Natural Help for Depression
By: Dr.
Andrew Weil
Depression is a widespread problem in our society that
causes a great deal of suffering, and I'm often
approached by patients seeking advice on treating it.
Fortunately, in the case of mild to moderate depression,
I've found that natural approaches can be very successful
in keeping symptoms at bay. And even severely depressed
patients who do require antidepressant drugs can also
benefit from natural approaches. Depression is far more
common than many people think. One in five women and one
in 10 men can expect to suffer an episode of clinical
depression at some point in their lives, and the
likelihood of a repeat or multiple episodes is about 50
percent. Depression cuts across the life span: An
estimated 15 percent of people over age 65 have some
symptoms of depression, and teen suicide rates have
tripled since the 1950s. (See the boxes below for more on
elder depression and teen depression). Besides its mental
toll, depression can have other serious health
consequences: Recent research links chronic depression to
an increased incidence of asthma, cancer, diabetes, and
heart disease.
More than the Blues Depression is more than the blues,
and you don't simply "snap out of it." A
diagnosis of clinical depression (either mild, moderate,
or severe) requires a depressed mood or loss of interest
in ordinary activities for at least two weeks, plus four
or more of the following symptoms: a change in appetite
or weight, inability to sleep or oversleeping,
restlessness or feeling "slowed down," reduced
energy, difficulty in concentrating or making decisions,
feelings of guilt or worthlessness, and recurrent
thoughts of death or suicide. The symptoms must also be
severe enough to interfere with normal functioning. (Note:
October 7 is National Depression Screening Day. To locate
a site near you offering free, anonymous screenings for
depression and manic-depression, call 800-573-4433.) Some
people think of depression as a personal weakness or
character flaw, but in fact the medical community regards
it as an illness. Some depressive episodes occur suddenly
for no apparent reason, while others are triggered by a
stressful event such as loss of a job or death of a close
relative. One type of depression, called seasonal
affective disorder (SAD), strikes during the fall and
winter, and is often treated successfully with light
therapy. Depression can also be caused or aggravated by
numerous physical ailments (including thyroid disease,
diabetes, heart disease, and cancer); certain medications
(antihypertensives, corticosteroids, and oral
contraceptives); and abuse of alcohol or other
recreational drugs. People with a family history of
depression are also more prone to the disorder.
Psychiatrists regard depression as the result of
disordered brain biochemistry, such as low levels of the
neurotransmitter serotonin. Consequently, they treat
depression largely by prescribing drugs, especially a
newer class of antidepressants called selective serotonin
reuptake inhibitors (SSRIs): The best-known examples are
Prozac, Zoloft, and Paxil. However, it's also possible
that disordered moods and thinking may cause disordered
brain biochemistry, so I'm inclined to explore other
treatments as well. Although SSRIs are safer and more
effective than the older antidepressants, they still
cause significant side effects, including insomnia,
nervousness, nausea, diarrhea, headaches, and sexual
dysfunction. Also, people who take Prozac and its
relatives often say they simply feel all emotions less
intensely. While antidepressant drugs are usually
necessary in cases of severe depression, I worry about
what I see as the overprescribing of these drugs which
can cause emotional flatness. It is my belief that one
cannot comes to terms with depression by disowning it or
suppressing it. The way to emotional freedom is to own
your depressions, and learn to transform them into more-useful
states through meditation, psychotherapy, or other
reflective practices.
Easing Depression Naturally If you have only a few
symptoms of depression and they aren't interfering with
your normal functioning, I believe it's safe to
experiment with natural approaches on your own. However,
if you suspect you may have clinical depression, I
encourage you to discuss your concerns openly with your
doctor, who should make sure that your symptoms aren't
due to an underlying medical problem, and then refer you
to a psychiatric professional if necessary. For people
who are diagnosed with mild to moderate clinical
depression, I think it's worth trying the natural
approaches below (and having you doctor track your
progress) before turning to antidepressant drugs. If
you're severely depressed and require antidepressant
drugs, I'd recommend adding the following lifestyle
measures to any antidepressant regimen, as well as
supplementing with B-complex. Finally, I suggest that
anyone with depression (no matter what the severity)
consider some form of psychotherapy to explore underlying
emotional issues.
