Depression is a widespread problem in our society that causes a great deal of suffering, and I’m often approached by patients seeking advice on treating it. Fortunately, in the case of mild to moderate depression, I’ve found that natural approaches can be very successful in keeping symptoms at bay. And even severely depressed patients who do require antidepressant drugs can also benefit from natural approaches. Depression is far more common than many people think. One in five women and one in 10 men can expect to suffer an episode of clinical depression at some point in their lives, and the likelihood of a repeat or multiple episodes is about 50 percent. Depression cuts across the life span: An estimated 15 percent of people over age 65 have some symptoms of depression, and teen suicide rates have tripled since the 1950s. (See the boxes below for more on elder depression and teen depression). Besides its mental toll, depression can have other serious health consequences: Recent research links chronic depression to an increased incidence of asthma, cancer, diabetes, and heart disease.
More than the Blues Depression is more than the blues, and you don’t simply “snap out of it.” A diagnosis of clinical depression (either mild, moderate, or severe) requires a depressed mood or loss of interest in ordinary activities for at least two weeks, plus four or more of the following symptoms: a change in appetite or weight, inability to sleep or oversleeping, restlessness or feeling “slowed down,” reduced energy, difficulty in concentrating or making decisions, feelings of guilt or worthlessness, and recurrent thoughts of death or suicide. The symptoms must also be severe enough to interfere with normal functioning. (Note: October 7 is National Depression Screening Day. To locate a site near you offering free, anonymous screenings for depression and manic-depression, call 800-573-4433.) Some people think of depression as a personal weakness or character flaw, but in fact the medical community regards it as an illness. Some depressive episodes occur suddenly for no apparent reason, while others are triggered by a stressful event such as loss of a job or death of a close relative. One type of depression, called seasonal affective disorder (SAD), strikes during the fall and winter, and is often treated successfully with light therapy. Depression can also be caused or aggravated by numerous physical ailments (including thyroid disease, diabetes, heart disease, and cancer); certain medications (antihypertensives, corticosteroids, and oral contraceptives); and abuse of alcohol or other recreational drugs. People with a family history of depression are also more prone to the disorder. Psychiatrists regard depression as the result of disordered brain biochemistry, such as low levels of the neurotransmitter serotonin. Consequently, they treat depression largely by prescribing drugs, especially a newer class of antidepressants called selective serotonin reuptake inhibitors (SSRIs): The best-known examples are Prozac, Zoloft, and Paxil. However, it’s also possible that disordered moods and thinking may cause disordered brain biochemistry, so I’m inclined to explore other treatments as well. Although SSRIs are safer and more effective than the older antidepressants, they still cause significant side effects, including insomnia, nervousness, nausea, diarrhea, headaches, and sexual dysfunction. Also, people who take Prozac and its relatives often say they simply feel all emotions less intensely. While antidepressant drugs are usually necessary in cases of severe depression, I worry about what I see as the overprescribing of these drugs which can cause emotional flatness. It is my belief that one cannot comes to terms with depression by disowning it or suppressing it. The way to emotional freedom is to own your depressions, and learn to transform them into more-useful states through meditation, psychotherapy, or other reflective practices.
Easing Depression Naturally If you have only a few symptoms of depression and they aren’t interfering with your normal functioning, I believe it’s safe to experiment with natural approaches on your own. However, if you suspect you may have clinical depression, I encourage you to discuss your concerns openly with your doctor, who should make sure that your symptoms aren’t due to an underlying medical problem, and then refer you to a psychiatric professional if necessary. For people who are diagnosed with mild to moderate clinical depression, I think it’s worth trying the natural approaches below (and having you doctor track your progress) before turning to antidepressant drugs. If you’re severely depressed and require antidepressant drugs, I’d recommend adding the following lifestyle measures to any antidepressant regimen, as well as supplementing with B-complex. Finally, I suggest that anyone with depression (no matter what the severity) consider some form of psychotherapy to explore underlying emotional issues.
Lifestyle measures: Get moving. I’ve long recommended regular physical activity as a powerful natural antidepressant. So I was pleased to see a recent review of published studies (Professional Psychology: Research and Practice, June 1999) that concluded “regular exercise is a viable, cost-effective but underused treatment for mild to moderate depression” and may be useful in the comprehensive treatment of severe depression. The review found that nonaerobic forms of exercise such as strength training were just as effective in treating depression as aerobic forms such as walking and running. Exercise may alleviate depression for any number of reasons: by releasing “feel-good” chemicals called endorphins, increasing levels of the neurotransmitter serotonin, offering distraction from negative thoughts, increasing resistance to stress, and enhancing self-esteem. Whatever the mechanism, I strongly encourage people with depression to exercise regularly: My standard prescription–a brisk, 45-minutes walk at least five days a week–easily fills the bill. Practice relaxation. Regular use of relaxation techniques such as meditation, breathing exercises, and yoga can help promote emotional balance. I advise depressed patients to incorporate some method of relaxation into their daily routine and to practice it faithfully. If you’re interested in exploring meditation, check out a new book called The Zen Path through Depression by Philip Martin (HarperSanFrancisco, 1999). As for breathing exercises, you’ll find detailed instructions on my new CD/audiotape set called Breathing: The Master Key to Self Healing. Eat salmon. The heart-healthy omega-3 fatty acids found in salmon and other oily cold-water fish may also improve symptoms of depression and other psychiatric disorders, according to studies presented at a National Institutes of Health workshop last September. Previously, epidemiological studies had shown that countries where people eat large quantities of fish have lower rates of depression. Researchers speculate that omega-3s may ease depression by influencing production of the neurotransmitter serotonin. While research continues, I encourage people with depression to eat salmon, sardines, mackerel, or herring several times a week. Alternatively, you can get a good ration of omega-3s by sprinkling a couple of tablespoons of ground flaxseed on your cereal, soup, or salad every day. Another option is to snack on toasted hemp seeds (which, by the way, aren’t psychoactive). You can order hemp seeds from The Ohio Hempery, (800) BUY-HEMP. Connect. Depression is often linked to social isolation or a feeling of loneliness. Fortunately, there are many ways to foster connectedness: Spend time with friends and acquaintances who make you feel happier and more alive. Consider doing some volunteer work. A pet can offer companionship and make you laugh. You can connect with nature by visiting a park or another natural setting. There’s also benefit in connecting with a higher power: Numerous studies have linked religious faith to a reduced incidence of depression. Avoid depressant drugs. These include alcohol, sedatives, and antihistamines. Limit caffeine. Addiction to coffee, caffeinated sodas, and other forms of caffeine can interfere with normal moods and make depression worse. And obviously, caffeine can contribute to insomnia, a common symptom of depression. Don’t smoke. Smokers have a significantly higher risk of depression than nonsmokers, possibly because of nicotine’s mood-altering effects.
