Usually when I hear someone complain about “feeling depressed,” it just means they’ve had a bad day or are feeling temporarily down. As a medical condition, however, depression is quite different: It’s a mood disorder that can range from mild but persistent melancholy, to alternating moods of elation and despair, to a despondency so severe that a person can even feel suicidal. Fortunately, there are lots of options for people with depression. At WholeHealth Chicago we suggest a wide range of treatments–from counseling, lifestyle changes, and natural therapies to supplements and even prescription medications.
Clearly, antidepressants have bettered the lives of many of our patients. But it’s also our experience that for mild-to-moderate depression, a variety of nondrug treatments, including herbs and other supplements, can also be very helpful. Even if you and your doctor decide you will benefit from a medication, alternative measures that complement your drug therapy may enable you eventually (with your doctor’s advice) to reduce your dosage.
What is Depression?
Depression is more than just “feeling blue” or experiencing sadness or grief because of a specific circumstance. It is a mood disorder characterized by a persistently sad or empty feeling, irritability, and a diminished or absent interest in everyday activities. Usually depression occurs in episodes, which can last for weeks, months, or even years. Many patients experiencing such bouts of depression actually feel quite “normal” in between flare-ups. Depressive moods can range from mild but enduring feelings of sadness to a really profound despair that typically interferes with routine daily functions. Rarely, severe depression may be accompanied by thoughts of suicide. This type of condition is known as a major depressive disorder and it’s characterized by a deep sense of despondency. Yet another type of depression is called bipolar disorder; here bouts of depression are interspersed with periods of elevated (manic) moods. Mild but chronic depression, known as dysthymia, lasts a long time–at least two years or more–but in fact it’s really almost a lifelong sense of sadness.
About 18 million Americans suffer from periods of clinical depression, which can be defined as a sense of sadness noticeable enough to require treatment. Women are affected twice as often as men. Episodes can occur at any age, though often they first surface during adolescence. Fortunately, the overwhelming majority of people with depression can be helped by counseling (psychotherapy), antidepressant drugs, or other therapies. In fact, it’s largely a heightened awareness of depression by primary-care physicians–and their increased use of antidepressant medications and prompt referral to counselors–that has lowered the hospitalization rate and the suicide risk for people with severe depressive conditions.
- Persistent feelings of sadness or “emptiness”
- Sense of hopelessness, worthlessness, and guilt
- Inability to enjoy ordinary pleasurable activities, including sex
- Noticeable change of appetite, possibly accompanied by significant weight loss or weight gain
- Shifts in sleeping patterns, such as insomnia or sleeping too much
- Difficulty concentrating, persistent irritability, excessive crying
- Preoccupation with thoughts of death or suicide
- Decreased energy, fatigue
- Persistent aches and pains
What Causes Depression?
The cause of depression hasn’t been established. Initial episodes may be connected to a major life event, such as a divorce, serious illness, death of a loved one, or loss of a job. Recurrent episodes, however, appear unrelated to such specific circumstances.
Experts now think that medical, biochemical, and environmental factors all play a role. There is very likely a genetic component behind some cases of depression: The condition appears to run in families, although no specific genes have been identified. Researchers have also focused on depression-linked imbalances in the brain’s production of neurotransmitters, chemicals that pass messages from one nerve cell to another.
Not infrequently, depression develops in response to a medical illness, particularly heart disease; cancer; an endocrine imbalance, such as underactive thyroid or premenstrual syndrome (PMS); or a neurologic disorder such as stroke. Depression is also associated with long-term use of numerous medications, including beta-blockers for high blood pressure and corticosteroids for arthritis.
Stress, overconsumption of alcohol, smoking, and nutritional deficiencies may also contribute to depression. Some nutritionally oriented physicians believe that hidden food sensitivities and exposures to toxins in the environment are related to depression as well.
Some people become depressed during winter months, when there is less sunlight–a condition known as SAD, or seasonal affective disorder. Depression can also be caused or aggravated by inappropriate or unhealthful ways of coping with anger, guilt, and other emotions.
Treatment and Prevention
If you suspect symptoms of depression in yourself or someone close to you, consulting a physician or trusted professional counselor such as your clergyman is an excellent first step. A doctor can help assess the seriousness of any depressive episodes, and determine whether they are associated with particular drugs, medical problems, or other underlying cause. Many clergy are trained in counseling and can advise you if professional medical help is needed.
Antidepressant drugs are now prescribed for even moderate cases of depression. SSRIs (selective serotonin reuptake inhibitors), which include Prozac and Zoloft, are favored by many physicians over older antidepressants because they have fewer and milder side effects. Expect at least three to six weeks for any significant improvement to occur. If SSRI’s aren’t effective, your doctor may recommend tricyclic antidepressants.
Any drug treatment can cause undesirable side effects. For mild-to-moderate depression, there are a number of vitamin, mineral, and herbal supplements that can be beneficial at alleviating symptoms without producing the side effects of these conventional medications. If your depression is associated with diminishing amounts of sunlight during fall or winter months, light therapy (exposure to a bright light, typically from an artificial source) may help.
Major depression is a potentially serious condition and should always be diagnosed and initially treated by a physician or qualified psychotherapist. Treatment of major depression usually requires prescription antidepressants along with psychotherapy, although alternative measures may help as well.
Just a reminder: If you have a serious medical or psychiatric condition, it?s always a good idea check with your doctor before using supplements to treat depression. Also, be sure to review your current conventional medicines with your physician; many drugs are known to cause depression as a side effect.
