Part I reminded us walking in fresh air, sharing food with friends simple pleasures help stave off depression, and that a balanced, whole foods diet is essential to maintaining good mental health.  The book, Natural Prozac by Joel Robertson and Tom Monte, does a wonderful job explaining the role of food in controlling depression.  We ended last month on the subject of nutrients that can help and had covered 5-HTP, which is a precursor to serotonin.

Tyrosine and Phenylalanine, Precursors to Catecholamines:   Most of us have heard about serotonin, the ‘happy’ neurotransmitter.  But serotonin is only part of the equation.  Other neurotransmitters, called catecholamines, also elevate mood, but in a different way. Serotonin helps us feel relaxed, calm, and at peace with the world, and catecholamines provide pizzazz, get-up-and-go, etc. While the research on 5-HTP as a serotonin precursor is fairly compelling, that on the catecholamine precursors is not.  There have been few studies, with mixed results.  I have known a few people over the years who have sworn by tyrosine and/or phenylalanine, but they were in the minority.  

With that, if you fit the description for catecholamine deficiency (poor concentration, low energy, low motivation, and apathy), tyrosine and phenylalanine are worth a try.  They can be useful, especially in situations where the precursors tend to be depleted, such chronic stress or alcoholism.  A number of clinicians report they are quite useful in keeping recovering alcoholics sober.  Also, in those instances when depression is combined with narcolepsy, tyrosine has been shown to be remarkably useful.

SAMe: the best antidepressant in the world?  SAMe is versatile enough to help the body make more serotonin and catecholamines, as well as other important compounds such as glutathione (the number one antioxidant in the liver) and coenzyme A.  For many, it is the ideal all-around pick-me-up.  Personally, I’ve gotten feedback on SAMe that has been very, very, very good.  Now here’s what the Life Extension Foundation Disease Prevention and Treatment manual has to say about this supplement:

The safest and most effective antidepressant in the world is the European drug S-adenosylmethionine (SAMe).  SAMe is a simple natural metabolite produced from the essential amino acid methionine.… It is found in every cell within the body and plays an important role in critical biochemical processes…. When compared with other antidepressants, SAMe works faster and more effectively, with virtually no adverse side effects.  In fact, unlike FDA-approved antidepressants that have both lethal and non-lethal side effects, SAMe produces side benefits, such as improved cognitive function, protection of liver function, and a potential slowing of the aging process.  Some people take SAMe for its anti-aging properties alone.”

The book goes on to summarize almost a dozen studies where SAMe was compared to both placebos and other drugs in a variety of different conditions, in a variety of depressive states.   We have a reference copy of this book which you are more than welcome to come in and take a look at.

The major drawback with SAMe is the price. SAMe is expensive to make and expensive to package right, although the price has come down.  Then you look at the doses used in the studies, which generally fall into the 800-1600 mg range. SAMe can be more expensive than Prozac!   And when I said earlier that I’ve been getting “very, very, very good” feedback, I was referring to the people I’ve spoken with who were taking at least 800 mg a day.  Obviously, not everyone needs to take that much, and I’ve also spoken to people who’ve done well on a lot less.  Most recently, a coworker of mine says a friend of his is doing great on just 400 mg.  This will be up to you.

Can you combine these supplements with prescription antidepressants?  Well, yes and/or no.    Amino acid precursors do not interact directly with prescription antidepressants.  SSRIs like Prozac, Zoloft, and Paxil work by keeping serotonin around longer once it’s been made.  MAOIs do a similar thing with catecholamines.  As you can imagine, combining precursor therapy with prescription antidepressants could be quite effective at combating depression.  And indeed, a number of studies have reported positive results doing just that.

It is possible, however, to “overload the brain” this way, leading to occasional serious side effects.  It all depends on what dose you’re using, which antidepressant you’re on, and your own individual biochemistry.  The bottom line is this: despite the strong possibility of real benefits, especially in the more severe forms of depression, you should not combine the two unless you are working with a healthcare practitioner knowledgeable about both the prescription drugs and the supplements.

Herbal & Aromatherapy

The herb St. John’s Wort (Hypericum Perforatum) is a safe and effective antidepressant with a long tradition of use, backed now by strong research.  It has few side effects, if any.  But before I get into the research, let me quote my favorite herbalist, Michael Moore, from his Medicinal Plants of the Pacific Northwest:  (He does have a tendency to be opinionated…)

“Hypericum is one of our best herbal therapies for depression and numbing frustration.  It seems to work best for those people, especially men, who find things falling apart but who really have little life experience with failure or loss of confidence.  This is all very subjective on my part, but I think of using Hypericum when someone whose circumstances have changed is unable to alter his ways of acting and responding.  Such people follow previously reliable responses and strategies, but their life needs new approaches…  Hypericum has little or no value in bipolar depression or depressive states with a clear pathology.  It is for normal folks whose strategies have failed and who are temporarily adrift.  I realize this is an almost impossibly broad description, but you can narrow it down a bit, since there are usually transitory and ill-defined physical symptoms that further define Hypericum as appropriate.  Old physical problems or nervous habits may have returned, such as nail biting, breathing problems, sexual dysfunction, constipation, or skin disorders signs that there are underlying physical frustrations and unresolved nervous agitation as fellow travelers to feeling frustrated… Some will find quick help from the tincture; others will find it takes a week or two to start feeling more focused and alert.”

