Depression (Holistic)

Omega-3 fatty acids found in fish oil, particularly DHA, are needed for normal nervous system function. Depressed people have been reported to have lower omega-3 fatty acid levels (e.g., DHA) than people who are not depressed. Low levels of the other omega-3 fatty acid from fish, EPA, have correlated with increased severity of depression. In some double-blind trials, supplementation with various amounts of fish oil or with the omega-3 fatty acids present in fish oil was beneficial for the treatment of depression in both children and adults, but fish oil was ineffective in other double blind trials.

EPA alone has also been reported to be beneficial. There is one case report of a man with a long history of severe depression who showed clear improvement within one month of starting a purified EPA supplement (4 grams per day of the ethyl ester of eicosapentaenoic acid [E-EPA]). In a double-blind study, supplementation with E-EPA for 12 weeks was significantly more effective than a placebo at relieving symptoms of depression. E-EPA was beneficial, even though the participants in the study had failed to respond adequately to conventional antidepressant drugs. The conventional medications were continued during treatment with E-EPA or placebo. An effective level of intake was 1 gram per day, whereas larger amounts of E-EPA resulted in little or no benefit. The authors of the study suggested that taking too much E-EPA might cause an imbalance with other essential fatty acids, which could reduce the effectiveness of the treatment. Less.

In a double-blind study of patients suffering from depression, the combination of antidepressant medication and curcuminoids (substances present in turmeric) given for 6 weeks improved depression to a significantly greater extent than antidepressant medication alone. The product used in the study provided daily 1,000 mg of curcuminoids plus 10 mg of piperine (a substance in black pepper that is thought to increase the absorption of curcuminoids.) In another study, supplementation with 1,000 mg per day of curcumin (one of the substances present in turmeric) for 8 weeks significantly improved depression, compared with a placebo, in patients suffering from depression. In that study, about one-third of the participants were taking an antidepressant medication. In another double-blind study, supplementation with 1,000 mg per day of curcumin enhanced the beneficial effect of antidepressant medication.

Disruptions in emotional well-being, including depression, have been linked to serotonin imbalances in the brain. Supplementing with 5-HTP (5-hydroxytryptophan) may increase serotonin synthesis. Some trials using 5-HTP with people suffering from depression have shown sign of efficacy. However, much of the research was either uncontrolled or used 5-HTP in combination with antidepressant drugs. One double-blind trial found that 5-HTP was as effective as, or nearly as effective as, an antidepressant drug (fluoxetine). Depressed people interested in considering this serotonin precursor should consult a doctor. Less.

In a double-blind study of postmenopausal women who were experiencing psychological symptoms, a combination of black cohosh and St. John's wort was significantly more effective than a placebo in improving both menopausal symptoms and . The product used in this study contained (per tablet) black cohosh standardized to 1 mg of triterpene glycosides and St. John's wort standardized to 0.25 mg of hypericin. The amount taken was two tablets twice a day for eight weeks, followed by one tablet twice a day for eight weeks.

Omega-3 fatty acids found in fish oil, particularly DHA, are needed for normal nervous system function. Depressed people have been reported to have lower omega-3 fatty acid levels (for example, DHA) than people who are not depressed. Low levels of the other omega-3 fatty acid from fish, EPA, have correlated with increased severity of depression. In some double-blind trials, supplementation with various amounts of fish oil was beneficial for the treatment of depression in both children and adults, but fish oil was ineffective in other double blind trials.

EPA alone has also been reported to be beneficial. There is one case report of a man with a long history of severe depression who showed clear improvement within one month of starting a purified EPA supplement (4 grams per day of the ethyl ester of eicosapentaenoic acid [E-EPA]). In a double-blind study, supplementation with E-EPA for 12 weeks was significantly more effective than a placebo at relieving symptoms of depression. E-EPA was beneficial, even though the participants in the study had failed to respond adequately to conventional antidepressant drugs. The conventional medications were continued during treatment with E-EPA or placebo. An effective level of intake was 1 gram per day, whereas larger amounts of E-EPA resulted in little or no benefit. The authors of the study suggested that taking too much E-EPA might cause an imbalance with other essential fatty acids, which could reduce the effectiveness of the treatment. Less.

Ginkgo biloba (240 mg per day) may alleviate depression in depressed elderly people not responding to antidepressant drugs. It is unknown if ginkgo could alleviate depression in other age groups. A small, preliminary trial has shown that ginkgo can reduce sexual problems caused by antidepressants like fluoxetine (Prozac), bupropion (Wellbutrin), venlafaxine (Effexor), and nefazodone (Serzone) in men and women. Double-blind trials are now needed to determine whether ginkgo is truly effective for this purpose. Less.

Disruptions in emotional well-being, including depression, have been linked to serotonin imbalances in the brain. L-Tryptophan is the precursor to serotonin, and low body levels of L-tryptophan are associated with depression symptoms. Furthermore, L-tryptophan supplements have been shown to increase serotonin levels.  Many uncontrolled studies report that 3 to 6 grams per day of L-tryptophan helps improve mood in depressed people. Several controlled trials found that 3 to 6 grams per day of L-tryptophan were equally as effective as antidepressant medications. Some, though not all, double blind studies reported that similar amounts of L-tryptophan were superior to a placebo for improving depression symptoms. Trials using amounts above 6 grams per day of L-tryptophan have often found no benefit for depression, suggesting that 3 to 6 grams per day is optimum. 5-Hydroxytryptophan (5-HTP), a breakdown product of L-tryptophan and a serotonin precursor, has also been studied as a treatment for depression. Some trials using 200 to 300 mg per day of 5-HTP with people suffering from depression have shown signs of efficacy. However, much of the research was either uncontrolled or used 5-HTP in combination with antidepressant drugs. Depressed people interested in considering 5-HTP should consult a doctor. Less.

