfully treated with a variety of naturopathic and holistic options, such as dietary changes, dietary supplements, exercise, massage, herbs, and sunlight. Naturopathic medicine is based on the philosophy of addressing the basic underlying cause of any health condition. Proper nutrition is a foundational component of any natural medicine program. Nutrition affects mood through the many substrates and nutrients needed for proper neurotransmitter synthesis and function. A healthy diet is not only essential for proper neurotransmitter balance, but it affects the immune system in ways that then affect neurotransmitter function. The inclusion of exercise is also of utmost importance in any program addressing mood disorders. In addition to nutritional intervention and exercise, there are many other therapies that may improve mood in patients with mild depression. Following are a number of evidence-based, effective alternative/naturopathic treatments for depression, including dietary supplements, massage, herbs, sunlight, and more.
Anthroposophy is a spiritual science whose practical applications include biodynamic agriculture, anthroposophical medicinal products, and eurhythmy (“movement as visible speech”). Anthroposophic therapy is rooted in a healing method known as anthroposophical medicine, a branch of anthroposophic philosophy founded by Austrian philosopher and social thinker Rudolph Steiner in the 1920s. It utilizes a holistic approach, endeavoring to restore the balance between the physical, mental, and emotional states of the patient. Anthroposophical practitioners use medicines based on homeopathic principles and physical therapies that call upon massage and artistic expression to trigger the patient’s self-healing capacity. Anthroposophic medicine uses the anthroposophic view of the human being as a blend of 3 interdependent aspects: the physical body; the life force, understood as the source of growth and regeneration and sometimes called the soul; and the “astral body,” which mediates between the body and the soul, also called the “ego” or “consciousness.” A 4-year study of the effectiveness of anthroposophic therapies in the treatment of depression evaluated 97 outpatients from 42 medical practices in Germany. Patients ranged from 20 to 69 years old and were referred to anthroposophic therapies (art, eurhythmy movement exercises, or rhythmical massage) or started physician-provided anthroposophic therapy (counseling, medication) for depression. Participants had suffered from depressed mood and at least 2 of 6 further depressive symptoms for a minimum of 6 months. Data were collected from July 1998 to March 2005. The authors concluded “in outpatients with chronic depression, anthroposophic therapies were followed by long-term clinical improvement. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that the anthroposophic approach, with its recourse to nonverbal and artistic exercising therapies can be useful for patients motivated for such therapies.”1
Aromatherapy is the use of essential oils to treat a variety of conditions. Naturopathic physicians use aromatherapy to treat depression, anxiety, insomnia, and stress-related disorders and to manage chronic pain. Essential oils have been used effectively for centuries as a traditional medicine, but they have been the subject of few studies. Even in the absence of sufficient studies to completely explain the pharmacological effects of many essential oils or their active chemical constituents, the studies that have been done show measurable pharmacological effects when essential oils enter the blood stream through either inhalation or topical application. Researchers at the Medicinal Plant Research Centre, United Kingdom, reviewed the published clinical trials of “psychoaromatherapy” in relation to psychiatric disorders, as well as evidence from mechanistic, neuropharmacological studies of the effects of essential oils. The authors concluded that aromatherapy may offer effective treatment for a range of psychiatric disorders. They also found that it does not appear to pose the risk of adverse effects found with many conventional psychotropic drugs.2 Various aromatherapy oils, diluted in carrier oil like almond or olive oil, are massaged into the skin, where they are absorbed into the bloodstream. Below is a list of some of the essential oils used in the treatment of depression and anxiety.
- Clary sage is used for treating insomnia, anxiety, and depression.
- Basil lifts fatigue, anxiety, and depression.
- Rose acts on the nervous system.
- Ylang ylang is used for anxiety, depression, insomnia, and stress.
- Sandalwood has sedative properties and is good for treating depression and tension.
- Lavender is used for depression, headache, hypertension, insomnia, migraine, nervous tension, and other stress-related conditions.
- Jasmine increases the beta waves in the frontal lobe, which can create a more alert and responsive state of mind.
- Rosemary relieves headaches and aids clear thinking.
- Patchouli has an uplifting effect for depression and anxiety.
- Chamomile is very calming; it soothes nerves and helps insomnia.
