Depression Home Remedies

The WHO (World Health Organization) has stated that depression (also known as major depressive disorder) is now the leading cause of disability worldwide and the second largest global disease burden next to heart disease. It can negatively impact all aspects of physical health, and it’s so complex that without a comprehensive approach—including medication (only if needed), exercise, therapy, dietary supplements, and other lifestyle changes—the chances that treatment will be successful drop dramatically. 

Many doctors just want to throw some drugs at it. One randomized study from Duke University published in the Archives of Internal Medicine (since renamed JAMA Internal Medicine) more than 15 years ago showed men and women with major depressive disorder (MDD) had a greater chance of remission when they exercised just three times a week for 30 minutes a session (high-intensity walking or jogging) in addition to taking their prescription meds compared to taking medication alone. Overall, the impact of exercise on MDD was just as good as the drug itself over time (together they are synergistic). 

Did you hear about this study? Not many people did, although recent research has confirmed it. In another of my favorite unsung studies, men and women with MDD had a greater chance of responding to conventional prescription drugs for depression— after failing to respond to them initially—when a specific dietary supplement was added (hint: the supplement is ranked number one in this section).

Sometimes we fool ourselves in conventional medicine, just like in alternative medicine, and tell ourselves we have all the answers for patients. The truth is that conventional antidepressants have been lifesavers for many people, but in academic center studies as many as 50 percent of individuals do not see their depression get better with drugs. Other studies point to even higher numbers. This serves as a gentle reminder of the desperate need to continue to be open to all kinds of options for treating this very common, debilitating, and life- threatening condition.

What is Depression?

Major depressive disorder is a remarkably heterogeneous condition; two patients with the same diagnosis can have few if any symptoms in common. It’s often caused by abnormal changes in neurotransmitters in the brain (dopamine, serotonin, and norepinephrine), and it can also be triggered by age, life events, illness, medication, and even seasons.

Symptoms include feelings of sadness or absence of emotion, decreased interest or pleasure in activities, appetite change with weight loss or gain, decreased or increased sleep, fatigue or loss of energy, feelings of guilt or worthlessness, agitation or feelings of moving in slow motion, trouble concentrating, and recurrent thoughts of death or suicide. While doctors usually look for the presence of at least five of these symptoms, a diagnosis can be made based on just one or two. The major issue is that it disrupts your life.

Subtypes of MDD include atypical depression (where sufferers may not have the classic symptoms, and they don’t respond to the classic treatments either), postpartum depression, seasonal affective disorder, melancholic depression, and catatonic depression. Dysthymia, mild depression lasting for at least 2 years, is not considered a type of MDD.

Depression Home Remedies

1. SAM-e (S-adenosylmethionine) 800 to 1,600 milligrams once a day or 400 to 800 milligrams twice a day

SAM-e improves the production and use of several brain neurotransmitters, including dopamine and serotonin. Overall, it appears to work similarly to other anti-depressants, but there are some differences. A review of approximately 50 studies on the treatment of MDD with SAM-e reported significant benefits with this drug over a placebo.

Recent preliminary research funded by the National Institute of Mental Health suggests individuals who haven’t responded to conventional SSRI (selective serotonin reuptake inhibitors) medications can see a significant improvement in depression (primarily MDD) when taking 400 milligrams of SAM-e twice daily for 2 weeks, and then transitioning to 800 milligrams twice daily for 4 weeks with their conventional medications.

There has been a concern in the past that SAM-e raises blood levels of homocysteine (a controversial marker of heart disease), but recent studies haven’t shown this. Your doctor can always follow up with a blood test after you start taking it if you’re concerned.

Rare side effects include stomach upset, diarrhea, dry mouth, headache, mild insomnia, anorexia, sweating, dizziness, nervousness (especially at high dosages), and feelings of anxiety. Be aware that SAM-e might cause a toxic reaction when used with the cough suppressant dextromethorphan, certain antidepressants, or narcotic pain relievers, and it could worsen Parkinson’s symptoms when taken with the drug levodopa.

There are two positive side effects with SAM-e: It doesn’t appear to cause sexual dysfunction, which some other antidepressants commonly do, and it may be one of the best supplements out there for osteoarthritis pain (it works as well as over-the-counter pain relievers, with fewer side effects).

I have recommended this supplement to patients for almost 2 decades with outstanding success. (It’s also being studied specifically for atypical depression.) The primary problem is the price; I’ve seen bottles going for anywhere from $10 to $100, so you have to shop around. Also, always check the expiration date. SAM-e oxidizes quickly and the date marked on the bottle is the date to follow; it’s not one of those pills you can take for a year or two after it expires.

2. St. John’s wort (Hypericum perforatum) 500 to 1,200 milligrams a day in divided doses

St. John’s wort was used in ancient Greece and has been used in Europe for depression since the 1980s. Researchers aren’t sure exactly how it works yet, but it seems to block serotonin uptake in the brain and alter levels of multiple brain neurotransmitters, including dopamine, norepinephrine, and GABA (gamma- aminobutyric acid).

