Overcome mild depression with this integrated approach.
It’s one thing to feel down in the dumps; how much of a problem the feeling is depends on how deep into the dumps you go and how long you stay there. A couple of weeks of sadness, a case of the winter blahs, grief over the loss of a love—everyone has an occasional run-in with mild depression. However, a diagnosis of mild depression needn’t send you running to the pharmacy for bottles of antidepressants. Nature has provided natural treatments for mild depression that are safe, effective and much less expensive than the pharmaceutical alternatives—and without their undesirable side effects, such as anxiety, insomnia and sexual problems.
Major depression is a different kettle of fish—a life-threatening illness that should be treated by medical experts. Do not try to self-diagnose or self-treat depression. No individual medical test can diagnose major depression, but tests can rule out whether health problems, such as hypothyroidism, with symptoms similar to depression are present. Major depression is also treatable, but the condition requires management by a psychiatric professional.
On the other hand, if you suffer from mild depression, relief may be only a few medicinal herbs or supplements away. Consider the case of Richard Bland (not his real name) who had been depressed, shy and withdrawn nearly all his life. At age 42 (two years ago), he began to take positive steps to conquer these personal challenges. For the first year, he made good progress in talk therapy with his psychotherapist but then began “topping out”—his results had peaked. Bland was still experiencing regular bouts of anxiety, which were not responding to therapy. The therapist suggested beginning a course of antidepressant medication.
Bland was uncomfortable with using pharmaceutical antidepressants, especially since these drugs are notorious for reducing libido. Undaunted, Bland turned to herbal medicine. Having had success with medicinal herbs for other conditions, he saw himself as a good candidate for this approach.
Bland revealed that he had a long history of recreational drug and alcohol use, which he used to “anesthetize the pain” of his anxiety and depression. Many people try to relieve their depression with mind-altering substances. Marijuana, alcohol and other drugs may lift mood in the short run, but the high soon wears off. The long-term effects of these drugs include insomnia, fatigue and withdrawal from life—exactly the symptoms of a deepening depression. Herbal medicine, on the other hand, offers hope for a way out of this downward spiral without troublesome side effects.
Soon after our consultation, Bland began a personalized program that mainly included the herbal antidepressants St. John’s wort (Hypericum perforatum) and ginkgo (Ginkgo biloba), along with high doses of cayenne (Capsicum annuum). Within three weeks, Bland noted the difference. He became aware of a gradual, natural change of mood and attitude. He felt like “a different person—a person without anxiety for the first time in my life.”
Now, two years later, Bland continues to take his herbs for maintenance. He recently found out the hard way that they have been working. On an extended bike tour vacation, he ran out of his therapeutic herbs. Thinking he could squeak by, he decided to wait until he returned home, only to confront his old feelings of depression after an herb-free week.
Back on his herbs, all was quickly back to normal. Bland is “so thankful I didn’t do the [pharmaceutical] drugs. I have control, and I can use the herbs the rest of my life if necessary and not worry.”
Bland was fortunate to be able to effectively manage his symptoms before they spiralled out of control. But if his feelings of sadness had become intense, lasted for several weeks or longer and had prevented him from leading a normal life, his situation would have been characterized as a treatable medical condition called major depressive disorder. Other symptoms of the disorder can include changes in appetite or sleep patterns as well as persistent, sometimes severe feelings of worthlessness, guilt, helplessness and hopelessness.
A number of types of depression exist, among them: major depression, chronic depression (dysthymia), bipolar depression, postpartum depression and seasonal depression (seasonal affective disorder, or SAD).
Dysthymia is less-severe depression that lingers chronically for at least two years. People with dysthymia usually function adequately but seem consistently unhappy.
Bipolar depression (or manic depressive disease) is characterized by extreme high and low moods. Because of the two poles of mood, the condition is referred to as bipolar depression. In between mood swings, a person may experience normal moods.
Postpartum depression is a complex mix of physical, emotional and behavioral upsets that occur after having a baby. This depression stems from the chemical, social and psychological changes associated with pregnancy and childbirth. About 50 to 75 percent of new mothers go through the “baby blues.”
SAD, sometimes called “winter blahs,” is the result of a lack of light in winter, and is mainly limited to climates with gray skies. It’s treated with light therapy, usually from specially constructed lights that people shine in their homes during dull winter days.
The news about depression is not all bleak: The condition can be treated well with medications and counseling. Studies have shown that antidepressant drug therapy combined with psychotherapy appears to have better results than either therapy alone.
Drugs include tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs) and others. Lithium, a drug familiar to many, is used mainly for bipolar disorder.
