Move over Prozac
. . .
and make room for
the NATURAL competition
by
Syd Baumel
For
a moment back there in the early nineties, it seemed as if the magic
bullet for depression had finally arrived. Materializing in the form of
a bicolored capsule named Prozac, it was for many thousands of people an
instant success, transforming their lives with few, if any, significant
side effects. Even when Prozac fell short, one or another of its SSRI (selective
serotonin reuptake inhibitor) clones -- drugs like Zoloft or Paxil -- often
worked in its stead.
It was easy to think depression
was finally a problem solved -- case closed.
But just as prior generations
of antidepressants had failed to offer long-term satisfaction to more than
a modest percentage of users, so too would the Prozac generation leave
many depressives unrelieved -- or put off by unacceptable side effects:
weight gain, sexual dysfunction, emotional numbness. . .
And so the search for antidepressant
drugs continues. Yet right under our noses many safe, viable alternatives
and adjuncts await our attention. Some, like the herb St. John's wort,
have achieved glittering stardom in their own right. But many more are
no less promising.
There is more to treating
depression than just riding the antidepressant drug merry-go-round. If
you want to get the best of what modern healthcare -- both mainstream and
complementary -- really has to offer, here are ten of the most important
things you can do:
Get a good check-up.
Even Sigmund Freud warned that "the diagnosis of depression must include
the search for other causes, as any illness can cause depression." Yet,
too often doctors make a beeline for the prescription pad, despite abundant
evidence that a thorough medical examination can uncover a causative physical
illness in up to one half of depressed patients.
In one remarkable study,
one hundred severely mentally ill patients were intercepted on route to
the mental hospital by researchers from the Texas University Medical Center.
Nearly half -- including 13 of the 30 depressed patients -- were found
to have a causative physical illness. With treatment, "twenty-eight of
these 46 patients," the researchers reported in The American Journal
of Psychiatry, "evidenced dramatic and complete clearing of their psychiatric
symptoms." The rest improved.
Unfortunately, even a conventionally
thorough medical examination can leave important stones unturned. Since
1980, studies
have suggested that about 10% of depressions, mostly in women, are caused
primarily by subclinical hypothyroidism, a subtle failure of the thyroid
gland. Still, doctors seldom screen depressed patients for anything other
than overt clinical or mild hypothyroidism. They fail to order the TRH
stimulation test, which is the key to detecting the subclinical variety;
nor do they test for antithyroid antibodies, which also hint strongly at
the condition's presence. When subclinical hypothyroidism is diagnosed,
a simple prescription for thyroid hormones can mean the difference between
years of chronic fatigue and depression and a new lease on life.
Books
on hypothyroidism at Amazon.com
Books
on depression and physical illness at Amazon.com
An
exceptional book devoted largely to subclinical hypothyroidism and other
hidden medical causes of depression.
Take a good look at your
diet. What you eat -- or don't eat -- could have a lot to do with why
you're depressed. A pattern is emerging from research which suggests that
the same dietary indiscretions -- too much sodium and saturated fat, not
enough whole, fresh plant foods and unrefined essential fatty acids --
that promote heart disease, cancer, and other "diseases of civilization"
also promote the mental diseases of civilization, including depression.
Moreover, many nutritionally-oriented
practitioners believe that allergies or intolerances to commonly eaten
foods also are a common cause of depression. These allergies typically
have an addictive quality: the foods a person eats compulsively are the
most likely offenders.
Thus, it's well-known that
many depressives are "carbohydrate cravers." Compulsive snacking or bingeing
on sweet or starchy foods makes them feel better -- but only for the moment.
For many years, clinicians who have seen these symptoms as a sign of deranged
blood sugar metabolism or reactive hypoglycemia have treated such
patients by all but banning refined carbohydrates from their diets. These
practitioners report that after an inevitable withdrawal period patients
typically go on to enjoy a sustained improvement in health and well-being.
Researchers at Texas A & M University and other centers have confirmed
this in several
small controlled studies. And other
double-blind studies have tended to support the broader claim that
"brain allergies" to many commonly eaten foods -- wheat,
milk, corn, beef, eggs... -- are also a trigger for many depressives'
moodswings.