- Geranium is both sedative and uplifting and thus is used for treating nervous tension, depression, and hormonal and menstrual problems.
A 2007 clinical study published in the Journal of Clinical Oncology looked at the effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer. Two hundred eighty-eight cancer patients in the United Kingdom referred to complementary therapy services because of clinical anxiety and/or depression were randomized to a course of aromatherapy massage or usual supportive care alone. The authors concluded that aromatherapy massage does not appear to confer benefit on cancer patients’ anxiety and/or depression in the long term but is associated with clinically important benefit up to 2 weeks after the intervention.3 In other words, aromatherapy is not a cure for depression, but it may be an effective short-term aid in managing depression and anxiety when used with other treatment options. According the World Health Organization (WHO), depression is common worldwide, affecting about 121 million people.Another study was conducted with nursing students in Korea to test the effectiveness of lavender essential oil on insomnia and depression. In a 4-week-long, single-blind, repeated-measurements experiment, researchers studied 42 female students who complained of insomnia. The lavender fragrance had a beneficial effect on insomnia and depression in the students, though repeated studies would be needed to confirm effective proportions of lavender oil and carrier oil for insomnia and depression.4 A controlled trial conducted in Thailand tested the relaxation properties of ylang ylang oil. The oil caused a significant decrease in blood pressure, a significant increase in skin temperature, and a greater sense of calm and more relaxation. The authors conclude that there is evidence of the effectiveness of ylang ylang oil for relief of depression and stress in humans.5
The first line of naturopathic treatment for almost every disease is improved patient nutrition. Nutrition plays a key role in the onset, severity, and duration of depression, including daily mood swings. Food patterns preceding the onset of depression and during a depressive episode are similar. These patterns may include skipping meals, poor appetite, and a desire for sweets. Depressive symptoms are exacerbated by nutritional imbalances, including
- frequent consumption of caffeine;
- sucrose consumption;
- deficiencies in vitamins and minerals (biotin, folic acid, and other B vitamins; vitamin C; calcium; copper; iron; magnesium; or potassium);
- excesses of vanadium6,7;
- imbalances in amino acids; and
- food allergies.
A recent study published in Neuropharmocology demonstrates that physiologically relevant doses of caffeine can significantly depress adult hippocampal neurogenesis.8 (Adult neurogenesis has been associated with learning, memory, and depression). A review published by the Oklahoma State Medical Association finds that “caffeine is a widely used psychoactive substance that has the potential to contribute to many psychiatric symptoms.”9 Sugar intake has been linked to depression. In an article in the Journal of Depression and Anxiety, the national rate of sugar consumption was shown to directly affect the prevalence of major depression. The basis for this includes the relationship between sugar consumption, β-endorphins, and oxidative stress.10
The main dietary focus in treating depression is to ensure that the patient’s diet is rich in foods containing omega-3 fatty acids and those containing magnesium, vitamins B and D, and the antioxidant vitamins A, C, and E. Along with proper food, sufficient water intake plays a vital role in maintaining proper chemical balance in the body; even mild dehydration can cause fatigue. The Institute of Medicine advises that women should consume 2.7 Ls (91 oz) of total water (from all beverages and foods) each day, and men should average approximately 3.7 L (125 oz daily) of total water. The panel did not set an upper limit for water consumption.11
Omega-3 Fatty Acids
Foods that are rich in omega-3 fatty acids have been shown to reduce neuronal phospholipid turnover. In 1 study, registered difference images showed that the “omega-3 treatment was accompanied by structural brain changes including, in particular, a reduction in the lateral ventricular volume.”12 A 2007 meta-analysis of trials involving patients with major depressive disorder and bipolar disorder provided evidence that omega-3 PUFA supplementation reduces symptoms of depression.13 The foods with the highest amounts of omega 3 are flax seeds, Chia seeds, walnuts, baked/broiled salmon, soybeans, baked/broiled halibut, sardines, herring, tofu, and winter squash. Other foods containing omega-3s are canola oil, olive oil, broccoli, cantaloupe, kidney beans, spinach, grape leaves, Chinese cabbage, and cauliflower.
