Natural remedies, therapies can be part of an effective overall treatment plan.
When world-renowned comedian and actor Robin Williams took his own life earlier this year, many were surprised to learn that the high-energy comic suffered from depression. All too often, this disorder is associated with only those groups singled out as being “down on their luck” or struggling to “make ends meet.”
Experts agree, however, that depression doesn’t discriminate, and the numbers are eye-opening. According to the National Institutes of Mental Health, the disorder affects approximately 16 million people in the U.S. and more than 350 million worldwide, and the World Health Organization. The Centers for Disease Control and Prevention (CDC) says that one in 10 U.S. adults report depression. Of course, those are only the ones that actually report feeling depressed, not the actual numbers that are suffering with the disorder.
Putting a label on depression can also be confusing. According to the Anxiety and Depression Association of America (ADAA), when feelings such as hopelessness, being discouraged or unmotivated, or general disinterest in life lasts for more than two weeks and begin to interfere with daily activities at home or in the workplace, it should be considered a major depressive episode, also know as major depression. This is when thoughts or attempts of suicide may occur. The ADAA also points to persistent depressive disorder, or PDD, which it identifies as a form of depression that usually continues for at least two years.
It’s also believed that people who suffer with depression may have low levels of the neurotransmitter serotonin, which facilitates learning and memory.
Also, depression and anxiety disorders often go hand-in-hand, but are not the same, according to the ADAA. Each disorder, the association says, has its own causes and its own emotional and behavioral symptoms. Bipoloar disorder is also closely linked with depression.
So how can you make sure patients are properly diagnosed when suffering from depression and what are the best treatment options? Are prescription antidepressants the answer or do they simply lead to more challenges for the patient and physician? Are their natural remedies that should come into play here?
According to Decker Weiss, NMD, FASA, cardiology clinical advisor to Pharmasan Labs and Wisconsin-based NeuroScience, Inc., conventional medicine looks for warning signs of depression as feelings of helplessness and hopelessness, loss of interest in daily activities, appetite or weight changes, sleep changes, anger or irritability and loss of energy, among others, while functional medicine looks for warning signs such as joint and chest pain, poor digestion, fibromyalgia, chronic fatigue and any chronic inflammatory condition. He stated that all medical approaches, however, do have things in common, including the principles of prevention and early detection. “By expanding the warning signs of depression, earlier detection and prevention become possible.”
Initial signs of depression my involve lack of pleasure in everyday activities, withdrawal from others, irritability and fatigue, and the symptoms may gradually worsen over time, according to Adrian Lopresti, MD, a clinical psychologist in Perth, Australia specializing in treating adult and children with depression and anxiety and lead author of a recently-published study reporting that high absorption of BCM-95 curcumin was more effective than placebo in improving depression symptoms.
“Currently, there is no well-accepted medical test for depression,” Dr. Lopresti said. “The best way to assess depression is through interviews and questionnaires. Saying this, it is important that many people with depression undergo a battery of blood tests measuring things like folic acid, iron, vitamin B12 and vitamin D, which can all affect mood. Even undergoing tests examining blood sugar levels, sex hormones and inflammation may be beneficial for some people.”
“Research has shown that one of the most reliable tests for telling if someone is depressed is to ask them this simple question, ‘Are you depressed?’ “This turns out to be as reliable as complex testing,” said Jacob Teitelbaum, MD, director of the Practitioners Alliance Network (PAN) and a member of the Natural Practitioner (NP) editorial advisory board member.
Dr. Teitelbaum also cited the recent BCM-95 curcumin study and the critical role that inflammation plays in depression. In the eight-week, randominzed, doubleblind, placebo controlled study, the antidepressant effects of curcumin on 56 people with depression was examined. BCM-95 was administered at a dose of 1,000 mg/day. Findings indicated that from weeks four to eight, people on placebo no longer got better, as was the case in the four prior weeks, while those on curcumin continued to get better. Curcumin was particularly effective for a subset of people with atypical depression as well.
“This powerful study shows how important inflammation is in depression,” Dr. Teitelbaum said. “Where both prescription antidepressants and St. Johns wort are often not strong enough to have significant effect in major depression, the highly absorbed BCM-95 curcumin is.”
