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Depression
Depression, characterized by unhappy feelings of
hopelessness, can be a response to stressful events,
hormonal imbalances, biochemical abnormalities, or other
causes. Mild depression that passes quickly may not require
any diagnosis or treatment. However, when depression
becomes recurrent, constant, or severe, it should be
diagnosed by a licensed counselor, psychologist, or
psychiatrist. Diagnosis may be crucial to determining
appropriate treatment. For example, depression caused by
low thyroid function can be successfully treated with
prescription thyroid medication. Suicidal depression often
requires prescription antidepressants. Persistent mild-tomoderate depression triggered by stressful events is often
best treated with counseling and not necessarily with
medications.
When depression is not a function of external events, it is
called endogenous. Endogenous depression can be due to
biochemical abnormalities. Lifestyle changes and herbs
may be used with people whose depression results from a
variety of causes, but dietary and nutrient interventions are
usually best geared to endogenous depression.
Dietary changes that may be helpful: Although some
research has produced mixed results,1 several double blind
studies have shown that food allergies can trigger mental
symptoms, including depression.2 3 Individuals with
depression who do not respond to other natural or
conventional approaches should consult a nutritionally
oriented doctor to diagnose possible food sensitivities and
avoid offending foods.
Restricting sugar and caffeine in people with depression
has been reported to elevate mood in preliminary research.4
How much of this effect resulted from sugar and how much
from caffeine remains unknown. Researchers have reported
that psychiatric patients who are heavy coffee drinkers are
more likely to be depressed than other such patients.5
However, it remains unclear whether caffeine caused
depression or whether depressed people were more likely to
want the “lift” associated with drinking a cup of coffee. In
fact, “improvement in mood” is considered an effect of
long-term coffee consumption by some researchers, a
concept supported by the fact that people who drink coffee
have been reported to have a 58-66% decreased risk of
committing suicide compared with non-coffee drinkers.6
Nonetheless, a symptom of caffeine addiction can be
depression.7 Thus, consumption of caffeine (mostly from
coffee) has paradoxically been linked with both
improvement in mood and depression, by different
researchers. People with depression may want to avoid
caffeine as well as sugar for one week to see how it affects
their mood.
Lifestyle changes that may be helpful: Exercise increases
the body’s production of endorphins—chemical substances
that can relieve depression. Scientific research shows that
routine exercise can positively affect mood and help with
depression.8 As little as three hours per week of aerobic
exercises can profoundly reduce the level of depression.9
Nutritional supplements and other natural therapies
that may be helpful: Oral contraceptives can deplete the
body of vitamin B6, a nutrient needed for maintenance of
normal mental functioning. Double blind research shows
that women who are depressed and who have become
depleted of vitamin B6 while taking oral contraceptives
typically respond to vitamin B6 supplementation.10 In one
trial, 20 mg of vitamin B6 were taken twice per day. Some
evidence suggests that people who are depressed—even
when not taking the oral contraceptive—are still more
likely to be B6 deficient than people who are not
depressed.11
Several studies also indicate that vitamin B6
supplementation helps alleviate depression associated with
premenstrual syndrome12 (PMS), although the research
remains inconsistent.13 Many nutritionally oriented doctors
suggest that women who have depression associated with
PMS take 100–300 mg of vitamin B6 per day—a level of
intake that requires supervision by a nutritionally oriented
doctor.
Iron deficiency is known to affect mood and can exacerbate
depression, but it can be diagnosed and treated by any
nutritionally oriented doctor. While iron deficiency is easy
to fix with iron supplements, people who have not been
diagnosed with iron deficiency should not supplement iron.
Deficiency of vitamin B12 can create disturbances in mood
that respond to B12 supplementation.14 Depression caused
by vitamin B12 deficiency can occur in the absence of
anemia.15 Diagnosis of deficiency requires a doctor
knowledgeable in the field of nutrition.
Mood has been reported to sometimes improve with high
amounts of vitamin B12 (given by injection) even in the
absence of a B12 deficiency.16 Supplying the body with
high amounts of vitamin B12 can only be done by
injection. However, in the case of overcoming a diagnosed
B12 deficiency, following an initial injection by oral
maintenance supplementation (1,000 micrograms per day)
is possible even when the cause of the deficiency is
pernicious anemia. (See the Vitamin B12 section above for
more information.)
A deficiency of the B vitamin folic acid can also disturb
mood. A large percentage of depressed people have low
folic acid levels.17 Folic acid supplements appear to
improve the effects of lithium in treating manicdepressives.18 Depressed alcoholics report feeling better
with large amounts of a modified form of folic acid.19
Anyone suffering from chronic depression should be
evaluated for possible folic acid deficiency by a
nutritionally oriented doctor. Those with abnormally low
levels of folic acid are sometimes given short-term, high
amounts of folic acid (10,000 mcg per day).
A deficiency of other B vitamins not discussed above
(including B1, B2, B3, pantothenic acid, and biotin) can
also lead to depression. However, the level of deficiency of
these nutrients needed to induce depression is rarely found
in Western societies.
Omega-3 oils found in fish, particularly DHA, are needed
for normal functioning of the nervous system. Depressed
people have been reported to have lower DHA levels than
people who are not depressed.20 Low levels of the other
omega-3 oil from fish, EPA, have correlated with increased
severity of depression.21 However, researchers have yet to
investigate whether omega-3 fish oil supplements help
people with depression.
The amino acid tyrosine can convert into
norepinephrine—a neurotransmitter that affects mood.