Lifestyle measures: Get moving. I've long recommended
regular physical activity as a powerful natural
antidepressant. So I was pleased to see a recent review
of published studies (Professional Psychology: Research
and Practice, June 1999) that concluded "regular
exercise is a viable, cost-effective but underused
treatment for mild to moderate depression" and may
be useful in the comprehensive treatment of severe
depression. The review found that nonaerobic forms of
exercise such as strength training were just as effective
in treating depression as aerobic forms such as walking
and running. Exercise may alleviate depression for any
number of reasons: by releasing "feel-good"
chemicals called endorphins, increasing levels of the
neurotransmitter serotonin, offering distraction from
negative thoughts, increasing resistance to stress, and
enhancing self-esteem. Whatever the mechanism, I strongly
encourage people with depression to exercise regularly:
My standard prescription--a brisk, 45-minutes walk at
least five days a week--easily fills the bill. Practice
relaxation. Regular use of relaxation techniques such as
meditation, breathing exercises, and yoga can help
promote emotional balance. I advise depressed patients to
incorporate some method of relaxation into their daily
routine and to practice it faithfully. If you're
interested in exploring meditation, check out a new book
called The Zen Path through Depression by Philip Martin (HarperSanFrancisco,
1999). As for breathing exercises, you'll find detailed
instructions on my new CD/audiotape set called Breathing:
The Master Key to Self Healing. Eat salmon. The heart-healthy
omega-3 fatty acids found in salmon and other oily cold-water
fish may also improve symptoms of depression and other
psychiatric disorders, according to studies presented at
a National Institutes of Health workshop last September.
Previously, epidemiological studies had shown that
countries where people eat large quantities of fish have
lower rates of depression. Researchers speculate that
omega-3s may ease depression by influencing production of
the neurotransmitter serotonin. While research continues,
I encourage people with depression to eat salmon,
sardines, mackerel, or herring several times a week.
Alternatively, you can get a good ration of omega-3s by
sprinkling a couple of tablespoons of ground flaxseed on
your cereal, soup, or salad every day. Another option is
to snack on toasted hemp seeds (which, by the way, aren't
psychoactive). You can order hemp seeds from The Ohio
Hempery, (800) BUY-HEMP. Connect. Depression is often
linked to social isolation or a feeling of loneliness.
Fortunately, there are many ways to foster connectedness:
Spend time with friends and acquaintances who make you
feel happier and more alive. Consider doing some
volunteer work. A pet can offer companionship and make
you laugh. You can connect with nature by visiting a park
or another natural setting. There's also benefit in
connecting with a higher power: Numerous studies have
linked religious faith to a reduced incidence of
depression. Avoid depressant drugs. These include
alcohol, sedatives, and antihistamines. Limit caffeine.
Addiction to coffee, caffeinated sodas, and other forms
of caffeine can interfere with normal moods and make
depression worse. And obviously, caffeine can contribute
to insomnia, a common symptom of depression. Don't smoke.
Smokers have a significantly higher risk of depression
than nonsmokers, possibly because of nicotine's mood-altering
effects.
Supplements: In addition to the lifestyle measures above,
I typically recommend that people with mild to moderate
depression take St. John's wort. Alternatively, you might
try a newly popular supplement called SAM-e. St. John's
wort is definitely my first choice, since it's far
cheaper than SAM-e. In addition, anyone with depression--including
those on antidepressant drugs--should be sure to take a B-complex
supplement. St. John's wort. This herb (Hypericum
perforatum) has become hugely popular as an alternative
treatment for depression, and for good reason: A well-publicized
1996 meta-analysis of 23 randomized trials, published in
the British Medical Journal, concluded that St. John's
wort worked as well as standard antidepressants in
treating mild to moderate depression, while causing far
fewer side effects. The recommended dosage of St. John's
wort is 300 mg of a standardized extract, three times a
day with food. While extracts of this herb are usually
standardized for the compound hypericin, recent research
in Germany suggests that another compound, hyperforin,
may be more important as an active ingredient. A St.
