David: Can you give us a short list of nutrients that would be helpful to reducing depression?
Syd Baumel: The important thing is to cover all bases by taking a well-rounded, moderate/high dosage multivitamin and mineral supplement. Then one can focus on higher doses of nutrients with a high profile as antidepressants, at least for some people. The B vitamin folic acid is probably at the top of the list right now, based on current evidence. Other contenders include vitamins B1, B6, and B12, vitamin C, and the mineral selenium.
It's hard to generalize, because a combination of testing people for specific deficiencies and using nutrients as if they were drugs - in high or mega doses - is the "art" and science that's involved here.
David: Mr. Baumel is coming to us from Winnipeg, Manitoba, Canada. He dealt with depression for a long time and actually started researching, then using, natural remedies to treat his own depression.
We have a lot of audience questions. I want to get to a few, then get into a discussion of some of the herbs that might be helpful in treating depression. Here's the first question:
donotknow: What foods should we avoid?
Syd Baumel: There are two general answers to that question. The first one has to do with what kinds of food everyone would be best off avoiding, the second has to do with individual sensitivities, intolerances, or allergies that can cause some people - some research and much anecdotal evidence suggest - to be more susceptible to depression.
Regarding the first consideration: In general, as far as the evidence has been able to show us so far, the same kind of diets that help prevent cancer, heart disease, etc. also are good for the brain and the mind and one's mood. This means avoiding things like a diet over endowed with processed grains, sugar, and an evolutionarily unnatural balance of fatty acids.
On the latter point, what I mean is: avoid too much saturated and hydrogenated fat, and also attempt to concentrate on fats and oils that are unrefined and that have a higher balance of omega-3 fatty acids to omega-6 fatty acids than modern diets typically have.
Omega 3s abound in the fat of wild animals - especially cold-water fish - and in vegetable crops from temperate or northern climates, especially dark leafy greens, beans, and (above all) flax and hemp.
David: Here's an interesting comment from one audience member, which has to do more with the stigma of having depression or a mental illness:
WildWindTeesha:There is a stigma attached to taking prescribed anti-depressants. In my case, I have found it almost shameful to admit that I am taking anti-depressants, but if I were to tell my family and friends I am on NATURAL remedies, well, that means that their relative or friend (me) is not so MAD after all.
Syd Baumel: That's interesting. In some circles, I think being on Prozac et al is almost considered normal. It is nice, though, to see that using natural treatments has become kind of "cool," where years ago it was rather... dorky .
David: Before we get into the herbs, do you see herbal remedies as being as effective as pharmaceutical antidepressants? And secondly, I'm wondering if natural treatments work as well for clinical depression (brain chemical depression) as non-clinical depression?
Syd Baumel: The evidence - research and anecdote both - suggest that natural antidepressants (NAs) can be as effective or more effective than drugs for some people and that some NAs are generally about as effective as any drug for mild, moderate, or even severe major depression. I'm thinking of St John's Wort (SJW), for example.
David: So what herbs have you found to be the most effective in treating depression and in what dosages?
Syd Baumel: St Johns Wort (SJW) is, so far, the star here. The most commonly used and recommended dosage is 300 mg of a standardized extract (0.3% hypericin) three times a day. But if you actually look at the studies and what people say, you find that people can apparently respond to as little as 300 mg and as much as 2700 mg a day.
I believe, if memory serves, it was 2700 mg that was used in a recent study which found SJW about equal to imipramine (the gold standard tricyclic) for severe major depression, but with far fewer side effects. The current NIMH-sponsored trial is supposedly allowing research psychiatrists to administer up to 2700 mg also.
Other herbs that show varying degrees of effectiveness or promise include Ginkgo biloba (at least as an adjunct to drugs) and several herbs for "women's problems" (traditionally) that appear to work for PMS and/or perimenopausal depression, e.g. Vitex agnus-castus and black cohosh.
David: Here's an audience question on St. John's Wort:
MsPisces:I've read that St John's Wort only helps mild depression... Is this true? Will it help with clinical depression?
Syd Baumel: The "rap" on SJW that it only helps for mild depression is based on the fact that most clinical trials have used only patients with mild to moderate depression (major or dysthymic are undefined). But at least one or two have successfully used it for severe major depressive disorder. By "successfully" I mean that the response rate was significantly better than a placebo and/or not significantly different from an adequate dosage of an effective antidepressant drug.
It's really hard to say just how effective SJW might truly be for severe depression. The large NIMH study should help answer that question. For now, it's very much a trial and error, your mileage may vary thing. But then that's true of any antidepressant drug when it comes down to the individual.
donotknow:What about the side effects of St. Johns Wort?
Syd Baumel: The more SJW has been used, the more people have reported side effects. The studies, overall, suggest SJW has a net side effect rate that's little different than a placebo, but some studies suggest worse. And there's always the concern that - as probably happens with drugs in some studies - the researchers are biased against reporting the full extent of SJW's adverse effects.
All in all, I think St Johns Wort has a much lower side effect profile than the average drug (probably any drug) and that most people don't notice any side effects, but there is good reason to use SJW and other supplements knowledgeably and cautiously. Most books and websites that write about SJW et al. in any depth are very forthcoming about known side effects, drug interactions, precautions, etc.