Depression
Drug-Free Depression Treatments
Depression remains stubbornly intractable for many
of the estimated 20-plus million Americans who suffer from it.
Many of these people have difficulties
with the pharmaceutical drugs so often prescribed
for depression, finding them either ineffective or to cause
disagreeable side effects including lowered
libido and weight gain.
Also several of these drugs have been associated
with an increased risk for suicide, though this remains
a controversial issue.
All this has opened the door to a growing interest
in natural solutions for depression.
Research into CAM (complementary and alternative medicine)
treatments for depression is active in some very mainstream
academic medical centers, and several natural substances
have earned a respected position on the list
of depression treatment alternatives.
A chief researcher in this area is David Mischoulon, MD, PhD,
assistant professor of psychiatry, Harvard Medical School,
and director of Alternative Remedy Studies
at the Depression Clinical and Research Program,
Massachusetts General Hospital.
I spoke with Dr. Mischoulon recently to get an update
on alternative treatments for depression.

THE "BIG THREE"
Depression researchers refer to the "big three"
in natural substances for treating depression.
One well-studied natural treatment
is SAM-e (S-adenosyl methionine), a synthetic form
of a chemical produced naturally in the body
with numerous functions including influencing
moods and emotions.
Research on SAM-e and depression has been encouraging,
showing that it works better than placebo and that it is
as effective as tricyclics, a class of older anti-depressants
that dates back to the 1950s and is still very popular today.
Dr. Mischoulon's research group is now studying
SAM-e against the newer antidepressant drugs,
SSRIs (selective serotonin reuptake inhibitors)
such as fluoxetine (Prozac) and sertraline (Zoloft).
The typical prescribed dosage of SAM-e
is 800 to 1,600 mg a day, and SAM-e seems
to be well-tolerated, with few if any immediate side effects.
Next, perhaps surprisingly, comes omega-3 fatty acids.
We have known for some time that omega-3 fatty acids
help treat many physical conditions,
including cardiovascular disease.
But Dr. Mischoulon says there have been numerous studies
on omega-3 fatty acids and their impact on mental health,
including bipolar disorder as well as depression,
with many suggesting that these fatty acids are indeed effective.
The types of omega-3 fatty acids that help with depression
are EPA and DHA,
found in cold-water fish and fish oil supplements.
Psychiatric benefits are commonly obtained
with about 1,000 mg a day of combined EPA/DHA.
And then there is our old friend,
St. John's wort (hypericum perforatum).
Dr. Mischoulon says that it has tested well in a number
of studies, including against older antidepressant drugs.
Studies have shown that this substance is calming
while at the same time it seems to work in part like SSRIs.
Recommended doses are on the order
of 900 to 1,200 mg per day, but because of subtleties
regarding dosage and the fact that St. John's wort is known
to interact with many other medications, it's imperative
to take this supplement under the supervision
of a medical professional experienced in its use.

OTHER NATURAL TREATMENTS
Yet another substance that Dr. Mischoulon says may be
helpful is Valerian (valeriana officinalis).
It has primarily been studied as a sleep aid, but
Dr. Mischoulon says it may also be useful for anxiety.
It's important to keep in mind that Valerian requires
several weeks to work, whether for sleep
purposes or for anxiety relief, although many report
feeling positive effects fairly quickly.
The usual dose administered is 400 mg to 600 mg of extract
in capsule form, but there is considerable variety
among brands as to purity and active ingredients.
Different brands may achieve different results
in different people, so Dr. Mischoulon says not to give up
if a particular one doesn't work for you.
A number of physical treatment modalities are being
incorporated in depression treatment,
though research remains limited.
Acupuncture is one that studies have found promising,
says Dr. Mischoulon.
Curiously, acupuncture studies have an unusually
high placebo-effect rate
(subjects on placebo showing improvement),
so how much acupuncture actually helps is unclear.
On the other hand, most people find acupuncture
to be neither painful nor harmful, so it may be worth a try.
Exercise has also been studied with regard to potential benefits
for depressed people, with new studies suggesting
beneficial mood-elevating effects.
However, because depression tends to cause a decrease
in energy and motivation, it can be difficult to get
depressed people to engage in exercise programs,
Dr. Mischoulon acknowledged.
But if they can push past the lethargy,
they may be pleasantly surprised
by how good exercise makes them feel
-- including the sense of accomplishment.

DEPRESSION IS MANAGEABLE
Anyone who experiences depression for more than
a few weeks should seek professional treatment,
says Dr. Mischoulon.
Though it may take a while to find the treatment
that works for you, it is important to remember
that depression is usually manageable.
Left untreated, it can become chronic and difficult to treat.
When choosing to treat depression with natural substances,
always work under the supervision
of a naturopathic physician or other health care professional
who can help identify the best solution for you.
To find such a doctor, seek referrals from your primary care
physician and consult the database of the AANP
(American Association of Naturopathic Physicians)
at NaturoPathic.
Then speak with the doctors to find one
that seems to be a good fit for you.

Patience is in order
-- just as with pharmaceutical drugs for depression,
natural treatments often require time to take effect,
from three to six weeks, says Dr. Mischoulon.
Finally, some of these therapies have been found effective
in treating mild to moderate depression.
While some may be of help for severe depression,
the evidence to date relates only to the milder forms
-- treatment of more serious cases
may require a different strategy.


Source(s)
David Mischoulon, MD, PhD,
assistant professor of psychiatry
at Harvard Medical School and director
of Alternative Remedy Studies
at the Depression Clinical and Research Program,
Massachusetts General Hospital, Boston.

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