Depression (Mild to Moderate)
Depression is a common emotional illness that varies widely in its intensity. Many of the natural treatments described in this section have been evaluated in people with major depression of mild to moderate intensity. This apparently contradictory language indicates a level of clinical depression that is significantly more intense than simply feeling "blue," but not as disabling as major depression of severe intensity, which usually requires hospitalization.
Typical symptoms of major depression of mild to moderate severity include depressed mood, lack of energy, sleep problems, anxiety, appetite disturbance, difficulty concentrating, and poor stress tolerance. Irritability can also be a sign of depression.
More severe depression includes markedly depressed mood complicated by symptoms such as slowed speech, slowed (or agitated) responses, markedly impaired memory and concentration, excessive (or diminished) sleep, significant weight loss (or weight gain), intense feelings of worthlessness and guilt, recurrent thoughts of suicide, and lack of interest in pleasurable activities. This form of clinical depression is a dangerous and excruciating illness. The emotional structure of the brain has frozen into a pattern of misery that cannot be altered by willpower, a change of scenery, or the most earnest efforts of friends. In a sense, the brain has locked up like a crashed computer.
One of the earliest successful treatments for major depression was shock therapy. This technique is in some ways analogous to rebooting a computer, and in cases of major depression, its effects were revolutionary. For the first time, a reliable way was available to bring people out of the depths of severe major depression.
However, shock treatment was overused at first and became unpopular as a result. The accidental discovery of antidepressant drugs provided a route with fewer interventions. The original antidepressants, known as MAO inhibitors, could bring people out from the depths of major depression as successfully as shock treatment. However, MAO inhibitors can cause serious and even fatal side effects. No one would ever think of using MAO inhibitors to treat mild to moderate depression.
Subsequently, antidepressants with progressively fewer side effects came on the market, but most of them still caused significant fatigue. Since fatigue is one of the most characteristic symptoms of mild to moderate depression, such medications were seldom found useful for anything other than severe depression. With the appearance of the selective serotonin reuptake inhibitor (SSRI) class of antidepressants, however, suddenly there was a practical option for depression that was less than catastrophic. Practically overnight, enormous numbers of people began taking Prozac and similar drugs for mild to moderate depression, as well as for the related, but more mild condition, known as dysthymia.
The big advantage of the SSRIs is that they usually don't cause severe fatigue. Many people find them to be entirely side effect-free. However, side effects are not uncommon and include sexual disturbances (such as impotence in men and the loss of the ability to experience an orgasm in women), insomnia, and nervousness. The antidepressant drug Wellbutrin is an option for people who have sexual side effects from SSRIs.
Principal Proposed Natural Treatments
Alternative medicine offers numerous options for treating depression, but only one has strong scientific evidence behind it: the herb St. John's wort.
What Is the Scientific Evidence for St. John's Wort?
Numerous double-blind, placebo-controlled studies have examined the effectiveness of St. John's wort for the treatment of mild to moderate major depression, and most have found the herb more effective than placebo.
In addition, at least 8 studies have found that St. John's wort is at least as effective as
standard antidepressants, including fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and paroxetine (Paxil).
Note: St. John's wort alone should never be relied on for the treatment of severe depression.
Much has been made of two double-blind, placebo-controlled trials performed in the United States that failed to find St. John’s wort more effective than placebo for mild to moderate depression
St. John's wort seldom causes immediate side effects. However, it interacts adversely with a large number of critical medications and may present other safety issues as well. For more information, see the full
Other Proposed Natural Treatments
There are a number of other herbs and supplements that may be helpful in depression, although the evidence for them is nowhere near as strong as that for St. John's wort.
In the body, the vitamin folate works in tandem with SAMe.
have suggested that depressed people have reduced folate levels, and a bit of evidence hints that folate supplements may help alleviate depression.
Based on these findings, a study examined the effects of combining folate with antidepressant treatment.
For more information, including dosage and safety issues, see the full
The supplement S-adenosylmethionine (SAMe) has been widely marketed for the treatment of depression, but the evidence to indicate that it works remains incomplete.
Several double-blind, placebo-controlled studies have found SAMe effective in relieving depression;
In addition to placebo-controlled studies, several trials have compared SAMe against antidepressant drugs in the
Other small studies have also compared the benefits of oral or intravenous SAMe to those of tricyclic antidepressants and have found generally equivalent results, although, again, poor reporting and inadequacies of study design (such as too limited a treatment interval) mar the meaningfulness of the outcomes.
