Depression

  Depression IS NOT necessarily “all in your head”

Depression may be caused by purely psychological issues such as grief, loss, and fear; research tells us these types of issues themselves can bring about physical problems including elevations in homocysteine, decrease in thyroid function, and a host of other problems requiring nutritional intervention. Depressive symptoms may signal underlying physical disorders or may be a common side effect of a medicine you’ve been taking.

A fact that receives too little attention is that feelings of sadness, being out of control of our lives, anxiety and fatigue  are often triggered by purely physical causes. The Merck Manual for Healthcare Professionals acknowledges this, listing possible causes including diseases, endocrine imbalances, nutritional deficiencies, pathogens and endocrine issues. Unfortunately most conventional Western physicians ignore this advice and view depressive symptoms as a “mental disorder.” They try to suppress depressive feelings though drug treatments that for the most part create emotional numbness.

No one should suffer from unremitting depressive feelings. CHS recommends you see a qualified Psychologist as your first Mental Health Professional, and consider one of our natural support formulas, which are far safer than antidepressants and antipsychotics that are promoted on TV!

What can I do?

Western Medicine

Conventional Western Allopaths broadly consider depressive symptoms to be caused by a chemical imbalance, primarily involving serotonin. Antidepressants are seen as first line treatment (in the U.S. only), with increasing supplementation with antipsychotics such as Abilify. Both classes of drugs have a long list of common and often severe harmful effects. They have not been proven to work, and are known to worsen depression in up to 8% of recipients. CHS recommends you AVOID “anti”depressants and antipsychotic drugs. Research has shown them to be ineffective for all but the most severe cases of depression, and benefits even then are lacking adequate scientific justification. If you have been taking these chemicals routinely DO NOT stop without professional guidance; they cause “withdrawal” symptoms, a buzzword for their addictive properties and must be tapered SLOWLY. Seek help from a qualified Medical Psychologist who will work with your primary physician and psychiatrist in developing a treatment plan.

Western Naturopathy

The Western Naturopathic approach calls for identifying nutritional imbalances. Natural products are used to help the body return to normal functioning, rather than trying to trick the body into not reabsorbing serotonin as it was designed to do.  Adequate diagnostic testing and close examination of physical as well as psychological symptoms is a hallmark of natural, Functional Medicine.  Several natural substances have been shown to help with depression. Significant research has been published supporting effectiveness;  sample of some of these studies are referenced below.

Traditional Chinese Medicine

Traditional Chinese Medicine approaches mental or emotional problems such as depression as an imbalance or blockage in one or more of the internal organs (Zang/Fu) and the energy pathways (meridians) that pertain to them. Some common patterns that can manifest as depression are Liver Chi Stagnation, Spleen Chi Deficiency, Kidney Essence Deficiency or Lung and Heart Meridian disorder. The appropriate remedies are chosen by the TCM practitioner based on patterns of symptoms.

Research

Lithium: Lithium has been shown to be effective for management of bipolar mania and depression (9) and is considered first line treatment by the APA (5). “Lithium alone or in combination with an atypical antipsychotic may reduce aggressive behaviors in children and adolescents with CD.” (10) The exact mechanism of action of lithium in psychological and behavioral disorders in humans is “unknown,” however it appears to affect dopamine and serotonin activity. Lithium might increase monoamine oxidase (MAO) activity. It also enhances folate and vitamin B12 transport into brain cells, which might affect mood (11). Reliable evidence demonstrates that a low level of lithium— trace levels found in many water supplies— is effective at reducing suicide rates (7) (12) (13) (14) (15) (16). Low dose lithium has been found to reduce rates of aggression in both humans and animals (7) (17). Lithium appears to work partially by inducing elevations in brain and erythrocyte glycine levels (18).

Although low dose lithium has not been promoted as useful in humans, veterinary science has embraced it for management of healthy animals; lithium is added to commercial pig, chicken and other feed. Low dose lithium has been found helpful for mild cognitive impairment and Alzheimer’s disease (19) (20) (21) (22). Lithium has been used for mania and depression since 1871 (23). It was used as a salt substitute in the 1940’s, although this was abandoned with emergence of dose dependent toxic effects. Lithium carbonate was listed as a controlled substance in 1970.

