According to the CDC, 1 in 10 Americans suffer from some form of Depression. As pharmaceutical drugs show less effect in some studies compared to no drugs, the use of natural medicine is high in this chronic condition.
How Depression Works
Depression is caused by multiple factors such as emotional, social and environmental as well as genetic.
Interestingly, the initial episode although of tremendous stress, recurrence of depression leads to less intense stress related episodes but more autonomous in a process known as 'kindling.' This process leads to dysfunction in the nervous system by increasing cortisol, reducing restful sleep, increasing rapid eye movements which lead to easy arousal or early arousal during sleep and disruption among the nervous system itself.
The body is in a constant state of learning and these changes caused by depression on the nerve cells ends up in gene transcription factors and nerve growth factors. The end result is the disruption of the nerve proteins and neurotransmitters such as serotonin, GABA, dopamine and norepinephrine. These neurotransmitters and there disruption can cause problems with synthesis of neurotransmitters, increases its breakdown and as a result causes an imbalance in this delicate cycle.
How Modern Medicine works
As a Modern doctor, there is a stepwise approach or pathways to treating depression by starting with the most common Selective serotonin reuptake inhibitors such as fluoxetine, paroxetine. Also known as Prozac, paxil and similar drugs. The purpose to bring these neurotransmitters to increase and thus leading to a balance.
With my practice in primary care, I encountered atleast close to 70% of my patients on one form of antidepressant or in need of them. I would go through their in office questionnaire PHQ 9 which helps assess if the patient needs treatment. I would do my best to learn what is the root cause of depression for this patient. But honestly, given the time restraints in all of primary care, there is not enough time to go towards a balanced approach and so I came up with the idea that I will use my very own Youtube channel and website to help my patients.
HOW INTEGRATIVE MEDICINE HELPS?
Exercise
Some studies show that those who regularly exercise are able to prevent onset of depression. So a healthy individual who partakes in physical activity is less likely to suffer depression in the first place. But a good point to understand is that regularly performed exercises are equally powerful as a psychotherapy session or an antidepressant.
Another study indicated that exercise combined with pharmaceutical therapy gave better results than either component alone in preventing recurrence of depression. The additional benefits alone is a reason to begin exercise. Better self esteem, better fitness, and reduced risk of relapsing back to depression makes this strategy a winner.
Does the type of exercise matter? Both aerobic and anaerobic activities are effective. But studies also indicate that the total energy expenditure is more important than how many times a person exercises meaning a high intensity exercise is superior in its effect.
Although science is not clear, it is possible that exercise increases serotonin, norepinephrine, and endorphins. And it may also increase nerve cell growth in areas of our brain related to mood similar to medications.
Nutrition
A cross national epidemiology study suggested a direct correlation between sugar intake and major depressive disorder. Patients with depression have a higher sugar intake than the general population.
A small study suggested that restricting sugar from the diet of depressed patients ended up with positive result within 1 week. There symptoms worsened when they were reintroduced to sugar in diet.
Another nutritional factor is caffeine. High caffeine consumption exactly 750mg daily is also associated with depression. A regular 8 ounce cup of coffee is around 91 mg for reference and most people don't fall in that spectrum but if you do its important to reduce consumption.
A large study in Australia showed that those who follow a more traditional diet of vegetables, fruit, beef, lamb, fish and whole grains had a 35% reduced likelihood of depression than a Western style diet of more processed and refined foods. People that follow a Mediterranean diet pattern ingestion omega 3s from fish, good fats from olive oil and B vitamins from legumes, fruits, nuts and vegetables had significant reduction in depression.
Alcohol
Although alcohol consumption may in short term increase turnover of serotonin, in the long term the results show low levels of both serotonin and catecholamines. Given that alcohol related problems are more common in depressed individuals often a traditional medicine doctor will inquire of your use of alcohol and advise to avoid at all costs.
