In many respects, antidepressants have revolutionized the treatment of depression. By rebalancing the neurotransmitters in the brain, they impact mood at the biochemical level and allow the tormented sufferer to achieve emotional equilibrium. However, not everyone responds to these drugs favorably. For some people the side effects are too harsh, while others fail to experience the desired relief.

      Fortunately, nutritionally oriented doctors and herbalists have researched a number of "natural" therapeutic approaches to depression which include herbs, vitamins and exercise. What follows is a brief summary of the most commonly used alternative modalities. While I did not use these remedies during my depressive episode, I have since tried St. John's Wort and tyrosine and have heard of positive anecdotal reports from other patients. Although scientific studies of St. John's Wort have been done in Germany, many of the other remedies have not been subjected to the same rigorous double-blind studies that are used with pharmaceutical drugs. This is largely because no one has put up the millions of dollars that would be needed to research the safety and effectiveness of these compounds. Because even "natural" substances can produce strong reactions in sensitive individuals, anyone taking these remedies should do so under the supervision of a nutritionally oriented physician (psychiatrist, family doctor, chiropractor, naturopath, etc.). As with antidepressants, it is important to try one natural remedy at a time until you discover what works. Moreover, you should not switch from a prescription antidepressant to any of these supplements without first consulting your health care provider.

St. John's Wort

      St. John's Wort (Hypericum perforatum) is the star attraction in the field of natural alternatives to Prozac. The yellow flowering tops of St. John's Wort have been consumed for centuries in tea or olive oil extract for a variety of "nervous conditions." In 1994, physicians in Germany prescribed 66 million daily doses of St. John's Wort, making it the country's medication of choice for the treatment of mild to moderate depression. Patients who respond to St. John's Wort show an improvement in mood and ability to carry out their daily routine. Symptoms such as sadness, hopelessness, feelings of worthlessness, exhaustion, and poor sleep also decrease. In one study, St. John's Wort was as effective as the prescription antidepressant Imipramine for treating mild to moderate depression (it is less effective for major depression). Moreover, St. John's Wort is relatively free of side effects when compared to pharmaceutical antidepressants (common side effects are gastrointestinal symptoms, allergy, fatigue, and increased sensitivity to light). The standard dosage of St. John's Wort prescribed by the European doctors is a 0.3 percent extract of the active ingredient, hypericin, taken in 300 milligram capsules, three times a day. A person using St. John's Wort should be monitored for four to six weeks before evaluating its effectiveness. In addition, St. John's Wort should not be taken along with the traditional antidepressants. If you are already taking Prozac or another antidepressant and would like to try St. John's Wort, consult with a psychiatrist or other medical person and wean yourself from the pharmaceutical before you start the St. John's Wort.

5-Hydroxy-Tryptophan

      L-tryptophan is an amino acid that serves as a precursor to the neurotransmitter serotonin (the one that is affected by SSRI drugs such as Prozac, Zoloft and the like). L-tryptophan was quite popular in treating depression and insomnia during the 1980s. However, in 1990 the substance was deemed responsible for a number of deaths and was pulled from the market in the United States. Although the deaths were later attributed to a contaminated non-pharmaceutical-grade product made by one particular manufacturer, L-tryptophan is currently available only by prescription in the United States. (Ironically, just four days after L-tryptophan was banned, the March 26, 1990, issue of Newsweek announced "Prozac: A Breakthrough Drug for Depression.") However, a product similar to L-tryptophan, 5-hydroxy-tryptophan, is currently available over the counter. 5-HTP is a metabolite of tryptophan and a precursor to serotonin that may work even better than tryptophan. In a head-to-head study conducted by German and Swiss researchers in 1991, 5-HTP and the antidepressant Luvox were shown to be equally effective in treating depression over a six-week period. Since then, 5-HTP has been used by many people to lower their current dosages of antidepressants or to replace them completely. Such adjustments should be made under the care of your psychiatrist or physician.