Studies have shown an inverse relationship between magnesium intake and depression and anxiety.14-16 Patients with depression should add foods that are high in magnesium to their diet, such as fish, barley, artichokes, buckwheat, oat bran, almonds, cashews, pine nuts, black beans, white beans, cornmeal, spinach, broccoli, tomatoes, pumpkin seeds, and soybeans. Whole-wheat flour contains magnesium, but the magnesium-rich germ and bran are removed in the process of making white flour. All green vegetables are sources of magnesium because the center of the chlorophyll molecule contains magnesium.
The B-complex vitamins are water-soluble vitamins that are essential to mental and emotional well-being. B-vitamin deficiency is common because B vitamins are easily destroyed by common lifestyle behaviors such as drinking alcohol and caffeinated beverages, smoking, and eating foods rich in refined sugars. Studies have shown that vitamin-B deficiency can be a cause of both depression and epilepsy and that “preventive vitamin B supplementation and sufficient intake seem very important for secondary and primary prevention of neuropsychiatric disorders, especially in subjects with a low intake or status of the vitamins.”17 When advising patients to supplement with specific B vitamins, it must be remembered that the patient must also take a B-complex supplement to prevent imbalances. Nerve tissue requires vitamin B1 to utilize glucose to produce energy; this vitamin modulates cognitive performance, especially in the elderly. Folic acid preserves the brain during its development and preserves memory during aging. Vitamins B6 and B12, among others, are directly involved in the synthesis of some neurotransmitters. Vitamin B6 is likely to benefit the treatment of premenstrual depression. Good sources of B vitamins include the following.
- Asparagus, broccoli, spinach, bananas, potatoes
- Dried apricots, dates, and figs
- Milk, eggs, cheese, yogurt
- Nuts and legumes (includes rice, corn, soy beans, string beans, peas, lentils, mustard, sesame seeds, and poppy seeds)
- Brown rice, wheat germ, whole grain cereals
Seasonal affective disorder (SAD) is prevalent when vitamin D stores are typically low. Researchers note that people suffering from depression, particularly those with SAD, tend to improve as their levels of vitamin D in the body increase.18 It has been hypothesized that vitamin D increases levels of serotonin in the brain.19 There are individual differences in the amount of vitamin D needed daily based on geographical location, the time of year, skin type, and amount of sun exposure. Research is ongoing to establish new standards for recommended daily vitamin D intake for adults as the importance of proper vitamin D levels becomes more obvious; currently, tolerable upper intake levels for vitamin D according to the National Institutes of Health Office of Dietary Supplements is 2,000 IU for adults and children over the age of 13 and 1,000 IU for children under one year of age.20 In an experiment conducted in 1998, Australian researchers found that vitamin D3(cholecalciferol) given in doses of 400 IU and 800 IU had significant positive effects on the mood of healthy individuals. Forty-four people were given either 400 IU of vitamin D, 800 IU of vitamin D, or a placebo for 5 days during the late winter. Research subjects reported that vitamin D3 had the effect of enhancing a positive mood and also reducing a negative mood in some cases. The authors concluded, “Vitamin D3 deficiency provides a compelling and parsimonious explanation for seasonal variations in mood.”21 In 1999, a study done by Hollis, Gloth, and Alam showed that a one-time dose of 100,000 IU of vitamin D improved symptoms of depression better than light therapy in a small group of participants who suffered from SAD.22 All of the participants in the vitamin D group improved according to all depression scale measurements, and the increase of serum 25-hydroxyvitamin D [25-(OH)D] levels was strongly associated with the degree of improvement of SAD symptoms. A study at the Institute of Clinical Medicine in Norway examined the relationship between serum 25-(OH)D levels and depression in overweight and obese subjects and assessed the effect of vitamin D supplementation on depressive symptoms. Researchers found a significant improvement in Beck Depression Inventory scores after 1 year in the 2 groups given vitamin D but not in the placebo group. There was a significant decrease in serum parathyroid hormone in the 2 vitamin D groups without a concomitant increase in serum calcium. There are receptors for parathyroid hormone (PTH) and 1,25–dihydroxyvitamin D in the brain, and there are clinical and experimental data indicating that PTH and vitamin D may affect cerebral function.22 The authors concluded that there “appears to be a relation between serum levels of 25-(OH) D and symptoms of depression. Supplementation with high doses of vitamin D seems to ameliorate these symptoms indicating a possible causal relationship.”23 Dietary sources of vitamin D include milk, salmon, and tuna. The best food source of vitamin D is salmon, with 530 IU per 3 oz of canned salmon. Salmon is also rich in omega 3 fatty acids, making it a very important part of a depression prevention or treatment diet.