I have had patients who suffer from severe depression and down there misery with alcohol and they would not cut back. A doctor can only help so far. If you have problems cutting out then sometimes expert help is important for your mental health.
Omega 3 fatty Acids
Data is suggesting that low omega 3 or an imbalance between omega 6 and omega 3 has a direct correlation in increasing depression. How is that? Well our nerves require these essential fatty acids to build there ends or synapses and their function which helps regulate the neurotransmitters. Now although there use alone is not recommended to treat depression, smaller studies did show benefit with combined use with antidepressants. Some early evidence also shows benefit with children and women that are pregnant in depression.
A good dose for depression treatment is not yet known but some dose studies do show that 1 g is superior to 2 or 4 g daily. Or similarly eating cold water fish such as wild salmon, herring 2-3 serving each week. However beware of pesticide and heavy metal contaminated fish so always consider wild than farmed.
Studies suggest that EPA or combination of EPA and DHA is better than DHA alone. DHA is important for cell structure in brain and eyes and EPA helps in cells function and communication between each other. You will also see these listed on your omega 3 supplements as well. Vegetarian option includes flax seed oil or meal around 2 tablespoons daily and a small handful of walnuts if no nut allergy. The Vegetarian options however are not studied in depression so keep that in mind.
DIETARY SUPPLEMENTS
Vitamin D
Large Dutch study showed in people 65 and older that the lower the Vitamin D the higher the severity of depression. Supplementing is an inexpensive way to help depression and some evidence is also suggesting its role in frequent falls, heart disease and colon cancer.
B Vitamins
Folic acid and Vitamin B12 have been shown to be important in making neurotransmitters in brain. No studies are yet available for there role in depression but it can be considered in people with diets that are not rich in Vitamin B and elderly who are more prone to deficiency. B6 is important in making serotonin and its levels have been found to be low in depressed patients. Especially premenopausal due to use of oral contraceptives or estrogen therapy. A dosage of atleast 100 mg of major B Vitamins can help particularly in people who I have mentioned are more prone to deficiency. The link above combines both B complex and Folic acid for your convenience.
Folic acid
Now studies show that low folic acid which is important for neurotransmitters synthesis is identified in depressed people. And it has also been shown that those with low folic acid also don't respond well to traditional pharmaceutical therapy. There has been limited evidence that its addition had benefit in depression. Therefore can be added as an add on therapy for treatment with Vitamin B. Dose is between 400mcg to 1mg daily of folic acid.
Beware that high doses have been shown to cause changes in sleep patterns, vivid dreams, irritability, may increase seizure frequency and gut disturbance. So it is important to not overdo on dosage.
SAMe or S-Adenosylmethionine
Very important again in the metabolism of norepinephrine, serotonin and dopamine. This important enzyme is not formed well in depression and supplementation shows increase in brains neurotransmitter function.
However large studies are lacking in showing its benefit. But some smaller studies do show its comparison with antidepressants and found similar benefits. Another study showed combined with SSRI it had better results. Particularly those not responding to antidepressants. This enzyme is well tolerated and has lesser side effects than our typical antidepressant drugs and has a faster onset of action. Some doctors use SAMe when starting antidepressants and can taper off when the antidepressants take effect in 4 to 6 weeks. The most stable form of it is 1,4 butane-disulfonate that is stable for 2 years at room temperature.
A dosage of up to 1600mg may he necessary to treat depression followed by 200 mg twice daily to maintain. However, I recommend slow start of SAMe 200 mg once or twice daily to minimize gastrointestinal side effects and then titrate up over 1 to 2 weeks. For those not responding to SSRI antidepressants 800mg twice daily may help. High doses can cause nausea, vomiting, diarrhea and gas. Avoid taking the evening dose close to bedtime as it can cause insomnia.
