I am very passionate about helping people with depression using naturopathic medicine. Alternative medicines, herbal medicines, nutritional therapies, diet, and lifestyle are wonderful complementary approaches to addressing depression over the long haul.
Please do keep in mind when I am discussing depression I am doing so VERY generally and you will need to work with your health care provider to determine the type of depression you have whether it be mild, moderate, severe, bipolar or what not.
Also, I am writing this up as general self help to get you pointed in the right direction with the natural medicines that should be the most helpful.
You can print out this list of well researched and safe suggestions for depression and bring it to your appointment with your physician to determine which treatments will particularly benefit your form of depression. You should ALWAYS work with a professional when treating your depression because the consequences of sub-optimally treated depression can be life threatening.
I also strictly advise AGAINST combining herbs or natural therapies (aside from vitamins, minerals, or fish oil) with any form of anti-depressants. Although it is occasionally done, most naturopathic physicians, MD’s, and psychiatrists agree that until we have research demonstrating efficacy and safety herbs and natural anti-depressants with similar mechanisms to prescription drugs should not be simultaneously used. Also, although these medicines are “natural” they are still medicines. Please do not choose to discontinue your natural medicines without the advice of your physician, someone should be overseeing your care. Depression is complicated to sort out. Please do not try to do it alone. Someone needs to be documenting your mood fluctuations as well as when you start and stop specific therapies.
Before we get started let’s just be perfectly frank about what natural medicines and herbs will and will not do. Herbs work well for mild, moderate, and situational depression, however they will not likely be solely effective for SEVERE depression. Herbs are a great alternative for people that do not like the side effects of their anti-depressant, or that feel they no longer need to be on a treatment as strong as a prescription anti-depressant. Herbs are helpful for transitioning all the way off medications and can be used for a period of time after an anti-depressant is discontinued to help stabilize the mood. Natural remedies may be helpful for women suffering from pre-menstrual, menopausal, or post-partum depression, however if you are pregnant or breast feeding you should never take any natural remedies aside from vitamins (at standard prenatal doses) unless advised by your physician.
Unless you are actually deficient in a vitamin, mineral, or amino acid that is causing your depression, natural treatments will not likely “cure” your depression, as they have similar mechanisms as medications, and most medications typically only work while you are taking them. Be sure, however, that you are not iron deficient if you are depressed, as a public health study saw a correlation between iron deficiency anemia and depression in young women. Herbs and natural medicines are more gentle than drugs and will thus take longer to work in your system. You therefore have to be PATIENT when working with naturopathic medicines. Most therapies will take at least two weeks to notice an effect. Natural medicines also require the same diligence as daily drugs and should be taken at the same time of day religiously for optimal effect.
Addressing the root cause of your depression with therapy is fundamental to any treatment plan, whether prescription or alternative. If counseling “did not work”. Find a new counselor with a different approach or technique. There are so many helpful techniques out there, don’t give up on therapy, give up on the therapist if after three months you do not notice notable improvement.
The Nine Best Natural Remedies for Depression:
1. St. John’s wort- Pictured above, the bright yellow flowers of the St. John’s wort plant are full of an oily red substance called hypericin. If you have St. John’s Wort growing nearby you can see the little red spots in the plant (hence the perforations in the name Hypericum perfoliatum), now roll the flowers between your fingers to release the red oils and see the medicine first hand! The red oily hypericin is the active constituent of Hypericum perfoliatum. This herb has been highly studied in many double blind research trials and shown to have significant effects similar to prescription anti-depressants. St. John’s Wort has also been shown to have a lower risk of side effects than conventional anti-depressants.
THIS HERB SHOULD NOT BE COMBINED WITH OTHER MEDICATIONS! The reason for this, is that it activates the liver’s cytochrome p450 detoxification pathway and will metabolize drugs at a faster rate, thus moving them out of your system before they likely can have their therapeutic effect. This is why we don’t combine St. John’s wort and birth control pills. I find it interesting that St. John’s Wort works so well for depression and is also such a great detoxifying agent. According to Chinese Medicine most depressed people have “sluggish livers” and thus the liver/bowel meridians are typically treated. St. John’s wort should NOT be used with prescription anti-depressants as it has a weak MAOI and SSRI effect similar to the standard activity of anti-depressants and thus may cause adverse effects. Standard dose of St. John’s Wort for those not on any other medications, is 300 mg THREE times daily of the 0.3% standardized extract.
