TREATING DEPRESSION NATURALLY

The following is part of an occasional series by Dr. Rona, called “Drugs You May Not Need.”

Depression is a form of human suffering associated with many symptoms. Not everyone diagnosed with depression by a medical doctor has all these symptoms, but most will have some combination of the following complaints: chronic low energy or lethargy; feelings of sadness, guilt or worthlessness; inability to concentrate; short-term memory impairment; inability to make decisions; sleep disturbances (either too much, interrupted, or not enough); loss of interest or pleasure in most activities; restlessness; persistent thoughts or talk of suicide; and major weight loss or weight gain.
Depression is most often treated in the mainstream by drugs. Although there are some attempts by conventional doctors to treat people with different forms of psychotherapy, few people go without a prescription of some kind. But, is this scientific?

“After thousands of studies, hundreds of millions of prescriptions and tens of billions of dollars in sales, two things are certain about pills that treat depression: Antidepressants like Prozac, Paxil and Zoloft work. And so do sugar pills.” – Shankar Vedanta, Washington Post, May 7, 2002

‘Expensive Urine’

Medical doctors, pharmacists and conventional medical gurus have for years admonished complementary and alternative medicine (CAM) practitioners and their patients for taking vitamins, minerals, herbs and other natural compounds. These scientific types are fond of saying that natural remedies are unproven and just create ‘expensive urine’; if natural remedies work to relieve any human condition, it’s only because of the placebo (sugar pill) effect, and anything that works as a placebo cannot possibly be worth taking. The insinuation is that one is wasting time and money taking a placebo remedy. Interestingly, that is exactly what several recent studies have concluded about prescription antidepressants.

“There is little evidence to suggest that [antidepressants] produce specific pharmacological benefit for the majority of patients.” – Fournier JC, DeRubeis RJ, Hollon SD, et al., Journal of the American Medical Assn, 2010

Whether it’s a tricyclic antidepressant or one of the new Selective Serotonin Reuptake Inhibitors (SSRIs) such as Prozac, Paxil, Zoloft, Celexa and Cipralex, the conclusion is the same. These drugs are little better than placebo, and just create ‘expensive urine’ for most people suffering from mild to moderate depression. That’s all well and good if one is willing to accept the myriad side effects of these placebos. The situation, however, is somewhat different if claims are being made that drugs provide some sort of scientific “balancing of brain biochemistry” – when nothing of the sort actually occurs. For one thing, depression has never proven to be due to a “chemical imbalance” in the brain. Studies show that this concept is science fiction.

This is not new information. As far back as 1998, Kirsch and Sapirstein conducted a meta-analysis of 19 double-blind studies (the kind of studies demanded by scientific types to classify a treatment as legitimate) which showed that placebos reproduced 75% of the improvement in depression seen with prescription antidepressants. These authors also asserted that the remaining 25% of improvement accounted for by these drugs was debatable because of the enhanced placebo effects people experience with the side effects of the active drugs. In other words, if you feel like you’ve been kicked in the head after taking a pill, chances are you are perceiving something happening with your brain biochemistry and assuming that it’s beneficial. How does that song go again? “When the moon hits your eye like a big pizza pie, that’s amoré.” Or is that just Prozac?

The Kirsch and Sapirstein study was replicated in 2002 by Kirsch. This time his group used studies from the U.S. Food and Drug Administration database and found similar results. Using the FDA database reduced the problem of publication bias associated with meta-analysis studies. What they found was a very small benefit of the active drug over placebo, hardly a strong argument for the use of antidepressants. In 2002, Montcrief and colleagues also conducted a meta-analysis of all the available antidepressant trials and found no difference between the effects of antidepressants and placebo. The major difference between antidepressants and placebos is that the placebos have no side effects.

Also of interest is the fact that, in 2002, out of 47 company-sponsored studies on SSRIs like Prozac, Paxil, Zoloft, Effexor, Serzone and Celexa, 22% were never published. According to Kirsch, “By and large the unpublished studies were those that had failed to show a significant benefit from taking the actual drug. If depression can be equally affected by drugs that increase serotonin and by drugs that decrease it, it’s hard to imagine how the benefits can be due to their chemical activity.”

Another researcher, Arif Khan, also investigated the placebo effect in the FDA antidepressant trials and concluded that the effect of antidepressants could not be distinguished from the effect of placebo in 52% of the cases. He did note that in serious cases of depression, the beneficial effect of the antidepressants over placebos was associated with greater changes in depressive symptoms. In other words, the more serious the depression, the more likely that the medications will work better than placebo.

Toxic and Dangerous Drugs

One can quibble about studies that argue the scientific validity of using prescription antidepressants, but no one will dispute the fact that these drugs are potentially toxic and dangerous. By the middle of the 1990s the media started reporting disasters associated with the use of SSRIs like Prozac. Suicides and even mass murders were being increasingly documented. By 2005, even the drug-friendly FDA warned that this class of antidepressants was associated with an increase in suicide risk. Not only is there a higher suicide risk in those using these drugs, but there is also a greater risk of suicide in those trying to get off these drugs after years of continuous use. Going off antidepressants suddenly can produce serious withdrawal reactions, so I am not advising people to go off their prescriptions. If a person wants to stop taking these drugs, the best thing to do is to work with a doctor to gradually wean off the pills over a period of several months while simultaneously using natural remedies for depression to reduce the withdrawal reactions (see below). Some of the other less serious side effects of antidepressants include sexual dysfunction, weight gain, sleep disturbances, constipation, headaches, nervousness and nausea.