A review of 29 trials with approximately 5,500 patients found that it may work as well as conventional antidepressants and that participants were 50 to 75 percent less likely to drop out compared to those taking a prescription. The most commonly used dosage in clinical trials was 900 milligrams daily, but doses between 500 to 1,200 milligrams (taken in divided amounts two or three times a day) over 4 to 12 weeks have been effective. The active ingredient in St. John’s wort is hypericin, and whatever product you choose should be standardized to contain 0.3 percent hypericin.

Side effects have been low or rare in clinical trials, but they can include insomnia, vivid dreams, anxiety, dizziness, and skin sensitivity. However—and this is a biggie—it has the potential to interact with or reduce the effectiveness of almost half of all available prescription drugs, including birth control pills. And unlike SAM-e, you shouldn’t combine St. John’s wort with prescription antidepressants, such as SSRIs, tricyclic antidepressants, or MAO (monoamine oxidase) inhibitors.

You should also avoid it if you’re taking immunosuppressants, antiretrovirals (anti-HIV drugs), blood thinners (like warfarin), and chemotherapy drugs. Still, it’s worth talking with your doctor about it; St. John’s wort has been inappropriately tagged as the poster child of why supplements cannot be combined with prescription drugs, and this is not entirely fair.

Many alternative medicine experts say St. John’s wort works as well as most

conventional drug options for depression, but that’s not exactly true; many of the positive head-to-head clinical trials with St. John’s wort were with older prescription drugs that are no longer used. Still, many doctors recommend it as a monotherapy (by itself) for depression.

3. 5-HTP (5-hydroxytryptophan) 200 to 300 milligrams a day

An extract from the Griffonia simplicifolia bean or plant of West Africa, 5-HTP (also called L-5-HTP) is an intermediate metabolite in the conversion of L- tryptophan to serotonin. In other words, it helps increase the production of serotonin in the brain. There have been many positive small clinical studies over the past few decades showing reductions of depression-related symptoms in 33 to 66 percent of participants with 5-HTP supplementation.

The dosage usually ranges from 20 to 3,250 milligrams per day, but most of the positive studies that had good safety used 200 to 300 milligrams, with results noticeable in 2 to 4 weeks. Critics would argue that many of the past clinical trials (there have been more than 100 of them) were not adequate enough and that it still has not been proven to be effective or safe, but I disagree. What these critics fail to mention is that even in the few high-quality clinical trials, there were positive results and overall safety was not a serious issue.

You can take 5-HTP with meals, but be aware that higher doses can lead to nightmares and vivid dreams, dizziness, nausea, vomiting, and diarrhea. Most important, don’t combine 5-HTP with any other medications that also impact serotonin levels, such as antidepressants, without talking to your doctor because there is an increased risk for serotonin syndrome (although it hasn’t been an issue in studies so far). This, like SAM-e, is also being studied specifically for atypical depression.

4. Folic acid, B12, and L-methylfolate

Folic acid, B12, and L-methylfolate are showing promise. In some people, these B vitamins play a larger role in the production of brain neurotransmitters, so doing a blood test for them would be helpful. In addition, there are individuals who have abnormal changes in the gene that impacts folate, known as the “MTHFR” gene, and your doctor can test for this to determine if you have an increased need for folate or B12. A form of folate, L-methylfolate at 15

milligrams a day has recently shown some real promise in initial clinical trials of people with MDD who were not responding or partially responding to selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, when added to their conventional treatments.

5. Inositol

Inositol (a vitamin-like substance present in all body tissues, with the highest concentrations being in the brain and heart) supplementation may modulate serotonin activity, and it’s being tested for depression in bipolar disorder. The only issue I have with this supplement is large doses—as high as 12 grams— have been used in some successful preliminary studies, which can be hard to take and isn’t very realistic in the real world of patient care.

6. Rhodiola rosea

Rhodiola rosea (look for the extract called SHR-5), a hardy plant that grows in very cold climates, has already accumulated some interesting data in terms of improving mental performance and reducing anxiety, and there are signs that it may help people with mild to moderate depression as well (see the Stress and Anxiety section). Basic scientific studies suggest it can increase levels of a variety of neurotransmitters—including serotonin, dopamine, and norepinephrine—by blocking enzymes that reduce these compounds. It may also work by affecting opioid levels in the body (natural stress reducers).

Researchers believe they’ve found the active ingredients—rosavin and salidroside—and the extracts used in many studies have been standardized to 3 percent rosavin and 0.8 percent salidroside. A fairly recent 6-week study of 340 or 680 milligrams per day of SHR-5 compared to placebo found both dosages reduced depressive symptoms without side effects.