Melatonin might help some people suffering from depression. Preliminary double-blind research suggests that supplementation with small amounts of melatonin (0.125 mg taken twice per day) may reduce winter depression. People with major depressive disorders sometimes have sleep disturbances. A timed-release preparation of melatonin (5–10 mg per day for four weeks) was shown to be effective at improving the quality of sleep in people with major depression who were taking fluoxetine (Prozac), but melatonin did not enhance its antidepressant effect. There is a possibility that melatonin could exacerbate depression, so it should only be used for this purpose under a doctor’s supervision. Less.

SAMe (S-adenosyl methionine) 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. Higher SAMe levels in the brain are associated with successful drug treatment of depression, and oral SAMe has been demonstrated to be an effective treatment for depression in most, but not all, clinical trials. SAMe has been found to be effective both when used by itself and when used as add-on treatment to antidepressant medication. Most trials used 1,600 mg of SAMe per day. While it does not seem to be as powerful as full applications of antidepressant medications or St. John’s wort, SAMe’s effects are felt more rapidly, often within one week. Less.

Caution: It is likely that there are many drug interactions with St. John's wort that have not yet been identified. St. John's wort stimulates a drug-metabolizing enzyme (cytochrome P450 3A4) that metabolizes at least 50% of the drugs on the market. Therefore, it could potentially cause a number of drug interactions that have not yet been reported. People taking any medication should consult with a doctor or pharmacist before taking St. John's wort.

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.

St. John’s wort extract has been compared to the prescription tricyclic antidepressants imipramine (Tofranil), amitriptyline (Elavil), fluoxetine (Prozac®), and maprotiline (Ludiomil). The improvement in symptoms of mild to moderate depression was similar, with notably fewer side effects, in people taking St. John’s wort.

In a double-blind trial using standard amounts of fluoxetine (Prozac)—20 mg per day—St. John’s wort extract in the amount of 400 mg twice daily was equally effective at relieving depression in people aged 60–80 years. Another trial found that 250 mg of St. John’s wort extract two times per day was also as effective as 20 mg of fluoxetine in treating adults with mild to moderate depression. In both trials comparing St. John’s wort to fluoxetine, there were far fewer side effects reported by people taking St. John’s wort.

One clinical trial compared a higher amount of the St. John’s wort extract LI 160 (1,800 mg per day) with a higher amount of imipramine (150 mg per day) in more severely depressed people. 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.

Two well-publicized double-blind studies published in the Journal of the American Medical Association (JAMA) concluded that St. John's wort is not an effective treatment for depression. However, each of these studies had potential flaws. In the first study, 900–1,200 mg of St. John's wort per day was slightly more effective than a placebo, as assessed by the Hamilton Rating Scale for Depression. However, the difference was not statistically significant. Although the remission rate was significantly greater with St. John's wort than with placebo, only 14.3% of the patients who received the herb went into remission, causing the authors of the report to question St. John's wort's efficacy. However, the 4.9% remission rate in the placebo group was far below the placebo response rate seen in other studies of depression. That finding suggests that many of the patients recruited for this study would have been unlikely to respond to any treatment.

In the second JAMA study, depressed patients were given one of three treatments: St. John's wort, placebo, or an antidepressant medication with proven efficacy (e.g., sertraline; Zoloft). Although St. John's wort was no more effective than the placebo, by many measures neither was sertraline. The relatively poor outcome with sertraline makes one wonder whether the design of the study, or the criteria used to select participants, may have somehow skewed the results to make St. John's wort appear less effective than it really is.

Despite these two negative studies, the bulk of the scientific evidence indicates that St. John's wort is an effective treatment for mild to moderate depression.

Recent European trials have successfully treated mild to moderate depression using 500 to 1,050 mg of St. John’s wort per day. As an antidepressant, St. John’s wort should be taken for four to six weeks before judging its effectiveness. Less.

In a double-blind study of Egyptian children with depression, the combination of vitamin C (500 mg twice a day) and an antidepressant drug (fluoxetine) was significantly more effective than fluoxetine alone.

Caution: Calcium supplements should be avoided by prostate cancer patients.   

In one double-blind trial, people without depression took 600 IU of vitamin D along with 1,000 mg of calcium, or a placebo, twice daily for four weeks. Compared to the placebo, combined vitamin D and calcium supplementation produced significant elevations in mood that persisted at least one week after supplementation was discontinued. Less.

Damiana has traditionally been used to treat 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.

An isolated preliminary trial suggests the supplement NADH may help people with depression. Controlled trials are needed, however, before any conclusions can be drawn. Less.

Pumpkin seeds contain L-tryptophan, and for this reason have been suggested to help remedy depression. However, research is needed before pumpkin seeds can be considered for this purpose. It is unlikely the level of L-tryptophan in pumpkin seeds would be sufficient to relieve depression. Less.

Damiana has traditionally been used to treat 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. Less.