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Depression Several prescription medications are effective, however they don't always result in the full remission of symptoms and they are often poorly tolerated, especially in the elderly. Here are some possible alternatives for adults. Like conventional medications used in psychiatric practice to treat depression, it can be seen that supplements may similarly effect neurotransmitter systems including those for serotonin, norepinephrine, and dopamine. Please read the warnings and precautions described on the "Disclaimers" webpage, included on this page are several but not all risks, interactions, contraindications, and side effects. The treatment of depression can further be complicated by the potential emergence of mania, psychosis, and suicidal thinking, which are conditions that need immediate psychiatric attention. Some dosing guidelines are given, but dosing should be guided by your health care provider. Additional resources concerning efficacy, dosing, contraindications and safety guidelines can be viewed on the "Science & Evidence" webpage.
SAMe has demonstrated efficacy in numerous studies. The Natural Medicines Comprehensive Database at www.naturaldatabase.com rates SAMe as likely effective for depression and the Natural Standard at www.naturalstandard.com gives it an C ranking (unclear scientific evividence for this use). SAMe appears to work as an antidepressant on its own, possibly as it is an naturally occurring substance important in neurotransmission which may become depleted with age. It also seems to help many of the prescription antidepressants work better and faster. Benefits may be appreciated as early as 3-7 days. One risk, as with other medications and supplements used in depression, is that it may trigger mania. Other potential side effects include nausea, vomiting, diarrhea, insomnia, and anxiety. There is a risk of hyperactive muscle movements, and caution should be used in cancer patients or if undergoing gene therapy. There are many drug interactions and SAMe is contraindicated in persons with active bleeding, at risk for bleeding or taking anticoagulants. SAMe is somewhat expensive. The butanedisulfonate salt may be the most bioavailable and stable form of SAMe, though this has been debated, and this form is difficult to find. A typical starting dose is 200 mg twice per day.
5-Hydroxytryptophan (5-HTP) seems effective for depression, anxiety and insomnia. The Natural Medicines Comprehensive Database at www.naturaldatabase.com rates 5-HTP as possibly effective for depression. It apparently works through the serotonergic system which is also effected by medications like Prozac and Zoloft but through a different mechanism as 5-HTP is metabolized to serotonin. Improvement in mood may be appreciated as early as 3-14 days. L-Tryptophan, a cousin of 5-HTP may have some advantages for cases where there is more insomnia (see section for insomnia) because it may be more sedating. 5-HTP needs to be avoided in carcinoid syndrome and may adversely interact with antidepressants. Side effects may include nausea, dry mouth, gastrointestinal irritation, and sedation. Both 5-HTP and L-Tryptophan may be of some risk in causing eosinophilia-myalgia syndrome, though this may have been secondary to a contaminated batch of L-Tryptophan which had been manufactured in Japan. Dosing usually starts at 50 mg once to three times per day. Fish oil contains omega-3 fatty acids which are thought to have several potential health benefits. The Natural Medicines Comprehensive Database at www.naturaldatabase.com rates fish oil as possibly effective for depression and the Natural Standard at www.naturalstandard.com gives fish oil a C ranking (unclear scientific evividence for this use). Fish oil may normalize membrane sturcture in the brain and may also improve neurotransmitter uptake. Some studies suggest it may be helpful for cognitive disorders as well. The EPA (Eicosapentaenoic Acid) component of fish oil seems most important in depression. These supplements can cause loose stools, nausea, hypoglycemia, hypotension, gastrointestinal upset, with an acidic "burping", and can also thin blood which can increase the risk for bleeding, hemorrhagic stroke, and surgical complications. As there may be an increased bleeding risk, caution must be used with anticoagulants. Fish oil is containdictated in conditions where there is active bleeding. There are several potential drug interactions. Omega-3 fatty acids must be discontinued before surgery and avoided in hemophiliacs. There is some possibility that they supress natural killer cell activity. Studies have shown an onset of action as early as two weeks. Effective dosing starts at about 1 gm per day.
