Depression is the most common psychiatric ailment in Western society. Over 1.4 million people in Canada suffer with depression at any given time and it is the second leading cause of long-term disability among workers. It is much more than simply a case of the blues or feeling down. It is a true medical condition that can range from mild to severe, with a significant impact on all aspects of one’s life.
While prescription drugs play an important role in the treatment of this disease, many people can’t tolerate the side effects and high costs. The good news is that there are several nutritional supplements that have been clinically studied and found beneficial for depression, without all the side effects seen with prescription drugs.
Depression is most often caused by a number of underlying factors, including:
Environmental – exposure to chemicals that disrupt brain chemistry (cigarette smoking, heavy metals, prescription and recreational drugs)
Nutritional – deficiency of vitamins (B12), minerals (magnesium) or essential fatty acids; food allergies
Situational – stress, trauma, injury, divorce, job loss, death of a loved one
Biological – imbalance of neurotransmitters (chemical messengers in the brain): dopamine, serotonin and norepinephrine; or hormone imbalance (low estrogen, progesterone, testosterone, thyroid) such as post-partum depression
Conventional treatment of depression focuses on prescription drugs and psychiatric counseling. Anti-depressant drugs are divided into two major categories: tricyclic antidepressant drugs and the newer selective serotonin re-uptake inhibitors (SSRIs). The SSRIs, which are most commonly used today, include fluoxetine, fluvoxamine, citalopram, paroxetine, and sertraline. While these drugs help some people, they are often over-prescribed – given out too easily and for those without true depression.
There are several concerns with anti-depressant drugs. First, they are associated with numerous side effects, such as nausea, weight gain/loss, headaches, anxiety, insomnia or drowsiness, diarrhea, sweating, tremor, and sexual dysfunction. Second, there are numerous possible drug interactions. Third, these drugs can be very costly. And lastly, these drugs are not effective for everyone. In fact, some estimates show that one-third of individuals taking these drugs will not be helped or are unable to tolerate the side effects.
SAMe (pronounced Sammy) is a compound that is naturally produced in the body and involved in numerous biochemical reactions. SAMe increases the action of several brain neurotransmitters, such as dopamine, serotonin and norepinephrine. SAMe enhances cell membrane fluidity and improves cellular communication between neurons. It is also involved in energy production in the brain by supporting the function of the mitochondria (powerhouse of cell). In addition, SAMe has antioxidant properties, protecting brain tissues against damage from free radicals. Together these actions support brain health and help alleviate depression.
Numerous clinical studies have shown SAMe to be safe and effective for depression. A report by The U.S. Department of Health and Human Services, which reviewed 47 studies on SAMe for depression concluded that, “SAMe is more effective than placebo for relief of symptoms of depression” and “equivalent to standard therapy for depression.”
Unlike antidepressant drugs, SAMe is very well tolerated. Side effects are rare and minor, including nausea and upset stomach. While some antidepressants cause liver damage, SAMe has been shown in many studies to be liver-protective.
SAMe has a rapid onset of action. Effects are often noticeable within one or two weeks compared to four weeks or longer for most antidepressants. One precaution with SAMe is that it is not recommended for use by those with bi-polar disorder (manic-depression) as it can worsen the manic symptoms. Those who are taking anti-depressant medications, pregnant or breast-feeding should consult with their doctor before taking SAMe. The usual recommended dosage is 400 to 1600 mg daily – start low and gradually increase if needed.
5-HTP is a substance used by the body to make serotonin. A few small studies have shown that it is effective for depression, and well tolerated. In one study 5-HTP was found equally effective to Prozac with fewer and less severe side effects. Possible side effects include upset stomach. The usual dosage is 100 mg three times daily.
St. John’s wort
Prior to the discovery of its numerous drug interactions, St. John’s wort was one of the most popularly used natural products for depression. It helps increase neurotransmitter levels and studies have found it effective for mild to moderate depression. Benefits with this herb may be noticed in two to four weeks. Side effects include stomach upset, fatigue, itching, sleep disturbance, skin rash, and sun-sensitivity. St. John’s wort can reduce the efficacy of many drugs including oral contraceptives, blood-thinners, digoxin, organ transplant drugs (immune suppressants), statins and theophylline. For this reason, it is important to check with your pharmacist/doctor before taking this herb. The usual dosage is 300 mg three times daily.
Fish Oil – rich in omega-3 fatty acids, which are essential for the nervous system and support neurotransmitter function. Levels may be depleted in those with depression. Studies show benefits for depression, especially for those not getting adequate response to antidepressant drugs. Dosage: 3 to 9 grams daily.
Theanine – an amino acid extracted from green tea. It reduces stress and anxiety without causing drowsiness or addiction; also improves sleep quality. It has a quick onset of action (30 minutes to one hour); no side effects. Dosage: 50 to 200 mg daily.
For optimal physical and emotional well-being it is important to eat a healthy, whole-foods diet, get adequate sleep, exercise regularly and reduce stress. These lifestyle strategies can have a profound impact on emotional health.
If you or someone you know is suffering with depression it is important to seek professional help. Do not stop taking your medication unless advised by your health care provider. Abruptly stopping antidepressants can cause withdrawal symptoms. Discuss natural alternatives with your doctor.
Sherry Torkos is a pharmacist and health author. Visit, www.sherrytorkos.com
1. Canadian Pharmacists Association. 2002. Compendium of Pharmaceuticals and Specialties. Ottawa
2. Hardy, M., I. Coulter, S.C. Morton, et al. 2002. “S-Adenosyl-L-Methionine for Treatment of Depression, Osteoarthritis, and Liver Disease.” Evidence Report, Technology Assessment Number 64. Prepared by Southern California Evidence-based Practice Center under Contract No. 290-97-001. AHRQ Publication No. 02-E034. Rockville: Agency for Healthcare Research and Quality.
3. Parikh, S.V., and R.W. Lam. 2001. “Clinical Guidelines for the Treatment of Depressive Disorders. I. Definitions, Prevalence, and Health Burden.” Canadian Journal of Psychiatry 46(Supplement 1):13S–20S.
5. Poldinger W, Calanchini B, Schwarz W. A functional-dimensional approach to depression: Serotonin deficiency as a target syndrome in a comparison of 5-hydroxytryptophan and fluvoxamine. Psychopathology. 1991;24:53–81.
6. Gastpar M, Singer A, Zeller K. Comparative Efficacy and Safety of a Once-Daily Dosage of Hypericum Extract STW3-VI and Citalopram in Patients with Moderate Depression: A Double-Blind, Randomised, Multicentre, Placebo-Controlled Study. Pharmacopsychiatry. 2006;39:66-75.
7. Fava M, Alpert J, Nierenberg AA et al. A Double-blind, Randomized Trial of St John’s Wort, Fluoxetine, and Placebo in Major Depressive Disorder. J Clin Psychopharmacol. 2005;25:441-447.