The blues, the doldrums, being in a funk—no matter what you call it, mild to moderate depression affects us all at some point in our lives. Feelings of worthlessness or deep sadness, apathy, irritability, sleep disturbances, and changes in appetite can all signal a bout of depression. Approximately 19 million Americans are diagnosed with depression each year, with women being twice as likely to suffer from “the blues” as men. Possible causes include stressful events such as losing a loved one, chemical imbalances in the brain, nutritional deficiencies, thyroid disorders, or even food allergies.
Until the 1950s, conventional treatment for mild to moderate depression was limited to psychotherapy—a remedy that could keep a patient on the couch for months, even years, before any improvement was made. But the invention of antidepressant drugs ushered in a new era of conventional therapy that worked in a matter of weeks. The first antidepressants were tricyclics, drugs that enhance the concentrations of norepinephrine and serotonin, two neurotransmitters that affect mood. Next came the monoamine oxidase (MAO) inhibitors, which boost mood by reducing the amount of MAO, an enzyme that transports neurotransmitters to the neurons in the brain. Today, the most widely prescribed antidepressants are the selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft and Paxil. SSRIs work by preventing nerve cells from absorbing the serotonin that is already circulating, leading to a sense of well-being. SSRIs are also used to treat conditions from postpartum depression to seasonal affective disorder, and even everyday maladies such as shyness and perfectionism.
Possible side effects
While these mood-enhancing drugs can be effective, numerous studies confirm that their use can come with a price. Common to all three types of antidepressants are sexual side effects, including reduced sex drive and impotence. According to Joseph Glenmullen, M.D., author of Prozac Backlash (Simon & Schuster, 2000), sexual dysfunction affects 60 percent of Prozac users. But other troubling side effects can also surface. Tricyclics may cause drowsiness, heart irregularities, blurred vision, confusion, nightmares, and anxiety. The use of MAO inhibitors can result in insomnia, dizziness, weight gain, and an elevation in blood pressure. The highly publicized SSRIs can cause headaches, hallucinations, anxiety, nausea, insomnia, drowsiness, diarrhea, sweating, tremors, and rashes. And like all medications, antidepressants can interact with other drugs. There have also been cases where some antidepressants, including Prozac, have been linked to an increase in uncontrollable agitation, violent outbursts, and suicidal tendencies when improperly administered to persons with a manic-depressive illness. There is some debate, however, whether antidepressants can precipitate mania in someone who would otherwise not have a manic component to their illness.
If you suffer from mild to moderate depression, you may respond well to a natural treatment approach and be able to forego synthetic drugs. However, depression, when left untreated, can be serious. See a doctor if symptoms persist.
The first herb most people think of when it comes to banishing the blues is St. John’s wort (Hypericum perforatum), and with good reason. John Cardellina II, Ph.D., vice president of botanical science and regulatory affairs at the Council for Responsible Nutrition in Washington, D.C., says, “There is a strong, significant, and consistent body of evidence, based on more than thirty controlled clinical trials, that St. John’s wort provides benefit in relieving mild to moderate symptoms of depression.” Used in Europe for centuries as a nervine tonic, St. John’s wort targets depression by inhibiting the breakdown of several neurotransmitters, including serotonin. One recent double-blind German study compared 126 patients taking St. John’s wort with 114 taking Prozac and found that both groups achieved similar improvement. Yet only 8 percent of the group taking the herb experienced side effects, compared to 23 percent of the Prozac group. Another clinical trial of 324 patients found that St. John’s wort was just as effective as the tricyclic drug imipramine and was better tolerated and more effective in relieving anxiety.
The most common dosage prescribed by physicians in Germany, where St. John’s wort is used to treat at least half of all depressed patients, is 300 to 400 mg two to three times per day. Side effects are rare but may include dry mouth, dizziness, stomach upset, and photosensitivity. High doses may speed up the rate at which liver enzymes process some medications, including oral contraceptives, certain anti-retrovirals, anti-epileptics, and calcium channel blockers. Consult a qualified health-care practitioner before taking St. John’s wort with prescription medications.
Another herb that may help relieve some of the symptoms of depression, particularly in the elderly, is ginkgo (Ginkgo biloba). Researchers speculate that ginkgo may work by increasing the number of serotonin receptor sites in the brain, as well as by increasing blood flow to the brain. A study of elderly rats showed a 33 percent increase in the number of serotonin receptor sites after ginkgo supplementation. A human study of sixteen patients taking a standard antidepressant drug by the Psychiatric University Hospital in Basle, Switzerland, found that ginkgo significantly improved quality of sleep and cognitive ability after only eight weeks. Recommended dosage is 40 to 80 mg taken two to three times per day.
