DescriptionSt. John's Wort (Hypericum perforatum)DepressionDepression, characterized by unhappy feelings
of hopelessness, can be a response to stressful events, hormonal imbalances, biochemical
abnormalities, or other causes. Mild depression that passes quickly may not require any
diagnosis or treatment. However, when depression becomes recurrent, constant, or severe, it
should be diagnosed by a licensed counselor, psychologist, or psychiatrist. Diagnosis may be
crucial to determining appropriate treatment. For example, depression caused by low thyroid
function can be successfully treated with prescription thyroid medication. Suicidal depression
often requires prescription antidepressants. Persistent mild-to-moderate depression triggered
by stressful events is often best treated with counseling and not necessarily with
medications.When depression is not a function of external events, it is called endogenous.
Endogenous depression can be due to biochemical abnormalities. Lifestyle changes and herbs may
be used with people whose depression results from a variety of causes, but dietary and nutrient
interventions are usually best geared to endogenous depression.Dietary changes that may be
helpful: Although some research has produced mixed results,1 several double blind studies have
shown that food allergies can trigger mental symptoms, including depression.2 3 Individuals
with depression who do not respond to other natural or conventional approaches should consult a
nutritionally oriented doctor to diagnose possible food sensitivities and avoid offending
foods.Restricting sugar and caffeine in people with depression has been reported to elevate
mood in preliminary research.4 How much of this effect resulted from sugar and how much from
caffeine remains unknown. Researchers have reported that psychiatric patients who are heavy
coffee drinkers are more likely to be depressed than other such patients.5 However, it remains
unclear whether caffeine caused depression or whether depressed people were more likely to want
the ?lift? associated with drinking a cup of coffee. In fact, ?improvement in mood? is
considered an effect of long-term coffee consumption by some researchers, a concept supported
by the fact that people who drink coffee have been reported to have a 58-66% decreased risk of
committing suicide compared with non-coffee drinkers.6 Nonetheless, a symptom of caffeine
addiction can be depression.7 Thus, consumption of caffeine (mostly from coffee) has
paradoxically been linked with both improvement in mood and depression, by different
researchers. People with depression may want to avoid caffeine as well as sugar for one week to
see how it affects their mood.Lifestyle changes that may be helpful: Exercise increases the
body?s production of endorphins?chemical substances that can relieve depression. Scientific
research shows that routine exercise can positively affect mood and help with depression.8 As
little as three hours per week of aerobic exercises can profoundly reduce the level of
depression.9Nutritional supplements and other natural therapies that may be helpful: Oral
contraceptives can deplete the body of vitamin B6, a nutrient needed for maintenance of normal
mental functioning. Double blind research shows that women who are depressed and who have
become depleted of vitamin B6 while taking oral contraceptives typically respond to vitamin B6
supplementation.10 In one trial, 20 mg of vitamin B6 were taken twice per day. Some evidence
suggests that people who are depressed?even when not taking the oral contraceptive?are still
more likely to be B6 deficient than people who are not depressed.11Several studies also
indicate that vitamin B6 supplementation helps alleviate depression associated with
premenstrual syndrome12 (PMS), although the research remains inconsistent.13 Many nutritionally
oriented doctors suggest that women who have depression associated with PMS take 100?300 mg of
vitamin B6 per day?a level of intake that requires supervision by a nutritionally oriented
doctor.Iron deficiency is known to affect mood and can exacerbate depression, but it can be
diagnosed and treated by any nutritionally oriented doctor. While iron deficiency is easy to
fix with iron supplements, people who have not been diagnosed with iron deficiency should not
supplement iron.Deficiency of vitamin B12 can create disturbances in mood that respond to B12
supplementation.14 Depression caused by vitamin B12 deficiency can occur in the absence of
anemia.15 Diagnosis of deficiency requires a doctor knowledgeable in the field of
nutrition.Mood has been reported to sometimes improve with high amounts of vitamin B12 (given
by injection) even in the absence of a B12 deficiency.16 Supplying the body with high amounts
of vitamin B12 can only be done by injection. However, in the case of overcoming a diagnosed
B12 deficiency, following an initial injection by oral maintenance supplementation (1,000
micrograms per day) is possible even when the cause of the deficiency is pernicious anemia.