A 2004 study published in General Hospital Psychiatry shows that treatment of depression by the patient’s primary care physician fails half the time. But for most depressed people, this treatment from the primary care doctor is the only treatment they’ll receive. If your depression isn’t improved by a visit to your doctor, consider seeing an experienced psychiatrist or psychologist.
Depression is a complex condition, frequently involving many nutritional, environmental and lifestyle factors. It is important to recognize that these factors are vital for total life and heath, not just in depression. Generally speaking, when people get healthy, their depression begins to lift. Herbal medicine can be very effective for maintaining general health and treating mild depression.
As we come to better understand the biochemistry of mood and behavior, many conditions previously thought to have a psychological base now are being shown to have at least some physiological cause, as well. For example, virtually any nutrient deficiency can result in depression, particularly vitamin C and the B vitamins.
Many medical conditions, including diabetes, cardiac disease and hypothyroidism, are associated with an increased incidence of depression. Be sure to have a thorough work-up by your health practitioner to round up all the possible suspects. To date, there is no scientific evidence that any alternative treatment is effective for treating moderate to severe depression; if you suffer from moderate to severe depression, consult your doctor. However, the herbal world has a host of remedies that work very well in treating mild depression. Used for centuries, the effectiveness of these remedies now is being confirmed by scientific studies. Remarkably free of side effects, especially when compared to the drugs they replace, herbal remedies certainly are worth consideration.
As was the case for Richard Bland, St. John’s wort truly is an effective herb for mild depression. St. John’s wort acts in the brain to preserve serotonin, an important mood-regulating hormone, as Prozac (fluoxetine) and similar drugs do, but it does so more weakly. It also modulates and balances the brain chemical norepinephrine, much as tricyclic antidepressant drugs do. It also may increase endorphin levels. The chemistry of St. John’s wort and its action on the brain is complex. Additional mechanisms of action likely will be discovered.
St. John’s wort is the most thoroughly researched and widely prescribed herbal antidepressant in the world. Dozens of studies have shown it to be very effective in treating mild depression, equal if not superior to comparable drugs. Plus, it is virtually free of side effects.
The herb consistently achieves a greater than 50 percent reduction in the Hamilton Depression Scale (a series of measurements used to quantify depression) in a large percentage of patients, and does better than tricyclic antidepressants, without the side effects.
Recently, The Lancet included two reports stating St. John’s wort could interfere with drugs used to treat HIV and heart transplants. It also has been implicated in possibly reducing the effectiveness of oral contraceptives. If you are taking protease inhibitors, birth control pills or cyclosporin, don’t take St. John’s wort.
In recent years, some controversy has surfaced concerning neg- ative results of two trials of St. John’s wort for major depression, both published in the Journal of the American Medical Association. One of these studies used a comparison only to a placebo, with no reference to a known drug, so the findings are difficult to interpret. The other study reported negative results for both the SSRI sertraline (Zoloft) and for St. John’s wort.
Patients in both studies had moderate to severe (rather than mild) depression, and the results of both studies have been challenged by various groups, including the American Botanical Council. On the whole and over a long period of time, the evidence supporting the effectiveness of St. John’s wort for mild depression remains compelling. Use an extract standardized to 0.3 percent hypericin at a dose of 300 mg, three times a day, or capsules of a good-quality source of the whole herb at a dose of up to 5,000 mg per day.
Among the more popular herbs these days, ginkgo is known mainly as a treatment for cognitive disorders, such as Alzheimer’s disease. However, it is quite effective for depression and works well in combination with St. John’s wort.
Ginkgo is known primarily to increase circulation, particularly to the head, so it seems a natural to consider for depression. Sure enough, researchers began studying ginkgo for depression after noting mood improvements in patients taking the herb for cerebrovascular insufficiency.
One study, for example, showed that 40 elderly patients with depression, who had not benefited fully from standard antidepressant drugs, were given ginkgo. After eight weeks, the Hamilton Depression Scale average score had dropped from 14 to 4.5. A 2003 study, published in Pharmacopsychiatry, indicated that ginkgo significantly improved cerebral function and depression.
Use an extract standardized to 24 percent flavone glycosides at a dose of 120 to 240 mg per day.
Ashwaganda (Withania somnifera) is one of the most promising herbs for building overall health. A scientific article published in 2000 by Los Angeles researchers reviews a host of confirmed benefits: anti-inflammatory, anti-tumor, anti-stress, antioxidant, immune-boosting and rejuvenating properties. Scientists say it also appears to exert a positive influence on the endocrine, cardiopulmonary and central nervous systems. Study after study continues to confirm the stress-tolerance, performance- and endurance-enhancing benefits of this herb.