On the other side of the
dietary coin are deficiencies of those nutrients that help create that
all-important chemical balance in the brain. Many studies have found such
deficiencies to be unusually common among depressed patients. Folic
acid, for instance, which is a B vitamin that sparks the synthesis
of several important mood-regulating neurotransmitters, typically is low
in 30-40% of depressives. A wholesome, balanced diet can go a long way
toward correcting these deficiencies, but it may not always go far enough.
Books
on depression and diet at Amazon.com
Books
on nutritional aspects of depression at Amazon.com
Books
on depression and allergy at Amazon.com
Try antidepressant supplements.
Antidepressant drugs work by boosting the activity of certain brain chemicals
that tend to be "depressed" when we're depressed. Could supplements of
the nutrients these chemicals are made of or with also work? The answer
would seem to be yes. There is considerable
evidence that many depressives do find relief with supplements of such
neurochemical boosting nutrients as phenylalanine, tyrosine, tryptophan,
methionine, s-adenosylmethionine (SAM-e), acetylcarnitine, vitamins B1,
B3 (niacin), B6, and B12, folic acid, vitamin C, gamma- and alpha-linolenic
acid, calcium, magnesium, lithium, and zinc. For example, clinical studies
of both DL-phenylalanine
(DLPA) and L-phenylalanine (LPA) for
depression have been almost uniformly positive, as have a smaller number
of trials of tyrosine. Both of these amino acids are converted in the brain
to norepinephrine, a neurotransmitter that's called upon (and used up)
a lot when we're under stress and which also appears to push the buttons
in our brains' "pleasure centers." LPA and especially DLPA are also converted
into phenylethylamine, a neurochemical that depressives often lack and
which has been likened to the brain's natural amphetamine or "speed." DLPA
also slows down the breakdown of the brain's pain-blunting endorphins.
Take a good look at
your environment. The myriad of "space age" chemicals in our homes
and workplaces includes many heavy metals, petrochemicals, pesticides and
other toxicants that are known to target the nervous system. At the National
Institute for Occupational Safety and Health, Dr.
E. L. Baker and his associates point out that when exposure is relatively
mild but chronic, "mild mood disorders predominate as the patient's chief
complaint." And such "behavioral toxicity" may often occur even in officially
safe workplaces, according to studies of "painter's syndrome" from the
Centers for Disease Control and elsewhere.
The pharmacy is another
common cause of toxic depression. Roughly two hundred drugs have been implicated,
including many of the most popular ones: beta-blockers, major and minor
tranquilizers, corticosteroids, birth control pills, not to mention alcohol
and most other "recreational drugs." Even some nutritional supplements
can, in large doses, promote depression: niacinamide, choline/lecithin,
and calcium, among others.
A less obvious threat are
the magnetic fields near high voltage power lines and many electrical appliances.
Implicated by some studies as a cause of cancer, chronic overexposure has
also been linked epidemiologically to an increase in depression
and suicide.
Try alternative medicine.
Traditional and alternative medicine are a source of many potentially helpful
treatments for depression. Acupuncture, for example, is a staple in the
treatment of depression in China and in many acupuncture clinics in the
West. Studies
have shown that needling certain acupuncture points can trigger the release
of comfort-inducing endorphins and mood-regulating neurotransmitters. More
to the "point" are clinical trials from Russia and China. In one controlled
study from Beijing Medical University, daily electroacupuncture was
extremely effective for most of the 47 severely depressed inpatients --
and without side effects.
Many herbs are reputed to
be natural antidepressants. One in particular, St. John's Wort, has come
in for extensive study. Research suggests it has a range of psychopharmacological
effects characteristic both of major antidepressant drugs, like Prozac,
and minor tranquilizers, like Valium. More compelling are the controlled
clinical trials. There have been dozens, mostly from Germany, and they
have quite consistently found a standardized extract of the herb (0.03%
hypericin, usually 300 mg, three times a day) to be significantly superior
to placebo and just as effective as antidepressant drugs for mild to moderate
(and possibly severe)
depression. Side effects have been almost undetectable. A seminal 1996
review in The British Medical Journal hailed St. John's Wort
as "a promising treatment for depression." In Germany, prescriptions for
it outnumber Prozac 25 to 1.
Relax or meditate.
Depression is seldom, if ever, just a chemical imbalance: it is also a
collapse or withdrawal of the personality in the face of subjectively overwhelming
stress. And being depressed is very stressful in its own right. The opposite
of being stressed out is being relaxed; and there are numerous techniques
that can help you get there and perhaps take the edge off your depression
in the process. These techniques include everything from relaxing herbs
and scents to relaxing music,
suggestions,
and imagery.
