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home BOOKS BY SYD BAUMEL
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Syd Baumel in conversation
with Steve Lankford and guests
STEVE: Our guest this morning is Syd Baumel. He is the author of Dealing with Depression Naturally. Syd, good morning and welcome to Health Quest. SYD: Good morning. STEVE: This is an important book. Before we get to the book though, could you give us a little bit about your history. Why is it you are interested in depression and the natural approach. How did you come to write this book? SYD: Well, I went through quite a bit of depression when I was a lot younger, and I looked for solutions and tried a great number of approaches and a number of drugs, as well (antidepressant medications). Probably my best results initially came with one or two antidepressant drugs, and that sort of sparked me to look a little more aggressively for natural alternatives. I’ve found one or two things in particular that work very well for me as substitutes for antidepressant medications, so far at least. It has been quite a few years. I have just been interested in natural medicine for many, many years, and that has been one of the focuses of my career as a writer. Writing a book on the natural approach to treating depression is a “natural” subject for me. STEVE: Is this something where you went out and interviewed practitioners who use natural therapies in dealing with depression? SYD: I did the bulk of my research by looking through the medical literature and looking at scientific studies and then also looking at popular books on depression and other subjects that were related to it, with a small amount of correspondence with some experts in the field. STEVE: I noticed that you have some introductions by some people; Abram Hoffer, Melvyn Werbach and Harvey Ross, who certainly have staked out their own place in the study of natural approaches to healing and depression. Can you give us a little oversight as to the scope of depression? It seems like everybody gets depressed and moody, occasionally. To what extent does this book cover the range of depression? SYD: I think it does, because normally when somebody has very mild depression, so-called “normal depression or everyday depression,” they are not normally considered a candidate for medical treatment, because the risks, side effects and the expense of taking an antidepressant medication are considered to outweigh the severity if somebody just has the blues that last no longer than a day or two or something that isn’t disabling. If it is a problem for somebody, if you have enough depression that it’s something you would rather get over, many of the natural approaches are so innocuous that they are very good candidates for treating even the mildest depression and, at the same time, quite a few of them have been used successfully to treat the severest depressions. STEVE: When we talk about severe depression, do we find that the natural approaches in some people eliminate the need for prescription drugs or do they reduce the need? SYD: I think it’s probably both, judging by, I think, to some extent my experience and also by the experience that one gains from reading about other people’s experiences by doctors and other people. There are cases of people with a history of severe depression who have been able to find natural substitutes or natural adjuncts allowing them to be less reliant on medications. STEVE: Do we know what the causes of depression are, or are there a variety of causes? SYD: There is a huge variety of causes. Depression is nonspecific in terms of causes; it’s a nonspecific syndrome, and so many different kinds of things can precipitate a depression. The obvious ones, of course, are the circumstantial things; but there are many physical kinds of illnesses and agents that can promote depression: toxic exposure to things that you don’t normally suspect (things like heavy metals); many drugs can cause or promote depression; illnesses (glandular illnesses, such as hypothyroidism, is an extremely common cause). When somebody is depressed, it’s always a good idea - in fact, I think it’s a necessity - to have a good evaluation, medical examination and work-up and to use your own head, as well, to try to figure out not just what is happening in your life socially and psychologically. Also look at what’s happening in your life in terms of your physical environment and what you're putting into your body and what’s going on in your body that might be causing or contributing to your depression. STEVE: I was making some notes here, and what I have down here is social, toxins, drugs, illnesses. What about chemical imbalances in the brain? Is that a factor? SYD: That’s probably how depression is expressed, and it winds up being an imbalance or deficiency, in all or most cases, of certain chemicals and probably certain neurotransmitters in the brain. I believe, and it seems pretty obvious from all the research, that the kind of change in the brain which is associated with depression can come about not just from physical things, but also from our circumstances, because our brains are very plastic - every state we go through is associated with different physiological changes. In the case of depression, those changes that are associated with it are probably for the most part, or for some people entirely, a reflection of a transient kind of change that is brought on by anything from a vitamin deficiency to a chronic stress on our ability to cope. It overwhelms some of the chemical processes that we normally use to remain healthy in our brains. STEVE: [Regarding] the different causative events that you have described here, are you saying that in many cases or in most cases these trigger the chemical imbalances that are then associated