Why Take Any Drugs At all?

No one is more over-medicated than those who claim to feel depressed. Widespread use of SSRIs and other antidepressants in the U.S. military has led to an unprecedented increase in reported suicides. The same is true for many other sectors of society that are exposed to unusually high levels of stress. Being in the army is indeed stressful, but drugs are rarely the answer. Studies show that at least a quarter of all people suffering from depression may be that way because of normal and expected emotions. It is normal to feel sad because of a loss or traumatic event. Losing your job, or being dumped by your girlfriend or husband should not automatically qualify you for a prescription. Drug treatments are inappropriate for people suffering from life’s stresses.

Talk to a friend, your priest or rabbi, get some exercise, meditate, get acupuncture, take a few natural remedies (see below) or see a therapist and deal with it in a drug-free way. Also, let’s not forget that depression could be a sign of physical or biochemical imbalances. Physical illness, whether it’s a heart attack, cancer or chronic fatigue syndrome, can cause an individual to feel depressed. This is normal. Depression can also be the result of food allergies, anemia, an underactive thyroid, suboptimal adrenal hormone levels, low ovarian or testicular hormones, a vitamin B6, B12, folic acid or vitamin D deficiency, or an excess of toxic heavy metals like mercury, lead or cadmium in the body.  Depression could also be caused by an imbalance in dozens of other nutrients including amino acids and essential fatty acids. Get tested by a natural health care practitioner before resorting to toxic and dangerous drugs that work no better than sugar pills.

The Natural Approach

There are many natural remedies for depression. One or more will help most people suffering from mild to moderate symptoms. The most popular of these include:

Exercise – It is a scientific fact that vigorous exercise alleviates depression. It doesn’t work for everybody, but it is often a very effective low-tech way to beat depression. Exercise boosts metabolism and improves circulation. It brings more oxygen and other nutrients to the brain, clears the cobwebs and enhances mood. Exercise raises the level of mood-elevating chemicals called endorphins, optimizes the levels of cholesterol, glucose and many other metabolites involved in both physical and mental health. If you are physically healthy enough to do it, get into regular vigorous exercise.

Optimized Diet – While there is no single diet that will be suitable for all those suffering from depression, avoidance of sugar, alcohol and refined carbohydrates will help many. So will abstention from foods that may contain hidden or unsuspected allergens. Commonly, this involves gluten and dairy products but other foods may trigger symptoms in certain individuals. This is something that could be sorted out for individuals by a natural health care provider.

St. John’s Wort – At least 20 clinical trials suggest that St. John’s Wort is as effective as antidepressants for mild to moderate depression, with fewer side effects. It is not effective for major depression. Full benefit is seen within four to six weeks, but there can be a potential problem with increased skin sensitivity to sunlight. In addition to this adverse reaction, St. John’s Wort can potentiate or decrease the effectiveness of numerous drugs. Consult a naturopath before using in combination with any prescription drug.

Omega-3 fatty acids – Omega-3 fatty acids are critical to the structure and function of neuronal membranes. The communication between various nerves could not occur in a normal way without omega-3 fatty acids. As a result, just about every brain condition would benefit from optimal levels of DHA and EPA. Depression is one of many common conditions that could benefit from omega-3 fatty acids. They influence something called the cytokine system in the brain. These cytokines are known as interleukin-1 -2 and -6, interferon-gamma, and tumor necrosis factor alpha. They can directly and indirectly influence the severity of depression.

SAM-e – S-adenosyl-L-methionine, or SAM-e, is an amino acid that is thought to optimize the levels of the neurotransmitters serotonin and dopamine. Studies indicate that it is superior to placebo in its antidepressant effects.

B Complex Vitamins – Vitamin B12 and folic acid are often effective in raising mood. They are most effective when given in the intramuscular or intravenous form. While a great deal of the evidence for their benefit in depression has been anecdotal in the past, researchers at Harvard University have recently found that patients on antidepressants supplemented with these B complex vitamins improved a great deal more than those on antidepressants who did not supplement with them. Vitamin B6 is needed by the body to produce serotonin. Oral supplementation is also usually beneficial.

5-HTP, L-Tryptophan and Melatonin – 5-HTP (5-hydroxytryptophan) and L-Tryptophan are amino acids that are used by the body to make the neurotransmitter serotonin. They are also responsible for the synthesis of melatonin, a hormone involved in healthy sleep. These supplements can be very useful in those trying to wean off prescription antidepressants. As the dosage of the antidepressant is gradually reduced, one can slowly substitute 5-HTP or L-Tryptophan to help reduce the withdrawal reactions that are inevitable with most antidepressants.