Research has shown that exercise is an effective but often underused treatment for mild to moderate depression, even in elderly patients, and has virtually no side effects.24,25Researchers at Duke University demonstrated several years ago that exercise can be an effective antidepressant even for those patients with major depressive disorder.26 According to a report from the UK Mental Health Foundation, exercise may be just as effective at treating depression as antidepressant medicines, and they also claim that being physically active may help prevent depression in the first place. The UK report also states that exercise therapy should be used as a first-line treatment for mild depression because it may be just as effective as antidepressant medicines.27 Exercise has a number of beneficial physiological effects that make it ideal for treating depression. Exercise has been proven to increase activity in both the frontal lobe of the brain and the hippocampus. It also has been found to increase mood-enhancing brain-derived neurotrophic factor levels.28,29 Studies have also found that exercise increases levels of serotonin, dopamine, and norepinephrine.30-35 Physical activity should last at least 20 minutes a session for at least 10 weeks in order to help improve psychological well-being. Aerobic activities such as brisk walking, jogging, cycling, swimming, and dancing tend to be the most effective for treating depression.36
Several herbs have been proven to have a beneficial effect on depression and its symptoms of anxiety, sleeplessness, and inability to concentrate. Following are some of the most common herbs and supplements used for mild to moderate depression.
St John’s Wort (Hypericum perforatum)
St John’s wort is a bushy plant with a turpentine-like odor and yellow flowers whose petals have black dots on the margins. Its extract has been used in various folk remedies and herbal tinctures since Roman times. It is used extensively in both the United States and Europe to treat mild to moderate depression. A German study compared the effectiveness of St John’s wort with imipramine, a well-known antidepressant. The trials involved 40 outpatient clinics in Germany with a total of 324 outpatients suffering mild to moderate depression. Participants were given either 75 mg imipramine twice daily or 250 mg Hyericum perforatum extract ZE 117 twice daily for 6 weeks. The study concluded that H perforatum extract is therapeutically equivalent to imipramine in treating mild to moderate depression and is better tolerated.37 Another German review investigated the efficacy and side effects of H perforatum. This study looked at 27 trials that included a total of 2,291 patients who met inclusion criteria. Seventeen trials, with a total of 1,168 patients, were placebo-controlled (16 addressed single preparations, 1 a combination with 4 other plant extracts). Ten trials (8 single preparations, 2 combinations of Hypericum and Valeriana) with a total of 1,123 patients compared Hypericum with other antidepressant or sedative drugs. Most trials were 4 to 6 weeks long. Participants usually had “neurotic depression” or “mild to moderate severe depressive disorders.” The study concluded that “there is evidence that extracts of Hypericum are more effective than placebo for the short-term treatment of mild to moderately severe depressive disorders.” The proportions of patients reporting side effects were 26.3% for Hypericum single preparations vs 44.7% for standard antidepressants and 14.6% for combinations vs 26.5% with amitriptyline or desipramine. In other words, patients taking standard antidepressant medications were almost twice as likely to experience side effects as patients taking Hypericum.38 Until 2004, only 1 randomized controlled trial had been conducted using Hypericum in patients with severe depression, but it was underpowered and so its negative findings were questionable.39 With this in mind, German researchers conducted a study of acute treatment of moderate to severe depression with Hypericum extract WS 5570 vs paroxetine. The study involved 251 adult outpatients with acute major depression with total score ≥22 on the 17-item Hamilton Depression Scale from 21 psychiatric primary care practices in Germany. Patients were given either 900 mg/day Hypericum extract WS 5570 (300 mg 3 times/d) or 20 mg paroxetine once per day for 6 weeks. (In initial nonresponders, doses were increased to 1,800 mg/day Hypericum or 40 mg/day paroxetine after 2 weeks.) The study concluded that Hypericum extract WS 5570 is at least as effective as paroxetine in the treatment of moderate to severe major depression and is better tolerated.40 A comprehensive clinical review by British researchers supports the findings of the various studies above, and the authors note that all studies have found Hypericum to be less likely to cause side effects than standard pharmaceutical drugs used currently.41 The mechanism of action with St John’s wort is being investigated. Initial biochemical studies report that St John’s wort inhibits the uptake of serotonin, dopamine, and noradrenalin (norepinephrine). However, other