We do not intend the information provided here to be used as a diagnostic tool. Do not use it to arrive at or exclude a diagnosis. Our intention in providing information about depression is so you can recognize some of its features.

Do not use this as a substitute for professional evaluation or professional treatment.

If you have a problem, you should first consult a licensed mental health professional to assess the severity of the problem. Try to find a mental health professional who is sympathetic or at least not opposed to the concept of using alternative medicine for psychological-emotional ailments. Then, seek a licensed practitioner for the particular form of alternative therapy, e.g. herbalist, acupuncturist, naturopath, etc. Stay in consultation with the mental health professional to monitor your progress.

Traditional psychiatric treatment must be sought if depression is so severe that the sufferer is suicidal or dangerous to others or his or her ability to function at home or work is severely impaired.

Use alternative medicine as a temporary aid to give you the symptomatic relief. As your symptoms are lessened and stress is reduced, learn the coping skills you need. Make appropriate emotional changes. Do not use alternative medicine in lieu of coping skills and emotional education. You must learn how your thoughts, feelings, attitudes, perceptions, and behaviors contribute to your psychological-emotional ailments.

Psychological techniques and self-help measures are alluded to, but not discussed in detail in order to keep this presentation brief. Refer to other books, tapes, and magazines to learn about how you can make use of such psychological techniques and self-help measures to benefit you.

Make your goal to reach the state of self-sufficiency and self-reliance, that is, that eventually, you will not be needing a traditional medicine specialist, alternative therapist, or a counseling professional. For example, you will have the necessary skills to handle your tendency for depression, anxiety, or addiction.

Remarks

Signs and Symptoms

Treatment Approaches

Chemically Induced Depression

Exercise, A Great Mood Elevator

Light Therapy and "Winter Blues" (SAD)

St. John’s Wort, A Natural Antidepressant

Guidelines for Using Alternative Medicine for Depression

Remarks:

Depression is not a sign of personal weakness. If you are depressed it doesn’t mean that you have failed in life or that you don’t have any control over your emotions. Many people are depressed today. Depression is a product of our culture. It is estimated that nine times more people are depressed in the Nineties than they were at the turn of this century. About one in eight will have a serious problem with depression at sometime in their life. Depression is not a reflection on your ability in the society as a man or a woman. Extremely competent, efficient and creative people have to struggle with depression.

Depression remains severely undertreated in our country because many depressed individuals don’t either don’t recognize that they have a depressive disorder or don’t think there is a treatment for it. Patients, their primary care physicians, and their families fail to recognize the symptoms of depression. We tend to think that children are too young to worry about anything or to get depressed. As many as half of people with depression either never been treated or receive inadequate treatment. Make sure you become a part of the other 50% that receive adequate treatment for it. The good news is that 85 % of people who receive adequate treatment for depression get better.

A small percentage of people don’t want to take traditional medication or quit taking them because of their side effects. There is a good news for them, for herbal medicines like St. John’s Wort have minimal side effects and far less than the conventional antidepressants.

Likewise, there are proven effective psychotherapies, such as cognitive-behavioral therapy or interpersonal therapy, but some people don’t take advantage of them either because of stigma or because they feel nothing can help in their situation. Some think that counseling is for "crazy people," and they’re not crazy. Don’t be a victim of such misconceptions. If you have distressful symptoms of depression such as, too little sleep, reduced or increased appetite, low energy, or tiredness, you can see yourself driving on the recovery road right now with a combination of herbal medicine and just a few sessions of an effective psychotherapy.

Let’s first identify the symptoms of chronic depression which are adapted from the Diagnostic And Statistical Manual of Mental Disorder, fourth edition (DSM-IV). with several modifications.

Signs and Symptoms

Depression of mild to moderate intensity:

History of depressed moods, starting from early age

Mild to moderate depressed mood which comes and goes in cycles. A depressed mood is more than occasional sadness. Note that children instead of sad mood may experience irritable and peevish mood.

Diminished interest in several activities that once used to be interested which cannot be accounted for by change in age, education, fashion fad, culture, values, or priorities.

Diminished pleasure or joy in several activities that once used to be interested which cannot be accounted for by change in age, education, fashion fad, culture, values, or priorities.

Poor appetite or overeating

Too little sleep or too much sleep

low energy or fatigue

low self-esteem

poor concentration or difficulty making decisions

feelings of hopelessness

feelings of personal worthlessness

Excessive guilt, excessive self-blame or too critical of oneself

Loss of joy in living or expression of a death wishes, e.g., "I wished I could just go to sleep one day and not get up."

Note: A death wish is different from a suicidal wish as the latter indicates greater hopelessness. A person with a suicidal wish would say something like, " I feel like taking a bunch of pills so I don’t have to fool with any of it." Even more serious is a suicidal intention. A person with suicidal intention would say something like, "Some day I will take a bunch of pills." Still more serious is presence of a suicidal plan. A person with a suicidal plan would say something like, "On Monday, when I am by myself and everyone in my family is gone, I will take those pills." Finally, acting on a suicidal plan, in this example, would involve acquiring those pills. A person who expresses suicidal wish, intention, or a plan should be evaluated for its seriousness right away.

Make sure that the depressive symptoms you experience are not a result of medication you are taking or due to a general medical condition such as, hypothyroidism.

Signs and Symptoms of Severe Depression, called, "a major depressive episode" by experts:

(The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. I have adapted the signs and symptoms of severe depression, (major depression) from the Diagnostic And Statistical Manual of Mental Disorder, fourth edition (DSM-IV) with several modifications)

Have you experienced one or more of these problems in the past two weeks, nearly every day and for most of the day?