2. Schisandra- “Chinese Prozac” is the perfect herb for depressed people that are stressed out. The berries of Schisandra chinensis improve mood, break up anxiety, support the adrenal glands through their “adaptogen” properties, enhance libido, and aid the liver’s detoxification.
I would say if you are a stressed out stay at home mom with a low libido and feeling frazzled then this herb is most likely created just for you! Standard capsule dose is two 500mg capsules taken twice daily. Take in the morning and at lunch. Because of the adaptogen properties, do not take this herb in the evening as we want it to support the adrenal glands when they are the most active. Adrenal gland support is imperative for people “running on empty” and under chronic stress, as the adrenal glands create the “fight or flight” response in the form of cortisol and catecholamines that eventually become burnt out and dysfunctional from chronic stress.
3. Passionflower- I have yet to meet a depressed person that does not have some degree of anxiety, so I am including this gentle nervine relaxant herb on my list so that if you are depressed because you are anxious, you can use Passiflora incarnata to help calm down a bit. From my observations anxiety typically feeds depression forward.
Watch your depression patterns, and if you tend to get REALLY stressed out, and then just crash and burn in to a depressive state, an herb like passionflower might help you more than an anti-depressant herb, or both can also simply be used. Implementing stress management tools are key, such as “Square Breathing” or “Five Minutes to Zen”. Passion flower extract at 45 drops daily (tincture) was shown to be as effective as oxazepam (similar to valium).
4. B-vitamins- Now I never prescribe B-vitamins alone without prescribing the WHOLE family. The family works synergistically together on the Kreb’s cycle to produce energy in the form of ATP as well as serves as very important coenzymes for a ton of other important biochemical pathways. B-12, cyanocobalmin, for instance is needed for the production of the myelin conductive sheath that insulates the neurons of our nervous system, adequate B-12 is thus critical to a healthy nervous system. B-6, pyridoxine, is imperative for women suffering from PMS, and folic acid has research supporting it’s ability to improve the efficacy of fluoxetine (prozac) in a clinical trial. Folic acid comes from “foliage” so be sure to eat your green leafies too! All depressed people need green vegetables. Be sure you are taking 800mcg of folic acid in your supplement.
B-vitamins are dirt cheap and can be like water on a wilting plant for a depressed person. A good quality multi-vitamin is typically what I prescribe to my depressed patients for B-vitamins. A multi-vitamin is a great insurance policy that nutritional deficiency is not contributing to depression. B-vitamins and standard multi-vitamin doses are most likely safe to take with anti-depressants and most medications.
5. Calcium/Magnesium- Also dirt cheap are a simple quick fix for reducing the stress, muscle tension, and insomnia associated with depression. Most people on the Standard American Diet (SAD) are deficient in magnesium, and some are likely deficient in calcium. A 500mg calcium citrate with a 250 mg magnesium an hour before bed will help replete this likely deficiency while improving quality of sleep at night. Cal/mag is most likely safe to combine with most prescription medications, but always check with your doctor before starting anything new!
Magnesium helps SAMe donate methyl groups to form neurotransmitters, and is also needed for muscle relaxation as well as over 400 enzymatic processes in our body including detoxification pathways and is also beneficial for constipation, muscle cramping, torticollis, acute angina after myocardial infarction, stroke, asthma, kidney stone prevention, dysmenorrhea, premenstrual syndrome, acute gastrointestinal spasms or cramping, eclampisa, heart disease especially cardiomyopathy, diabetes mellitus, nocturnal muscle cramping, mitral valve prolapse, toxemia of pregnancy, fibromyalgia, migraine headaches, lead toxicity, and fatigue.