Try it first at the lowest effective dosage, about 340 milligrams daily, for 4 to 8 weeks. If that doesn’t work, you can increase the dose to 680 milligrams for another 4 to 8 weeks. Take it 30 minutes before meals and early in the day because it could cause some insomnia and vivid dreams. Not much is known about drug interactions with this supplement, except that it appears not to interact with the blood thinner warfarin or theophylline, a drug used for asthma and COPD.

Overall, the safety of R. rosea has been good, but mild and uncommon side effects—such as irritability, allergic reaction, fatigue, insomnia, and restlessness — have been reported in some studies, especially as the dose increases. Some experts have suggested that R. Rosea may be most promising in people with a history of a more “lethargic” depression, who require physical and mental energy-boosting.

7. Omega-3 fatty acids

Omega-3 fatty acids, both plant and fish sources, may slightly reduce depression, and the latest evidence suggests that the compound EPA may be better at preventing and treating depression than DHA (both are omega-3 fatty acids found in fish oil). Regardless, there have been many clinical studies, but they’ve been too short.

The best trials have used 1,000 to 2,000 milligrams daily of the active ingredients in fish oil, which means a higher ratio of EPA to DHA (fish and inexpensive fish oils tend to have more EPA than DHA). Doctors may be more inclined to add omega-3s to current conventional antidepressants instead of other supplements because there’s less risk of drug interactions.

The reason omega-3s made my list isn’t because I believe their impact is profound; it’s just that the benefit at these dosages completely outweighs the risk. Good sources of omega-3s from fish include salmon, mackerel, anchovies, sardines, trout, and whitefish; good plant sources include chia seeds, flaxseeds and flaxseed oil, canola oil, and even walnuts.

What Supplements Are Useless For Depression?

Lemon balm, borage, and mimosa

These have all been tested for depression (individually) in the lab, but we need more human studies to support the lab findings. Results for lemon balm have been weak so far, and manufacturers need to improve the standardization of ingredients in borage so customers know what to look for. Mimosa has no real studies to support it at all.

Saffron

The research on this herbal has mostly been dominated by one group of researchers in one area of the world (Iran), and even though I am half Iranian and damn proud of it, there needs to be some outside research to support it (no different from what is expected from ginseng or maca, which also tend to be grown predominantly in certain areas and heavily researched in those areas as well). 

Lavender

We need human research to support the laboratory research that’s been done with lavender. It’s mostly used as aromatherapy for depression, but results from some of the largest studies haven’t been very promising. Still, for aromatherapy purposes it has been proven safe, and if it can help some people, then that works for me.

What Are The Supplements For Kids To Treat Depression?

There is a small amount of data to suggest that 150 to 300 milligrams of St. John’s wort taken three times a day may help adolescents (12 to 17 years old) with depression. There is also some positive research on SAM-e, starting at really low doses, such as 200 milligrams. 

However, the data on any supplement helping children with depression is generally weak. Always work closely with your physician when using these with kids, and remember that socialized exercise (group sports or games) is perhaps the strongest lifestyle change that has had a positive impact on depression in children. Recent research also suggests an improvement in physical strength and muscle mass in children and adolescents may be predictive of a lower risk of suicide. This is a preliminary finding, but I believe it’s due to the impact of physical health on mental health.

What Lifestyle Changes Can Help With Depression?

Heart healthy = brain healthy

Almost everything associated with improving heart health can improve brain function. Eating a Mediterranean diet—rich in fish, fruit, vegetables, fiber, and whole grains and low in unhealthy fats and processed foods—is good for your heart and appears to improve mood as well.

Work out! 

Three large clinical trial reviews found that exercise can enhance the effects of prescription antidepressants and can also reduce the risk of depression when used by itself. In other words, there is no greater lifestyle change you can make to help reduce depression or improve your response to an antidepressant drug. Aim for at least 30 minutes a day of aerobic exercise and consider joining a gym or working out with a group because it increases your socialization, which can help depression as well (plus, most of the studies looked at group or trainer-directed exercise).

Moderate to vigorous exercise appears to result in even more profound mental health benefits. The release of neurotransmitters and endorphins increases with exercise intensity—maybe to take your mind off all the hard work! Weight lifting, yoga, tai chi, Pilates, and other modalities may also provide a mental health boost, but the vast majority of clinical trials involved aerobic exercise.

Again, I believe the social factor played a role in the positive effects seen in these studies. And we’re going to be seeing a lot more research about this. Personally, every morning I either run with a friend or sprint on a treadmill, and it turns me from groggy and grumpy to happy and healthy within minutes.

Grab a java

A large prospective study (the Nurses’ Health Study), which included more than 50,000 women who did not have depressive symptoms at the beginning, found that those who consumed coffee daily had a significant reduction in the risk of depression compared to those who drank a cup or less a week. It was the same for ingesting caffeine in general, and there was no benefit seen for decaffeinated coffee. Caffeine crosses the blood-brain barrier and appears to improve neurotransmitter function in the brain.

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