(See the Vitamin B12 section above for more information.)A deficiency of the B vitamin folic
acid can also disturb mood. A large percentage of depressed people have low folic acid
levels.17 Folic acid supplements appear to improve the effects of lithium in treating
manic-depressives.18 Depressed alcoholics report feeling better with large amounts of a
modified form of folic acid.19 Anyone suffering from chronic depression should be evaluated for
possible folic acid deficiency by a nutritionally oriented doctor. Those with abnormally low
levels of folic acid are sometimes given short-term, high amounts of folic acid (10,000 mcg per
day).A deficiency of other B vitamins not discussed above (including B1, B2, B3, pantothenic
acid, and biotin) can also lead to depression. However, the level of deficiency of these
nutrients needed to induce depression is rarely found in Western societies.Omega-3 oils found
in fish, particularly DHA, are needed for normal functioning of the nervous system. Depressed
people have been reported to have lower DHA levels than people who are not depressed.20 Low
levels of the other omega-3 oil from fish, EPA, have correlated with increased severity of
depression.21 However, researchers have yet to investigate whether omega-3 fish oil supplements
help people with depression.The amino acid tyrosine can convert into norepinephrine?a
neurotransmitter that affects mood. Women taking oral contraceptives have lower levels of
tyrosine, and some researchers think this might be related to depression caused by the Pill.22
Tyrosine metabolism may be abnormal in other depressed people as well,23 and preliminary
research suggests supplementation might help.24 25 Several nutritionally oriented doctors
recommend a twelve-week trial of tyrosine supplementation for people who are depressed.
Published research has used a very high amount?100 mg per 2.2 pounds of body weight (or about 7
grams per day for an average adult). It remains unclear whether such high levels are necessary
for optimal effect.L-Phenylalanine is another amino acid that converts to mood-affecting
substances (including phenylethylamine). Preliminary research reported that L-phenylalanine
improved mood in most depressed people studied.26 DLPA is a mixture of the essential amino acid
L-phenylalanine and its synthetic mirror image, D-phenylalanine. DLPA (or the D- or L-form
alone) reduced depression in thirty-one of forty people in an uncontrolled study.27 Some
doctors of natural medicine suggest a one-month trial with 3?4 grams per day of phenylalanine
for people with depression, although some researchers have found that even very low
amounts?75?200 mg per day?were helpful in preliminary studies.28 In one double blind trial,
depressed people given 150?200 mg of DLPA experienced results comparable to that of an
antidepressant drug.29Phosphatidylserine (PS), a natural substance derived from the amino acid
serine, affects neurotransmitter levels in the brain that affect mood. In a controlled trial,
older women given 300 mg of PS had significantly less depression compared with placebo.30 After
forty-five days, the level of depression in the PS group was more than 60% lower than the level
achieved with placebo.Levels of the hormone dehydroepiandrosterone (DHEA) may be lower in
depressed people. Supplementation with DHEA improved depression in an uncontrolled study with
only six subjects.31 A double blind trial reported a significant reduction in major depression
in six weeks using a maximum of 90 mg per day of DHEA.32 In that trial, no people had
significant improvement with placebo, but five of eleven people given DHEA had a 50% or greater
decrease in symptoms. Depressed people considering taking DHEA should consult a nutritionally
oriented doctor. In addition, experts have concerns about the safe use of DHEA, particularly
because long-term safety data do not exist. See the DHEA article for more information about the
safety concerns.Preliminary evidence indicates that individuals with depression may have lower
levels of inositol; however, the clinical application of this remains to be determined.33An
isolated preliminary trial suggests that the supplement NADH may help people with depression.34
Controlled trials are needed before any conclusions can be drawn.S-adenosyl methionine (SAMe)
is a substance synthesized in the body that has recently been made available as a supplement.
SAMe appears to raise levels of dopamine, an important neurotransmitter in mood regulation, and
higher SAMe levels in the brain are associated with successful drug treatment of depression.