Treating underlying metabolic and endocrine disorders

       Untreated endocrine problems of all sorts are recognized as having the potential to cause mood difficulties. The most common of these is depression caused by hypothyroidism (underactive thyroid), which can be successfully treated using thyroid medication. Other medical conditions which may exacerbate or even cause depressive symptoms are chronic fatigue syndrome, candidiasis, reactive hypoglycemia, hormonal imbalances, vitamin and mineral deficiencies, and amino acid deficiencies.

Balancing mood through diet

      In her book Potatoes Not Prozac, Kathleen DesMaisons, Ph.D., an addiction and nutrition expert, claims that many people who are prone to addictive disorders, as well as to depression, are also sugar sensitive-i.e., they have a special body chemistry that reacts in extreme ways to sugar and refined carbohydrates. The reaction throws off not only the blood sugar levels, but also the levels of serotonin and beta-endorphins (nature's pain killers) in the brain. This in turn causes an inability to concentrate; creates feelings of exhaustion, hopelessness and despair; and contributes to confusion, irritability, and low self esteem-i.e., symptoms of clinical depression! Fortunately, DesMaisons has discovered that eating the right foods at the right times often can bring the body and emotions back into balance.
Her dietary recommendations include:

* eating three regular meals a day spaced no more than
   five to six hours apart.
* eating the recommended amount of protein
   (a portion the size of your fist) at every meal.
* eating more complex carbohydrates.
* reducing or eliminating sugars (including alcohol).

      DesMaisons' plan has achieved a high success rate with recovering alcoholics as well as with people with mood disorders who are striving for emotional stability. During my depressive episode, I followed these guidelines before I even discovered her work, and I continue to work with them as part of my recovery. In addition, you may want to take a daily supplement of essential fatty acids (EFAs). EFAs help to maintain proper cell membrane functioning, which is necessary for the optimal functioning of the brain's neurotransmitters. Some preliminary studies show a link between low EFA intake and depression.

Vitamin and mineral supplementation

      Many clinicians believe that supplementing your food intake with certain vitamins, minerals and amino acids may also help to balance your brain chemistry.

Vitamins B6 and B3

      The entire vitamin B complex is known to maintain and promote normal mental functioning. Deficiencies of any or all of these vitamins can produce significant symptoms relating to depression, e.g., anxiety, irritability, lethargy, and fatigue. Although the research remains inconsistent, several studies indicate that vitamin B6 supplementation (100 to 300 milligrams per day) helps alleviate depression associated with premenstrual syndrome. Since oral contraceptives can deplete the body of vitamin B6, women taking birth control pills need to supplement their diets with B6 as well. In addition, niacinamide, a form of vitamin B3, has shown some success in alleviating both depression and anxiety.

Folic acid

      A large percentage of depressed people have low levels of the B vitamin folic acid (British Journal of Psychiatry; 117:287-92). Anyone suffering from chronic depression should be evaluated by a nutritionally oriented doctor for a possible folic acid deficiency. Folic acid is usually taken with vitamin B12 and is best supervised by a physician. Large doses of folic acid may contribute to mania. Thus anyone with a bipolar disorder should be evaluated by a qualified health care provider before trying this supplement.

GABA

      GABA is usually classified as an amino acid, although it actually serves as a neurotransmitter (there are more GABA sites in the brain than for other neurotransmitters, such as dopamine or serotonin). GABA basically acts as an inhibitory transmitter, keeping the brain and body from going into "overdrive." Supplementation of GABA seems to be quite effective for anxiety disorders as well as insomnia (especially the type of insomnia where racing thoughts keep the individual from falling asleep). Hence, those suffering from depression exacerbated by anxiety might want to consider taking this supplement.