John's wort product that I typically recommend, Perika
from Nature's Way, is standardized for both compounds. St.
John's wort takes longer than prescription
antidepressants to reach optimum effectiveness, so give
it a two-month trial to see whether it's helpful. If your
symptoms abate while using this herb, try discontinuing
it after six months of use, but keep following the
lifestyle measures in order to help ward off depression
in the future. A couple of cautions: Because high doses
of St. John's wort may cause photosensitivity, it's
prudent to take precautions against sun exposure while
using this remedy. More importantly, if you're now taking
a prescription antidepressant and want to try St. John's
wort instead, be sure to work with your doctor on making
a gradual transition. SAM-e. Used for many years in
Europe to treat both depression and osteoarthritis, this
natural supplement hit the US market in March to much
fanfare. SAM-e (short for S-adenosyl-methionine) is
produced naturally in the body and plays a role in many
biochemical reactions. Despite studies suggesting that
"Sammy" has antidepressant effects, there's
still question as to whether it's well absorbed by the
body when taken orally: Some of the research studies used
an injectable form. SAM-e is also very expensive, costing
$75 or more per month. If you decide to try this
supplement, use enteric-coated tablets containing the
butanedisulfonate form of SAM-e (which is best absorbed),
and follow package directions. SAM-e is thought to have
few side effects, but it's not recommended for people
with manic-depression, as it may intensify manic episodes.
B-complex. Several B vitamins help protect against
depression. For instance, studies show that about a third
of depressed patients are deficient in folic acid, and
vitamin B-12 deficiency is considered a major cause of
depression among the elderly. Folic acid may also
increase the effectiveness of antidepressant medications.
If you suffer from depression, I urge you to follow my
standard recommendation to take a daily B-100 B-complex
supplement containing 400 mcg of folic acid. (Incidentally,
I've previously recommended a supplement called DLPA for
people with depression, but there is now better evidence
for the supplements discussed above.)
BOXES The Promise of Acupuncture Acupuncture holds
promise for treating mild to moderate depression,
according to several recent studies. For example, a
University of Arizona study of 38 depressed women,
published in Psychological Science last September, found
that 64 percent of the subjects who received a series of
acupuncture treatments specifically designed to ease
depression experienced a full remission of symptoms. To
find an acupuncturist near you, call the National
Certification Commission for Acupuncture and Oriental
Medicine at (703) 548-9004, or the National Acupuncture
and Oriental Medicine Alliance at (253) 851-6896.
A Real Concern for Elders Although common among older
Americans, depression is not a normal part of growing
older. Depression after age 65 is often triggered by an
underlying medical condition, drug interactions, or
another psychosocial problem such as bereavement or
social isolation. Also, depression may go unrecognized
because older people are less likely to talk about
feeling sad and more likely to mention aches and pain,
constipation, and fatigue. Fearful of seeking help, some
older people may turn to alcohol for comfort. If you
suspect that an older relative may suffer from
depression, urge him or her to get a complete physical
checkup. For cases of mild to moderate depression, I'd
suggest trying the natural therapies discussed in the
main article. For severe depression, I'd seek out a
psychiatrist or other mental-health professional who is
experienced in treating older people. To locate a
geriatric psychiatrist near you, call the American
Association for Geriatric Psychiatry at (301) 654-7850.
Recognizing Teen Depression With teenager suicide rates
on the rise, it's important to recognize the signs of
depression in this age group. Depressed teens may exhibit
increased irritability rather than a despondent mood, or
they may complain of physical ailments such as headaches
or stomachaches. Some teenagers reveal their depression
through behavioral problems such as fighting or having
trouble at school. Also, a formerly outgoing teen who is
now quiet and withdrawn may be suffering from depression.
Teenage depression is not just a passing phase: A recent
study in the Journal of the American Medical Association
(May 12, 1999) found that more than 60 percent of
depressed adolescents had another depressive episode in
adulthood. If you suspect your teenager is depressed,
share your concerns with her, and seek out help.
Bio:
** Dr. Andrew
Weil Self Healing Monthly Newsletter **
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