with the depression, and if we can somehow change or have an effect on that chemical imbalance that, in fact, affects the depression. Can we do it that way? SYD: I think that’s the way that antidepressant therapy usually or always works. It was the only thing that I didn’t say that I should have said. There are chemical imbalances that probably also are very common in people who are prone to depression that are always there but are kind of latent and that would probably be mild genetic sorts of quirks that, for example, might mean that a certain enzyme that is responsible for synthesizing an important chemical in the brain is not very effective, but it’s effective enough to allow people who have it to function well under most conditions. But under overwhelming conditions, it’s not up to it. That is why they become depressed sooner than other people do. In terms of treatment, I think that all effective treatments for depression, one way or another, lead to enough changes going on not just in a person’s personality or state but also in a person’s physiology in the brain shifting back to a homeostatic, normal functioning state. STEVE: Let’s get right into your book then. As I have it here in front of me, I see that you have a great deal of information. Where would you like to start? What would you like people to know about depression? Let’s start with that. SYD: I think that the most important thing for people to know is that it is much more treatable, depending on how pessimistic they are, than they think it is. When people are depressed, the depression itself makes a person very pessimistic and skeptical about the possibility of their being helped. Yet, depression is one of the most treatable conditions. There is a very wide range of alternatives and options that people have to get back to normal. There are options for every kind of personality and for every type of person with different kinds of taste. If your depression is not terribly severe, you can find your way back to normality by exercising vigorously every day or two and within a week or two or three the odds are about two out of three that you will find yourself recovering. You can just as likely do it that way as you might be able to do it by medicating, or by taking up some kind of deep relaxation type of technique, or by taking certain herbal supplements (St. John’s Wort for example), or some of the amino acids that are used by the brain to manufacture some of these chemicals that tend to be in short supply when we're depressed, or by getting involved in . . . certain kinds of psychotherapy, like cognitive behavioral psychotherapy, or by taking an antidepressant drug, or some combination of these things. . . .Research suggests . . . that the odds [of responding to] a natural approach are 60 to 70 percent. With a drug, the odds are fairly high that you’ll quit because of side-effects. I shouldn’t say they are too high, but perhaps about 15-30%. If you take a combination of things, the odds are higher; but you do have to be persistent because often people do have to keep looking before they find some treatment or combination of treatments that gives them adequate relief and protection from easy relapse. STEVE: Does it appear that most people will respond better to a combination approach? You mentioned exercise and the herb St. John’s Wort. Is it more likely that if somebody combined meditation with exercise and herbs, they are going to get better results than they are likely to get just using one type of approach? SYD: I think so. Intuitively you would think that would be the case. I have to admit that in research, often you don’t see combinations of more than two things. Often combinations are not significantly better than one effective therapy, to the surprise of everybody. Still, I think that it makes sense to combine things. Natural approaches are more easily and safely combined than multiple drugs, where you are dealing with more concern about unknown interactions, especially if you are combining very different natural kinds of approaches, like taking a herb, improving the quality of your diet, exercising, getting into some kind of counseling, etc. If you combine all those things, none of those things are likely to interact in any kind of adverse way with each other. They are far more likely to work positively together. STEVE: It sounds, then, that people may have to experiment a little bit to find out what factors play a role in their particular case. It seems that what you have done in this book is offer many different options for them to explore. That’s what we will do. We have a listener who would like to talk to you, Syd. Let’s go right to the phones. Good morning, you’re on Health Quest. How can we help you? CALLER #1: I would like to know about a friend of mine. She’s so depressed. She goes to the doctor and he gives her an antidepressant and something for sleeping. She even experiments a little on her own. I mentioned that I thought she should really go to a psychiatrist and get medicine because that’s what I did. She said that her doctor said, “No, she doesn’t need it.” STEVE: Well, I’m not sure. Syd, can you offer this woman any advice. SYD: Well, when you say she should go to a psychiatrist, do you mean for the psychiatrist to counsel her or for him to give her drugs or both? CALLER #1: Well, to see what really is wrong with her. She said this all came on after she was sick with the flu and she has never been a person like that to really get down and now she doesn’t want to be alone and just is frantic. SYD: Her depression came on after she had the flu? CALLER #1: Yes, but she is 85 years old. She has never been a person like that. She could always cope with everything. She never had anything. SYD: Normally, the procedure is that your primary care practitioner, your