Probably the largest body
of evidence for relaxation's antidepressant effect comes from research
on meditation. Studies suggest that meditation
may have the most to offer for people who are mildly to moderately depressed
and distressed (worried, anxious) and that it may be of limited or no value
for those who are severely depressed. Most of these studies have utilized
transcendental
meditation, which involves closing your eyes and allowing a holy
Sanskrit word -- a mantram -- to repeat in your mind for 20 minutes
twice a day. But similar, nonproprietary mantra techniques as taught in
many self-help books have also
been found useful. And at the University of Massachusetts Medical Center,
controlled trials by psychologist Jon Kabat-Zinn have demonstrated the
power of yet another major meditative technique -- mindfulness
meditation -- to help people rise above pain, depression, and anxiety.
Get up off the couch, potato.
So massive is the evidence that regular exercise promotes mental health
and well-being that major medical authorities and institutes such as the
National Institute of Mental Health have lined up to endorse it. Of at
least a dozen controlled clinical trials, most have found exercise to be
as effective as any other therapy for mildly to moderately depressed subjects.
And in a few studies, exercise has even proven its mettle as a primary
treatment or adjunct for severely depressed patients. Most of these
studies have employed aerobic exercise (typically a walk/jog routine,
20-30 minutes three or four times a week), but a few suggest that weightlifting
and other nonaerobic practices may be just as effective.
Get a handle on your
depressive thoughts and attitudes. Negative thinking is a hallmark
of depression. But while it may seem to have a life of its own, to be impervious
to reason, apparently it's not. Psychiatrist Aaron Beck and the many clinicians
who have followed in his path have demonstrated in controlled
study after study that a well-reasoned and persistent full-frontal
attack known as cognitive therapy may even be more effective, in
the long run, than drugs for mild to moderate depression. And it can even
penetrate the gloom of some of the most severe, "endogenous" depressions.
Cognitive therapists teach
patients to become more conscious of the negative thoughts and attitudes
that feed their depressions and to systematically challenge and refute
(or at least mitigate) them. Usually in a series of weekly one-hour sessions,
they combine this with advice on how to gradually increase the patient's
level of pleasant or rewarding activities, because this is one of the most
potent of all behavioral antidepressants. Widely endorsed by authorities,
cognitive therapy is, nevertheless, very seldom prescribed by doctors.
Books
on cognitive therapy at Amazon.com
Express yourself. We
humans have instincts for dealing with our pain and depression, and by
far one of the most natural ones is to express ourselves. Whether by talking
to a sympathetic friend or counsellor, sharing in a support group, or channeling
our innermost feelings into works of art, we can lighten our load and get
"one up" on our depressing problems.
Psychologist James Pennebaker
has documented the healing power of self-expression
in a series of studies. He has shown that spending just a few minutes a
day "confessing" your most troubling feelings and experiences in a private
diary can have impressive long-term benefits on mental and physical
health. And he has also shown that chronic secrecy, even if only from yourself,
may do just the opposite.
Get Wise to the Alternatives.
It's impossible in a short article to do more than introduce the range
of alternatives and adjuncts to antidepressant drugs. I've gone considerably
further in my books Dealing With Depression
Naturally, Natural Antidepressants,
and Serotonin. So have a few other
authors. In the 1980s, psychiatrist Priscilla Slagle recommended her favorite
natural and nutritional antidepressants in a book (reissued in 1994) called
The
Way Up From Down. (It's now available from the author as a free
e-book.) More recently, another psychiatrist named Michael Norden published
an excellent volume called Beyond
Prozac which gives readers an inside track not only on most natural
antidepressants, but on antidepressant drugs as well. Another worthwhile
work is Natural
Alternatives to Prozac by naturopath Michael T. Murray. There also
are dozens of books that deal in depth with single therapeutic approaches,
such as David
Burns's popular books on cognitive therapy, and truckloads of books
on popular antidepressant supplements like St.
John's wort, 5-HTP,
and SAM-e.
You can also find some useful resources on the Internet, like Hypericum
& Depression, which is a professionally written book on St.
John's Wort, free to read online, and Camilla Cracchiolo's excellent FAQ
on SJW.
Copyright (c) 1997, 1998,
1999, 2002 by Syd Baumel.
Originally published in Energy
Times, January 1997.
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