Hydroxytryptophan or 5 HTP
This guy converts tryptophan to serotonin. Evidence pointing to studies is poor. Only 2 studies in a Cochrane review were performed with good quality. At some point it was being used as treatment for depression and insomnia but due to contamination and some resemblance to an illness called eosinophilic myalgia syndrome which causes skin rash, muscle pain and breathing problems, it was banned by FDA. It was then discovered that the illness was caused by a contaminant in manufacturing and not the 5HTP itself so it is reinstated.
5 HTP is not to be used with other antidepressants as it can cause excess serotonin and lead to insomnia, muscle rigidity, irritability in a spectrum of symptoms called serotonin syndrome.
Dosage start from 50mg of 5 HTP with slowly increasing every 2 to 3 weeks up to 200mg three times daily.
BOTANICALS
St. John's Wort (SJW)
Licensed product to be used for mild to moderate depression in Germany since 1984, this herb has affects on serotonin, dopamine, norepinephrine and GABA. However two large US studies found SJW was not effective for severe major depression. However a systemic review of 29 studies found that it was as effective as antidepressants in mild to moderate depression. Along with that it had 10 times less side effects than pharmaceutical drugs.
Doses of 300mg three times a day were used in clinical trials up to a dose of 900mg daily. But its important to choose your product correctly. A standard product should have minimum 2 to 5 % hyperforin or 0.3% hypericin as these were tested in the clinical trials. Based on my research only a few products on the market exhibit these requirements. Perika by Natures way has the minimum 3% hyperforin. Once clinical improvement is maintained then consider going down to twice daily dosing. It may take up to 2 months before full effects are seen.
Some side effects such as gastrointestinal upset, allergic reaction, fatigue, dry mouth, restlessness, constipation, sexual side effects such as decrease in desire and possible increase risk of cataracts. However still fewer than pharmaceutical drugs.
This herb also activates a liver metabolism enzyme Cytochrome p450 and can decrease blood levels of certain drugs so always ask your doctor before taking especially if you use HIV medication, coumadin a blood thinner, cyclosporine or oral contraceptives.
Saffron
A traditional Middle-Eastern and Islamic medicine. An Iranian study of 500 patients showed that it was better than nothing for treatment of mild to moderate depression and similar to antidepressants. So consider 30mg of Saffron daily for dosing. Hardly any side effects to report as it is considered safe to consume in US.
Rhodiola rosea
Again, no mechanism of action of this herb is known however in a small study addition of Rhodiola to antidepressant therapy led to improvement than SSRI drugs alone. Doses between 0.3 g to 0.6 g/day are recommended.
MIND AND BODY THERAPY
Atleast 60% of patients who undergo psychological therapy with a trained therapist do find them beneficial as they help replacement of negative thoughts with a positive outlook. There are many approaches to this therapy. One such approach is Mindfulness-Based Cognitive Therapy which uses distressing thoughts to come and go and training the patient not to react to them by fighting or escaping them. There are many ways you can join this program, you can search for mindfulness based stress reduction programs in your area or my favorite way is to read. I recommend reading Mindful Based Stress Reduction by Linda Lehrhaupt.
Another method is neurofeedback therapy where electrodes are attached to the brain and they detect brain waves that is transmitted as images or sounds to the patient and so patient becomes aware and complete certain tasks that encourage good thoughts and behavior. Again this is still under active research and not much is known of the benefit yet.
Studies on Hatha and Vinsaya yoga showed significantly greater decline in depression. However many forms of yoga exist, only these two have thus been studied.
What about Acupuncture
Studies on humans and animals show that stimulation of certain Acupuncture points does alter the neurotransmitter levels. The WHO recognizes Acupuncture as effective in treatment of mild to moderate depression. It is consider safe to be tried for interested patients.
Phototherapy for seasonal affective disorder (SAD)
Studies are mostly showing benefit with patients who experience depression as the seasons change and so the 30 to 60 minutes of bright light helped reduce SAD by 36%. However cause of its low cost it is definitely a good option to consider using a full spectrum, 10,000 lux special bulb daily.
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