in vitro binding assays carried out using St John’s wort extract demonstrate significant affinity for adenosine, GABA (A), GABA (B), and glutamate receptors. In vivo, St John’s wort extract leads to a decrease in the number of beta-adrenergic receptors and an increase in the number of serotonin 5-HT(2) receptors in the rat frontal cortex and causes changes in neurotransmitter concentrations in brain areas that are implicated in depression. However, there are reasons to be cautious when prescribing St John’s wort, as it has been found to have significant interactions with some other drugs. In a study done at the College of Pharmacy in Little Rock, Arkansas, comparisons of pre– and post–St John’s wort phenotypic ratios revealed significant induction of CYP3A4 and CYP2E1 activity.42 Because CYP3A4 is involved in the oxidative metabolism of more than 50% of all drugs, this suggests that Hypericum extracts are likely to interact with many more drugs than previously had been realized. Examples of medications that could be affected include carbamazepine (anticonvulsant and analgesic), cyclosporine (immunosuppressant), irinotecan (cancer drug), midazolam (anesthetic), nifedipine (calcium channel blocker), birth control pills, simvastatin (cholesterol-lowering drug), theophylline (bronchodilator), tricyclic antidepressants, warfarin (blood thinner), or HIV drugs such as nonnucleoside reverse transcriptase inhibitors or protease inhibitors. St John’s wort may also interact with digoxin or digitoxin (cardiac drug), resulting in a decrease in digoxin blood concentration. There may also be an interaction with triptan-type headache medications. Examples include naratriptan, rizatriptan, sumatriptan, and zolmitriptan. In theory, St John’s wort may also interact with certain chemotherapy drugs such as anthracyclines and may increase antiinflammatory effects of COX-2 inhibitor drugs or nonsteroidal antiiflammatories such as ibuprofen.
The Ginkgo biloba tree is an ancient species of tree native to the Asia. Chinese herbalists have used ginkgo for thousands of years, and it is one of the most widely studied botanical products. Ginkgo is widely used throughout both the United States and Europe. Since ginkgo nuts are mildly toxic, most of the ginkgo sold is in the form of a standardized extract of the leaves of the tree. Ginkgo has a long history in traditional medicine for treating circulatory disorders and enhancing memory. Scientific studies throughout the years support the effectiveness of ginkgo for these problems.43-48 Evidence to date shows that ginkgo biloba extract (GBE) is primarily effective in the elderly and when treating disorders that are caused by diminished cerebral blood flow. Laboratory studies have shown that “GBE improves blood circulation by dilating blood vessels and reducing the stickiness of blood platelets.” Ginkgo leaves also contain flavonoids and terpenoids, which are powerful antioxidants.49,50Ginkgo biloba can be used to enhance other depression treatments and sometimes can be used alone instead of pharmaceutical treatments for mild cases of depression. Even in cases where ginkgo is used as an adjunct to other depression treatments, it can be helpful as an aid to improving short-term memory by improving cerebral circulation.
S-adenosylmethionine is sold as a nutritional supplement under the marketing name SAMe. SAMe is also marketed as an approved prescription drug in Russia, Italy, and Germany. The supplement SAMe is a synthetic form of a compound formed naturally in the body from the essential amino acid methionine and adenosine triphosphate. It was first discovered in 1953. SAMe serves as a primary methyl group donor in various physiological reactions and is then converted to S-adenosyl-homocysteine.51-54 Clinical trials have shown that SAMe is effective in treating depression when taken on a regular basis. Other conditions that SAMe has been shown to help in clinical trials are liver disease and osteoarthritis. SAMe is required for the biosynthesis of the neurotransmitters dopamine and serotonin as well as for cellular growth and repair. Patients with bipolar disorder or anxiety disorders or other psychiatric disease must be closely monitored while taking SAMe as it has been associated with hypomania and mania. There are also concerns that SAMe could cause levodopa to be less effective when taken over a long period of time, so patients with Parkinson’s disease should be advised to avoid this supplement.55 There are a number of side effects associated with SAMe; the most commonly reported are nausea and other digestive disturbances. Less common side effects include anxiety, insomnia, increased thirst, increased urination, headache, hyperactivity, decreased blood glucose levels, skin rashes, dry mouth, and blood in the stool. Therapeutic doses range from 400 mg per day to 1,600 mg per day, although higher doses are used empirically in some cases. In contrast, some physicians recommend lower doses ranging from 50 to 200 mg per day to treat mild depression in an effort to lessen the risk of triggering the side effects mentioned above.