For more information, including dosage and safety issues, see the full
Ginkgo is used mainly for age-related mental decline such as that from
One double-blind study, published in 1990, evaluated this effect in 60 people who suffered from depressive symptoms along with other signs of dementia.
Another study followed 40 depressed people over the age of 50 who had not responded successfully to antidepressant treatment.
In 1994 an interesting piece of research was reported that may shed light on the mechanism by which ginkgo may reduce depression.
For more information, including dosage and safety issues, see the full
Phenylalanine is a naturally occurring amino acid that we all consume in our daily diets. There is some evidence that phenylalanine supplements may help reduce symptoms of depression.
Phenylalanine occurs in a right-hand and a left-hand form, known as D- and L-phenylalanine, respectively. Some studies have evaluated the D form, and others have evaluated a mixture of the D and L forms. Both formulations may provide some measure of relief for symptoms of depression. The mixed form (DLPA) is the one most commonly available in stores.
A 1978 study compared the effectiveness of D-phenylalanine against the antidepressant drug imipramine (taken in daily doses of 100 mg) and found them to be equally effective.
Another double-blind study followed 27 people, half of whom received DL-phenylalanine and the other half imipramine in higher doses of 150 mg to 200 mg daily.
Unfortunately, there do not seem to have been any properly designed studies that compared phenylalanine to placebo. Until these are performed, phenylalanine cannot be considered a proven treatment for depression, but it is certainly promising.
For more information, including dosage and safety issues, see the full
When the body sets about manufacturing serotonin, it first makes 5-hydroxytryptophan (5-HTP). The theory behind taking 5-HTP as a supplement is that providing the one-step-removed raw ingredient might raise serotonin levels.
There have been several preliminary studies of 5-HTP.
5-HTP caused fewer and less severe side effects than fluvoxamine. The only real complaint was occasional mild digestive distress.
For more information, including dosage and safety issues, see the full
It has been suggested that fish oil or the related substance ethyl-EPA may be helpful for people with depression.
In another study, 40 people who had committed repeated acts of self-harm were given either fish oil or placebo for 12 weeks.
However, the best and most recent studies have failed to find benefit. A meta-analysis (formal statistical review of evidence) published in 2007 failed to find convincing evidence of benefit.
For more information, including dosage and safety issues, see the full
In seven out of eight studies reviewed, various forms of exercise proved beneficial for depression. Aerobic exercise, weight training, dancing, and racquetball all produced improvements in mood as compared to no exercise.
However, the findings of the one negative study reported in this review cast doubt on the others. In this trial, some participants exercised, while others took a course at school and didn't exercise at all. The results: equal benefits in both groups. This suggests that it may not be the exercise itself that is helping, but rather the general effects of participation in an organized activity.
Another feature of the positive studies also tends to cast doubt on the value of exercise per se in depression. You'd think that if it were exercise itself improving mood, the more effectively the participants exercised the greater the effect. However, no correlation was seen between how much participants increased their physical fitness and how significantly their depression improved.
Repetitive Transcranial Magnetic Stimulation
In a well-designed trial, for example, 70 people with major depression were given rTMS or sham rTMS in a double-blind setting over a period of 2 weeks.
In another trial involving 92 older patients whose depression has been linked to poor blood flow to the brain (so-called vascular depression), actual rTMS was significantly more effective than a sham rTMS. Benefits were more notable in younger patients.
In a particularly persuasive piece of evidence, researchers pooled the results of 30 double-blind trials involving 1,164 depressed patients and determined that real rTMS is significantly more effective than sham (fake) rTMS.
Two separate studies suggest that rTMS may be an effective additional treatment for the 20%-30% of depressed people for whom conventional drug therapy is not successful.
Other Herbs and Supplements
Like gingko, the supplement
Diets low in
In a small double-blind, placebo-controlled study, tincture of
When depression is characterized by rapid mood changes, excessive sleeping and eating, a sense of leaden paralysis, and extreme sensitivity to negative life events, the condition is called atypical depression. A very small (15 participants) double-blind, placebo-controlled study found that
One study found weak evidence that
According to five preliminary double-blind studies, use of the herb
Two studies of somewhat questionable validity reported benefit with an herbal combination used in
A double-blind study of 42 people with severe depression found no improvement with the supplement
Herbs and Supplements to Use Only With Caution
Various herbs and supplements may interact adversely with drugs used to treat depression. For more information on this potential risk, see the individual drug article in the Drug Interactions<![CDATA]> section of this database.
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