Depressed mood. For example, do you feel sad or "empty" or others have seen you to be sad or tearful. (Note: that a child or a teenager may feel irritable rather than depressed).

Markedly diminished interest or pleasure in all, or almost all, activities.

Weight loss or weight gain of more than 5% of body weight in a month which is not due to dieting or medical condition. (Note: In children, failure to make expected weight gains without a medical disorder may be a sign of depression).

Decrease or increase in appetite.

Too little or too much sleep.

Slowing down of thinking or of physical movements.

Agitation and/or restlessness.

Tiredness or loss of energy.

Feelings of worthlessness.

Excessive or inappropriate guilt.

Diminished ability to think or concentrate

Marked indecisiveness.

Recurrent thoughts of death or irrational fear of dying, or recurrent suicidal ideation, or a suicide attempt, or a specific plan for committing suicide

Significant distress or impairment in social, occupational, or other important areas of functioning due to depression.

Note: If you personally or someone else that you care about has experienced even one of these signs in the past two weeks, seek a professional evaluation right away. Do not delay to get help. A person with major depression is advised to get conventional professional help. Once the severity of your depression is modified, you may then attempt the alternative medicine approach.

In case of bereavement: A person in mourning, that is, in the phase of active grieving may have some of the features of major depression. A question I am often asked is, "How do we know when and if the bereaved need professional help?" Answer: If a person is experiencing suicidal thoughts or is suspected to be suicidal, or if the symptoms become too distressful, treatment should be sought right away. In absence of suicidal inclination or extreme distress, one can wait for two months after the loss of the loved one before seeking help. If the major depression like symptoms persist for more than two months after the loss, it may not be a normal grief process; you may be dealing with what experts call, "complicated grief." Grief counselors are familiar with the condition of "Major Depression with Complicated Grief." If you or your loved one is in bereavement and experiencing depression, consult a professional who specializes in griefwork.

Treatment Approaches for Depression

The individual as a whole must be considered to treat depression. Find out what medical, nutritional, environmental, familial, and personal-psychological factors are contributing to your depression.

Check the Physical Factors

It is important to rule out the simple organic factors which are known to contribute to the depression, i.e. nutrient deficiency or excess, drugs (prescribed, illicit, alcohol, caffeine, nicotine, etc.), hypoglycemia, hormonal derangement, allergy, environmental and microbial factors.

Thyroid function: Low thyroid function can cause depressive symptoms. Depression is often a first or early manifestation of thyroid disease, as even subtle decreases in available thyroid hormone are suspected of producing symptoms of depression. Depressed patients should be screened for hypothyroidism, particularly if they complain of fatigue as well.

Adrenal function Dysfunction of the adrenal gland is associated with depression. Defects in adrenal function observed in depressed subjects include excessive cortisol secretion, abnormal nocturnal release of cortisol and inadequate suppression of the secretion of cortisone by the drug dexamenthasone.

Check the Psychological Factors

There are several models on which psychological therapies are based.

THE AGGRESSION-TURNED-INWARD MODEL: According to this model, unresolved aggression, frustration, and anger has turned inward, that is, turned upon oneself and results in depression. To seek relief from depression, you must deal with your unresolved anger, aggression, and frustration. Psychodynamic therapy is most suited for this approach.

THE LOSS MODEL: Depression is a reaction to the loss of a person, thing, status, or self-esteem. To seek relief from depression, you must come to terms with your loss and restore your self-esteem and level of functioning. Interpersonal psychotherapy and psychodynamic therapies are most suited for this approach.

THE INTERPERSONAL- RELATIONSHIP MODEL: According to this model, depression is a result of trauma, defect, pain or failure in relationships. The person who is depressed uses depression as a way of controlling other people. The outward depression may be an extension and outgrowth of such simple behavior as pouting, silence, or ignoring something or someone. The attempts to seek and restore satisfactory relationships fail to serve the need and the problem worsens. Interpersonal therapy is most suited for this approach.

THE COGNITIVE MODEL: According to this model, we think it first and then we feel it. In other words, we feel what we think. Therefore, when we think depressive and negative thoughts, we feel depressed. Cognitive therapy is most suited for this approach.

Check the Chemical Imbalance Factor

Check the Amino acids and neurotransmitters that are associated with depressive symptoms. According to biogenic amine model, depression is caused by imbalances of amino acids. Amino acids contribute to the manufacturing of the brain neurotransmitters. Neurotransmitters are chemical compounds, which transmit information to, and from nerve cells. Many of the anti-depressant drugs and the nutritional treatments are designed to correct the imbalances in the biogenic amines. Serotonin, dopamine, adrenaline and noradrenaline are some of the neurotransmitters targeted by these antidepressants. Amino acids are precursors of neurotransmitters. For example, the amino acid tryptophan serves as the precursor to serotonin and Melatonin. Phenylalanine and tyrosine are precursors to dopamine, adrenaline and noradrenaline.

The use of monoamine precursors is regarded by some as a more natural way of treating depression than taking the prescribed antidepressants. There is mixed evidence regarding the effect of mono-amine precursor therapy. Some studies have demonstrated that precursor therapy is as effective as Imipramine. Other studies have, however, demonstrated inconsistent therapeutic effects. Some regard the use of amino acids for depression as nothing more than a placebo response. Some amino acids are considered beneficial in depression. Tryptophan and phenylalanine are discussed briefly below.

