According to a World Health Organization study (2000), approximately 17-21 million Americans (roughly 10% of the country) are diagnosed with depression each year. Its many causes include prescription drugs, low/high blood sugar, nutrient deficiencies, candidiasis, hypothyroidism, anemia, and sleep deprivation. If you suffer from chronic depression, consider consulting with a holistic physician and/or a therapist. However, if you are among the majority with mild-to-moderate depression who prefer not to seek treatment, consider trying the natural remedies discussed below.
The Neurochemistry of Depression
To support its many functions, the brain uses a number of neurotransmitters, chemical messengers constantly released and received by the brain’s nerve cells (neurons), to communicate with other parts of itself and the nervous system. The entire information transmission cycle occurs in seconds. Any problem that interrupts the smooth functioning of this chain of chemical events can negatively impact the brain and nervous system. Studies have linked depression especially to imbalances in the brain of these neurotransmitters:
(1) Dopamine (take L-tyrosine, SAM-e; eat almonds, chocolate, avocados, pumpkin seeds, bananas) – creates a natural high, required for sexual arousal, linked to movement disorders (e.g. Parkinsons)
(2) Serotonin (take 5HTP, SAM-e; eat carbohydrates, chicken/turkey, nuts, Chia seeds) – controls emotions, cognition, blood sugar/insulin, appetite, cardiovascular health, impulse control, and sleep
(3) Norepinephrine/Adrenaline (take L-tyrosine) – involved in fight or flight reaction, arousal, and cortisol production
(4) GABA (take GABA or L-glutamine; eat salmon, nuts, eggs, legumes) – mood stabilizer, relaxant, inhibits other neurotransmitters
(5) Glutamate (converts to L-glutamine) (wheat protein is 35% glutamic acid) – high or low levels can cause depression
(6) Opioids (increase endorphins through exercise, yoga, acupuncture) – feeling of well-being, memory/brain motivation, natural morphine; and
(7) Acetylcholine (take phosphotydilcholine; eat eggs, salmon, Brussels sprouts, broccoli, wheat germ) – increases excitement, higher mental function/memory, muscle function.
Drugs That Can Cause Depression
Medications that cause depression alter brain chemicals in some way. These are some common drugs that have been reported to cause depression, and the elderly are particularly at risk: alcohol; Accutane; antibiotics (Zithromax Z Pak, Cipro, tetracyclines, amoxicillin); anti-anxiety, insomnia, and seizure/muscle medications (e.g., barbiturates, benzodiazepines such as Xanax, Ativan, Librium, and Klonipin); beta-blockers (Lopressor, Tenormin, and Coreg) and calcium-channel blockers for heart problems (e.g., Procardia); HRT estrogens (e.g., Premarin, Prempro) and birth control drugs (Norplant); Opioids for pain (codeine, morphine, Demerol, Percocet, Percodan, OxyContin); and statins for high cholesterol/cardiovascular support (Lipitor, Mevacor, Zocor, Pravachol).
To avoid drug-induced depression, research the class a prescribed drug is in and whether it has that side effect. Ask the prescribing physician whether an alternative drug is available. A holistic practitioner may know a safe natural remedy that can counter the depression or even substitute for the drug altogether.
Safe Natural Remedies
1) Fish Oil/Omega-3 Fatty Acids (O3s)
Studies have linked depression with low dietary intake of omega-3 fatty acids and suggest that O3s, in combination with antidepressants, may be more effective than antidepressants alone.
Cold water fish such as salmon, sardines, herring, anchovies, haddock, halibut, white albacore tuna, and mackerel, are the richest food source of O3s. Molecularly distilled or pharmaceutical grade fish oil capsules are considered a cleaner source of O3s than many consumed fish that can contain mercury, PCBs, and other toxins. Fish oil capsules should ideally be taken with Vitamin E to prevent oxidation, and with a fatty food to maximize absorption.
2) Vitamin D3 & Light Therapy
Sunlight deprivation, which frequently occurs during the dark winter months, can cause seasonal affective disorder (SAD). Exposure to sunlight, especially in the morning, increases serotonin production and promotes proper function of the body’s sleep/wake cycle. Another option is to use study-supported special lights that simulate natural daylight.