GP or whatever, will try his or her best to help you. And if it isn’t working out, and you have a problem that could be dealt with by a specialist -- in this case by a psychiatrist or maybe an internist -- she should be referred to the more specialized practitioner. If it isn’t working out for her, then maybe that should be the route for her to go. How long has she been under treatment by the doctor? CALLER #1: She even talks about going to a nursing home. SYD: That’s pretty bad. CALLER #1: That’s what we think. The neighbors are concerned about her. SYD: Someone her age, with those kinds of symptoms, really has to be examined very, very carefully and in great detail because there are a lot of treatable things that can be causing those symptoms. CALLER #1: I know. I was depressed and went to a psychiatrist and went to counseling and that really helped. SYD: Counseling could be a good idea for her. CALLER #1: I would be interested in this alternative, but that is still taking things. SYD: That’s another possibility. CALLER #1: Thank you. SYD: Your welcome. STEVE: It’s often difficult to stand by and watch somebody go through something when you think that there are better alternatives. It would sound to me, in this case, that if her primary care physician isn’t successful in treating her, then it would be appropriate to go to a specialist and possibly to explore some of these alternatives as well. Is that common for people to develop depression after an event like the flu or some other kind of episode? SYD: It’s a recognized symptom or syndrome of depression and/or fatigue coming in association with a major infection, sometimes before the illness becomes obvious, sometimes during it, and sometimes afterwards. That could be the problem. I’m not sure exactly. I don’t think there are any specific treatments for that, other than the type of treatments that are normally used for treating depression in general. STEVE: Is depression more common in any particular age group or gender? SYD: People in that woman’s age group have been thought to be the group that’s most commonly hit by depression, but recently the research has been uncovering a trend for much younger people to be very commonly hit by depression. People in the “baby boomer” generation, people who would now be in their 30’s and 40’s and maybe 50’s. Depression is also very common among teenagers. There are several age groups, several clusters of age groups, that are hit more often by depression (i.e. teenagers, young to middle-aged adults and senior citizens). STEVE: Do all of these groups have the same potential for benefit from a natural approach. SYD: I think so. There is really no evidence one way or the other. I would think that all would be equal candidates. STEVE: All right. Let’s talk about what some of the options are that people have. If you were giving someone some advice who wanted to explore their options with your book, what would be some of the best and most effective starting points for them? What have you found to be the most generally effective kinds of approaches that people can institute for themselves? SYD: I think that getting a good medical examination is one thing that should be done. It may result in something treatable being found. Research suggests that as many as 50% of cases -- but I think that’s probably an exaggeration, maybe as many as 15-25% of people -- if they are examined very carefully, something physical or some medically recognized physical illness may be the cause. STEVE: Like the glandular condition. SYD: Hypothyroidism, which is the most common physical medical cause of depression, will [sometimes] be found and will be treated and will result in recovery or be a critical factor in a person’s recovery. Looking at certain basic things, like your diet for example, will also help. If somebody is depressed and they are eating a really lousy junk food diet, I would strongly suggest that they try to improve that. There is no guarantee that that will cause them to recover from depression, but it’s worth a shot. It’s generally important, so even if it doesn’t help you with your depression, it’s something you should be doing anyway for your general health and also for the long-term prevention of depression. Also, try to be at least moderately physically active. That kind of goes against the grain often when you’re depressed. There is a two-way vicious cycle between depression and many of the things that are potentially capable of treating it, so that, for example, when you’re depressed, you’re more likely to neglect your diet. That, of course, can worsen the depression, and you’re also more likely to become more sedentary, and that can contribute to maintaining your depression to the extent that you can’t motivate yourself [to exercise]. That’s one of the big challenges when you’re depressed -- being motivated to do the kinds of things that could help you. That is one of the reasons why sometimes you have to go directly to taking a pill of some sort. In terms of supplements, I would say that at the moment St. John’s wort seems like perhaps the most effective and user-friendly supplement that’s out there. There are quite a few others, though. Most supplements need to be used with a certain amount of knowledge and caution, because typically they are associated with a potential of certain side effects, with certain cautions or contraindications. You can’t just hand out a prescription to somebody if you’re not sanctioned to do so, as would be the case with me. I can’t just say, “take phenylalanine,” which is an amino acid that is a precursor to one of the neurotransmitters that tends to be low when people are depressed and which has been found to be an effective antidepressant in quite a few clinical trials. In my book, for example, I give pretty well all of