Ashwaganda is a grounding herb — one that nourishes and regulates metabolic processes and stabilizes mood. Researchers from a 2000 Phytomedicine study concluded, “The investigations support the use of Withania somnifera as a mood stabilizer in clinical conditions of anxiety and depression.”
Because ashwaganda is a very safe herb, large doses are often used short term. For mild depression, take 1 to 10 grams daily, until symptoms resolve. As a tonic herb (used long term), take 1 gram per day.
This relative of black pepper, native to the South Pacific Islands, excels as an herb to treat mood disorders. Known primarily as an anti-anxiety herb, it also treats depression. Kava is an extensively researched herb, used widely in Europe. The active ingredients in kava (kavalactones) exhibit sedative, pain-relieving and muscle-relaxing effects. Many studies have shown kava to be equal, if not superior, to benzodiazepines, the Valium class of anti-anxiety drugs.
Use a dose of standardized extract containing 100 to 200 mg of kavalactones per day for depression and anxiety. For sleep, use up to 250 mg of kavalactones before bedtime. Whole herb preparations of kava root vary in content and quality. Seek out a quality source of capsules or cut the root for tea. Adjust the dose to best effect.
In the past several years, a few cases of liver toxicity have been associated with kava. Although little has been reported in the American literature, Mark Blumenthal of the American Botanical Council recommends that people who consume alcohol regularly, or those who have liver problems or are taking drugs or supplements known to produce liver toxicity, refrain from using kava. Also, because liver toxicity has been connected with chronic kava use, do not take the herb on a daily basis for more than four weeks. If any symptoms of liver damage, such as dark urine, jaundice or yellowing of the eyes, occur, discontinue use immediately.
Several lesser-known herbs I like to use for depression are listed below. They are available at health-food stores and online.
Gokshura fruit, also known as puncture vine (Tribulus terrestris). This well-known Ayurvedic herb is getting a reputation in the United States. Often called something equivalent to “horny goat weed,” it is, in fact, an Ayurvedic standout for building sexual stamina. Gokshura promotes mental clarity, and I recommend it for its exceptional clinical effect in depression. It has no known side effects and may be taken with ashwaganda as a tonic nervine for nervous disorders. Take 1 to 2 grams daily.
California poppy (Eschscholzia californica) is a pleasant, relaxing medicine. In Europe, the German Commission E lists it as an antispasmodic and sedative for a wide variety of anxiety and depressive conditions. A French animal study from 1991 indicated a clear-cut anti-anxiety effect. At higher doses, this herb has a sedative effect.
California poppy has been shown to inhibit the body’s production of adrenaline and to reduce monoamine oxidase, which allows energizing neurotransmitters (catecholamines) to remain active longer. Take 1 teaspoon of California poppy tincture three times a day.
Shankhapushpi (Evolvulus alsinoides). When we need sleep and peace of mind, we can call upon shankhapushpi. Used in Ayurveda to help with relaxation and restoration of mental clarity, this herb is also an outstanding rejuvenative tonic for the mind and nerve tissue. It is especially effective for mental disorders of anxiety and fear. Often taken with or prepared in ghee (clarified butter), it promotes tranquility without dulling the mind. In depression, it uplifts. In mania, it calms. For sleep, use shankhapushpi at a dose of about 6 grams at bedtime. For general use, take 2 to 3 grams throughout the day.
Bacopa (Bacopa monnieri), a traditional Ayurvedic herb, has been used in Ayurvedic medicine for centuries for the treatment of nerve diseases and to improve memory. It is used in the treatment of anxiety, emotional stress, mental exhaustion and forgetfulness. Take 2 grams of the whole herb twice a day with warm water.
Bupleurum root (Bupleurum chinense) is the main herb used in Chinese herbal medicine for depression associated with PMS. Chinese herbal formulas designed to regulate the menstrual cycle or treat PMS almost always center on this “minor tonic.” The main action of this herb is to relieve blood stagnation in the liver. In women, liver stagnation can cause irritability and food cravings, according to Traditional Chinese Medicine.
Bupleurum is relaxing, so it can be very helpful with anxiety and irritability. The energy of bupleurum is bitter and cool, making it particularly good in women who always feel hot or who are developing a fever. If you suffer from PMS, bupleurum is certainly worth a look, especially considering that standard medical treatment often involves potent antidepressant drugs. Dose: 3 grams daily in capsules or tea.
Cayenne (Capsicum spp.). In my experience, cayenne and other chiles, especially red varieties, are excellent treatments for depression. I’ve seen this remedy work countless times. Although the mechanism is not yet known, it is proven that chiles enhance production of endorphins, the mood-elevating brain chemicals responsible for the “chile eater’s high.”