Women taking oral contraceptives have lower levels of
tyrosine, and some researchers think this might be related
to depression caused by the Pill.22 Tyrosine metabolism
may be abnormal in other depressed people as well,23 and
preliminary research suggests supplementation might
help.24 25 Several nutritionally oriented doctors
recommend a twelve-week trial of tyrosine
supplementation for people who are depressed. Published
research has used a very high amount—100 mg per 2.2
pounds of body weight (or about 7 grams per day for an
average adult). It remains unclear whether such high levels
are necessary for optimal effect.
L-Phenylalanine is another amino acid that converts to
mood-affecting substances (including phenylethylamine).
Preliminary research reported that L-phenylalanine
improved mood in most depressed people studied.26 DLPA
is a mixture of the essential amino acid L-phenylalanine
and its synthetic mirror image, D-phenylalanine. DLPA (or
the D- or L-form alone) reduced depression in thirty-one of
forty people in an uncontrolled study.27 Some doctors of
natural medicine suggest a one-month trial with 3–4 grams
per day of phenylalanine for people with depression,
although some researchers have found that even very low
amounts—75–200 mg per day—were helpful in
preliminary studies.28 In one double blind trial, depressed
people given 150–200 mg of DLPA experienced results
comparable to that of an antidepressant drug.29
Phosphatidylserine (PS), a natural substance derived from
the amino acid serine, affects neurotransmitter levels in the
brain that affect mood. In a controlled trial, older women
given 300 mg of PS had significantly less depression
compared with placebo.30 After forty-five days, the level
of depression in the PS group was more than 60% lower
than the level achieved with placebo.
Levels of the hormone dehydroepiandrosterone (DHEA)
may be lower in depressed people. Supplementation with
DHEA improved depression in an uncontrolled study with
only six subjects.31 A double blind trial reported a
significant reduction in major depression in six weeks using
a maximum of 90 mg per day of DHEA.32 In that trial, no
people had significant improvement with placebo, but five
of eleven people given DHEA had a 50% or greater
decrease in symptoms. Depressed people considering
taking DHEA should consult a nutritionally oriented
doctor. In addition, experts have concerns about the safe
use ofDHEA, particularly because long-term safety data do
not exist. See the DHEA article for more information about
the safety concerns.
Preliminary evidence indicates that individuals with
depression may have lower levels of inositol; however, the
clinical application of this remains to be determined.33
An isolated preliminary trial suggests that the supplement
NADH may help people with depression.34 Controlled
trials are needed before any conclusions can be drawn.
S-adenosyl methionine (SAMe) is a substance synthesized
in the body that has recently been made available as a
supplement. SAMe appears to raise levels of dopamine, an
important neurotransmitter in mood regulation, and higher
SAMe levels in the brain are associated with successful
drug treatment of depression. Oral SAMe has been
demonstrated to be an effective treatment for depression in
most,35 36 37 but not all,38 controlled studies. While it
does not seem to be as powerful as full doses of
antidepressant medications39 or St. John’s wort, SAMe’s
effects are felt more rapidly, often within one week.40
Disruptions in emotional well-being, including depression,
have been linked to serotonin imbalances in the brain.41
Supplementation with 5-HTP may increase serotonin
synthesis, and thus researchers are studying the possibility
that 5-HTP might help people with depression. Some42 43
trials using 5-HTP with people suffering from depression
have shown sign of efficacy.44 45 46 Depressed people
interested in considering this hormone precursor should
consult a nutritionally oriented doctor.
Are there any side effects or interactions? Refer to the
individual supplement for information about any side
effects or interactions.
Herbs that may be helpful: St. John’s wort extracts are
among the leading medicines used in Germany by medical
doctors for the treatment of mild to moderate depression.
Using St. John’s wort extract can significantly relieve the
symptoms of depression. People taking St. John’s wort
show an improvement in mood and ability to carry out their
daily routine. Symptoms such as sadness, hopelessness,
worthlessness, exhaustion, and poor sleep also decrease.47
48
The St. John’s wort extract LI 160 has been compared to
the prescription antidepressants imipramine,49
amitriptyline,50 and maprotiline.51 The improvement in
symptoms of mild to moderate depression was similar with
notably fewer side effects in people taking St. John’s wort.
It is important to note, however, that the above studies
compared 900 mg per day of St. John’s wort extract with
only 75 mg per day of the prescription antidepressants.
Healthcare professionals consider this a very low amount.
A more recent study compared a higher dose of the St.
John’s wort extract LI 160 (1,800 mg per day) with a
higher dose of imipramine (150 mg per day) in more
severely depressed persons.52 Again, the improvement was
virtually the same for both groups with far fewer side
effects for the St. John’s wort group. While this may point
to St. John’s wort as a possible treatment for more severe
cases of depression, this treatment should only be pursued
under the guidance of a healthcare professional.
In the German Commission E monograph, the amount of
St. John’s wort taken is typically based on hypericin
concentration in the extract, which should be approximately
1 mg per day.53 For example, an extract standardized to
contain 0.2% hypericin would require a daily intake of 500
mg (usually given in two divided dosages). Many European
studies use higher intakes of 900 mg daily and this has
become the accepted daily dosage in modern herbal
medicine. Recent research suggests, however, that
hypericin is not the antidepressant compound in St. John’s
wort, and attention is starting to shift to the compound
known as hyperforin.54 As an antidepressant, St. John’s
wort should be monitored for four to six weeks to check
effectiveness. If possible, St. John’s wort should be taken
near mealtime.
Ginkgo is supportive in the alleviation of depression and
has been shown in one double blind study to be helpful for
depressed elderly people not responding to antidepressant
drugs.55 Damiana also has a tradition of being used to
stimulate people with depression. Yohimbine (the active
component of the herb yohimbe) inhibits monoamine
oxidase (MAO) and therefore may be beneficial in
depressive disorders. However, clinical research has not
been conducted for its use in treating depression.
Are there any side effects or interactions? Refer to the
individual herb for information about any side effects or
interactions.
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