Supplements: In addition to the lifestyle measures above, I typically recommend that people with mild to moderate depression take St. John’s wort. Alternatively, you might try a newly popular supplement called SAM-e. St. John’s wort is definitely my first choice, since it’s far cheaper than SAM-e. In addition, anyone with depression–including those on antidepressant drugs–should be sure to take a B-complex supplement. St. John’s wort. This herb (Hypericum perforatum) has become hugely popular as an alternative treatment for depression, and for good reason: A well-publicized 1996 meta-analysis of 23 randomized trials, published in the British Medical Journal, concluded that St. John’s wort worked as well as standard antidepressants in treating mild to moderate depression, while causing far fewer side effects. The recommended dosage of St. John’s wort is 300 mg of a standardized extract, three times a day with food. While extracts of this herb are usually standardized for the compound hypericin, recent research in Germany suggests that another compound, hyperforin, may be more important as an active ingredient. A St. John’s wort product that I typically recommend, Perika from Nature’s Way, is standardized for both compounds. St. John’s wort takes longer than prescription antidepressants to reach optimum effectiveness, so give it a two-month trial to see whether it’s helpful. If your symptoms abate while using this herb, try discontinuing it after six months of use, but keep following the lifestyle measures in order to help ward off depression in the future. A couple of cautions: Because high doses of St. John’s wort may cause photosensitivity, it’s prudent to take precautions against sun exposure while using this remedy. More importantly, if you’re now taking a prescription antidepressant and want to try St. John’s wort instead, be sure to work with your doctor on making a gradual transition. SAM-e. Used for many years in Europe to treat both depression and osteoarthritis, this natural supplement hit the US market in March to much fanfare. SAM-e (short for S-adenosyl-methionine) is produced naturally in the body and plays a role in many biochemical reactions. Despite studies suggesting that “Sammy” has antidepressant effects, there’s still question as to whether it’s well absorbed by the body when taken orally: Some of the research studies used an injectable form. SAM-e is also very expensive, costing $75 or more per month. If you decide to try this supplement, use enteric-coated tablets containing the butanedisulfonate form of SAM-e (which is best absorbed), and follow package directions. SAM-e is thought to have few side effects, but it’s not recommended for people with manic-depression, as it may intensify manic episodes. B-complex. Several B vitamins help protect against depression. For instance, studies show that about a third of depressed patients are deficient in folic acid, and vitamin B-12 deficiency is considered a major cause of depression among the elderly. Folic acid may also increase the effectiveness of antidepressant medications. If you suffer from depression, I urge you to follow my standard recommendation to take a daily B-100 B-complex supplement containing 400 mcg of folic acid. (Incidentally, I’ve previously recommended a supplement called DLPA for people with depression, but there is now better evidence for the supplements discussed above.)
BOXES The Promise of Acupuncture Acupuncture holds promise for treating mild to moderate depression, according to several recent studies. For example, a University of Arizona study of 38 depressed women, published in Psychological Science last September, found that 64 percent of the subjects who received a series of acupuncture treatments specifically designed to ease depression experienced a full remission of symptoms. To find an acupuncturist near you, call the National Certification Commission for Acupuncture and Oriental Medicine at (703) 548-9004, or the National Acupuncture and Oriental Medicine Alliance at (253) 851-6896.
A Real Concern for Elders Although common among older Americans, depression is not a normal part of growing older. Depression after age 65 is often triggered by an underlying medical condition, drug interactions, or another psychosocial problem such as bereavement or social isolation. Also, depression may go unrecognized because older people are less likely to talk about feeling sad and more likely to mention aches and pain, constipation, and fatigue. Fearful of seeking help, some older people may turn to alcohol for comfort. If you suspect that an older relative may suffer from depression, urge him or her to get a complete physical checkup. For cases of mild to moderate depression, I’d suggest trying the natural therapies discussed in the main article. For severe depression, I’d seek out a psychiatrist or other mental-health professional who is experienced in treating older people. To locate a geriatric psychiatrist near you, call the American Association for Geriatric Psychiatry at (301) 654-7850.
Recognizing Teen Depression With teenager suicide rates on the rise, it’s important to recognize the signs of depression in this age group. Depressed teens may exhibit increased irritability rather than a despondent mood, or they may complain of physical ailments such as headaches or stomachaches. Some teenagers reveal their depression through behavioral problems such as fighting or having trouble at school. Also, a formerly outgoing teen who is now quiet and withdrawn may be suffering from depression. Teenage depression is not just a passing phase: A recent study in the Journal of the American Medical Association (May 12, 1999) found that more than 60 percent of depressed adolescents had another depressive episode in adulthood. If you suspect your teenager is depressed, share your concerns with her, and seek out help.