If that’s the “personality” of St. John’s Wort, here’s the science.  In 1996, the British Medical Journal published a meta-analysis of St. John’s Wort.  (A meta-analysis is when researchers look at a bunch of individual studies and “add them up.”)  They analyzed twenty-three trials, twenty of which were double-blind, in a total of 1757 people with mild to moderate depression.  Of the twenty-three trials, fifteen compared St. John’s Wort to a placebo, and eight compared it to a tricyclic antidepressant.  In every single trial, improvements were reported in the people taking St. John’s Wort.  In the eight trials which compared it to the tricyclics, St. John’s Wort performed as well as the drugs.  All told, 55.1% of the people taking St. John’s Wort improved, versus 22.3% of those getting a placebo.[1]

One thing you’ll notice when you look at the research on St. John’s Wort is that it has almost exclusively focused on people with mild to moderate depression.  And until recently, the question still remained: what would St. John’s Wort do for major depression?  That question was finally answered just a few months ago with the results of a large trial out of Duke University.  And if you were reading the papers or watching the news, you already know what they found: namely, that St. John’s Wort was not effective in this situation.  I want to say first of all that this was a good study.  I do not believe that it was designed to “make herbal medicine look bad,” like some people allege.  Rather, it was designed to test the limits of an herbal medicine, and it did so.  I will say, however, that the media coverage of the study was pretty bad.  Big banner headlines screaming “Herbal Medicine Found Ineffective.”  That kind of thing.  To clarify, its ineffectiveness against major depression does nothing to negate its efficacy in cases of mild to moderate depression.  And secondly, the study compared St. John’s Wort to Zoloft, the world’s number-one-selling antidepressant, and found that neither of them worked in the situation!  But you had to get past the headlines and into the small print to get that aspect of the story… 

St. John’s Wort is a safe herb.  Although it doesn’t appear to have the side effects of traditional MAO inhibitors, it still would be wise to avoid using it in those situations where MAOI’s are contraindicated.  Check with your pharmacist.  There are reports that St. John’s Wort may increase sensitivity to sunlight, allowing people to sunburn a lot easier.  Long story, but the bottom line is this: if it happens at all, it is quite, quite rare.  St. John’s Wort might also interfere with AIDS drugs.  And if we’re on the subject of side effects, I should mention the positive ones as well.  First of all, it has been clearly documented that St. John’s Wort increases the rate of wound healing in lab rats.  There’s also some indication the St. John’s Wort is anti-viral.  Traditionally, St. John’s Wort has been used to lessen nerve pain.  A St. John’s Wort oil for topical use is quite useful for healing burns and other forms of skin damage.

A word about standardization.  Herbs are complex medicines.  Each one is composed of hundreds of different naturally-occurring chemicals which exist in varying amounts from plant to plant, batch to batch.  While this complexity is part of what makes herbs special, it can be frustrating for researchers, manufacturers, and consumers who want to know exactly what they’re getting.  Standardized extracts address this issue by guaranteeing precise levels of specific constituents.  But because herbs are so complex, we don’t always know which constituents are the most important.  For years, St. John’s Wort products were standardized for a chemical called Hypericin.  And these products seemed to work well enough.  But in the last few years, people have begun to pay attention to another marker compound called Hyperforin.  It appears now that products standardized for Hyperforin work better than those standardized for Hypericin.  A number of companies are even making products standardized for both 0.3% Hypericin and 4% Hyperforin.  I’d look for one of those.  The standard dose is 300 mg, three times a day.  Most people notice results in a few weeks.

Beyond St. John’s Wort, there are literally dozens of herbs which can be useful for depression, but the others seem to work indirectly.  Some can be calming and some can be energizing.  Others help to ease anxiety.  Still others work by improving mental function in general, which is often the key with older folks as they start to lose some of their abilities.  Some herbs, like the Ginsengs, Ashwaganda, and Reishi Mushroom, help the body adapt to stress in general.  I’d pay special attention to Kava for anxiety, and Passionflower to help wind you down if you get wound up. The list could go on and on.  It’s pretty arbitrary of me to pick these two.  But that’s how much space I have.  Now a few words about aromatherapy.

Aromatherapy:  Olfaction [the sense of smell] is thus not only the most primitive of all the senses, it has the most direct line to the higher centres; in short, olfaction is the ability of an animal to feel its environment directly.  Even in the human, the direct access to our deepest consciousness remains intact, and it is the case that a scent can still move directly, deeply, in a way that owes nothing to rationalization or conceptualization.  The most direct of senses is still associated with that part of consciousness that provides the ability to make immediate experience meaningful.  – Simon Mills, from Out of the Earth

I am not an expert on aromatherapy, not even close.  One thing I do know, however, is that it is a very personal experience.  No matter what experts say, choose an essential oil that resonates with you.  That’s why we have open bottles (“testers”) for you to try.  Nevertheless, there are some essential oils which are often recommended for depression.  Rose, especially for depression accompanied by grief; Lavender: the most universally attractive and soothing of the oils, an all-purpose scent; Neroli, or orange blossom, for its ability to soothe while it strengthens; Jasmine, which is uplifting and sometimes even euphoric; the citrus oils, like lemon and grapefruit and orange, for their brightness and clarity.  Use the oils in a diffuser, or dilute in an elegant carrier oil like sweet almond or jojoba, and apply to the wrists, temples, etc.  Or use for massage.  You can even add a few drops to a warm bath.

… Adam Stark

[1] I absolutely love the fact that placebos are so effective!  They really are the best medicine!  And I think we can learn an important lesson from this.  If you go into any medical treatment with a positive attitude especially when you’re dealing with depression you’re likely to get better results out of it.