Tryptophan The basic premise of tryptophan supplementation is depression is that there is a deficiency of serotonin within the brain of depressed individuals. Serotonin is dependent on blood tryptophan levels, particularly unbound or free tryptophan levels. Low serum tryptophan levels lead to reduced brain serotonin and melatonin syntheses.

Supplementation with tryptophan has resulted in mixed results. There are many variables to be considered when evaluating controlled studies of tryptophan supplementation, such as the size, duration and dosage. The use of tryptophan alone as the sole therapy is not as effective as when used in conjunction with other critical nutrients. In some cases tryptophan used alone may worsen the condition. Tryptophan may offer benefit to depressed patients with sleep disorders. A protein-rich meal will result in decreased brain tryptophan uptake. A carbohydrate rich meal will result in increased tryptophan.

Phenylalanine: Phenylalanine can be converted to phenylethylamine (PEA). This compound has amphetamine-like stimulant properties and is suggested to be an endogenous stimulatory or antidepressive substance in humans. PEA is found in high concentrations in chocolate and is associated with the feeling of love, which might explain chocolate’s addictiveness and association with romance.

Low PEA levels are found in depressed patients, while high levels are found in schizophrenia.

Tyrosine: Tyrosine is a precursor of norepinephrine. Depression has been associated with decreased activity of the neurotransmitter norepinephrine. But norepinephrine synthesis can be influenced by its amino acid precursor, tyrosine. Tyrosine (and ultimately norepinephrine) helps to promote positive moods as well as motivation and drive. Depressed patients who were given tyrosine improved their sleeping patterns, mood, libido, and other psychological and physiological patterns within a week.

Another amino acid that can help depressed people is D-Phenylalanine, which is also involved in epinephrine metabolism. D-phenylalanine is converted into tyrosine by the liver.

Nutrient deficiency may also cause depressive like symptoms: Virtually any nutrient deficiency can result in depression. Some examples of nutrient deficiencies that can cause depression-like symptoms:

Deficiency of Ascorbic acid can cause lassitude and low mood.

Deficiency of Biotin can cause extreme lassitude and sleepiness.

Deficiency of Cyanocobalamin can cause psychotic states, depression, irritability, confusion, memory loss, hallucinations, delusions or a paranoid attitude.

Deficiency of Folic acid can cause forgetfulness, insomnia, apathy, irritability, depression, psychosis, delirium, or dementia

Deficiency of Niacin can cause apathy, anxiety, depression, hyperirritability, mania, memory deficits, delirium, dementia, or emotional lability

Deficiency of Pantothenic acid can cause restlessness, irritability, or fatigue

Deficiency of Pyridoxine (Vitamin B6) can cause irritability

Deficiency of Thiamin (vitamin B1) can cause Korsakoff’s syndrome, depression, apathy, anxiety, or irritability

Tetrahydrobiopterin This vitamin-like compound functions as an essential coenzyme in the synthesis of several neurotransmitters. Some patients with depression have been shown to have low levels of tetrahydrobiopterin (BH4 ) in their brains. These patients typically respond to BH4 supplementation. BH4 is not currently available commercially. BH4 synthesis is stimulated by folic acid, vitamin B12 and ascorbic acid.

Folic acid and vitamin B12 As stated above, these vitamins stimulated BH4 formation and supplementation has been suggested for this reason. Furthermore, serum folate and B12 levels are low in a substantial number of patients suffering from various psychiatric syndromes, especially depression. In some studies of psychiatric patients, as many as 30 percent have been shown to be deficient in folic acid, and in one study 67 percent of geriatric patients admitted to a psychiatric ward were folate-deficient. The prevalence of B12 deficiency in psychiatric patients is less than that of folic acid.

Folate and B12 are closely associated with methionine metabolism. A popular biochemical model of depression concerns decreased brain levels of the methionine derivative S-adenosylmethionine (SAM). Supplemental SAM has been demonstrated to possess significant antidepressant activity in double-blind placebo controlled studies. An improvement is usually noted within four to seven days and virtually no side effects have been reported. Supplementing the diet with the amino acid methionine may offer the same benefit as SAM.

SAM, folate and B12 have been shown to influence monoamine metabolism, particularly serotonin metabolism. These serotonin-elevating effects are not fully understood but these nutrients seem to help with depression.

Supplementing Niacin could lead to a rise in tryptophan, as niacin is synthesized from tryptophan in the body.

Pyridoxine (Vitamin B6) is an important coenzyme in the synthesis of all monoamines. Patients with low pyridoxine status usually respond very well to supplementation. Improvement in tryptophan metabolism is generally the mechanism used to explain this effect, although pyridoxine is involved in the synthesis and metabolism of all monoamines.

My advice: If you can afford to have an analysis of vitamin, minerals, and amino-acid deficiency, get one. If you can’t, simply take a Vitamin C and B complex pill every day along with a multiple vitamin and mineral tablet such as, "One A Day."

Chemically induced depression

Depression could result from the side effects of a drug. Oral contraceptives, caffeine and cigarettes are implicated in some form or fashion for depression. Drugs, sometimes, associated with depression include corticosteroids, beta-blockers and other blood pressure medications. All these drugs disrupt the normal balance between the monoamines in the brain.

Corticosteroid drugs: Corticosteroid drugs take tryptophan away from serotonin thus lowering serotonin level. Lower serotonin level may contribute to depression.