5-Hydroxytryptophan (5-HTP) is a naturally occurring amino acid, a precursor to the neurotransmitter serotonin, and an intermediate in tryptophan metabolism. 5-HTP is effective in treating depression, suppressing appetite, and promoting sleep. 5-HTP increases serotonin synthesis and release, making it useful in the treatment of conditions thought to be caused or made worse by a lack of serotonin. Care must be used to avoid serotonin syndrome in patients taking antidepressant medications. 5-HTP is usually extracted from the seeds of Griffonia simplicifolia and sold in 50 mg or 100 mg gelatin or vegetarian capsules.
Siberian ginseng (Eleutherococcus senticosus)
Siberian ginseng, also known as Eleuthero, is an adaptogen that has been used for centuries in eastern countries, including China and Russia. As an adaptogen, it helps to control excess cortisol levels and thereby reduces depression.56,57 Although a distant relative of American ginseng (Panax quinquefolius) and Asian ginseng (Panax ginseng) with some overlap in its uses, Siberian ginseng is a distinct plant with different active chemical components. Ten compounds have been isolated from Siberian ginseng. Its pharmacological activities are mainly due to lignans and iridoid glycosides, such as eleutherosides.58Prized for its ability to restore vigor, increase longevity, enhance overall health, and stimulate both a healthy appetite and a good memory, it is widely used in Russia to help the body adapt to stressful conditions and to enhance productivity. Practitioners of Chinese medicine use Siberian ginseng to restore the balance of qi and to treat a deficiency of yang in the spleen and kidney. Siberian ginseng is also an antioxidant, a nervine, an anticholesteremic, and mildly antiinflammatory. Siberian ginseng is used to help the body deal with physical and mental stressors such as heat, cold, physical exhaustion, viruses, bacteria, chemicals, extreme working conditions, noise, and pollution. It works by strengthening the system, thereby helping to prevent illness. It has been shown to have significant antidepressant effects in rats that were subjected to the desperation test and neuropharmacological tests based on the antagonist activity with respect to reserpine clofelin, and L-DOPA,59 and a Chinese study has shown that Siberian ginseng exhibited antifatigue, antistress, immunoenhancing effect, central nervous system activity, and antidepressive effects.60
Phototherapy is the use of light to treat disease and is a treatment of choice for SAD. Other indications for bright light therapy include nonseasonal depression, bipolar depression, chronic depressive disorder, antepartum and postpartum depression, late luteal phase dysphoric disorder, circadian phase sleep disorders, jet lag, shift work problems, and behavioral disturbance and insomnia in organic dementia. A 2004 study combining bright light exposure and physical exercise showed that this treatment may be an effective way of relieving depressive symptoms. The study concluded that “problems with sleep, especially initial insomnia, may predict a good response to treatment using combined light and exercise. Bright light exposure and physical exercise, even in combination, seem to be well tolerated and effective on depressive symptoms.”61 At the Be’er Ya’akov Mental Health Center associated with Tel Aviv University, Israel, a pilot study was conducted using partial sleep deprivation during the second half of the night, medium (green) wavelength light in combination with dawn simulation, bright light therapy, and sleep phase advance. The results showed the procedure to be effective and well tolerated. It affords many advantages, such as “the achievement of a rapid response, no extinction of the therapeutic effect after 4 weeks of follow-up, safety, high patient compliance, and cost effectiveness.”62
