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- Description
- 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-to-moderate 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 manic-depressives.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 of DHEA, 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. Some4243 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.
Checklist for Depression
Ranking
Nutritional Supplements
Herbs
Primary Folic acid (for folate deficiency)
Iron (for iron deficiency)
Vitamin B6 (with oral contraceptives)
Vitamin B12 (for B12 deficiency)
St. John?s Wort
Secondary 5-HTP
Phenylalanine/DLPA
SAMe
Tyrosine
Vitamin B6 (for premenstrual syndrome)
Ginkgo biloba (for elderly people)
Other Fish oil (EPA/DHA)
Inositol
NADH
Phosphatidylserine
Ginkgo biloba
Damiana
Yohimbe
See also: Homeopathic Remedies for Depression at http://www.myvaluenutrition.com
information about the effects of a particular supplement or herb on a particular condition has been qualified in terms of the methodology or source of supporting data (for example: clinical, double blind, meta-analysis, or traditional use). For the convenience of the reader, the information in the table listing the supplements for particular conditions is also categorized. The criteria for the categorizations are: ?Primary? indicates there are reliable and relatively consistent scientific data showing a health benefit. ?Secondary? indicates there are conflicting, insufficient, or only preliminary studies suggesting a health benefit or that the health benefit is minimal. ?Other? indicates that an herb is primarily supported by traditional use or that the herb or supplement has little scientific support and/or minimal proven health benefit.
References:
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2. King DS. Can allergic exposure provoke psychological symptoms? A double-blind test. Biol Psychiatr 1981;16:3?19.
3. Brown M, Gibney M, Husband PR, Radcliffe M. Food allergy in polysymptomatic patients. Practitioner 1981;225:1651?54.
4. Christensen L. Psychological distress and diet-effects of sucrose and caffeine. J Applied Nutr 1988;40:44?50.
5. Greden JF, Fontaine P, Lubetsky M, Chamberlin K. Anxiety and depression associated with caffeinism among psychiatric inpatients. Am J Psychiatry 1978;135:963?66.
6. Kawachi I, Willett WC, Colditz GA, Stampfer MJ, Speizer FE. A prospective study of coffee drinking and suicide in women. Arch Intern Med 1996;156:521?25.
7. Gilliland K, Bullock W. Caffeine: a potential drug of abuse. Adv Alcohol Subst Abuse 1983-84;3:53?73.
8. Martinsen EW. Benefits of exercise for the treatment of depression. Sports Med 1990;9:380?89.
9. Martinsen EW, Medhus A, Sandivik L. Effects of aerobic exercise on depression: a controlled study. BMJ 1985;291:109.
10. Adams PW, Wynn V, Rose DP, et al. Effect of pyridoxine hydrochloride (Vitamin B6) upon depression associated with oral contraception. Lancet 1973;I:897?904.
11. Russ CS, Hendricks TA, Chrisley BM, et al. Vitamin B-6 status of depressed and obsessive-compulsive patients. Nutr Rep Internat 1983;27:867?73.
12. Gunn ADG. Vitamin B6 and the premenstrual syndrome (PMS). Int J Vitam Nutr Res 1985;(Suppl 27):213?24 [review].
13. Kleijnen J, Riet GT, Knipschild P. Vitamin B6 in the treatment of the premenstrual syndrome?a review. Brit J Obstet Gynaecol 1990;97:847?52.
14. Lindenbaum J, Healton EB, Savage DG, et al. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 1988;318:1720?28.
15. Holmes JM. Cerebral manifestations of vitamin B12 deficiency. J Nutr Med 1991;2:89?90.
16. Ellis FR, Nasser S. A pilot study of vitamin B12 in the treatment of tiredness. Br J Nutr 1973;30:277?83.
17. Reynolds E et al. Folate deficiency in depressive illness. Br J Psychiatr 1970;117:287?92.
18. Coppen A, Chaudrhy S, Swade C. Folic acid enhances lithium prophylaxis. J Affective Disorders 1986;10:9?13.
19. Di Palma C, Urani R, Agricola R, et al. Is methylfolate effective in relieving major depression in chronic alcoholics? A hypothesis of treatment. Curr Ther Res 1994;55:559?67.
20. Edwards R, Peet M, Shay J, Horrobin D. Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients. J Affect Disord 1998;48:149?55.
21. Adams PB, Lawson S, Sanigorski A, Sinclair AJ. Arachidonic acid to eicosapentaenoic acid ratio in blood correlates positively with clinical symptoms of depression. Lipids 1996;31:S-157?S-161.
22. Rose DP, Cramp DG. Reduction of plasma tyrosine by oral contraceptives and oestrogens: a possible consequence of tyrosine aminotransferase induction. Clin Chem Acta 1970;29:49?53.
23. Moller SE. Tryptophan and tyrosine availability and oral contraceptives. Lancet 1979;ii:472 [letter].
24. Kishimoto H, Hama Y. The level and diurnal rhythm of plasma tryptophan and tyrosine in manic-depressive patients. Yokohama Med Bull 1976;27:89?97.
25. Gelenberg AJ, Wojcik JD, Growdon JH, et al. Tyrosine for the treatment of depression. Am J Psychiatr 1980;137:622?23.
26. Sabelli HC, Fawcett J, Gustovsky F, et al. Clinical studies on the phenylethylamine hypothesis of affective disorder: urine and blood phenylacetic acid and phenylalanine dietary supplements. J Clin Psychiatr 1986;47:66?70.
27. Sabelli HC, Fawcett J, Gustovsky F, et al. Clinical studies on the phenylethylamine hypothesis of affective disorder: urine and blood phenylacetic acid and phenylalanine dietary supplements. J Clin Psychiatr 1986;47:66?70.