One product available to practitioners that offers the BCM-95 is CuraPro from Wisconsin-based EuroMedica, which is curcumin blended with turmeric essential oils, which the company says is up to 10 times more absorbable than standard 95 percent curcumin.
Another related health concern cites inflammation as the link between heart disease and depression, backed by research showing the link between the central nervous system, depression, inflammation and heart disease.
“Inflammation is indeed the link between heart disease and depression,” said Dr. Weiss. “But the bigger news is that health care practitioners can now measure via biomarkers the underlying links between heart disease and depression and effectively treat each patient as an individual, targeting therapies exactly where they are needed.”
Dr. Weiss also raised the question of whether depression causes inflammation or vice versa and cited research indicating that depression is a result of inflammation, not the cause. Chronic inflammation—whether presented as heart problems, gum disease, autoimmune difficulties, digestive disorders or other chronic inflammatory processes— stimulates the release of pro-inflammatory cytokines and suppresses anti-inflammatory cytokines, he stated. The action of the cytokines generates the proliferation of free radicals, which along with nutritional depletion, damages neurotransmitters and triggers the production of oxidated LDL.
“As the neurotransmitters deplete, familiar ones such as serotonin, GABA, norepinephrine and dopamine decrease, while glutamate spikes up,” Dr. Weiss said. “This is the specific link between inflammation, the immune system, depression and heart disease.
“What is really exciting is that now, for the first time, lab testing can measure immediate risk of heart attack, depression and underlying cause via the central nervous system, as well as traditionally laterappearing tissue markers, and target patient-specific therapy. Then within one month, we can know if the patient is improving or no. Treatment models include amino acids, herbs, and methylation support.”
Diet and Supplementation
Like most models connected with maintaining good health, the role of proper diet and supplementation, along with maintaining an active and healthy lifestyle, go a long way toward making patients feel good. But when it comes to disorders like depression, diet is one area that may often be overlooked.
“Diet is often a neglected area in depression treatment,” said Dr. Lopresti. “Our brain chemicals (neurotransmitters) can be significantly influenced by diet. For example, serotoin is created from protein. For the body to manufacture serotonin we require several vitamins and minerals such as folic acid and vitamin B6. If we are deficient in any of these nutrients our serotonin levels are adversely affected and mood worsens. What we eat can also influence levels of inflammation, oxidative stress and neurogenesis, which again are all associated with depression.”
Some natural supplements that have been purported to help support those with depression and could be included in an overall treatment plan include: omega-3 fatty acids; vitamins B12, C and D; probiotics for digestive health; SAM-e; 5-HTP; turmeric; amino acids, GABA (Gamma-aminobutyric acid); calcium; melatonin, magnesium; St. John’s wort; N-acetyl cysteine and zinc. Some useful herbs include ashwagandha, saffron and Brahmi.
Carolyn Dean, MD, ND, for example, points to the importance of magnesium in the diet in her book, The Magnesium Miracle, when she said, “A magnesium deficiency magnifies depression and stress. Serotonin, the feel good brain chemical that is boosted artificially by some medications, depends on magnesium for its production and function. A person that is going through a stressful period without sufficient magnesium can set up a deficit that, if not corrected, can linger, causing depression and further health problems.” Magnesium-based supplement products such as Natural Calm from Californiabased Natural Vitality can help protect against magnesium deficiency.
Making smart diet and lifestyle choices that include the vitamins and minerals mentioned previously is a good start when it comes to warding off depression. For those of us in the U.S., eating healthy isn’t always easy but is critical for overall health and well-being.
“The American diet is awful, with half of the vitamins and minerals being lost in food processing,” said Dr. Teitelbaum. “High sugar throws our mood into a tailspin and loss of omega-3s, which are critical for healthy mood and brain function.”
Rx Antidepressants vs. Natural Remedies
While natural remedies appear to have a place in an overall treatment plan for depression, there are plenty of prescription medications available to patients as well. There are well-documented side effects that come along with many of these drugs; the question that needs to be asked, of course, is whether or not the potential benefits outweigh the risks. Furthermore, can the two co-exist?
