Herbs And Supplements - Complementary And Alternative Treatments For Depression: Depression

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Herbs and supplements

It wasn't long ago that no one had heard of St. John's wort, let alone SAMe. But now, many people are trying supplements for their depression. But before you try any treatment, be sure to ask: Does it work, and is it safe?

St. John's wort

St. John's wort is the most popular herbal treatment for depression. However, it may be useful only when a person's depression is not too severe. An analysis of several trials on St. John's wort and depression published in the Annals of Internal Medicine in 2002 concluded that the herb seems effective for mild to moderate depression, working as well as the older tricyclic antidepressants such as imipramine. A three-year trial sponsored by the National Institutes of Health (NIH) and published in the Journal of the American Medical Association in 2002 found that St. John's wort was not helpful for more serious depression. And results from studies that compare it with newer medications such as SSRIs vary widely.

The exact mechanism by which St. John's wort works isn't known yet, but the herb appears to raise serotonin levels, much like Prozac does. It also seems to boost two other key neurotransmitters, dopamine and norepinephrine. Whether this neurotransmitter triple-header suffices to explain the herb's mood-lifting abilities or whether another mechanism is at work remains less clear.

One appeal of St. John's wort is its apparently mild side effects. While some people report problems such as dry mouth, dizziness, confusion, sensitivity to sunlight, or constipation or other gastrointestinal discomforts, very few find them onerous enough to stop taking it. The proportion of those who do stop using it (roughly 2%) compares favorably with the far larger percentages of people who switch or stop taking conventional antidepressants because of side effects.

It would be a mistake, however, to regard St. John's wort as entirely benign because it's an herbal remedy. St. John's wort can affect the action of quite a few drugs, including the anti-clotting drug warfarin (Coumadin), the AIDS drug indinavir (Crixivan), and birth control pills. There is a possibility, too, of bad interactions with drugs such as MAOIs and SSRIs that boost serotonin. Before taking St. John's wort or any other natural remedy, check with your doctor or a pharmacist about potentially dangerous interactions.

A number of questions about St. John's wort still remain. For example, it's unclear how long its effects last or how high the depression recurrence rate is. Some of these questions may be answered by a four-year, NIH-sponsored study testing St. John's wort against citalopram (Celexa) and a placebo in the treatment of minor depression. But until research provides more data, it may make more sense to turn to one of the many better-tested treatments for depression (see "Medications used for depression and bipolar disorder").

SAMe

Another supplement for depression that has been in the news is S-adenosyl-L-methionine (SAMe), which is made from an amino acid found in the body. A few small studies have found that it's as effective as the older classes of medications for depression, such as tricyclics. Preliminary studies have also found that for people who do not respond fully to an SSRI, the addition of SAMe can improve response. More study is needed, and before taking SAMe in addition to an SSRI, it is safest to talk to your doctor first.

Thus far, reported side effects from SAMe have been few. One important exception is that some individuals with bipolar disorder have become manic after taking SAMe. SAMe's most common side effects are headaches, insomnia, jitteriness, and loose stools.

Another problem with SAMe, as with many supplements, is determining the right dose. Doses used in studies have varied from 400 mg to 1,600 mg per day. It's also expensive — about $1 for a 200-mg tablet — and not covered by health insurance.

SAMe has not been studied nearly as well as standard antidepressants, and more information is needed before doctors can be sure about its effectiveness and proper dose levels. Until more research is done, it's best to opt for an antidepressant that's been better tested.

Exercise

Can a few laps around the block actually solve your emotional problems? Probably not, but a regular exercise program might help. A review of studies stretching back to 1981 concluded that regular exercise can improve mood in people with mild to moderate depression. It also may play a supporting role in treating severe depression.

Another study, published in the Archives of Internal Medicine in 1999, divided 156 men and women with depression into three groups. One group took part in an aerobic exercise program, another took the SSRI sertraline (Zoloft), and a third did both. At the 16-week mark, depression had eased in all three groups. About 60%–70% of the people in all three groups could no longer be classed as having major depression. In fact, group scores on two rating scales of depression were essentially the same. This suggests that for those who need or wish to avoid drugs, exercise might be an acceptable substitute for antidepressants. Keep in mind, though, that the swiftest response occurred in the group taking antidepressants, and that it can be difficult to stay motivated to exercise when you're depressed.

A follow-up to that study found that exercise's effects lasted longer than those of antidepressants. Researchers checked in with 133 of the original patients six months after the first study ended. They found that the people who exercised regularly after completing the study, regardless of which treatment they were on originally, were less likely to relapse into depression.

A study published in 2005 found that walking fast for about 35 minutes a day five times a week or 60 minutes a day three times a week had a significant influence on mild to moderate depression symptoms. Walking fast for only 15 minutes a day five times a week or doing stretching exercises three times a week did not help as much. (These exercise lengths were calculated for someone who weighs about 150 pounds. If you weigh more, longer exercise times apply, while the opposite is true if you weigh less than 150 pounds.)

How does exercise relieve depression? For many years, experts have known that exercise enhances the action of endorphins, chemicals that circulate throughout the body. Endorphins improve natural immunity and reduce the perception of pain. They may also serve to improve mood. Another theory is that exercise stimulates the neurotransmitter norepinephrine, which may directly improve mood.

Besides lifting your mood, regular exercise offers other health benefits, such as lowering blood pressure, protecting against heart disease and cancer, and boosting self-esteem. How often or intensely you need to exercise to alleviate depression is not clear, but for general health, experts advise getting half an hour to an hour of moderate exercise, such as brisk walking, on all or most days of the week.

Last updated:	January 23, 2007