Oral SAMe has been demonstrated to be an effective treatment for depression in most,35 36 37
but not all,38 controlled studies. While it does not seem to be as powerful as full doses of
antidepressant medications39 or St. John?s wort, SAMe?s effects are felt more rapidly, often
within one week.40Disruptions in emotional well-being, including depression, have been linked
to serotonin imbalances in the brain.41 Supplementation with 5-HTP may increase serotonin
synthesis, and thus researchers are studying the possibility that 5-HTP might help people with
depression. Some4243 trials using 5-HTP with people suffering from depression have shown sign
of efficacy.44 45 46 Depressed people interested in considering this hormone precursor should
consult a nutritionally oriented doctor.Are there any side effects or interactions? Refer to
the individual supplement for information about any side effects or interactions.Herbs that may
be helpful: St. John?s wort extracts are among the leading medicines used in Germany by medical
doctors for the treatment of mild to moderate depression. Using St. John?s wort extract can
significantly relieve the symptoms of depression. People taking St. John?s wort show an
improvement in mood and ability to carry out their daily routine. Symptoms such as sadness,
hopelessness, worthlessness, exhaustion, and poor sleep also decrease.47 48The St. John?s wort
extract LI 160 has been compared to the prescription antidepressants imipramine,49
amitriptyline,50 and maprotiline.51 The improvement in symptoms of mild to moderate depression
was similar with notably fewer side effects in people taking St. John?s wort. It is important
to note, however, that the above studies compared 900 mg per day of St. John?s wort extract
with only 75 mg per day of the prescription antidepressants. Healthcare professionals consider
this a very low amount.A more recent study compared a higher dose of the St. John?s wort
extract LI 160 (1,800 mg per day) with a higher dose of imipramine (150 mg per day) in more
severely depressed persons.52 Again, the improvement was virtually the same for both groups
with far fewer side effects for the St. John?s wort group. While this may point to St. John?s
wort as a possible treatment for more severe cases of depression, this treatment should only be
pursued under the guidance of a healthcare professional.In the German Commission E monograph,
the amount of St. John?s wort taken is typically based on hypericin concentration in the
extract, which should be approximately 1 mg per day.53 For example, an extract standardized to
contain 0.2% hypericin would require a daily intake of 500 mg (usually given in two divided
dosages). Many European studies use higher intakes of 900 mg daily and this has become the
accepted daily dosage in modern herbal medicine. Recent research suggests, however, that
hypericin is not the antidepressant compound in St. John?s wort, and attention is starting to
shift to the compound known as hyperforin.54 As an antidepressant, St. John?s wort should be
monitored for four to six weeks to check effectiveness. If possible, St. John?s wort should be
taken near mealtime.Ginkgo is supportive in the alleviation of depression and has been shown in
one double blind study to be helpful for depressed elderly people not responding to
antidepressant drugs.55 Damiana also has a tradition of being used to stimulate people with
depression. Yohimbine (the active component of the herb yohimbe) inhibits monoamine oxidase
(MAO) and therefore may be beneficial in depressive disorders. However, clinical research has
not been conducted for its use in treating depression.Are there any side effects or
interactions? Refer to the individual herb for information about any side effects or
interactions.Checklist for DepressionRankingNutritional SupplementsHerbsPrimary Folic acid (for
folate deficiency)Iron (for iron deficiency)Vitamin B6 (with oral contraceptives)Vitamin B12
(for B12 deficiency)St. John?s WortSecondary 5-HTPPhenylalanine/DLPASAMeTyrosineVitamin B6 (for
premenstrual syndrome)Ginkgo biloba (for elderly people)Other Fish oil
(EPA/DHA)InositolNADHPhosphatidylserineGinkgo bilobaDamianaYohimbeSee also: Homeopathic
Remedies for Depression at http://www.myvaluenutrition.cominformation about the effects of a
particular supplement or herb on a particular condition has been qualified in terms of the
methodology or source of supporting data (for example: clinical, double blind, meta-analysis,
or traditional use). For the convenience of the reader, the information in the table listing
the supplements for particular conditions is also categorized. The criteria for the
categorizations are: ?Primary? indicates there are reliable and relatively consistent
scientific data showing a health benefit. ?Secondary? indicates there are conflicting,
insufficient, or only preliminary studies suggesting a health benefit or that the health
benefit is minimal. ?Other? indicates that an herb is primarily supported by traditional use or
that the herb or supplement has little scientific support and/or minimal proven health
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