How Supplements Can Help
People experiencing mild-to-moderate depression might first want to try taking St. John’s wort, an herb that a number of well-regarded research studies have shown can positively affect mood in mild-to-moderately depressed individuals. Self-diagnosis, however, is never a good idea, especially in the case of depression. If you believe that you’re affected enough to merit taking St. John’s wort, it’s probably a good idea to talk about your feelings with your physician or a professional counselor.
St. John’s wort will take about a month to sufficiently build up in your system and produce noticeable benefits. In the meantime, add phosphatidylserine to your supplement regimen. This amino acid has been shown in clinical trials to lift mood and positively affect behavior.
The newly available amino acid SAMe (S-adenosylmethionine) has been shown in several studies to be as effective as such conventional antidepressants as amitryptiline or norpramine. In fact, European doctors frequently choose SAMe over conventional antidepressants because it works more rapidly than conventional antidepressants and it has virtually no side effects.
Until SAMe became readily available, many doctors recommended 5-HTP if St. John’s wort was not effective. Short for 5-hydroxytrptophan, 5-HTP is a derivative of the amino acid tryptophan. In the brain, this compound converts into an important neurochemical called serotonin, which studies are finding is a potent mood enhancer.
For those over age 50, ginkgo biloba sometimes seems to fight depression better than St. John’s wort. This is probably because depression has been linked to reduced circulation in the brain, and ginkgo has long been prescribed to increase blood flow. This makes it particular beneficial to older people, who often have cholesterol-clogged blood vessels.
Vitamin B complex helps strengthen the nerves because it enhances neurotransmitter production in the brain. All the B vitamins can be safely taken in conjunction with prescription antidepressants.
For depression accompanied by anxiety, kava can also be taken on a daily basis for its anxiety-relieving benefits. This herb, which seems to affect the brain’s limbic system, helps calm the revved up emotions that often accompany depression. It’s remarkably quick-working and generally not addictive.
If your depression is well correlated with the second half of your menstrual cycle, it may be a variation of PMS. Along with St. John’s wort, try adding the herb chasteberry (400 to 600 mg a day) during the days when you’re not menstruating
Get supplement dosages and tips in our WholeHealth Chicago Supplement Recommendations for Depression.
Regular exercise is one of the best tools for keeping depression at bay. Activities such as walking, running, swimming, or bicycling have been shown in a number of studies to reduce feelings of depression and related emotional states such as helplessness, anxiety, and hostility.
Mediation and yoga are two other methods that can be used to control anxiety related to depression.
Exposure to bright light, known as light therapy, may be effective, particularly when depression is related to seasonal changes.
Stay away from alcohol, tobacco, and excessive caffeine.
Eat turkey, salmon, and milk, which contain the amino acid tryptophan. Low levels of this amino acid reduce the brain’s production of serotonin, which helps control mood.
When to Call a Doctor
- If clear signs of depression (shown by you or by someone you know) last at least two weeks.
- If there are acts or words indicating suicidal thoughts, get help immediately.
From David Edelberg, M.D. at WholeHealth Chicago: Most depression is situational, temporary, and its symptoms don’t lead to an inability to function. Based on the experience of the physicians at WholeHealth Chicago, the supplements listed below can help ease this kind of mild-to-moderate depression. Many people combine supplements with short-term counseling to help understand what’s causing their depression. But if the supplements don’t help, it’s time to see a doctor about antidepressant medication.
A note of caution: If you are on an antidepressant, don’t stop on your own or try replacing it with supplements. This should only be done under a doctor’s care.
How to Take the Supplements
Finding the right combination of supplements may require patience. If your symptoms are mild, start with vitamin B complex and St. John’s wort (SJW), which can take up to six weeks to attain its maximum effect.
If you feel you can’t wait for the SJW to take effect, add the amino acid SAMe (S-adenosylmethionine) as well. It’s price-y, so you can discontinue after a month. (By that time, the SJW should be working.) If you’re over age 50, including ginkgo biloba may enhance the overall supplement effect by improving circulation to the brain.
In four weeks, take stock of how you are feeling.
If you’ve improved, continue the SJW/B Complex for at least six months. Then stop and assess how you are. If you don’t feel any depression for at least three weeks afterward, you probably don’t need to restart the supplements. However, if you feel symptoms coming back, return to the SJW/B Complex and consider talking to a mental health professional.
If you have not improved after these first weeks or if your improvement seems only marginal, try one of the following:
If you’ve been on SJW/vitamin B alone, you can increase the SJW to 1,200 mg a day, AND/OR you can add ONE of the following: SAMe, 5-HTP (5-hydroxytryptophan), or phosphatidylserine (PS) in the doses recommended.
If you’ve been on SJW/vitamin B plus SAMe, you can increase the SJW to 1,200 mg a day OR add 5-HTP or phosphatidylserine.
Finally, consider talking to your physician or counselor about conventional antidepressants. In other words, in my own practice, unless I am dealing with someone who has a major depression, I will allow about six weeks (maximum) for supplements and herbs, either singly or in combinations, to show some positive effects before shifting over to conventional antidepressants.
Of special note
Most menstruating women have a premenstrual component to their depression. Try adding a PMS Herbal Combination, which has a number of helpful nutrients for relieving PMS.
Disturbed sleep can be a real problem with depression, either in an inability to fall asleep, or in awakening inappropriately. Try melatonin (1-3 mg at bedtime).
You can also add the herb kava (250 mg 2 or 3 times a day) if your depression is accompanied by anxiety. Important:
We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.
Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions. The Healing Path for Depression provides more extensive therapeutic information about this condition.
For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001
David Edelberg, MD