St. John's Wort may have some similar properties to the prescription monoamine oxidase inhibitors (MAOIs) which increase the amount of active neurotransmitters in brain neuronal synapses. Unfortunately some of the large scale studies have not turned out as positive as some expected. Nevertheless it may help in mild cases and it is rated by The Natural Medicines Comprehensive Database at www.naturaldatabase.com likely effective for depression and the Natural Standard at www.naturalstandard.com gives it an A rating for depression (strong scientific evidence for this use). Like prescription antidepressants can have a lot of side effects, the time until the onset of theraputic effects may be weeks and it may be over stimulating when first used for anxiety. St. John's Wort should only be tried if depression is not severe. There are multiple drug interactions, for example it can lower the levels of drugs like oral contraceptives, theophylline, and Coumadin. Saint John's Wort may also inhibit medications used to prevent organ transplant rejection and which are used to treat HIV. Side effects may include photosensitivity with possible increased risk of cataracts, mania, psychosis, allergic skin rashes, fatique, restlessness, constipation, and headaches. Saint John's Wort can interact with other antidepressants and may cause a serotonin syndrome and can also cause a hypertensive crisis. St. John's Wort is containdicated in pregnancy and should be stopped several days before surgery. Typical dosing is 300 mg three times daily of a standardized extract with 0.3 to 0.5%hypericin and/or 3 to 5% hyperforin. Inositol is a naturally occurring isomer of glucose found in brain tissues. It is involved in signaling brain cells that neurotransmitters such as serotonin, norepinephrine, and dopamine are occupying receptor sites on the cell membranes. Inositol has demonstrated efficacy in treating disorders which may respond to the SSRIs and there is a good review of Inositol by James Lake M.D. in his book Complementary And Alternative Treatments in Mental Health Care . The Natural Medicines Comprehensive Database at www.naturaldatabase.com ranks inositol as possibly ineffective however, but this is in part because patients in one study seemed to relapse when it is was stoped and in another study it did not help individuals who failed to respond well to SSRIs. It is generally well tolerated, with potential side effects including flatuence along with other gastrointestinal problems. It is contraindicated in pregnant women as it might induce uterine contractions. It may also trigger manic reactions. Dosing usually starts at 2 gm twice per day. Acetyl-L-Carnitine may be of particular benefit to elderly persons who may be depressed and cognitively impaired. In part this supplement may work via the cholinergic and dopiminergic systems. It is rated by The Natural Medicines Comprehensive Database at www.naturaldatabase.com as having insufficient evidence for depression but possibly effective for age-related cognitive impairment and Alzheimer's disease. While generally well tolerated potential side effects and risks include nausea, vomiting, agitation, vertigo, and seizures. There are multiple potential drug interactions. A typical starting dose is 500 mg per day. DHEA is a cousin to Testosterone and Estrogen. As hormones decrease with age DHEA may also help with depression and cognition, but like with the Steroids, there may be risks including for cancer involved (especially postate breast, uterine, or ovarian). The Natural Medicines Comprehensive Database at www.naturaldatabase.com rates DHEA as having insufficient evidence for depression, with insufficient evidence for Alzheimer's and likely ineffective for cognitive function. The Natural Standard at www.naturalstandard.com gives DHEA a B ranking for depression (good scientific evidence for this use), a C ranking for Azheimer's (unclear scientific evividence for this use) and a D ranking for memory (fair scientific evidence against this use). In women DHEA can cause acne, deepening of the voice, facial hair growth and hair loss. DHEA levels may be tested durring treatment. DHEA should not be taken if there is a risk of pregnancy or with breastfeeding. Mania has been reported. There are multiple potential drug interactions and DHEA may also interfere with other hormones. Other risks include hypoglycemia and hypertension. A starting dose of 5 mg daily may often be used, versus higher doses for limited periods of time. Vitamin B12 and Folate are often adminitered together and seem helpful in the treatment of