L-Tyrosine – L-Tyrosine is an amino acid that the body uses to manufacture dopamine. It also uses L-Tyrosine to make thyroid hormone. As such it may be a very effective antidepressant for the right individual. One of the ways to boost L-Tyrosine levels is to supplement with vitamin C, which helps the body manufacture it in greater amounts.

Rhodiola rosea – This is an excellent herbal remedy for both anxiety and depression, without significant side effects. Athletes often use it for better stamina and higher energy. It may, however, be contraindicated for those suffering from bipolar disorder. Your natural health care provider should determine dosages for any or all of these supplements. Work with him or her for optimal results.

References

Fournier JC, DeRubeis RJ, Hollon SD, et al. “Antidepressant drug effects and depression severity: a patient-level meta-analysis.” Journal of the American Medical Association. 2010; 303:47-53.

Khan, A., Leventhal, R. M., Khan, S., & Brown, W. A. (2002). “Severity of depression and response to antidepressants and placebo: An analysis of the Food and Drug Administration database.” Journal of Clinical Psychopharmacology, 22, 40-45.

Kirsch, I., Moore, T. J., Scoboria, A., & Nicholls, S. S. (2002). “The emperor’s new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration.” Prevention & Treatment, 5, art. 23. Retrieved February 1, 2003, from http://journals.apa.org/prevention/ volume5/pre0050023a.html.

Kirsch, I., & Sapirstein, G. (1998). “Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication.” Prevention & Treatment, 1, art. 0002a. Retrieved February 1, 2003, from http://journals.apa.org/ prevention/volume1/pre0010002a .html.

Leber, P. (2000). “The use of placebo control groups in the assessment of psychiatric drugs: An historical context.” Biological Psychiatry, 47, 699-706.

Leuchter, A. F., Cook, I. A., Witte, E. A., Morgan, M., & Abrams, M. (2002). “Changes in brain function of depressed subjects during treatment with placebo.” American Journal of Psychiatry, 159, 122-129.

Mayberg, H. S., Silva, J. A., Brannan, S. K., Tekell, J. L., Mahurin, R. K., McGinnis, S., & Jerabek, P. A. (2002). “The functional neuroanatomy of the placebo effect.” American Journal of Psychiatry, 159, 728-737.

Moore, T. J. (1999, October 17). “No prescription for happiness.” Boston Globe, E01. Retrieved February 1, 2003, from http://www.thomasj moore.com/pages/prozpop.html.

Moncrieff, J., Wessely, S., & Hardy, R. (2002). “Active placebos versus antidepressants for depression” (Cochrane Review). The Cochrane Library, 1. Oxford: Update Software.

Quitkin, F. M., Rabkin, J. G., Gerald, J., Davis, J. M., & Klein, D. F. (2000). “Validity of clinical trials of antidepressants.” American Journal of Psychiatry, 157, 327-337.

Vedantam, S. (2002, May 7). “Against depression, a sugar pill is hard to beat.” Washington Post, A01. Retrieved February 1, 2003, from http://www. washingtonpost.com/ac2/wp-dyn /A42930-2002May6.

R.D. Gibbons, C.H. Brown, K. Hur, S.M. Marcus, D.K. Bhaumik, and J.J.
Mann, “Relationship Between Antidepressants And Suicide Attempts: An Analysis of the Veterans Health Administration Data Sets,” American Journal of Psychiatry 164 (2007): 1044-1049.

Valenstein M, Kim HM, Ganoczy D, McCarthy JF, Zivin K, Austin KL, Hoggatt K, Eisenberg D, Piette JD, Blow FC, Olfson M. “Higher-risk periods for suicide among VA patients receiving depression treatment: prioritizing suicide prevention efforts.” Journal of Affective Disorders, 2009 Jan;112(1-3):50-8.

M. Raja, A. Azzoni, and A.E. Koukopoulos, “Psychopharmacological treatment before suicide attempt among patients admitted to a Psychiatric Intensive Care Unit,”
Journal of Affective Disorders 113 (2009): 37-44.

“Depression Diagnosis Is Too Broad”: http://psychcentral.com/news/ 2007/04/03/depression-diagnosis-is-too-broad.

“Antidepressants: Are They Effective or Just Placebo?” Time Health; june 3, 2010.http://www.time.com/time/health/article/0,8599,1991841,00.html.

Sharon Begley, “The Depressing News About Antidepressants: Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse.” Newsweek Jan 28, 2010. http://www.thedailybeast.com/ newsweek/2010/01/28/the-depressing-news-about-anti depressants.html.

Dr. Dach on Placebos as Effective as Antidepressants: http://open. salon.com/blog/jeffrey_dach_md/2010/03/08/dr_dach_on_placebos_as_effective_as_antidepressants

Braverman ER, et al. The Healing Nutrients Within. New Canaan,CT: Keats Publishing, Inc; 1997:257-58.

Alive Research Group; Gursche, Siegfried, Publisher; Rona, Zoltan P., Medical Editor. Encyclopedia of Natural Healing. Vancouver: Alive Books, 1998.

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