Sunlight is required to produce Vitamin D3, a pro-hormone that has long been clinically proven to be linked to mood support. Normal range for vitamin D is 30-74ng/mL, with the recommended level around 50 ng/mL. Any levels below 20 ng/mL are considered serious deficiency states. Many practitioners recommend a minimum of 1,000-2,000iu of Vitamin D3 for general health, but 5,000iu is the minimum that can boost and maintain mood. Vitamin D3 should always be taken with calcium.
The body produces the amino acid 5-HTP from the amino acid L-tryptophan. The body then converts 5-HTP to serotonin, which it uses to produce the sleep/immunity hormone melatonin. Several small clinical trials have found that 5-HTP is as effective as antidepressants. In one 6-week clinical trial, 63 people were given either 5-HTP (100 mg) or an antidepressant (Fluvoxamine 50 mg) three times per day. The 5-HTP was found to be as effective as the antidepressant, with fewer side effects. 5-HTP should not be combined with antidepressants and should be checked for interactions with other prescription drugs.
SAM-e is a chemical found naturally in the human body that increases levels of serotonin and dopamine. Several studies have found SAM-e is more effective than placebo, and one Harvard/Massachusetts General study published in the American Journal of Psychiatry (2010) confirmed its ability to elevate mood. Enteric-coating of SAM-e maximizes absorption. Potential side effects include nausea and constipation.
5) Folic Acid/Folate
Folic acid is a B vitamin that is often deficient in people who are depressed. It is found in green leafy vegetables, other vegetables, fruit, and beans. Since all drugs deplete B vitamins (including aspirin and birth control pills), and due to the commonality of poor diet, it is one of the most common vitamin deficiencies.
Harvard University researchers have found that depressed people with low folate levels don’t respond as well to anti-depressents, and taking folic acid in supplement form can improve the effectiveness of antidepressants.
6) St. John’s Wort
The herb St. John’s wort has long been used in folk medicine. Today, the results of over 20 clinical trials inidcate that it works better than a placebo and is as effective as antidepressants for mild-to-moderate depression, with fewer side effects. It is available in capsules, liquid extracts, and as tea. It can take 4-6 weeks to feel this herb’s full effects.
St. John’s Wort increases sun sensitivity of the skin and eyes. Although it is reasonably safe when taken alone, St. John’s Wort can interfere with the effectiveness of prescription and OTC drugs, such as antidepressants, oral contraceptives, HIV/AIDS drugs, and drugs prescribed to prevent transplanted organ rejection. It is not recommended for pregnant or nursing women, children, or those with bipolar disorder, or liver or kidney disease.
Diet greatly impacts one’s mental state. Minimize your intake of all sugar sources (sweets, simple carbohydrates/starches (bread/pasta/rice/potatoes), many fruits/fruit juices), and avoid caffeine and alcohol, all which can initially improve mood but ultimately worsen mood swings, depression, anxiety, and insomnia.
Vitamin B6 is needed to produce serotonin and dopamine. Although deficiency of vitamin B6 is rare, a borderline deficiency may occur in people taking oral contraceptives and HRT.
Most people do not get enough magnesium, also required for serotonin production. Good sources are legumes, nuts, whole grains, and green vegetables. Stress depletes magnesium.
Regular aerobic exercise is critical to mood elevation. It releases endorphins, mood-elevating chemicals in the brain, and can decrease stress hormones. Try walking at least 10 minutes after each meal or a total of 40 minutes/day 5-7 days per week. Choose something you truly enjoy and will stick with.
Submitted by Michael Dworkin, PD, MS, CCN, a Registered Pharmacist and Connecticut Certified Clinical Nutritionist (CT Cert. No. 232), with J. Erika Dworkin, Nutrition Consultant, Certified Lifestyle Educator, Board Cert. Holistic Nutrition (pending). Owner of the Manchester Parkade Health Shoppe (860.646.8178, 378 West Middle Turnpike, Manchester), Pharmacist Dworkin has been guiding patients since 1956 and is available for consultation by appointment. Erika is available to speak to groups and for weight loss consultations. References are available upon request.