Kava Extract

      Kava (Piper methysticum) is a member of the pepper family native to the South Pacific. Its tuberous rootstock is used to make a beverage (also called kava) that is believed to make people happy and sociable. Hence, it has been used for hundreds of years in native ceremonies and celebrations. In recent years, a number of Western pharmacologists have prepared and ingested the beverage, reporting similar tranquilizing and uplifting effects. Like St. John's Wort, kava extracts are gaining in popularity in European countries for treating depression and anxiety. The active ingredients in kava are the kavalactones, although several other components seem to be involved as well. In a number of double blind studies, individuals taking kava extract containing 70 percent kavalactones showed improvements in symptoms of anxiety as measured by several standardized psychological tests, including the Hamilton Anxiety Scale. In addition, unlike the benzodiazepines- such as Xanax and Ativan, that are prescribed for anxiety-kava extract neither impairs mental functioning nor promotes sedation. Another problem with benzodiazepines is that the body gradually adapts to their presence, so that it takes more of the drug to produce the same effect. This condition, known as tolerance, does not seem to occur with kavalactones.

      Based on clinical studies, the recommended dosage for taking kava to reduce anxiety is 45 to 70 milligrams of kavalactones three times a day. For sedative effects, a dosage of 180 to 210 milligrams can be taken before bedtime. To put these dosages in perspective, the standard bowl of traditionally prepared kava beverage contains around 250 milligrams of kavalactones, and more than one bowl may be ingested at a sitting. Finally, although no significant side effects have been reported from taking kava at the normal levels, some case reports suggest that kava may interfere with dopamine and worsen Parkinson's disease. Until this issue is resolved, kava should not be used by patients who have this illness

Other Amino Acids

L-tyrosine
      L-tyrosine is an amino acid that serves as a precursor to the neurotransmitters norepinephrine and dopamine, which have been shown to be deficient in many depressives. The supplementation of this amino acid may help the body to form more of these substances during difficult times. Tyrosine may also be helpful in cases where clinical or subclinical thyroid disease is present.

L-phenylalynine and DL-phenylalynine
      Phenylalynine is a precursor to tyrosine, and so exhibits many of the same effects. In addition, the supplementation of phenylalynine can help the body produce a substance called "phenylethylamine," which is also present in chocolate and marijuana and is created by the body in greater amounts when the individual is "in love." Phenylethylamine is supposedly present to a greater degree in the DL form of phenylalynine than the L form; however, the DL form may be more likely to increase blood pressure.

Methionine
      Methionine is an amino acid that has been shown to be helpful for some individuals suffering from depression. Its metabolite, S-Adenosyl-Methionine (SAM), is intimately involved in the biochemistry of neurotransmitters and has been used in some European countries to treat depression. Recently, SAM has also become available in the United States.

Phosphatidylserine (PS)
      PS is one of a class of substances known as phospholipids. The permeability of brain-cell membranes depends on adequate amounts of the substance. Some studies have shown PS to be an effective antidepressant in the elderly. PS may work by suppressing the production of cortisol, a naturally occurring steroid hormone whose levels are elevated in depressed people.

Dehydroepiandrosterone (DHEA)
      DHEA is a naturally occurring androgen produced by the adrenal glands. It is abundantly found in plasma and brain tissue and is the precursor of many hormones produced by the adrenals. DHEA seems to alleviate some of the effects of aging, such as fatigue and muscle weakness. Levels of DHEA may be lower in depressed patients, while supplementation with DHEA may reduce symptoms. However, since DHEA is a hormone, you should not take it without having your doctor check your blood level of the hormone. Also check with your physician before adding it to your diet if you are on an antidepressant, a thyroid medication, insulin, or estrogen.

Alternative Medical Therapies

      In addition to the herbs, vitamins, minerals and amino acids listed above, there exist a number of alternative medical therapies such as homeopathy, Chinese medicine (including acupuncture and herbal medicine), chiropractic, Bach flower remedies (and other flower essences), therapeutic gemstones, etc. Although these modalities lie outside of mainstream medicine, I have seen them alleviate depression in certain individuals, especially those people who are sensitive to subtle energies and for whom traditional medicine has not worked.

   vIf you are interested in trying one or more of these alternative approaches, consult first with the health provider who is treating you for depression. Because of their non-invasive nature, you may be able employ these therapies at the same time that you are receiving standard treatment (medication and/or psychotherapy).