Oral contraceptive The use of oral contraceptives has been associated with several nutrient deficiencies, particularly folate, B12, riboflavin, pyridoxine, ascorbic acid, and zinc. On the other hand, oral contraceptives may contribute to an increase in iron, copper and vitamin A levels. It is speculated that oral contraceptives somehow may be affecting liver metabolism. One wonders if the reduced liver metabolism somehow contributes to depression.

Estrogens: Estrogens further affect mood by disturbing vitamin B6 and tryptophan metabolism, and blood sugar metabolism. Many of the side effects of oral contraceptive use can be corrected or reversed by vitamin B6 supplementation.

An incomplete list of chemicals that can induce depression or other mood disorders:

Substances: Alcohol, amphetamines (speed, diet pills), cocaine, hallucinogens, inhalants, opioids, PCP, sedatives, sleeping pills, and anxiety pills,

Medications: drugs for anesthesia, convulsions (seizures) high blood pressure, Parkinson’s disease, ulcers, and heart problems. Pain pills, muscle relaxants, oral contraceptives, pscyhotropics (antidepressants, benzodiazepines, antipsychotics, and disulfiram) steroids, and sulfonamides.

Heavy metals and toxins: gasoline, paints, organophosphate insecticides, nerve gases, carbon monoxide, and carbon dioxide.

Reduce the caffeine intake

Caffeine is the most widely used drug in our society. Caffeine is everywhere-in coffee, tea and colas, and in over-the-counter drugs such as stimulants and analgesics. A typical cup of coffee contains between 50 and 150 mg. A cup of tea contains 50 mg. A 12-ounce cola contains about 35 mg.

Average consumption of caffeine is 150-225 mg per day in our country, 75 per cent of which comes from coffee. Some people consume an excess of 7,500 mg per day which can cause "caffeinism." caffeinism can cause symptoms similar to generalized anxiety, panic attacks, depression, nervousness, heart palpitations, irritability, recurrent headache, twitching and the so-called ‘restless leg syndrome’.

Reduce Smoking

To oversimplify: Smoking increases carbon monoxide level, which is a toxin to the brain. Carbon monoxide and nicotine reduce vitamin C levels. A low level of vitamin C may contribute to depression. Nicotine stimulates adrenal hormone secretion, including increased adrenaline and cortisone secretion. People who smoke also tend to consume more sugar and caffeine. The adrenal hormone inhibits the uptake of tryptophan by the brain, which decreases serotonin activity in the brain.

Reduce alcohol and/or all recreational drugs

Alcohol or many other recreational drugs contribute to depression. It is ironical that some people use alcohol or some other drugs to "treat" their depression with drugs that actually induce depression. Not knowing that they are really taking depressants, they get caught into a vicious cycle of depression.

Exercise, A great Mood Elevator

First, let me draw your attention to the beneficial effects of exercise on general health. Depression and poor physical health often go hand in hand. Often, poor physical health contributes to depression. Let’s now refer to the Surgeon General’s 1996 Report on Physical Activity and Health is an important one. The report concludes that exercise and physical activity have the following beneficial effects on health:

Lowers mortality rates for both older and younger adults.

Lowers the risk of cardiovascular disease and coronary heart disease mortality.

Prevents or delays the development of high blood pressure.

Lowers blood pressure in people with hypertension.

Decreases the risk of colon cancer.

In older adults, helps to preserve the ability to live an independent living status and reduces the risk of falling.

Improves body-fat distribution.

Here are some of the conclusions related to psychological health from the Surgeon General’s 1996 Report on Physical Activity and Health:

Relieves symptoms of depression and anxiety and improves mood.

Reduces the risk of developing depression.

Enhances psychological well being and improves an individual’s level of functioning.

The value of an exercise program in the therapy of depression cannot be overstated. In another study, exercise alone has been demonstrated to have a tremendous impact on improving mood and the ability to handle stress. Increased participation in exercise, sports and physical activities is associated with decreased symptoms of depression, anxiety and insomnia.

Exercise can be a critical factor in treating depression. Many depressed people are not physically fit. If you feel slow in the morning, exercise soon after rising.

Here are a few exercise tips:

If you can, work up to a daily half-hour workout on a stationary bike and a half-hour jog in the afternoon.

A brisk daily walk is good for all depressed patients. Take brisk walks daily.

You don’t have to build up a 30-minute workout. If you do ten minutes exercise three times a day, it is as good as a thirty minutes workout.

Moderate exercise will provide you most of the physical and mental benefits; you don’t have to have a vigorous exercise program.

Many studies over the years have demonstrated the positive psychological effects of exercise. There are three psychological mechanisms by which we ignore these beneficial effects and resist or postpone moderate exercise and physical activity:

"I don’t have time."

Solution: Can you save time that you’re spending on less beneficial activities? Reevaluate your priorities. You can make time if you want to and resolve to honestly examine your priorities.

"I’m in real good health. Why do I need to exercise?"

Solution: Think long-term. Do you invest in future? If your answer is "yes," you should also invest in your future health. Building a solid foundation of health, maintaining it, and recovering from temporary health setbacks is a life-long process. The process should start from childhood, but right now is the best time to start.

"I’m not fat or sick. Why do I need to do exercise."

Solution: You have to really get away from the disease model and choose health model to minimize future problems for yourself. You don’t just have to dodge a disease, but actively seek the health and maximum efficiency that you’re capable of.

Have confidence in your ability to persist with your exercise program. Enjoy the physical activity and exercise. Ask your loved ones to support your exercise plan. Visualize the benefits of exercise as you do it. Set strength and resistance goals. As soon as you reach them, set new goals.