SAMe: S-Adenosyl methionine is produced naturally in the body and is made from adenosine triphosphate (ATP) and methionine. Several clinical studies show that taking SAMe is more effective than placebo and appears to be as effective as tricyclic antidepressants in trials lasting up to 42 days (26) (27) (28) (29). Rather than harming your liver, SAMe has been shown to combat liver disease as well as arthritis (30). Practice guidelines from the American Psychiatric Association suggest SAMe as a potential alternative to conventional antidepressants for patients with major depression who are interested in using alternative therapies (31).

St. John’s Wort: St. John’s Wort is a yellow-flowering perennial herb indigenous to Europe. It has been extensively studied and is commonly prescribed by psychiatrists in several countries The Cochrane Collaboration has found, “The available evidence suggests that the Hypericum extracts tested in the included trials a) are superior to placebo in patients with major depression; b) are similarly effective as standard antidepressants; and c) have fewer side-effects than standard antidepressants.” (32) St. John’s wort extracts are more effective than placebo for depression (33) (34) (35). Taking St. John’s wort extracts has been shown to improve mood, decrease anxiety and somatic symptoms, and decrease insomnia related to mild to severe major depression (36).

5-HTP: 5-Hydroxytryptophan (5-HTP) is a naturally occurring amino acid and precursor to serotonin and melatonin. It is used for sleep disorders, depression, anxiety, migraine and tension-type headaches, fibromyalgia, binge eating associated with obesity, premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), attention deficit-hyperactive disorder (ADHD), cerebellar ataxia, Ramsey-Hunt syndrome, Down syndrome, insomnia, and as adjunctive therapy in seizure disorder and Parkinson’s disease.

5-HTP readily crosses the blood-brain barrier and increases central nervous system synthesis of serotonin (37). There is good evidence for use for depression (37) (38) including treatment resistant depression (39). Taking 5-HTP orally appears to improve symptoms of primary fibromyalgia syndrome (PFS), including pain severity, morning stiffness, and sleeplessness (40) (41) (42). Preliminary evidence supports the use of 5-HTP for anxiety disorders (43) and cerebellar ataxia (44). Preliminary evidence suggests that taking 5-HTP orally might help reduce appetite, caloric intake, and weight in obese patients (45).

Omega-3 Fatty Acids: Three types of omega-3 fatty acids involved in human physiology are ALA (found in plant oils), EPA, and DHA (both commonly found in marine oils). Common sources of animal omega-3 EPA and DHA fatty acids include fish oils and krill oil. Significant research shows that fish oil can reduce triglyceride levels by 20% to 50% (46). The prescription form, Lovanza, is FDA approved for treating hypertriglyceridemia (47).

The EPA component of omega-3s has been found to be effective at depressive symptoms (48) (49) (50). Some clinical research shows that taking a fish oil supplement orally might reduce the risk of progression from sub-threshold psychosis to full-blown psychotic disorders (51). Taking EPA orally provides modest improvement in aggressive behavior and depression in women with moderately severe borderline personality disorder (52). EPA modestly improves the mental state in patients with schizophrenia compared to placebo (53).

EPA 500 mg orally, three times daily, provides modest, but significant reduction in the frequency of hot flashes compared to placebo (54). Limited evidence supports fish oil use for prevention of restenosis following angioplasy (55). Cochrane found benefit for asthma in children (56). Omega 3’s help with atherosclerosis (57), diabetic neuropathy (58), dysmenorrhea (59), hypertension (60), and rheumatoid arthritis stiffness (61).

Saffron: Saffron is derived from the flower of Crocus sativus, a native of Greece or Southwest Asia. Saffron is used for insomnia, depression, Alzheimer’s disease, fright, shock, asthma, cough, pertussis, and as an expectorant. Women use saffron for menstrual cramps and premenstrual syndrome (PMS). Men use it to prevent (premature ejaculation. Saffron is also used as an aphrodisiac and to induce sweating.