Calcium is of course necessary for bone and muscle health, optimal functioning of our nervous system and is shown in the research to benefit hypercholesterolemia, hypertension, blood clotting, periodontal disease, insomnia, smooth and skeletal muscle relaxation, anxiety, hyperactivity, lead toxicity, prevention of calcium oxalate stones, prevention of colon cancer, and leg cramps.
6. Omega 3 Fatty acids- although fish oil is likely more efficacious than flax oil, I would experiment with the oil that works best for you. You can read my article on “Fish oil vs Flax oil”. A concentrate of 9.6 grams per day was shown to be effective compared to a placebo in a small pilot trial. Patients on the study were not taken off their current medications. This is one natural therapy you can safely add as an adjunctive to most treatment plans unless you are taking blood thinning medications. I typically prescribe one tablespoon of Carlson lemon flavored cod liver right before a meal, and yes you can take it in capsules if the thought of drinking fish oil makes you gag.
7. 5-HTP- Now most studies have been done on tryptophan, but because of past contamination issues it is tough to get your hands on tryptophan except through diet. 5-Hydroxy Tryptophan is just the new and improved tryptophan, and is a better therapeutic agent in my opinion because it is a biochemical step ahead of tryptophan in the production of serotonin, passing the “rate limiting step” that tryptophan fails to do. This means that 5-HTP can only feed forward in to serotonin and not go backwards in to something else.
With that being said this medicine can be a bit expensive, but is certainly worth a try! Do NOT combine this natural anti-depressant with prescription anti-depressants. I typically prescribe about 250 mg of 5-HTP on an empty stomach once or twice daily. This is pretty mega considering that most capsules start at 50mg, but the 200mg to 300mg range is what appears to work best.
5-HTP is also beneficial for insomnia, pain syndromes, schizophrenia, anorexia and bulimia, PMS, and migraine headaches. Excess tryptophan in the body is converted to serotonin (makes us happy) and melatonin (makes us sleepy). So if you have depression with insomnia this should work well for you.
8. S-adenosyl-Methionine (SAMe)- A natural amino acid anti-depressant that is part of the homocysteine metabolism pathway and serves the role of “methylating” neurotransmitters. As SAMe converts to S-adenosyl-homocysteine it donates “methyl” groups (CH3) to the nervous system so that it can effectively produce neurotransmitters such as serotonin, dopamine, and catecholamines that make us feel GOOD and HAPPY. This natural anti-depressant is also a great detoxifying agent for the body as it activates phase II detoxification pathways in the body.
If you are recovering from alcoholism or drug abuse this may be the better choice of natural anti-depressants, however it should not be used by those that suffer from bipolar because of it’s ability to increase catecholamines and may trigger a manic episode. I would stick with St. John’s wort or 5-HTP for those susceptible to manic or hypomanic episodes. Do NOT combine with prescription drugs. Typical dose of SAMe is 50 mg once to twice daily. Always take SAMe with magnesium for optimal methylation of neurotransmitters, and a multi-vitamin as the B-vitamins folic acid, B-6, and B-12 are necessary for preventing homocysteinemia, a potential consequence of consuming elevated levels of SAMe. Homocysteine is correlated with cardiovascular damage and B-vitamins will ensure it’s conversion to an inert substance.
9. Vitamin D- I typically place depressed patients on a starting dose of 2000 IU’s of vitamin D, check their calcium and vitamin D levels and then decide if the dose should go up or down from there. I have seen great response to vitamin D especially in those that are low. Most people that live in the northern lattitudes like Seattle will be low on vitamin D. Out of the hundreds of patients I have checked, I have only found one person in Seattle that had a normal vitamin D level. Repleting deficiency is imperative, as this vitamin that is now considered a “pro-hormone” may have more of a role in the physiology of the body than we are currently aware. Overdosing on vitamin D can result in a life threatening case of hypercalcemia as vitamin D and calcium absorption are interrelated.
Do NOT take more than 1000 IU of vitamin D without being monitored by your doctor. Although the active form of vitamin D in the body is 1, 25 cholecalciferol the best test for vitamin D levels is 25-D-OH, ask your doctor to do a basic metabolic panel and check your vitamin D, pre-treatment, a month out, 3 months out and so forth. If you are deficient in vitamin D and start a 2000 IU daily dose it will take about 1 week to raise your vitamin D levels 1 point.