“Pharmaceutical antidepressants can be effective for people with major depression,” said Dr. Lopresti. “For people with mid-tomoderate depression, they are as effective as many natural forms of antidepressants. The problem with pharmaceuticals is that they are associated with side effects including weight gain, headaches and nausea.”
“Antidepressants have over five decades of history and have gone through a lot of evolution,” said Shailinder Sodhi, ND, president of Washington-based Ayush Herbs Inc. “They work really well for a percentage of people, but they are not the cure for depression. And considering the side effects, long-term use is undesirable.”
Which raises the question of whether conventional medicine and integrative medicine can unite in the treatment of depression.
“Conventional medicine and pharmaceutical drugs are essential in cases concerning suicide-homicide prevention, schizophrenia, bipolar disorders and other serious mental conditions,” offered Dr. Weiss. “However, for most cases of depression the two models cannot effectively co-exist. That’s because while integrative medicine identifies and seeks to treat the roots of a patient’s mood issues, conventional medicine operates from a reductionist perspective, generally treating one or two neurotransmitters at a time, versus balancing the entire system.”
In addition to natural supplements to help with depression, there are a host of alternative therapies that may also be an option for patients, including meditation, massage therapy, yoga, and even acupuncture and chiropractic treatments.
For example, a recent study1 published in JAMA Internal Medicine examined the effectiveness of using meditation to improve stress-related medical outcomes. The research showed that although the benefits were moderate, psychological stress across multiple categories—including anxiety, depression, and pain—was diminished through the use of meditation.
“Ayurveda (medicine) helps me recommend foods, herbs and spices to clients that are more specific to their individual constitution and thus more specific to their individual experience with depression,” said Amber Lynn Vitse, CN, a certified nutritionist in Integrative Nutrition. “Ayurvedic nutrition offers the foundation, the base, to a healthier, better functioning vessel for the spirit and the mind.
“Then a person can engage the mind and spirit through meditation, yoga and bodywork therapies, again tailored to their constitutional/ doshic imbalances to aid in the restoration of homeostatis and ideal health. Pranayama, breathing exercises and techniques, are also incredibly effective for depression with the proper preparation and instruction.”
Overall Treatment Plan
Developing an overall treatment plan for depression will likely have many layers, depending on whether the patient is being treated for major depression or mild to moderate depression.
“All treatments for depression should be multi-faceted. Antidepressants (either natural or pharmaceutical) should form only a part of treatment,” said Dr. Lopresti. “Other interventions may be beneficial or essential. These include consuming a healthy diet, engaging in regular exercise, having good sleep patterns, learning effective coping skills, developing positive social support/integration, engaging in pleasurable activities and having a life purpose. Psychological therapies such as cognitive-behavior therapy (CBT) can also be very helpful.”
There are other factors in play too that will need to be considered and addressed, such as the need for counseling. One popular counseling technique called cognitive behavioral therapy (CBZT) focuses on cognitive distortions and can help the client recognize patterns between trigger situations and their reactions to those situations, according to Dr. Sodhi.
“Counseling is one of the main aspects of managing depression,” said Dr. Sodhi. “Primarily, counseling can help to arrive at the root cause of depression. Understanding and addressing the root cause is the start of healing depression.”
“A social and support network is crucial for any human to feel connected,” added Vitse. “Beyond that, the need for professional counseling and therapy is both an individual choice and on a case-by-case basis. Sometimes it’s a person’s best option for having a neutral third party to talk to, to help work things through.”
1 Madhav Goyal, Sonal Singh, Erica M. S. Sibinga, Neda F. Gould, Anastasia Rowland- Seymour, Ritu Sharma, Zackary Berger, Dana Sleicher, David D. Maron, Hasan M. Shihab, Padmini D. Ranasinghe, Shauna Linn, Shonali Saha, Eric B. Bass, Jennifer A. Haythornthwaite. Meditation Programs for Psychological Stress and Well-being. JAMA Internal Medicine, 2014; DOI: 10.1001/jamainternmed. 2013. 13018