Clinical research shows that taking saffron orally seems to improve symptoms of major depression after 6 weeks of treatment (62) (63). It has shown similar efficacy to fluoxetine 10 mg twice daily in patients with mild-to-moderate depression after 6 weeks of treatment (64) (65).

Some clinical research shows that patients 55 years and older with dementia and probable Alzheimer’s disease treated with saffron orally have comparable cognitive and clinical outcomes to patients receiving conventional therapy with donepezil (Aricept®) 10 mg/day orally after 22 weeks of treatment (66). Saffron significantly improves symptoms of PMS after two menstrual cycles (67).

DHEA: DHEA is endogenously produced in the adrenal glands and in the liver. In men, DHEA is also secreted by the testes. Additionally, the neurons and glial cells in the brain synthesize minute quantities. DHEA and its sulfate ester, dehydroepiandrosterone sulfate (DHEA-S), are interconvertible. DHEA-S is the storage form of DHEA.

Taking DHEA orally might improve symptoms of depression and dysthymia (68) (69) (70). “DHEA treatment may have significant antidepressant effects in some patients with major depression.” (71) “We find DHEA to be an effective treatment for midlife-onset major and minor depression.” (72) “DHEA was superior in the intent-to-treat analysis, where the response rate was 56% (43 of 77) for the DHEA group versus 31% (21 of 68) for the placebo group.” (73)

Taking DHEA orally seems to improve both negative and positive symptoms in patients with schizophrenia (74) (75).  Limited evidence indicates DHEA may be effective for erectile dysfunction, lupus (SLE), Addison’s, Chronic fatigue Syndrome and aging skin.

*Statements contained herein have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat and cure or prevent disease. Information provided by CHS is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Any information given is only intended as a sharing of knowledge and information from scientific world literature. You are encouraged to make your own health care decisions based upon your own research of the subject and in partnership with a qualified health care professional.

Options in Depression Treatment

By David Reinhardt, Ph.D. MSP.Pharm, ABMP

Other substances that need more research

Preliminary evidence suggests several other natural substances offer benefit for depression. Studies are needed to understand if these benefits are due to a direct action on mood or if they are effective because they mitigate nutritional issues. The following substances have preliminary evidence of effectiveness:

Rhodiola (76)

Inositol (77)

Acetyl-L-carnitine (78) (79)

Chromium (80)

L-tryptophan (81)

L-phenylalanine (82)

Phosphatidylserine (83)

Vitamin C (84)

Other Healing Systems

The above discussion examined potentially antidepressant natural substances for a Western Science perspective, as used in Allopathic Medicine and in Western Herbology. Ayurveda and traditional Chinese medicine recognize the symptoms of depression but do not label it as a specific disease for which we must search for a magic pill or elixir.

Ayurveda is an alternative healing system developed over thousands of years and practiced primarily on the Indian subcontinent. From an Ayurvedic perspective, we are at our core healthy, whole, and happy by nature. We should engage in habits and practices that support the emergence of the essential nature and that bring balance to mind, body, and spirit. Ayurvedic medicine may prescribe yoga, breathing, and lifestyle techniques, in addition to using herbal remedies to address imbalance.

Symptoms of depression and anxiety are triggered by excessive mental and physical stress, or disruptions of natural biological rhythms. According to Ayurveda, psychological problems start when fundamental imbalances develop in the biological intelligence that controls all bodily processes. Depression and anxiety can be influenced by many factors, such as diet, digestion, toxin accumulation, stress, exercise levels and daily routine, Ayurveda treatments attempt to balance many physiological functions simultaneously. Ayurvedic formulas for depressive symptoms include 2 substances with limited human research of effectiveness (although several rat studies have been published):

Bacopa monnieri (Brahmi): Brahmi has been shown in many rat studies and a limited number of human studies to help with symptoms of depression (85) (86) (87).

Brahmi has been shown effective for measures of verbal learning, memory, and information processing in healthy men and women (88). It is used for the symptoms of ADHD (89).

Brahmi is available over the counter and costs about $3.12 per month.