the cautions and contraindications for phenylalanine and other natural supplements. Phenylalanine would be one example. STEVE: You give some potency guidelines then as well. This phenylalanine, this is an interesting one, because I’ve heard about this one for depression and I know that, in what I read, there were D-phenylalanine and L-phenylalanine, and there is actually a combination of the two that was the best. Is that your understanding as well? SYD: The two kinds that are probably the most often taken are DL-phenylalanine and L-phenylalanine, and D-phenylalanine is also potentially available, but I don’t think I have ever seen it being sold anywhere, but it has been used in some of the studies. DL-phenylalanine has the same general effect. The DL and L forms are slightly different. The DL form can increase the level of a certain neuromodulator in the brain more readily than the L form can. The DL form might be more effective for some people with depression than the L form would be. Both have been clinically tested in controlled and uncontrolled trials, usually with positive results. Usually they are performing at a level comparable to how antidepressant drugs have performed in other studies, or in some cases in the same studies in which they have been directly compared with these drugs. The DL form would potentially be a little more stimulating, a little more “speed-like.” That also could be an undesirable thing for some people who might be overstimulated by DL. This speaks again to the issue of cautions and people, for example, who have a history of mania or hypomania. People with a bipolar disorder or even people with a family history of bipolar disorder, for them . . . antidepressant drugs have to be used with great caution or not used at all because they’re more likely to trigger an episode of mania or hypomania, which is a milder form of mania. This also applies to some of the [natural] antidepressant substances. The phenylalanines are a case and point. For people like that [bipolars], something like 5-hydroxy-tryptophan [5-HTP] [or tryptophan would be a safer bet]. STEVE: Can somebody who is on medication for depression use these natural substances along with the medications? SYD: It depends on the substance. Unfortunately, not enough is known about the interactions in many cases. Up until the late 1980s, the general feeling was that natural substances are safe and innocuous enough that you shouldn’t have to worry about combining them with drugs. [Then] it was found that tryptophan, when combined with certain antidepressants, can cause a very severe reaction in some people. For that reason, that combination is no longer recommended, and it kind of makes one wonder about the potential for trouble when combining antidepressant drugs with some of the other supplements. For that reason, it’s not something that one can very casually recommend. If you are doing this with somebody watching over you, with a doctor ideally, or if you are very knowledgeable yourself, then I don’t think you have to worry. Also, I think for many supplements you don’t have to worry. You don’t have to worry, for example, if you are taking a multivitamin and mineral supplement. It’s only when you get into using very concentrated doses of any particular nutrient, or even some of the herbs, that there is some cause for concern. Even St. John’s wort, which can be considered in the same category as a major class of antidepressant drugs, could potentially be hazardous to combine with medications like Prozac. It also would potentially be hazardous to take it and to eat too much of certain foods or beverages. And again, there are no official reports of that kind of interaction taking place, but I have come across it recently on the Internet and in Internet newsgroups. A number of people claimed they had reactions when they combined St. John’s wort with eating too much cheese, for example. This [food/herb combination could] cause severe headaches or blood pressure elevations. [NOTE: It now seems pretty certain that these kinds of adverse interactions are only possible -- and even then, apparently rarely -- in St. John's wort products that have not been extracted with methanol or CO2.] STEVE: I think that what we could say in this case, then, is that if you are on medication, you should advise your practitioner that you’re considering using these products. And in either case, you should become informed about them, so that you know what the benefits are as well as what the risks are. That’s what your book covers, Dealing with Depression Naturally. We have the phone lines all lit up. Let’s go to our listeners. Good morning, you’re on with Syd Baumel. Go ahead. CALLER #2: Hi. I’m calling with some questions. In May, it will be a year that I’ve been on an antidepressant, Paxil, and I really want to try to get off of it. I was wondering if you could give me some specific help -- should I take different vitamins, eat different foods, etc.? What should I do to try to get off the drug? Right now, at this time, I am pregnant, and I wanted to also know what he knows about pregnancy and antidepressants. SYD: Pregnancy is one of those conditions that very often there is a cloud of uncertainty hanging over the safety of using pretty well any drug. I think that the SSRIs like Paxil have recently been somewhat exonerated of concerns that they might be dangerous for pregnant women. I’m not sure if that's a complete exoneration. I think there was a study done recently that suggested that they weren’t a threat. CALLER #2: My doctor wants me to stay on it through the pregnancy and through the first year of the baby’s life. SYD: Do you want to quit because you’re concerned about the effect it might have on the fetus? CALLER #2: I don’t want to be on an antidepressant all my life, so I would