Depression - Naturopathic Approaches
by: Shirley (Sheena) Mirpuri ND
Abrar Negahban ND
Depression is the second most common medical condition seen in general medical practice after hypertension and is seen as twice in women compared to men. It is known to be caused by altered levels of the dominant neurotransmitters in our central nervous system. These neurotransmitters include serotonin, dopamine and norepinephrine and they affect us in many different ways. They are responsible for vigilance, motivation, energy levels, sex drive, anxiety, irritability and appetite. Depression is a mood disorder that can present differently in different individuals. It ranges from mild depression to major depression, may be seasonal or postpartum and may coexist with other conditions such as anxiety, which is very common. The most common symptoms of depression include feelings of sadness, irritability, loss of interest and pleasure, lack of energy, changes in appetite, trouble concentrating, excessive worrying and at times suicidal thoughts. It can lead to a poor quality of life and can interfere with your day-to-day activities. It is important to differentiate between depression and just a bout of blues, as it requires long-term treatment. Many medications are used for treating depression. The most common ones prescribed are selective serotonin reuptake inhibitors (SSRI’s) such as Celexa, Prozac and Zoloft. Due to the side effect profile of these medications, many individuals seek naturopathic interventions to feel better. This article discusses a few naturopathic options available. It is important that before making any decision regarding taking any of the following that you discuss your health with your doctor in order to ensure the best treatment plan specific to your individual needs.
Interventions - St. John’s Wort
St. John’s wort is one of the most common herbs used for treating depression. This herb has been shown to help with symptoms associated with depression such as mood disturbances, difficulty sleeping, anxiety, low appetite and fatigue. Its Latin name is Hypericum perforatum emphasizing on its active constituents hypericin, hyperforin and adhyperforin. These constituents have been shown to modulate the effects of important neurotransmitters that affect our mood, including serotonin, dopamine and norepinephrine. The herbs effects on serotonin in particular are known to be responsible for its antidepressant activity. The active constituents of this herb reduce the reuptake of serotonin by our nerve cells leading to higher levels of serotonin circulating in our blood which is responsible for improved mood and less mood disturbances. St John’s wort is usually well tolerated and has been shown to be safe to use up to 12 weeks. At high doses however it may cause skin photosensitivity in some individuals. St. John’s wort is also a potent inducer of the liver enzymes cytochrome P450, which may result in reduced metabolism of some medications and decreased concentrations of medications in blood plasma. Therefore it is possible for this herb to interact with medications that you are taking. If you are on any medications and/or have any allergies and considering using St. John’s wort, make sure you consult with your doctor to ensure safety.
Interventions - 5-HTP
Another common naturopathic treatment for depression is 5-HTP. 5-HTP stands for 5-Hydroxy-Tryptophan, which is a naturally occurring amino acid and a precursor for serotonin and melatonin production. There aren’t as many dietary sources of 5-HTP, however it is produced intermediately in the metabolism of tryptophan in our bodies. Tryptophan is an amino acid that can be found in dietary sources such as milk, meat, potatoes, pumpkin and various greens. Optimal levels of both hormones are critical for regulating mood and sleep quality. Supplementation with 5-HTP leads to increased synthesis of serotonin in the central nervous system which in turn results in improvement in symptoms such as disturbed sleep, low appetite, low mood, weight gain and anxiety. It has also been shown to benefit patients with chronic pain and fibromyalgia. The side effects of using 5-HTP are common but are limited to digestive issues including heartburn, stomach pain, belching, flatulence, and nausea and vomiting. If used concomitantly with other sedative supplements, 5-HTP may also cause drowsiness and sedation. Due to its mechanism of action 5-HTP may interact with medications with similar mechanisms and it is advised to discuss your safety with your doctor when considering using 5-HTP.
Interventions - Fish Oil
Omega 3 fatty acids are a type of polyunsaturated fatty acids that comprise of ALA (-linolenic acid), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These fatty acids are essential in our diet as they play important roles in our body’s metabolism and inflammatory processes. EPA and DHA are minimally synthesized from ALA, which is found in plant oils; therefore it is not uncommon to have a deficiency in these fatty acids in a diet poor in sources of EPA and DHA. Fish oils, derived from fatty fish such as sardines, mackerel, anchovies and salmon, are a major source of EPA and DHA. Omega 3 fatty acids can also be found in walnuts, edible seeds and flaxseed oil. These fatty acids have been known to be widely used in prevention and improvement of cardiovascular health and in the reduction of inflammation in the body. Although eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) play a primary anti-inflammatory role, research has shown it to be beneficial in the prevention or treatment of depressive disorders. Studies have shown that a deficiency in omega 3 fatty acids, among other impacts to the body, may lead to an imbalance of certain neurotransmitters such as serotonin and dopamine in the brain, a disruption of which is commonly seen in depression. Chronic stress and high levels of cortisol also contribute to depression symptoms therefore the role of fish oils as an anti-inflammatory and a modulator of cortisol may also be useful in the treatment of depression. Supplementing with the right ratio of omega 3’s may therefore show a benefit in treating depressive disorders. Studies have also shown that having a higher ratio of EPA to DHA shows more benefit in treating depressive moods, therefore finding the right fish oil with a ratio of EPA:DHA greater than 2:1 and using a source such as sardines, mackerel or anchovy oils would be ideal.
SAMe and Concluding Remarks
S-Adenosyl methionine, or more commonly referred to as SAMe, is a natural compound that our body makes and it is comprised of adenosine triphosphate (ATP) and methionine, which is an amino acid that is commonly found in foods. SAMe is primarily produced in the liver with the help of certain cofactors like B12 and folate and it has several functions mainly in the liver and the brain. It plays an important role in methylation reactions in our body, ultimately contributing to the synthesis and functioning of neurotransmitters such as serotonin, dopamine and norepinephrine. An association with SAMe supplementation and the increase of serotonin turnover, as well as an increase in dopamine and norepinephrine levels has been postulated as its potential mechanism in the treatment of depression. Supplementation with SAMe is widely known for its use in liver disease, fibromyalgia, chronic fatigue, migraines, depression, anxiety, etc.. Several studies have shown its effectiveness in treating depression and its comparability to tricyclic antidepressants. The concomitant use of 400-800 mg of SAMe with conventional treatments for depression has been shown to improve remission in depressive moods. Along with supplementation of SAMe, supplementation of vitamins like B12 and folate could ensure optimal production of SAMe in the body and correct for any possible deficiencies.
In conclusion, there are several alternative treatments that can be used for the treatment and prophylaxis of depression and only a small number of them have been briefly mentioned here. It is also important to assess individually what alternative approach may work best for you and whether any of the supplements would interact with any pharmacological medicine you may be taking. Also, individuals are surrounded by several factors in their lives including social, psychological, spiritual and environmental factors. An imbalance or disruption in any one of these factors can as well make an impact on their mental well-being. Addressing these factors is as important and should be taken into consideration. In addition to supplementation and dietary modification, other lifestyle changes should therefore not be overlooked as it has been shown to have great benefits as well. Examples include the use of yoga and exercising, meditation, psychological counseling, and support groups. Therefore, taking on an individualistic approach to treating depression is ideal, so make sure to ask your doctor what options are safe and available to you.