Ashwagandha: Ashwagandha is used a part of treatment for arthritis, anxiety, insomnia, tumors, tuberculosis, and chronic liver disease. Ashwagandha is also used as an “adaptogen” to increase resistance to environmental stress. It is also used for improving cognitive function, decreasing inflammation, preventing the effects of aging, for menstrual disorders, fibromyalgia, and asthma. Studies have shown benefit for treating depression, particularly in the elderly (90) (91)

Ashwagandha is available over the counter and costs about $5.25 per month.

Traditional Chinese Medicine (TCM) is a broad range of medicine practices developed over more than 2000 years. TCM’s view of the body places little emphasis on anatomical structures, but is mainly concerned with the identification of functional entities (which regulate digestion, breathing, aging etc.). While health is perceived as harmonious interaction of these entities and the outside world, disease is interpreted as a disharmony in interaction. TCM diagnosis aims to trace symptoms to patterns of an underlying disharmony, by measuring the pulse, inspecting the tongue, skin, and eyes, and looking at the eating and sleeping habits of the person as well as many other things. Plant elements are by far the most commonly, but not solely, used substances; animal, human, and mineral products are also utilized. Complex formulas are tailored to the individual in treatment. Depression, according to TCM, is a disease caused by prolonged stagnation of qi, blood, dampness, or food. The treatment protocol is to break up all stagnation and moisten the internal organs.

Xiao Yao San: Xiao Yao San is a typical TCM depression formula with moderate evidence of effectiveness (92) (93). Xiao Yao San is made up of Bupleurum root (Bupleuri Radix), Chinese peony root (Paeoniae Radix), Chinese Angelica root (Angelicae Radix), White Atractylodes rhizome (Atractylodis Rhizoma), Tuckahoe mushroom (Poria), fresh ginger rhizome (Zingiberis Rhizoma), Chinese licorice root (Glycyrrhizae Radix), and wild mint herb (Menthae Herba). This formula in contraindicated during pregnancy and nursing. It does not contain St. John’s Wort and may be used concurrently with antidepressants or Shine®.

Xiao Yao San is available over the counter and is available from CHS for $20.00 for 100 capsules, a 1 month supply.

Evergreen Shine®: Evergreen makes high quality, modern Chinese formulas based on traditional prinicples and updated using Western standards of research. This formula contains St. John’s Wort, called Guan Ye Lian Qiao in TCM, which has been shown to be effective for depression (see references for St. John’s Wort, above). St. John’s Wort has similar action to Western antidepressants, and inhibits reuptake of serotonin. Because of this Guan Ye Lian Qiao should not be taken concurrently with antidepressant pharmaceuticals. This herb is used in Chinese medicine to clear heat, treat urinary tract and other infections and reduce inflammation. Evergreen Shine® is available from CHS for about $26.00 fper month

Depressive symptoms respond to natural treatments at least as well as pharmaceuticals, and in many cases better. Few if any adverse effects can be expected. They have the advantage of low cost, and freedom from seeing a psychiatrist monthly for monitoring.

Certain facts that are undeniable:

-None of these natural approaches increases depression by 8% (European antidepressant studies) or 4% (American studies, with us being “exceptional,” of course!)

-None of these natural approaches decreases libido

-None of these natural approaches cause serotonin syndrome, Stevens Johnson syndrome or other life threatening effects

-None of these natural approaches require the patient to see a psychiatrist once each month!

-None of these approaches cost $250-800 per month to try.

Although herbal approaches are much safer to try than highly concentrated pharmaceuticals, selection and use should be guided by a healthcare professional that is knowledgeable about interactions and contraindications.

About the author:

Dr. Reinhardt is a Medical Psychologist and head of the Center for Health Science in Long Beach, California. He is on the executive board and a founding member of NAPPP, the National Alliance of Professional Psychology Providers and a Fellow of the Academy of Medical Psychology. Dr. Reinhardt’s special training and passion is in uncovering the roots of poor mental and physical health and finding natural treatments that are both safe and effective. His education includes degrees in Clinical Psychology, Psychopharmacology, Holistic Health, Western Herbology and Engineering. For read more of his work visit his website and blog at CenterforHealthScience.com

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