So if your level is 16 and you need to get to 60, it will take about 44 weeks to get you back to the normal range. You are better off doing this gradually in my opinion as we do not want to cause atherosclerosis (hardening of the arteries) by hypercalcemia from taking large doses of vitamin D at once. Other naturopaths may be willing to dose you up really high, but I am completely against it, until we have more research supporting the safety of this fat soluble vitamin that stores in the body. Be sure to use vitamin D3 (cholecalciferol) in an emulsion form, because vitamin D2 is just crap, and not worth your time taking.
References:
- PMID: 11552767; A systematic review and meta-analysis of Hypericum perforatum ion depression: a comprehensive clinical review. Int Clin Psychopharmacol. 2001 Sep;16)5):239-52.
- PMID: 11939866; Effect of Hypericum perforatum (St. John’s wort) in major depressive disorder: a randomized controlled trial. JAMA. 2002 Apr 10;287(14):1807-14.
- PMID: 11308434; Effectiveness of St. John’s wort in major depression: a randomized controlled trial. JAMA 2001 Apr 18;285(15):1978-86.
- PMID: 12053635; St John’s wort or sertraline? Randomized controlled trial in primary care. Can Fam Physician. 2002 May;48 :905-12.
- PMID: 16160619; A Double-blind randomized trial of St. John’s wort, fluoxetine, and placebo in major depressive disorder. J Clin Psychopharmacol. 2005 Oct; 25(5):441-7.
- PMID: 9539254; Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology (Berl). 1998 Feb;135(4):319-23
- PMID: 386715; Symptom reduction in depression after treatment
- PMID: 11679026; Passionflower in the treatment of generalized anxiety: a pilot double blind randomized controlled trial with oxazepam. J Clin Pharm Ther. 2001 Oct; 26(5): 363-7.
- PMID: 12888186; Omega 3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial. Eur neuropsycholparmacol. 2003 Aug;13(4):267-71.
- PMID: 12365878; A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry. 2002 Oct;59(10);913-9.
- PMID: 10967371; Enhancement of the antidepressant action of fluoxetine by folic acid; a randomized, placebo controlled trial. J Affect Disord. 2000 Nov; 60(2):121-30.
So that is a long list of natural medicines! Gosh should you take it all at once?
Probably not!
So where to start?
If you are currently on anti-depressants, I would add only vitamins, minerals, and omega 3’s in for the time being and see if your mood can be improved enough to consider titrating off of them, work on implementing the Depression Diet gradually. NEVER ever ever… discontinue your prescription medicines without following the advice of the doctor that prescribed them.
I would start a depressed patient on either St. John’s Wort, 5-HTP, OR SAMe in conjunction with a multivitamin, vitamin D, omega 3’s, and cal/mag. If stress and anxiety is a problem, I would then add in schisandra or passion flower. Following the Depression Diet guidelines to ensure adequate amino acids in the nervous system, and counseling are integral to a comprehensive mind/body/spirit approach to the management of depression. Try the St. John’s wort, 5-HTP, or SAMe at least a month if not three before swapping out for a new treatment.
Be cautious when using combinations of the three together as “Serotonin Syndrome” which results in too much serotonin causing anxiety, profuse sweating, irritability and agitation may occur.
Recommended Reading for Depression: Ten Ways to Better Cope with Depression, The Depression Diet, The Low Glycemic Index Diet, Fish Oil vs Flax Oil, Depression, Anxiety, Square Breathing, Five Minutes to Zen, The 3 Day Depression Walk.
Online Recommended Resources for Depression: DocintheBiz: Online Psychotherapy; “A Daring Adventure” a Life Coaches blog featuring Neurolinguistic programming techniques; Ya-ttitude: Improve Your Attitude; Principles of Peace: Self Help Tips for Peaceful Living
Hope that helps! Please ask your general questions in the comments section.
~Dr. Nicole Sundene
Naturopathic Physician
http://kitchentablemedicine.com
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