Strategies for depression
Gillian Flower, ND
Low levels of serotonin may lead to depression. Some natural remedies such as St. John's wort, vitamin D, and fish oil can help relieve depression.
One in 10 Canadians is estimated to suffer from some form of depression, although symptoms vary widely from person to person. As you navigate the ups and downs of the winter months, lifestyle and supplemental therapies will help to keep your mood stable. Feelings of sadness and helplessness are often prominent in depression, and a loss of interest in life, changes in sleep and eating patterns, and difficulty concentrating are also tell-tale symptoms. In the most severe cases, thoughts can turn to suicide, making depression a potentially fatal condition requiring immediate and effective treatment. Seasonal affective disorder, aptly shortened to SAD, is a form of depression that occurs most commonly in the fall and winter. Although the exact cause of SAD is not understood, it seems to be linked with decreased amounts of sunlight exposure. Symptoms are severe in 2 to 3 percent of the population, while a further 15 percent suffer from some degree of “the winter blues.” Whether in the form of SAD or full-blown depression, feeling down can be draining and debilitating.
Serotonin, a chemical messenger (or neurotransmitter) in the brain, plays a central role in all forms of depression. Serotonin may be low in depressed individuals and is the target of common prescription drugs known as SSRIs, or selective serotonin reuptake inhibitors. SSRIs slow the reabsorption of this serotonin, allowing its positive effects to reach the brain for longer periods.
Counselling and pharmacological therapy are the first-line treatments for depression in conventional, mainstream medicine. Cognitive behavioural therapy (CBT) has been shown time and time again to be effective in the treatment of depression and should be considered by everyone suffering from depressive symptoms.
Prescribed SSRIs currently play a role in the treatment of depression for many Canadians—with an estimated 15 to 22 million prescriptions written last year. However, SSRI treatment may mean taking pharmaceuticals for life; pharmaceuticals that come with a wide range of undesirable side effects. For people who prefer to pursue alternative treatments, the following natural options may be effective.
St. John’s wort, Hypericum perforatum, is perhaps the best-known and best-studied natural antidepressant agent. Extracts from this plant have been found to be as effective as pharmaceutical antidepressants in some individuals and are safe for long-term use. St. John’s wort appears to mimic the action of SSRI drugs, prolonging the effect of serotonin in the brain.
Although St. John’s wort can be found in any supplement shop, an understanding of its side effects is not as widespread. St. John’s wort affects the way that many drugs behave in the body, potentially making birth control pills, blood thinners, and other common medications less effective. Increased sensitivity to sunlight can occur with the use of St. John’s wort, and it should not be taken with conventional SSRIs unless under the care of an herbalist or naturopathic doctor.
While the effects of serotonin may be prolonged, the natural production of this chemical can also be improved. The amino acid-based SAMe (s-adenosylmethionine), along with vitamins B12, B6, and folate, are vital elements in neurotransmitter production. Deficiencies of these compounds have been linked to depression, while supplementation has improved symptoms in some studies. B vitamins are generally used before SAMe due to cost considerations, and SAMe should not be used in cases of bipolar disorder or anxiety.
When B12 and folate levels are low, homocysteine levels increase. Although this byproduct of protein processing has been found in high levels in depressed patients, it is unclear whether it is a cause of depression on its own or whether it simply flags these deficiencies. Increasing B12 and folate intake will reduce homocysteine levels, providing another potential reason to take these vitamins for depression.
Serotonin levels can be improved even further by giving the body more of the necessary building blocks. 5-HTP (5-hydroxytryptophan) is a precursor to this neurotransmitter, an agent that the body converts into serotonin. Some studies have shown 5-HTP to improve depressive symptoms, but as it may directly influence serotonin levels, it should only be used with guidance when taken in combination with SSRIs.
Supplementing with fish oil has been shown to have great benefit in depression. Two fatty acids found in fish oil, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), have been studied extensively, with most results pointing to the superiority of EPA in relieving depressive symptoms. EPA may be just as effective as SSRIs, and can safely be used in combination with conventional drugs. Although effective, fish oil does not appear to alter serotonin levels.
Instead, the omega-3 fatty acids in fish oil exert their positive effect on the fat-filled wall of our cells, seeming to make all cells, especially those in the brain, more receptive to messages from their environment. Under the influence of fish oil, cells may have an enhanced ability to respond to serotonin, resulting in a decrease in depressive symptoms.
Vitamin D can also be deficient in those suffering from depression and early studies show benefit from vitamin D supplementation. As adults may spend entire winters indoors, it is easy to see how vitamin D deficiency could explain seasonal episodes of depression. The role of vitamin D in both seasonal and longer-term depression is not yet understood, but a link does seem to exist.
Depression can be a debilitating experience, especially when undiagnosed and untreated. Natural and complementary treatments can help to ease the burden of this condition.
Exercise has powerful antidepressant effects. Plan daily exercise to improve your mood overall; lift your spirits in the moment with a brisk winter walk and enjoy the time out with your family.
High protein intake supports serotonin synthesis. Avoid caffeine and sugar while increasing fibre to prevent daily peaks and crashes; use alcohol, a depressant drug, with care. Eat slowly to maximize nutrient absorption.
Get outside to boost your mood! Consider sunlight-simulating bright light therapy, especially for SAD.
Caring for yourself with massage, acupuncture, yoga, and meditation can provide great support to other antidepressant therapies.
Counselling, especially cognitive behavioural therapy (CBT), supports recovery from depression and may be more effective than drug therapy alone in preventing its recurrence.
Get assessed for depression if you are experiencing these symptoms:
Note: other causes of mood disturbance (hormone imbalance, drug effects) must be considered before self-treatment.
(Special thanks to Baljit Khamba Grewal, ND, for contributing her clinical expertise to this article.)