Many of the body’s electrical systems and energy fields are understood, readily verified, and a focus of established interventions. The application of lasers and magnetic pulsation, for example, can be described in terms of specific, measurable wavelengths and frequencies that have been found to be therapeutic.63 Other energies are considered to be of a more subtle nature and have not been directly measured by reproducible methods. While such subtle energies are generally not recognized in Western healthcare frameworks, they are at the root of numerous ancient systems of healing and spiritual development that are not only still in wide use throughout the world but increasingly being utilized in the West. Energy psychology has been referred to as “acupuncture without needles” in treating mental health disorders. More than two dozen variations of energy psychology can be identified, with the most well-known being Thought Field Therapy (TFT), the Tapas Acupressure Technique (TAT), and the Emotional Freedom Techniques (EFT). Many of these adapt practices and concepts from acupuncture and acupressure; others borrow from yoga, meditation, qigong, and other traditional practices. Some practitioners of these modalities describe their therapeutic mechanism as the activation of electrical signals that are said to influence brain activity64; others as describe them as catalyzing shifts in putative energy fields, such as the body’s biofield.65TFT, TAT, and EFT, each utilizing techniques derived from acupuncture and acupressure, have received by far the most attention. But what is the proof that there is any real effectiveness to these methods? Evidence is still preliminary, but energy psychology is gaining credence as an evidence-based treatment. In fact, 1 form has met the American Psychological Association’s criteria as a “probably efficacious treatment” for specific phobias; another has met the criteria for maintaining weight loss.66 The limited scientific evidence, combined with extensive clinical reports, suggests that energy psychology holds promise as a rapid and potent treatment for a range of psychological conditions.
A number of alternatives to standard antidepressant medications exist for patients with mild to moderate depression. An essential first step is to work with the patient to ensure proper diet and regular exercise. Once this has been done, nutritional supplementation, herbal medicines, phototherapy, and energy psychologies can be utilized according to patient needs as described above.
About the Author
Rena Freedenberg, ND, graduated from Michlelet Eden College of Natural Medicine in Jerusalem, Israel, where she did 2 years of internship in internal medicine. Freedenberg’s practice is located in Beitar Illit, Israel, where she specializes in women’s and children’s healthcare. Her primary interest is in addressing the underlying causes of illness and improving the health and quality of life of women and their families.
- Hamre HJ, Witt CM, Glockmann A, et al. Anthroposophic therapy for chronic depression: a four-year prospective cohort study. BMC Psychiatry. 2006; 6:57.
- Perry N, Perry E. Aromatherapy in the management of psychiatric disorders: clinical and neuropharmacological perspectives. CNS Drugs. 2006;20(4):257-280.
- Wilkinson SM, Love SB, Westcombe AM, et al. Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter randomized controlled trial. J Clin Oncol. 2007;25(5):532-539.
- Lee IS, Lee GJ. Effects of lavender aromatherapy on insomnia and depression in women college students. Taehan Kanho Hakhoe Chi. 2006;36(1):136-143.
- Hongratanaworakit T, Buchbauer G. Relaxing effect of ylang ylang oil on humans after transdermal absorption. Phytother Res. 2006;20(9):758-763.
- Naylor GJ, Smith AH. Vanadium: a possible aetiological factor in manic depressive illness. Psychol Med. 1981;11(2):249-256.
- Naylor GJ. Vanadium and manic depressive psychosis. Nutr Health. 1984;3(1-2):79-85.
- Wentz CT, Magavi SS. Caffeine alters proliferation of neuronal precursors in the adult hippocampus. Neuropharmacology. 2009; 56(6-7):994-1000.
- Broderick P, Benjamin AB. Caffeine and psychiatric symptoms: a review. J Okla State Med Assoc. 2004;97(12):538-542
- Westover AN, Marangell LB. A cross-national relationship between sugar consumption and depression? J Depression Anxiety. 2002;16:118-120.
- Panel on Dietary Reference Intakes for Electrolytes and Water, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate. Released February 11, 2004.
- Puri BK, Counsell SJ, Hamilton G, Richardson AJ, Horrobin DF. Eicosapentaenoic acid in treatment-resistant depression associated with symptom remission, structural brain changes and reduced neuronal phospholipid turnover. Int J Clin Pract. 2001;55(8):560-563.
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