What are the complementary and alternative therapy options for treating depression?
Depression results from many different influences in our lives, so an effective healing response to depression needs to come from an understanding of why it has developed in a person’s life. But there are natural therapies which can help. In this column, I’m going to focus on a few of these that have been well researched.
It’s usually best to start with the simplest approaches — such as nutrition. It is well known that some nutritional deficiencies, such as deficiencies of vitamin B121, B62 and folic acid3 are linked to depression. Poor quality diets are one likely cause of this. A survey of 200 people in England reported that 88 percent found that changing their diet improved their mental health4. Twenty-four percent said they had large improvements specifically in relationship to depression.
Dietary items that tended to worsen mental health were sugar, caffeine, alcohol and chocolate. Items that tended to improve emotions were drinking adequate water, and eating fresh vegetables, fruit and oil-rich fish.
Another straight-forward approach is exercise. At least one trial has shown exercise (45 minutes, three times per week) to be superior to pharmacological treatment of depression, particularly in preventing relapses5.
HIV is associated with some specific nutritional problems that can lead to or worsen depression. Aside from problems with malabsorption and other digestive problems, HIV can increase the need for at least four particular nutrients. One of these is the amino acid tryptophan6 which is converted by the body into the neurotransmitter serotonin. Serotonin is one of many brain chemicals that contribute to us feeling well and happy. Low serotonin often results in depression and so naturopaths may use a metabolite of tryptophan (called 5-hydroxytryptophan or 5HTP for short) to raise depleted serotonin.
One of the earliest trials of 5HTP found that 69 percent of 107 people with depression had “significant improvement” within two weeks on doses ranging from 50mg to 300mg/day7. This supplement is not available from Health Food stores but can be obtained through licensed naturopaths.
Another nutrient linked to depression is SAMe (pronounced “sammy” and short for S-Adenosylmethionine). SAMe is made in the body from the amino acid methionine. Many chronic illnesses and some liver diseases can interfere with its manufacture, so naturopaths supplement with it to treat depression and some liver problems.
A trial of SAMe in 20 HIV-positive people with major depression found it rapidly effective. Included with a starting dose of 200mg of SAMe twice daily was 1000 micrograms of B12 and 800 micrograms of folic acid. With the SAMe dose being gradually increased up to 800mg twice daily, participants in this trial reported significant improvement within one week and continued to improve over the course of the eight-week study8. People with bipolar disorder may have worse bouts of mania using SAMe so it should be avoided by people with this condition.
Many people may be familiar with the herb St John’s wort as a treatment for depression. Several trials have compared it to antidepressant medical drugs for treating mild to moderate depression and generally found, like SAMe and 5HTP, that the herb is as effective as medical drugs.
For example, 240 people with moderate depressive disorder took either Prozac or St John’s wort over a six-week period. Their depression improved by the same amount but researchers found that St John’s wort’s safety was “substantially superior” to Prozac, with fewer adverse event (23 percent in the Prozac arm and 8 percent in the St John’s wort arm)[2]. Prozac’s side effects included impotence and erectile dysfunction, agitation, digestive disturbances, retching, dizziness, tiredness and anxiety. St John’s wort produced some mild digestive disturbance.
St John’s wort can interfere with the metabolism of some anti-HIV and other medical drugs, potentially causing levels of antiretrovirals to fall too low to suppress HIV, so it should not be used in combination with any HIV medication unless you’ve cleared it with your doctor. As well, the quality of St John’s wort extracts can vary between brands so, to get the best product, see a naturopath or herbalist rather than relying on health food store brands.
It’s important that 5HTP, SAMe and St John’s wort are not combined with medical antidepressants as they may have additive effects that push chemicals like serotonin too high.
None of the treatments described here attracts a Medicare rebate and SAMe and 5HTP in particular are expensive. A much cheaper option is Bach flower essences. In a trial of 115 people with a range of symptoms of anxiety, depression or stress, 77 percent of those with depression improved and 51 percent rated themselves as “totally cured”.
There are three flower essences which are commonly used for depression (Gorse, Gentian and Mustard flowers), however, each remedy is specific in its effects and so work for different types of depression. Consult a natural therapist to find out which is most suitable for you.
References
1 Cobalamin level is related to self-reported and clinically rated mood and to syndromal depression in bereaved HIV-1(+) and HIV-1(-) homosexual men. Baldewicz TT, et al., J Psychosom Res. 2000 Feb;48(2):177-85.
2 Plasma pyridoxine deficiency is related to increased psychological distress in recently bereaved homosexual men. Baldewicz T., Psychosom Med. 1998 May-Jun;60(3):297-308.
3 Depression and folate status in the US Population. Morris MS., Psychother Psychosom. 2003 Mar-Apr;72(2):80-7.
4 Survey conducted by the “Food and Mood Project”, Amanda Geary, as reported on BBC Health.
5 Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Babyak M., et al Psychosom Med. 2000 Sep-Oct;62(5):633-8.
6 Tryptophan depletion and HIV infection: a metabolic link to pathogenesis. Murray MF., Lancet, Volume 3, Number 10 01 October 2003
7 L-5-hydroxytryptophan-(L-5-HTP) therapy. Sano I., Folia Psychiatr Neurol Jpn 1972;26:7-17.
8 S-adenosylmethionine (SAM-e) for the treatment of depression in people living with HIV/AIDS. Shippy RA., BMC Psychiatry. 2004 Nov 11;4(1):38.
fn9. Equivalence of St John’s wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mild-moderate depression. Int Clin Psychopharmacol. 2000 Mar;15(2):61-8. Schrader E.