Light Therapy and Winter Blues

Light therapy is found to be beneficial for "winter blues." There is a particular kind of depression that afflicts people in fall or winter when daylight is reduced. It is called "Seasonal Affective Disorder" (SAD).

These are the seasonal characteristics of SAD:

1. Seasonal Affective Disorder indicates presence of a "seasonal pattern" that has been observed for at least two years. In other words, onset of depression has occurred at a particular time of the year, perhaps during fall or winter, for the last two years or more. Did you start getting depressed in the fall or winter season which lasted for two weeks or more in the last two years?

2. Depression is lifted off, equally regularly, at a particular time of the year, perhaps in the spring. Did you get over your depression when spring arrived?

3. Also, you should have no incidence of non-seasonal depression in the last two years, that is, that there has been no incidence of depression outside the seasonal months. When you review your lifetime incidence of depression, there should be more bouts of seasonal depression than of non-seasonal depression.

SAD generally begins in autumn, as the days become shorter and peaks in January. It starts subsiding in spring when the days begin to get longer.

The winter blues problem is exacerbated because in winter people tend to stay indoors. They are less exposed to daylight. Women are four times more likely to suffer from SAD than men do. During the winter months, SAD patients lose energy and interest in sex, suffer increased anxiety, oversleep, overeat, and gain weight. They are also likely to crave for starchy foods. It has been estimated that five percent of the population in the North suffers from SAD. However, twenty-five percent of the people complain that they suffer through the winter with similar, if less severe, problems. Sometimes people who have regular annual cases of the "holiday blues"-particularly around Christmas may be suffering from SAD.

How does the light therapy work?

Light therapy involves daily exposure to bright fluorescent light or wide-spectrum light. When light enters the retina, electrical impulses transmit signals to the hypothalamus, which sends chemical and electrical messages to other parts of the brain as well as elsewhere in the body. Even blind people are synchronized with the daily rhythms of light and dark. Melatonin, a hormone that promotes sleep may be involved in the development of SAD. Supplements of Melatonin may help regulate sleep cycles and combat SAD. One-milligram dose rather than the generally available three-milligram capsules may be safer.

Why not take advantage of natural light therapy? Spend more time in a place where you can get natural sun light. To do light therapy, you sit in front of a light box that contains full-spectrum fluorescent lights at eye level. You can read, nap, or stare into space, but your eyes must be open and near the light source taking in the good light. The light should be about 2,500 lux (a well-lit room is about 500-700 lux). Sources from light boxes are listed at the end. You should expect to see results from the light therapy in two to three days.

Avoid sugar and caffeine, which exacerbate depression.

Take a walk at lunch.

Exercise regularly.

Take a winter vacation in a sunny place.

Note: that light therapy may be beneficial only if there is a pattern of seasonal depression as explained in the beginning, which is generally onset of depression in the winter and absence of depression in the spring and summer. If you have a clear pattern of winter blues and if during the winter you have problems such as too much sleep, increased appetite, carbohydrate craving, and a worsening of symptoms in the evening, you may especially benefit from light therapy.

However, if you have insomnia, poor appetite, anxiety symptoms, and worsening of symptoms in the morning, light therapy may not be so effective. Also, if you have a "bipolar disorder," that is, manic and depressive phases both, then, light therapy may not be all that effective. If you have a suicidal thoughts or inclinations, you must seek traditional help. Depression requires comprehensive treatment including reduction in depressive thinking and negative attitudes, exercise, family education, dietary changes and health food supplements. Do not depend solely on one form of treatment.

Resources for light therapy

A book by Norman E. Rosenthal, M.D. (1993) Winter Blues: Seasonal Affect Disorder. What it is and How to Overcome it. Guilford Publications, Inc. New York, N.Y.

Call or write to the Society for Light Treatment and Biological Rhythms. P.O. Box 478, Wilsonville, OR 97070, phone (503) 694-2404.

To purchase light box:

The Sunbox Company, (301) 762-1786; Apollo Light Systems, Inc., (801) 226-2370

MedicLight Inc., (201) 663-1214.

Wyman Way Lite Box, 331 Main Street, Keene, NH 03431 (603)357-4400

Vermont Light Box Co., 20 Western Ave., Brattleboro, VT 0530, (802) 254-4310

St. John’s Wort, A Natural Antidepressant

In Germany the number one drug for depression is St. John’s Wort, accounting for more than fifty percent of the market, 200,000 prescriptions per month, sold under the brand name Jarsin.. Prozac, which is number one antidepressant in U.S., has only two percent of the market in Germany. St. John’s Wort’s botanical name is Hypericum. St. John’s Wort is the name of a plant. Actually, in Old English, "wort" means plant.

St. John’s Wort is a common plant grows in the wild. You can see it while driving on the Interstates. It has vivid yellow flowers edged with tiny black beads. The plant’s red spots are said to symbolize the blood spilled by St. John the Baptist when he was beheaded. The plant blooms around June 24 in Germany and between May and June in U.S which coincides approximately with the traditional birthday of John the Baptist. St. John’s Wort when rubbed releases a red pigment, containing hypericin. Hypericin is the pharmacologically active chemical St. John’s Wort.

St. John’s Wort has been extensively tested in Germany and Austria, using a St. John’s Wort formula, known as LI 160. In Germany, St. john’s Wort outsells all other antidepressants combined and outsells Prozac by more than seven to one. It’s the drug of choice for mild to moderate depression. Every year German doctors write about 3 million prescriptions for St. John’s Wort. There are twenty-five meticulously conducted studies that confirm that the herb relieves mild to moderate depression as effectively as the conventional antidepressants without unpleasant side effects.

