Naturopathic Treatment Strategies for Depression
Depression is the leading cause of disability worldwide. According the World Health Organisation (WHO), depression affects about 350 million people. Untreated depression can lead to suicide, and the WHO estimates that 1 million people worldwide commit suicide every year. Their estimates project that depression will rise to second place in the global burden of disease listing by the year 2020.[i]
The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), delineates the different types of mood episodes and mood disorders. The pedantic details are beyond the scope of this article. I will discuss how naturopathic medicine looks at and treats depression. In general, all subtypes are simply referred to as “depression.”
According to the Centers for Disease Control (CDC) 2005-2006 statistics, more than 1 in 20 Americans 12 years of age and older had current depression. Persons 40-59 years of age had higher rates of depression than any other age group. Persons 12-17, 18-39, and 60 years of age and older had similar rates of depression. Depression was more common in females than in males. Non-Hispanic black persons had higher rates of depression than non-Hispanic white persons. These rates are much the same today.[ii]
A conservative estimate is that at least 50% of the patients in my practice have some type of mood disorder. It may not even be the main reason they come to see me, but it’s on their “problem list.”
Two of the cardinal rules of naturopathic medicine – 1) treat the whole person, and 2) therapeutic order (viz, least invasive/aggressive to most invasive aggressive treatments)-give naturopaths a distinct advantage over our allopathic brethren. Our strategies look at mental, emotional and physical aspects of the person to address their concerns. Although some individuals do in fact have a “chemical imbalance,” very few have a Prozac or Celexa deficiency. Study after study bears this out.
An article titled “Efficacy and Effectiveness of Antidepressants: Current Status of Research” in the journal Psychotherapy & Psychosomatics reviewed four meta-analyses of efficacy trials on antidepressants and the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) trial. Their conclusions: antidepressant studies with favorable outcomes were sixteen times more likely to be published as those with unfavorable ones; there are no significant drug/placebo differences; and the effects of antidepressants diminish more rapidly than those of placebo.[iii]
Research conducted by Dr. Irving Kirsch, who was interviewed on “60 Minutes” a few years ago, also determined that with mild to moderate depression, antidepressants are no more effective than placebo.[iv]
So, do people get better on antidepressants? Yes, but not because of the chemicals that the drugs are altering, except for those with severe depression. The leading theory is that it’s nothing more than the placebo effect enabling the power of the mind to treat the depression.[v] On the other hand, the side effects that many individuals experience on these medications often drive them to see a naturopath. Mayo Clinic reports the following as common side effects: nausea, increased appetite, weight gain, sexual side effects, fatigue, drowsiness, insomnia, dry mouth, blurred vision, constipation, dizziness, agitation, restlessness and anxiety.[vi]
Back to the therapeutic order tenet of the naturopathic approach to treatment, least invasive least aggressive first. Number one, look for causation. Anaemia’s, thyroid disorders, MTHFR polymorphisms, other genetic predispositions, prolonged stress, glucose (blood sugar), adrenal function (DHEA-S), zinc, magnesium, B12 and folate status, vitamin D, just to name a few, should all be addressed according to blood work and clinical picture.[vii],[viii],[ix],[x],[xi] There are many treatment options, but I only have space to mention a few.
First, remove the obstacles to cure. Many times depression can be situational. Work, family, area you live, toxic or poor relationships, negative outlook(s), etc. Some of these cannot be changed, some can. For the ones that cannot, behavioural therapy works beautifully. It can give one better coping strategies and the ability to change one’s outlook and perception of situations. Furthermore, just as behavioural therapy and medication management have better outcomes, than either one alone, so do natural therapies. I always strongly encourage my patients with depression to also be in therapy and find someone that they resonate with in the first few minutes of meeting them. If you don’t like the person you’re working with, treatment won’t work as well.
Exercise:[xii] We know how good it feels to exercise. This releases some of our feel good hormones: dopamine and serotonin (not to mention adrenaline). Furthermore, we will also feel better about how we look, which further bolsters exercises’ antidepressant effects. Even better, if we can get outside and be amongst the great outdoors, get fresh air, further accelerates exercises health benefits. “Earthing” has borne this out.[xiii]
Diet: We know that we should be eating more whole foods, fresh fruits and vegetables, less saturated fats, trans fats and processed foods. Now there’s some good research evidence to show that this is true. A study published in the February issue of Canadian Journal of Psychiatry looked at 97 adults diagnosed with mood disorders. Participants kept 3-day food diaries and food frequency questionnaires. Their Global Assessment of Functioning (GAF), Hamilton Depression Rating Scale and the Young Mania Rating Scale showed improved scores from baseline and furthermore, the vitamins and minerals in participant’s diets were what were associated with these improvements.[xiv] Imagine how you feel when you eat that McDonald’s meal, verses baked salmon with lemon, side of lightly steamed vegetables, brown rice and salad.