like to try to get off it. That’s why I want to know before I go off it for a few months, should I be eating a lot of carbohydrates. What is the natural way to do this? SYD: The thing is, there is no one natural way. There are a number of different kinds of things that you could try. If you talk about diet for example, I would say just try to see to it that you are following a good, healthy, balanced diet. One in which there is as little junk food as possible and as much whole food as possible. For example, when she’s taking Paxil -- and this is hard to say, because I don’t know how serious her depression is and how likely it is to recur if she were to stop taking her drug -- but all I can say is that there are a number of things that she could explore. STEVE: I think this might be an appropriate case to refer this person to your book because obviously you’re not going to be able to really give her enough information to make a decision, but your book certainly gives a strong background in what the options are and obviously our recommendation on Health Quest would be to always discuss these options with your physician, especially if you’re pregnant because that is a compounding situation. I think that we could also say that she does have alternatives and that is what she is going to have to explore. I don’t think that you can give her an answer, but we can perhaps guide her that way. Let’s go to a couple of our callers. We just have two callers and a few minutes left. Good morning, you’re on Health Quest. CALLER #3: Hi. I’ve been taking St. John’s wort since last May. I got the prescription for Prozac and I just decided all of a sudden that I wanted to try St. John’s wort for a while, and it really worked. I’m still taking it. I take it three times a day. Before I got mood swings, crying jags and things like that. That really stopped it, except now, in this season -- and I don’t know if it’s the season or not -- but I have been getting a little bit, once in a while, a crying jag, and I have been noticing that I have been getting a little more sleepy after I eat. Would the St. John’s wort be causing that? I would like to still keep taking it because I don’t want to take drugs if I don’t have to. I read a lot. I’ve been reading for 30 years on health, so I know a lot about the St. John’s wort, but I’ve never heard of it making you sleepy until recently. I think it was on Steve’s program that they said that St. John’s wort was also used for a sleep pattern. I don’t know if that’s what is making me sleepy or not, but I still don’t want to stop taking it. Do you think it would make you sleepy? Can I get off the phone and listen? STEVE: Yes you can. That would be fine. Go ahead Syd. SYD: In large clinical studies they have been having a hard time finding any significant difference in side effects between St. John’s wort and placebo, which means it doesn’t seem to have any significant side effects. I have heard, again on the Internet, that at least one person is saying that she felt sleepy often when she was on St. John’s wort. As your caller says, it is used as a bit of a tranquilizer and for sleep disorders as well. When somebody says that they are getting crying jags and feeling sleepy at this time of year, though, I inevitably think to want to ask if they are getting enough sunlight, because many, many people have a pattern of getting low in energy and/or depressed this time of year because of inadequate exposure to bright light. If that is the case, that would be the first thing I would suggest that your caller does. If it turns out that it is the St. John’s Wort that’s making her a bit sleepy, then it may still be worth it to continue taking it to be a bit sleepy or maybe to change when she takes it so that she takes more of it before bedtime and less of it during the day or maybe even to try to balance it with a supplement or herb that has a more activating effect during the day. STEVE: I notice in your book you touch upon those subjects: darkness and light; sleeping cures; sleep therapy, etc. So again, there may be some information in your book that can be helpful as well. We have one more caller and this is going to have to be it, because we are really fast running out of time. Good morning, you’re on Health Quest. Go ahead. CALLER #4: I’d like to ask the doctor about coffee. What, if anything, does coffee have to do with depression? There was a guest that talked about coffee and the ingredients in coffee. SYD: First of all, I’m not a doctor but thanks for saying that anyway. There have been some studies done on coffee and caffeine and mental symptoms. Coffee and caffeine seem to be an example of one of those substances -- and in this case we’re really dealing with a herbal substance, actually -- that has a two-sided or two faced effect. For some people, caffeine is a stimulant and a mood enhancer and general brain enhancer. This is why most people drink coffee, because it makes them a little bit “up” and sharpens their minds. Clearly for some people caffeine can cause anxiety and depression. That may be more of a delayed effect. If it seems to you that coffee is causing depression for you, that may very well be the case. STEVE: I think with that, Syd, we are out of time. We have just run right up to the end of our show. I would like to thank you for joining us on Health Quest. It’s been very informative to me. You’ve done a good job of condensing a great deal of information in this book. One of the things that this book has done is it has taken a complex topic and made it very readable and understandable. I think that is a great credit to the work that you have done. Thank you once again for joining us on Health Quest. SYD: Thank you very much, Steve. STEVE: All right. Good bye, Syd.
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