depression especially when there is a deficiency which may occur in the elderly and younger persons with certain intestinal disease where absorption is poor. The Natural Standard at www.naturalstandard.com gives B12 a C ranking for fatigue (unclear scientific evividence for this use) and also a C ranking for Alzheimers. Neither The Natural Standard or The Natural Data Base rank B12 for depression though The Mayo Clinic Book of Alternative Medicine points out that studies show that B12 deficiency can lead to abnormal psychiatric syptoms including fatique and mood disturbances. Deficiency of either B12 or Folate can lead to dementia. The Natural Standard at www.naturalstandard.com ranks B12 as possibly ineffective for cognitive function (presumably in the absence of a B12 deficiency) and with insufficient evidence for Alzheimer's disese. It ranks Folate as possibly effective for depression and with insufficient evidence for cognitive function and Alzheimers. The Natural Standard at www.naturalstandard.com gives Folate a C ranking (unclear scientific evividence for this use) for both depression and and Alzheimer's. B12, folate, and thiamine (another B vitamin) are often also low in alcoholics who demonstrate cognitive impairment. B12 and Folate are sometimes used to augment the effect of conventional antidepressants. Because B12 deficiency is associated with decreased absorption in the intestines, sublingual preparations are sometimes used. Folic acid supplementation alone my mask B12 deficiency and may lead to progression of neurological damage. B12 should not be taken with Leber's optic atrophy. High doses of folic acid (folate) may interact with other drugs. Multivitamins with minerals may also be helpful in depression, though their efficacy has not really been clearly demonstrated, they are reviewed by James Lake M.D. in his book Complementary And Alternative Treatments in Mental Health Care. It stands to reason that in depression and also in other disorders there may be inadequate absorption of vitamins and minerals from nutrition. Care should be taken in persons already taking other vitamins. Chromium is a trace mineral in the diet. It is invovlved in glucose metabolism and seems to impact the monoamine neurotransmitter sytems. The use of chromium in depression is reviewed by James Lake M.D. in his book Complementary And Alternative Treatments in Mental Health Care. Trivalent forms of Chromium like Chromium picolinate or nicotinate are considered to be relatively safe. Initial side effects may include insomnia and vivid dreams. Side effects can also include tremor and a stimulant effect. Psychomotor agititation is also possible. There have been reports of possible renal, liver, and blood problems and risk of stomach bleeding or ulceration caused by Chromium. There is also a question of potential carcinogenesis at extremely high doses. Chromium may decrease the absorption of Synthroid, and may lower blood sugar and thus adjustment of diabetes medications may be needed. Chromium may exert a positive effect within one week. Therapeutic doses are usually between 200 to 400 mcg daily. While there has not as of yet been large studies demonstrating the efficacy of chromium, the possible rapid onset of action and relative safety are potential benefits. Mucuna pruriens is an Ayurvedic herb which has been used for depression and which also may help in Parkinson's disease and for sexual desire possibly because it contains significant amounts of levodopa which is a precursor to dopamine. Since levodopa does not readily cross the blood-brain barrier without a facilitator like methyldopa, it is speculated that Mucuna has other constituents that may be active. The use of Mucuna in depression is reviewed by James Lake M.D. in his book Complementary And Alternative Treatments in Mental Health Care. While there is limited evidence of efficacy when used alone there has been at least one good study demonstrating efficacy within 8 weeks when combined with Ashwagandha (Withania) an Ayurvedic herb used for anxiety. Common side effects are nausea and a sensation of abdominal distension. There have been psychotic and manic like reactions including hallucinations and delusions. Mucuna should not be used if pregnant, breast-feeding, with cardiovascular disease, hypoglycemia, diabetes, liver disease, peptic ulcer disease, or melanoma. As above there is also risk of exacerbating pyschiatric disorders. Mucuna should not be taken with MAOIs or methyldopa and may also interact with several other drugs. |
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