Botanical medicine: Many herbs have a long history of traditional use. There are also many that have research trials behind their efficacy. One of the most well-known is Hypericum perforatum or St. John’s Wort. Trials comparing St. John’s Wort to sertraline (Zoloft),[xv] fluoxetine (Prozac),[xvi] fluvoxamine (Luvox),[xvii] and citalopram (Celexa)[xviii] have not only shown the herb to be superior to placebo, but just as effective as these medications, with far fewer side effects. However, long-term use of St. John’s Wort should be monitored because it can cause photosensitivity and interact with many medications.
Nutrients and amino acids: Zinc plays a role in over at least 100 enzymatic reactions in the body. Enzymes are what enable reactions to take place. If zinc is deficient, then the reactions don’t work optimally. Zinc is essential in maintaining and developing neurological networks and communication. One of the leading theories on the relationship between zinc and depression is that zinc is a necessary cofactor for neurotransmitter production and function.[xix]
L-Tryptophan and L-5-hydroxytryptophan (5-HTP)[xx] are amino acids that are precursors to serotonin. These amino acids should only be used under the supervision of a licensed physician. If these amino acids are combined with SSRIs, a condition called serotonin syndrome can result. This can cause irreversible damage in many organ systems or even death.
Omega 3 essential fatty acids: In an eight-week trial of 60 outpatients, 1000 mg EPA was found to be similar to fluoxetine in effects on depression (though EPA and fluoxetine in combination outperformed either alone).[xxi] Omega-3 fats benefited the treatment of childhood depression in a controlled double-blind pilot study.[xxii] Psychological scores were significantly improved after eight weeks among those who were supplemented with 1050 mg EPA/day plus 150 mg DHA versus the placebo.[xxiii]
SAM-e: S-adenosylmethionine is a substance naturally produced in the body. It has been shown to be effective even in major depression.[xxiv] It acts as a methyl donor in pathways that form nucleic acids, proteins, phospholipids, and neurotransmitters. Two major drawbacks of oral supplementation of this substance are poor oral absorption and cost. Furthermore, like tryptophan and 5-HTP, it can cause serotonin syndrome.[xxv]
Biotherapeutic drainage/biological medicine: This system of medicine from Germany, Holland, and France has been around since about the 1920’s. Biotherapeutic drainage utilises combinations of herbs and minerals that are system and organ specific; e.g., central nervous system, endocrine (hormones), cardiovascular, etc. The theory is that the ingredients optimise and correct a particular system’s function. One of my mentors used to tell me, “It is easier to correct physiology than pathology. Correcting the physiology, helps to correct the pathology. I have used biotherapeutic drainage in my practice for 4 years and have seen it work wonders.
Homeopathy: From experience, I consider this to be the most corrective and permanent solution to the mood disorders spectrum. I have literally seen it work “miracles.” The aforementioned treatments, besides drainage, are essentially “green allopathy”(using a natural substance in lieu of a medication). Homeopathy uses natural agents in lieu of pharmaceutical medications. The former can be helpful and effective, but often not permanently.
Patients who may already be on pharmaceutical medications might be worried about potential interactions. These are logical and legitimate concerns. This is where homeopathy can play a significant role in healthcare.
Homeopathy is considered an “energetic” medicine which does not interact with other medications, supplements, or herbs. Much like naturopathy, it takes a person’s physical, mental, and emotional picture and puts the pieces together like a jigsaw puzzle to match them to 1 of about 5,000 remedies – a seemingly daunting task. Although the science and art behind homeopathy are very challenging, a good naturopath can usually find the right remedy in a timely manner.
I have used homeopathy to help many patients not only wean off their medications, but also lift the cloud of depression from their life like never before. Here is just one success story:
During my residency in Seattle, I had a 28-year-old male patient who presented with fatigue, depression, anxiety, anger issues, and low libido (despite the fact that he was married within the last year, loved his wife and was deeply attracted to her).
He described his depression as sometimes feeling like he was living outside his body; he couldn’t think or concentrate; and he had difficulty being motivated. This was compounded by the fact that he and his wife had just moved to Seattle from a sunny location and were having a difficult time adjusting to the long, cold, dark days that Seattle is infamous for. He was also having trouble making friends and finding a job.
I ran the usual labs looking for organic aetiologies: iron deficiency anaemia, b-vitamin induced anaemias, low vitamin D, hypothyroidism, testosterone and low cholesterol. All were normal except for his vitamin D being slightly low. I encouraged him to see a colleague of mine for counseling. I suggested that he try www.meetup.com for a social outlet instead of staying home all day looking for a job in a difficult market. I repleted his vitamin D and put him on a high-quality fish oil supplement. This went on for about 6 weeks with very little improvement.