Herbs can also soothe the anxiety and insomnia that often accompany depression. Kava (Piper methysticum), while not used as a primary herb to treat depression, can reduce the stress, anxiety, and restlessness that tend to accompany the blues by relaxing the central nervous system. Although kava’s mode of action is not fully understood, one in-vitro study by Humboldt University in Berlin, Germany, found that the pyrones in kava inhibit MAO platelets in the brain. Other European studies have found that kava is just as effective at reducing anxiety as synthetic tranquilizers.
Used for centuries as a ceremonial herb in the South Pacific, kava promotes mental and physical relaxation without impairing mental clarity, and the herb induces sleep and eases muscle tension. The typical dosage recommended by the German Commission E is 100 mg two to three times per day. Although generally considered safe, kava can cause drowsiness and should not be used if you plan to drive or operate any type of machinery. Do not use kava if you are pregnant or nursing, or with other antidepressant drugs. And, notes Glenmullen, excessive doses taken over prolonged periods of time can cause yellowing of the skin and a scaly rash known as kava dermopathy.
Rosemary (Rosmarinus officinalis) is popular among aromatherapists for treating depression. It contains cineole, which has been shown to stimulate the central nervous system. A massage with a few drops of rosemary extract added to your massage oil might lift your spirits. Other scents that aromatherapists use for treating depression include bergamot, basil, lavender, clary sage, and jasmine. Remember—these oils are for external use only.
One natural antidepressant that received a flurry of media attention a few years ago is S-adenosyl-methionine, better known as SAMe. SAMe is a naturally occurring compound made from the amino acid methionine. Necessary for the manufacture of brain chemicals such as serotonin and dopamine, SAMe increases the binding of neurotransmitters to receptors and improves the fluidity of brain cell membranes. A recent animal study by the University of Modena and Reggio Emilia in Italy showed that SAMe reversed depression-like symptoms in rats without any apparent side effects. But how does that translate to humans? An open, multicenter study of 195 patients at Massachusetts General Hospital in Boston found that depressive symptoms improved within two weeks when 400 mg of SAMe were taken, leading researchers to conclude that SAMe is a relatively safe and fast-acting antidepressant.
Another supplement that may help lift you out of the doldrums is 5-hydroxytryptophan, or 5-HTP, the intermediate metabolite of L-tryptophan and a precursor to serotonin. Because we don’t get significant amounts of 5-HTP from our diets no matter how many L-tryptophan rich foods we consume, supplementing with 300 mg per day may help reduce anxiety and sleeplessness while boosting our sense of well-being. A recent review of 5-HTP by researchers at the Lawrence Berkeley National Laboratory in California found strong evidence that this serotonin precursor can help ease mild to moderate depression. Derived from the seeds of Griffonia simplicifolia, a West African medicinal plant, several European studies have found that 5-HTP is as effective as tricyclic antidepressants. A separate Swiss study even found it to be more effective than the SSRI Luvox. But a word of caution: 5-HTP should not be taken with St. John’s wort or SAMe.
Along with using herbs and supplements to treat mild to moderate depression, positive lifestyle choices can also help move you into a happier state of being. According to Elson M. Haas, M.D., director of the Preventive Medical Center of Marin in San Rafael, California, a well-balanced diet, rich in vitamin B6 and complex carbohydrates can increase serotonin levels. And foods rich in vitamin B12 and folic acid aid in the synthesis of naturally occurring SAMe. According to Haas, sugar, caffeine and alcohol can contribute to depression, as can undiagnosed food allergies. Moreover, preliminary studies show that diets low in omega-3 fatty acids, found especially in fatty fish such as salmon, canned white tuna and mackerel, may also make you more vulnerable to depression. Try for one or two servings of these high omega-3 fish a week.
Exercise is another way to elevate your mood. A regular workout increases endorphins, the body’s natural “feel-good” chemicals, and helps relieve the stagnant feeling that often accompanies depression. Mental exercise in the form of meditation or breathwork can also raise your spirits by reducing anxiety and stress. Finally, help curb depression by consciously looking for life’s positives instead of focusing on the negatives.
Kim Erickson writes frequently on natural health and environmental issues and is the author of a book on natural beauty products.