28. Beckman H, Strauss MA, Ludolph E. DL-Phenylalanine in depressed patients: an open study. J Neural Transmission 1977;41:123?34.
29. Beckmann H, Athen D, Olteanu M, Zimmer R. DL-phenylalanine versus imipramine: a double-blind controlled study. Arch Psychiatr Nervenkr 1979;227:49?58.
30. Maggioni M, Picotti GB, Bondiolotti GP, et al. Effects of phosphatidylserine therapy in geriatric patients with depressive disorders. Acta Psychiatr Scand 1990;81:265?70.
31. Wolkowitz OM, et al. Dehydroepiandrosterone (DHEA) treatment of depression. Biol Psychiatr 1997;41:311?18.
32. Wolkowitz OW, Reus VI, Keebler A, et al. Double-blind treatment of major depression with dehydroepiandrosterone. Am J Psychiatry 1999;156:646?49.
33. Barkai AI, Dunner DL, Gross HA, et al. Reduced myo-inositol levels in cerebrospinal fluid from patients with affective disorder. Biol Psych 1978;13:65?72.
34. Birkmayer JGD, Birkmayer W. The coenzyme nicotinamide adenine dinucleotide (NADH) as biological antidepressive agent: Experience with 205 patients. New Trends Clin Neuropharmacol 1991;5:19?25.
35. Bell KM, Potkin SG, Carreon D, Plon L. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand 1994;154(suppl):15?18.
36. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7?14.
37. Salmaggi P, Bressa GM, Nicchia G, et al. Double-blind, placebo-controlled study of s-adenosyl-methionine in depressed post-menopausal women. Psychotherapy & Psychosomatics 1993;59:34?40.
38. Kagan BL, Sultzer DL, Rosenlicht N, et al. Oral S-adenosyl-methionine in depression: A randomized, double-blind, placebo-controlled trial. Am J Psychiatr 1990;147:591?95.
39. Fava M, Rosenbaum JF, Birnbaum R, et al. The thyrotropin-releasing hormone as a predictor of response to treatment in depressed outpatients. Acta Psychiatr Scand 1992;86:42?45.
40. De Vanna M, Rigamonti R. Oral S-adenosyl-L-methionine in depression. Curr Ther Res 1992;52:478?85.
41. Van Praag HM, Lemus C. Monoamine precursors in the treatment of psychiatric disorders. Nutrition and the Brain, vol. 7, eds. RJ Wurtman, JJ Wurtman. New York: Raven Press, 1986 [review].
42. Van Praag H, de Hann S. Depression vulnerability and 5-hydroxytryptophan prophylaxis. Psychiatry Res 1980;3:75?83.
43. Angst J, Woggon B, Schoepf J. The treatment of depression with L-5-hydroxytryptophan versus imipramine. Results of two open and one double-blind study. Arch Psychiatr Nervenkr 1977;224:175?86.
44. Nolen WA, van de Putte JJ, Dijken WA, et al. Treatment strategy in depression. II. MAO inhibitors in depression resistant to cyclic antidepressants: two controlled crossover studies with tranylcypromine versus L-5-hydroxytryptophan and nimifensine. Acta Psychiatr Scand 1988;78:676?83.
45. Nolen WA, van de Putte JJ, Dijken WA, Kamp JS. L-5-HTP in depression resistant to re-uptake inhibitors. An open comparative study with tranylcypromine. Br J Psychiatry 1985;147:16?22.
46. D?Elia G, Hanson L, Raotma H. L-tryptophan and 5-hydroxytryptophan in the treatment of depression. A review. Acta Psychiatr Scand 1978;57:239?52 [review].
47. Harrer G, Sommer H. Treatment of mild/moderate depressions with Hypericum. Phytomedicine 1994;1:3?8.
48. Ernst E. St. John?s wort, an antidepressant? A systemic, criteria-based review. Phytomedicine 1995;2:67?71.
49. Vorbach EU, Hübner WD, Arnoldt KH. Effectiveness and tolerance of the Hypericum extract LI 160 in comparison with imipramine: Randomized double-blind study with 135 outpatients. J Ger Psychiatr Neurol 1994;7(suppl):S19?S23.
50.Wheatley D. LI 160, an extract of St. John?s wort versus amitriptyline in mildly to moderately depressed outpatients?controlled six week clinical trial. Pharmacopsychiatry 1997;30(suppl):77?80.
51. Harrer G, Hübner WD, Poduzweit H. Effectiveness and tolerance of the Hypericum extract LI 160 compared to maprotiline: A multicenter double-blind study. J Ger Psychiatr Neurol 1994;7(suppl 1);S24?S28.
52.Vorbach EU, Arnoldt KH, Hübner WD. Efficacy and tolerability of St. John?s wort extract LI 160 versus imipramine in patients with severe depressive episodes according to ICD-10. Pharmacopsychiatry 1997;30(suppl):81?85.
53. Blumenthal M, Busse WR, Goldberg A, et al, eds. The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 214?15.
54. Chatterjee SS, Bhattacharya SK, Wonnemann M, et al. Hyperforin as a possible antidepressant components of hypericum extracts. Life Sci 1998;63:499?510.
55. Schubert H, Halama P. Depressive episode primarily unresponsive to therapy in elderly patients; efficacy of Ginkgo biloba extract (EGb 761) in combination with antidepressants. Geriatr Forsch 1993;3:45?53. - Ingredients
Plant Part Extracted: Fresh flowering & budding tops
Ccertified organic grain alcohol & St. John's Wort extractives.
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***These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
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