National Institute of Mental Health is launching a pioneering clinical study to demonstrate its effectiveness in U.S. so FDA can approve St. John’s Wort as an alternative to conventional antidepressants.

St. John’s Wort has been compared with both inactive "sugar" pills (placebos) and other antidepressants. Studies show that about 60 to 80 percent of depressed patients improve on St. John’s Wort, which is about the same as that expected from conventional antidepressants. In a recent German survey of 3,250 depressed patients, 80 percent reported improvement after taking St. John’s Wort for four weeks.

St. John’s Wort works really well for mild to moderate depression. One study of 105 persons with depression by researchers at the University of Salzburg found that St. John’s Wort was two and a half time better than a placebo. Sixty-seven percent of subjects taking 900 milligrams of St. John’s Wort daily improved dramatically within four weeks compared with 28 percent on placebo. St. John’s Wort improved mood and sleep, and reduced headaches, cardiac troubles, tiredness and exhaustion.

A similar study of thirty-nine patients found that 70 percent were depression-free after a month. Patients became more active, less tired, and slept better.

Another major German study of 135 depressed patients at several medical centers compared 900 milligrams daily of St. John’s Wort with 75 milligrams of Imipramine, a popular tricyclic antidepressant. The herb scored as well as and on some measurements up to 25 percent better than Imipramine. St. John’s Wort is also much safer. It produces fewer and milder side effects. Other research declared St. John’s Wort equal to or even better for improving mental functions, as judged from EEG brainwave readings.

St. John’s Wort may help in seasonal affective disorder (SAD)-the "winter blues," a common mood disorder supposedly due to sunlight deprivation. Researchers gave SAD patients 900 milligrams of St. John’s Wort daily. They found St. John’s Wort was as effective as light therapy. SAD patients are likely to benefit more by adding St. John’s Wort to their usual light therapy.

The evidence for St. John’s Wort’s effectiveness as an antidepressant is summarized in the book, "Hypericum & Depression" by Bloomfield and others. The authors have included studies from twenty-five randomized clinical trials with 1,757 patients. St. John’s Wort relieves depression by acting as "serotonin reuptake inhibitor," (SSRI) which is the way Prozac, Paxil, and other SSRI antidepressants work. One can say that St. John’s Wort is a natural SSRI

St. John’s Wort’s antidepressant activity is attributed to hypericin, the plant’s red pigment and a documented psychotropic agent. But recent research finds the extract of whole plant is effective for depression. St. John’s Wort’s complex mixture of chemicals, including xanthones and flavonoids, are helpful in treatment of depression. .

Dosage

For mild to moderate depression, one tablet or capsule of 300 milligrams of St. John’s Wort extract (standardized to contain 0.3 percent of hypericin), three times a day. That supplies about 1 milligram of hypericin in one tablet. Check the label to be sure the product is "standardized" for the right amount of hypericin.

Current research in Germany indicates that higher doses of St. John’s wort, 1,800 milligrams daily, that is, exactly the double of the typical dose may relieve severe depression. However, not enough is known about it, so you shouldn’t yet try it for severe depression. Note that 900 milligrams dosage that is used in research studies is for moderate depression, or non-severe depression. St. John’s Wort is not meant for psychotic symptoms, such as hallucination or delusions that sometimes accompany depression. Incidentally, there are no increased side effects so far reported from the higher doses.

What You May Expect During the Course of Treatment

A few people see relief as early as two weeks. Typically, it takes several weeks before its benefits are significantly noticeable. One study reported that more than half the benefits from taking St. John’s Wort sere experienced between four and eight weeks. Animal studies also suggest that hypericum and its antidepressive effects accumulate in the brain. Give the natural medicine at least six weeks to work.

St. John’s Wort works well in case of a mild to moderate depression. Averaging from the studies, it appears that 80 percent of those who took it felt better. Seventy to ninety percent of patients improved on St. John’s Wort, compared with 42 percent to 55 percent on placebo. In a rather large sample of 3,250 patients, only 15 percent had no response to St. John’s Wort. However, the jury is still out on St. John’s Wort’s effectiveness in case of severe depression.

Side Effects

One of the plus features of St. John’s Wort is that its side effects are rare and relatively benign. The complaint most often reported is stomach and colon upsets. Allergies to St. John’s Wort are rare. The mild side effects, reported by 1 percent to 10 percent in various studies, go away quickly after discontinuing St. John’s Wort. No permanent side effects have been reported. Note that 36 percent of users of prescription antidepressants suffer side effects. If you develop side effects, sometimes you may have to just lower the dose slightly, and the side effects may disappear.

As a precaution, stay out of the sun when taking St. John’s Wort. St. John’s Wort may sometimes have "photosensitive" skin reactions. That has happened in light-skinned animals grazing on St. John’s Wort. It would take about thirty to seventy times the recommended antidepressant doses to cause such problems in humans. No short-term or long-term toxic side effects are reported at the recommended therapeutic doses.

Tips for Buying St. John’s Wort

Buy only the brand which is "standardized." You can now get the identical research-grade St. John’s Wort formula in the United States under the brand name Kira, which is made by Lichtwer Pharma of Berlin. Kira was recently introduced in Wal-Mart stores and is scheduled to be widely available in similar retail outlets and health food stores. Price at Wal-Mart stores is 13.97 for 45 tablets of 300 milligrams. Thus, the cost of one-month supply of research grade St. John’s Wort is about 28 dollars.