Use cayenne in gradually increasing doses, in capsules or as a food spice, as your tummy tolerates it.
Fatty acids. Past research reports that patients with depression have low levels of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Several studies of omega-3 fatty acid supplementation for depression have not formed a clear conclusion.
DHA has been capturing the attention of scientists lately. An omega-3 long-chain fatty acid, it is one of the primary structural components of the brain, and proper DHA levels are essential for proper functioning of neurotransmitters. Memory loss and depression have been linked to deficiencies of this essential fat. In a 1995 European study, elderly subjects treated for six months with 90 mg of DHA daily showed substantial improvement in apathy and social withdrawal symptoms.
A 2003 study published in the journal European Neuropsychopharmacology provides promising information. The 32 patients received either placebo or a supplement containing 440 mg of EPA and 220 mg of DHA for eight weeks. There were significantly greater benefits in the omega-3 patients compared to placebo.
S-adenosylmethionine (SAM-e) is a molecule that occurs naturally in the cells of plants and animals. As we age, our bodies produce less SAM-e. According to a review published in the American Journal of Clinical Nutrition in 2002, SAM-e worked well as an antidepressant in the treatment of clinical depression in some studies. It doesn’t cause side effects for most people. A small number of clinical trials with SAM-e have shown that, at doses of 200 to 1,600 mg a day, it works better than a placebo. A study in the International Journal of Neuropsychopharmacology compared injected SAM-e to the tricyclic imipramine for depression. The supplement was as effective as the drug, with far fewer side effects. The mechanism by which SAM-e might treat depression is not yet known. SAM-e is not recommended for people with mania or bipolar disorder.
NADH. This supplement is a coenzyme with a tongue-twister of a name—nicotinamide adenine dinucleotide, the active coenzyme form of the vitamin niacin. As a coenzyme, NADH provides the spark for the production of energy we get from food. Our bodies need energy every minute, so the more NADH, the more energy our cells can produce. Every one of our cells contains it. Would we do better if we added more as a supplement?
Health-care professionals are still looking into ways NADH may be used to ease fatigue. The science is building for NADH. Preliminary studies suggest a role in Parkinson’s, depression, Alzheimer’s and boosting athletic performance. So far, NADH has shown no toxicity or adverse effects, even at high doses.
Don’t take brain function decline lying down: Get up and exercise. Aerobic workouts can improve high-level brain functions in individuals 50 and older, say Duke University researchers.
A 1999 Duke study, appearing in a recent issue of the Journal of Aging and Physical Activity, demonstrated that aerobic exercise was as effective as medication in treating major depression in clinically depressed middle-age and elderly people. The exercise program not only helped the depression but also improved memory, as well as the ability to plan, organize and juggle different intellectual tasks.
The scientists speculate that better flow of oxygen-rich blood to specific regions of the brain might be responsible and are optimistic that exercise could help slow the brain’s aging process.
The side effects of pharmaceutical antidepressants vary depending upon several factors, including the type of drug used. The following is a list of potential side effects.
• Changes in appetite
• Cognitive changes (fuzzy thinking)
• Insomnia and other sleep problems
• Sexual side effects
• Experienced by everyone
• Doesn’t affect social relationships
• Not progressive
• Lasts two weeks or less
Seasonal Affective Disorder
• Winter blahs
• Caused by lack of light in winter
• Treated with light therapy
Chronic Depression (Dysthymia)
• Bad state of mind
• Sad, blue, low feeling most of the day, on most days
• Functioning normally but “just going through the motions”
• Often unaware of being depressed
• Low energy
• Difficulty concentrating
• Low self-esteem
• Lasts two or more years
Adjustment Disorder with Depressed Mood
• Stems from bad event or series of events
• Problems pile up
• Symptoms within three months of a stressful event
• Fades with time
• Exaggerated responses to events
• Coming to grips with death or loss
• Appetite loss
• Two months or less
Minor Depressive Episode
• Intense period of depression
• Lasts less than two weeks
Supplement for depression
Gokshura; brahmi; ashwaganda
St. John’s wort; ginkgo; SAM-e and other supplements
Gokshura; shankpushpi; ashwaganda
Karta Purkh Singh Khalsa, a frequent contributor to Herbs for Health, is an adjunct faculty member in the botanical medicine department of Bastyr University in Kenmore, Washington. Khalsa’s book Body Balance is available on our Bookshelf, Page 58.
The reference list for this article is extensive. If you would like a copy, please send a self-addressed, stamped envelope to “Depression,” Herbs for Health, 1503 SW 42nd St., Topeka, KS 66609; or e-mail us at email@example.com.
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