I decided to give him a homeopathic remedy. Two weeks later, on New Year’s Day, I received an e-mail from him telling me that everything was worse than before! He denied any suicidal or homicidal ideations, but was certainly not doing well. I told him that it was not uncommon to experience what is known in homeopathic theory as a “healing crisis.” (I prefer the term, “healing reaction.”) What it means is that one’s symptoms sometimes get worse before they get better. I asked him to come and see me the next week since I was on vacation.
A few weeks went by with no change. I gave him a different homeopathic remedy. At his follow-up a month later, it was as if a veil had been lifted from his life. He could think and concentrate, and he had regained his passion for photography. He reported that he felt better than he had in many, many years. His relationship with his wife improved. My colleague who was seeing him for counseling said he no longer needed his services. Two more weeks went by and he found a job. Life was good again. I spoke with him about 3 months later and his depression was still resolved.
About the Author
Dr. Todd Born is in private practice with his wife, Dr. Lindsay Jones-Born, at Born Naturopathic Associates, Inc. in Alameda, CA (www.bornnaturopathic.com). He is also Product Manager at Allergy Research Group, LLC and a Thought Leader for UK-based “Clinical Education,” a free peer-to-peer service that offers clinicians a closed forum to ask clinical questions and receive evidence-based responses by experts in their fields. Dr. Born graduated from Bastyr University in Seattle and completed his residency at the Bastyr Center for Natural Health and its thirteen teaching clinics, with rotations at Seattle-area hospitals. He may be reached at firstname.lastname@example.org.
[i] World Health Organization Media Centre. Depression Fact Sheet. October 2012. http://www.who.int/mediacentre/factsheets/fs369/en/index.html. Accessed Feb 6, 2014.
[ii] Pratt LA, Brody DL. NCHS Data Brief. Depression in the United States Household Population, 2005-2006. CDC. http://www.cdc.gov/nchs/data/databriefs/db07.htm. Updated 1/19/2010. Access Feb 6, 2014.
[vi] Mayo Clinic. Antidepressants: Get tips to cope with side effects. July 9, 2013. http://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/ART-20049305. Accessed Feb 6, 2014.
[viii] Patenaude Ciel. Depression? Think Zinc! HPC. 2013 Spring:13(1). http://holisticprimarycare.net/topics/topics-o-z/vitamins-a-supplements/1288-depression-think-zinc.html. Accessed Feb 6, 2014.
[xii] Penninx BW, Rejeski WJ, Pandya J, Miller ME,et al. Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. J Gerontol B Psychol Sci Soc Sci. 2002 Mar;57(2):P124-32.
[xv] Brenner R, Azbel V, Madhusoodanan S, Pawlowska M. Comparison of an extract of hypericum (LI 160) and sertraline in the treatment of depression: a double-blind, randomized pilot study. Clin Ther. 2000;22(4):411-419.
[xvi] Schrader E. Equivalence of St John’s wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mild-moderate depression. Int Clin Psychopharmacol. 2000;15(2):61-68.
[xvii] Rahimi R, Nikfar S, Abdollahi M. Efficacy and tolerability of Hypericum perforatum in major depressive disorder in comparison with selective serotonin reuptake inhibitors: a meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Feb 1;33(1):118-27.
[xviii] Singer A, Schmidt M, Hauke W, Stade K. Duration of response after treatment of mild to moderate depression with Hypericum extract STW 3-VI, citalopram and placebo: a reanalysis of data from a controlled clinical trial. Phytomedicine. 2011 Jun 15;18(8-9):739-42.
[xix] Swardfager W, Herrmann N, McIntyre RS, Mazereeuw G, et al. Potential roles of zinc in the pathophysiology and treatment of major depressive disorder. Neurosci Biobehav Rev. 2013 Jun;37(5):911-29.
[xx] Coppen A, Whybrow PC, Noguera R, et al. The comparative antidepressant value of L-tryptophan and imipramine with and without attempted potentiation by liothyronine. Arch Gen Psychiatr 1972;26:234-41.
[xxi] Jazayeri S, Tehrani-Doost M, Keshavarz SA, Hosseini M, et al. Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder. Aust N Z J Psychiatry. 2008 Mar;42(3):192-8.
[xxiii]Lespérance F, Frasure-Smith N, St-André E, Turecki G, et al. The efficacy of omega-3 supplementation for major depression: a randomized controlled trial. J Clin Psychiatry. 2011 Aug;72(8):1054-62.
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