For the latest information on St. John’s Wort, check the website of psychiatrist Harold H. Bloomfield. Bloomfield is the leading authority in the U.S. on St. John’s Wort. His website provides updates on St. John’s wort’s products and research. The website address is http\\www.hypericum.com. You may also refer to Dr. Bloomfield’s groundbreaking report in U.S. on hypericum in his book Hypericum & Depression.

Guidelines for Using Alternative Medicine for Depression

These guidelines outline a strategy of treatment which is based on three principles. The first principle is, "Be safe." Safety first should be the motto in all treatment of depression because depression can virtually kill. The second principle is, "Be free." Attain freedom from all drugs, even the herbal medicines. Herbs also have chemicals, more harmless than the ones in the conventional drugs. The third principle is, "Be wise." To overcome depression, in most of the cases, we must modify our ways of thinking and reacting to the events that happen in our lives. We have to modify our "world view." How do we see the world we live in? For example, do we have a highly distorted and negative view of others that cause much pain and aggravation for others and ourselves?

Overcoming depression also requires that we develop a more practical and workable philosophy of life. It requires that we constantly ask ourselves what we are about and continue to receive a certain amount of emotional education in the midst of "emotional illiteracy." Most of us need to learn new skills, that is, specific occupational, emotional, and interpersonal skills, to live in harmony with others and attain success. "Skills rather than pills," should be our goal if we want to not just overcome depression but also seek happiness.

If you have any of the signs and symptoms of depression listed in the beginning of this chapter, check for medical condition such as a thyroid condition or, consumption of a drug that may be the cause of your depression or depression-like symptoms. Low blood sugar, or hypoglycemia, can cause depressive symptoms. Find out from your physician if you have low blood sugar. Follow the treatment and also how to use diet and supplements to control low blood sugar.

When you are "medically cleared" by your physician, consult a licensed professional who is experienced in evaluation and treatment of depression. Let a licensed professional assess the severity of your depression. It is best to get a professional evaluation from an independent licensed psychologist or social worker who is open to the use of alternative medicine for psychological-emotional ailments.

Review the cautions at the beginning of this chapter, carefully. If you have any suicidal tendency or suicidal thoughts at present, follow conventional treatment and observe all the cautions given by professionals. .

Follow conventional treatment if your depression is diagnosed as "major depression, severe," or what is popularly called as the severe depression. Follow conventional medical treatment if you have one or more of the following physiological signs:

Significant weight change, that is, when you lose or gain more than 15% of your usual weight without any dieting efforts.

Extreme agitation or restlessness accompanying depression

Severe insomnia. For example, you have been unable to sleep for more than three to four hours for several days on end. Try "Valerian’ for sleep. Read the chapter on Insomnia. But if you do not get a significant relief and sleep deprivation is becoming intolerable or affecting your ability to perform your normal personal daily and work routines, seek conventional treatment.

Also, seek conventional treatment if you have "regular early morning awakening" and/or "regular morning depression worsening" symptoms. Regular early morning awakening means that you have been regularly waking up at least two hours before your usual time for awakening for last several days, for which there is no physical explanation such as, change of work shift. Regular morning depression worsening means that you have been consistently getting more depressed in the morning for last several days and you feel better as the day progresses.

Severe hypersomnia. For example, if you have been sleeping more than 25% of your normal sleep for last several days and are unable to perform your normal personal and work routines, seek conventional treatment.

Extreme tiredness and depletion of energy. If you are feeling so tired and depleted of energy that you just can’t perform the simple tasks required of you, start with the conventional treatment, first. When you feel a little more energetic and a little less tired, gradually wean yourself off the conventional medicine and utilize alternative medicine. Specific guidelines for weaning off the conventional antidepressants are given below. Also, make use of individual counseling, family counseling, and self-help material for mood management.

5. If the above stated symptoms and conditions are absent, St. John’s Wort will be the herbal medicine of choice for moderate depression. Search for a therapist who is knowledgeable about St. John’s Wort. Do not count on St. John’s Wort alone. It is most effective when used with other therapies, including counseling, family therapy, and sometimes, other medications.

6. If you are taking prescription antidepressants don’t quit suddenly and substitute St. John’s Wort. A quick withdrawal from prescription antidepressants could cause a "rebound" effect with potentially serious consequences. To get off antidepressants, such as Prozac and Paxil, slowly reduce the doses while gradually introducing St. John’s Wort.

St. John’s Wort is best recommended for treating mild to moderate depression, since most of the research has been done on patients with such depression. Don’t try it yet for severe depression

7. St. John’s Wort is not effective for manic depressive illness (also called "Bipolar Disorder.") If you had a manic spell or were described so by others, you should go for conventional psychiatric medication. Manic phase is when a person without being on drugs or extraordinary events, at least for a week experiences an expansive and effusive mood of feeling on top of the world, surge of excessive energy, decreased need for sleep, and inflated self-esteem. If in doubt, consult a mental health professional for proper evaluation.

8. Try conventional psychiatric medication rather than St. John’s Wort, if you have psychotic symptoms, such as hearing persecutory "voices" when nobody is talking or seeing imaginary "visions."

9. Try St. John’s Wort for at least six weeks before you conclude whether it works for you or not. As with other antidepressants, it takes a while for St. John’s Wort to produce noticeable benefits.

While taking St. John’s Wort, if your depression worsens or, you have suicidal impulses or, you notice severe side effects, stop taking it and see your doctor immediately. However, mild side effects wear off as your body adjusts to the medication. If side effect continue, consult your doctor.

Food allergies can cause depression like symptoms. Avoid allergenic foods.

Exercise helps with depression. Thirty minutes of brisk walking every day is very beneficial. Other forms or exercise such as biking, swimming, and aerobics classes are just as effective. Read the section on "exercise," for further information.

Avoid excessive sleeping or idly sitting unless you are doing the latter for recuperation and relaxation. Sleeping too much exacerbates depression. In the day time, if you have to take a nap, don’t exceed more than ten to fifteen minutes.

Learn to do physical and mental relaxation for about ten minutes or more, twice a day. Also try micro-relaxation, one or two minutes at a time, as many times as you need. Attend a class on meditation and relaxation or, buy a book and a tape to help you learn the steps.

Some people get depressed in a particular season, called "Seasonal Affective Disorder (SAD)." Combination of St. John’s Wort with Light treatment may be helpful for people who suffer from SAD. Read the section on SAD for further information.

Try these supplements:

A comprehensive multivitamin and mineral tablet a day, such as, "one a day," Vitamin B complex and C. Amino acid tyrosine: 500 mg. One or two capsules three times daily. Amino acid D-phenylalanine: 500 mg, one or two capsules three times daily. If you notice your depression is seasonal, add Melatonin: 1 to 3mg., at bedtime during the dark months.

Resources for light therapy

Society for Light Treatment and Biological Rhythms. P.O. Box 478, Wilsonville, OR 97070, phone (503) 694-2404.

To purchase light box:

The Sunbox Company, (301) 762-1786; Apollo Light Systems, Inc., (801) 226-2370

MedicLight Inc., (201) 663-1214.

Wyman Way Lite Box, 331 Main Street, Keene, NH 03431 (603)357-4400

Vermont Light Box Co., 20 Western Ave., Brattleboro, VT 0530, (802) 254-4310

Books for further reading:

American Psychiatric Association (1994) Diagnostic Statistical Manual of Mental Disorders (fourth edition) revised (DSM-IV). Washington, D.C. American Psychiatric Association.

Bloomfield, Harold, H. Nordfor, Mikael N.& McWilliams, (1996) Hypericum & Depression, Prelude Press, Los Angeles, CA

Branden, N. (1988) How To Raise Your Self-Esteem, Bantam Books, New York, N,Y.

Burns, David (1992) Ten Days to Self Esteem, William Morrow & Company, INC. New York, N.Y.

Burns, David D. (1980) Feeling Good: The New Mood Therapy, William Marrow & Company, INC New York, N.Y.

Burns, David D. (1989) The Feeling Good Handbook, William Marrow & Company, INC New York, N.Y.

Casarjian, Robin (1992) Forgiveness, Bantam, New York, N.Y.

Colgroove, Melba, Bloomfield, Harold, H. and McWilliams, Peter, (1991), How to Survive the Loss of a Love, Bantam Publications, New York, N.Y.

Copeland, Mary Ellen ( 1992) The Depression Workbook, New Harbinger Publications, Inc. Oakland, CA

Davis, Martha, Eshelman E.R. & McKay, Matthew (1989) Relaxation and Stress Reduction Workbook New Harbinger Publications Inc. Oakland, CA

DePaulo, J. and K. Ablow (1989) How To Cope With Depression, McGraw-Hill, New York, N.Y.

DePaulo, Jr., Raymond J., and Ablow, Russell, Keith, (1989) How to Cope with Depression: A Complete Guide for You and Your Family, Fawcet Crest, Ballantine, New York, N.Y.

Flach, M.D., Frederic (1974) The Secret Strength of Depression, Lippincott, Philadelphia

Freeman, Arthur and De Wolf, Rose (1989) Woulda, Coulda, Shoulda: Overcoming Regrets, Mistakes, and Missed opportunities, Harper Collins Publishers, New York, N.Y.

Greenberger, Dennis & Padensky, Christine A. (1995) Mind Over Mood, Guilford Publications Inc. New York, NY

Harp, D. (1990) The New Three Minute Meditator, New Harbinger Publications, Inc. Oakland, CA

James, John W. and Cherry, Frank (1989) The Grief Recovery Handbook, Harper Perennial, New York, N.Y.

McGrath, Ellen (1992) When Feeling Bad is Good, Henry Holt, New York, N.Y.

Miller, Lyle and Smith, Alma Dell and Rothstein, Larry (1993) The Stress Solution, Pocket Books, New York, N.Y.

Seligman, Martin E.P. (1990) Learned Optimism, Pocket Books, New York, N.Y.

Thorne, Julia with Rothstein, Larry (1993) You Are Not Alone, Harper Collins Publishers, New York, N.Y.

Videos:

Every One Needs A Hand To Hold On To by National Manic Depressive Association Call (800) 826-3632

When Someone You Love Suffers From Depression by Medcom Inc. (800) 320-1444

Consult the Dr. Bloomfield’s website http://www.hypericum.com for research updates and latest products related to ST. John’s Wort.

Consumer Organizations

Depression and Related Affective Disorders Association (DRADA)

Meyer 4-181, 600 N. Wolfe St., Baltimore, MD 21205

(301)955-4647

National Depressive and Manic-Depressive Association

53 West Jackson Suite 505, Chicago, IL 60604

The American Conference of Therepeutic Selfhelp/Selfhealth/Social Action clubs

710 Lodi St., B 1104, Syracuse, NY 13203 315/471-4644

VISIT OUR SELF-HELP SECTION TO LEARN MORE ABOUT DEPRESSION RELATED PROBLEMS