Herbs for Depression

by Karyn Siegel-Maier, HerbalMusings.com

About 17 million Americans are affected by clinical depression each year. In fact, clinical depression, also referred to as major or unipolar depression, is the most commonly occurring mood disorder.

While we all experience periodic "mood swings," the symptoms of true depression are outlined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). According to the DSM-IV, at least 5 of the following 8 symptoms must be present for at least one month in order to diagnose clinical depression:

- Weight loss due to a poor appetite, or overeating accompanied by weight gain
- Frequent insomnia or hypersomnia (sleeping too much)
- A lack of interest in regular activities and/or a decrease in sex drive
- Overall feeling of fatigue
- Excessive activity or inactivity
- Feelings of worthlessness or guilt
- Difficulty concentrating
- Suicidal thoughts

Anti-depressant drugs are an all-too-frequent course of treatment for depression, but are not necessarily the best. For one thing, there is a high rate of relapse and dependency associated with these drugs. One alternative gaining in popularity is cognitive therapy which serves to manipulate brain chemistry by empowering the patient with new "tools" for daily living. In effect, cognitive therapy teaches the depressed person to replace automatic negative thoughts with more appropriate ones. This restructuring of thought processes not only relieves the feeling of helplessness or loss of control in the patient, but actually results in stabilizing brain chemistry.

Depression has a variety of causes, of both physiological and organic origin.  Some of the most recognized include: food allergies, hypoglycemia, hypothyroidism, diabetes, heart disease, environmental toxins (heavy metals), poor adrenal functioning, nutritional deficiencies and even certain medications. Since this list is so lengthy, it is important to seek help from a qualified health care practitioner to rule out the presence of any of these
conditions. Severe or major depression (especially when thoughts of death or suicide are apparent) involves a range of therapies and should only be addressed by a qualified professional. However, mild to moderate depression may show improvement by employing certain botanicals and nutritional considerations. But, you should discuss these therapies with your physician first. It is also imperative that you never combine herbal medications with other anti-depressant prescription drugs.

Uncle Sam Meets SAMe
SAMe (S-Adenosyl-Methionine) is involved in the functioning of monoamines (such as serotonin, dopamine and gamma-amino-butyric acid or GABA), neurotransmitters and certain serum lipids. In "normal" brain chemistry, sufficient amounts of SAMe are produced by the amino acid methionine, but this synthesis is impaired in depressed individuals. Numerous double-blind, placebo-controlled studies have found SAMe to be one of the most effective natural anti-depressants and is better tolerated and works faster than many tricylic anti-depressant drugs. While SAMe has been widely used in Europe for at least 20 years, it has only arrived in the U.S. within the last few months.

The usual dosage is 400 mg four times per day, but since SAMe can cause nausea and vomiting it is sometimes started at 200 mg two times per day for several days and gradually increased to the full therapeutic dose. Note: SAMe supplementation is not suitable for manic (bipolar) depression patients as their manic symptoms may escalate.

St. John's Wort (Hypericum perforatum)
There are at least 10 pharmacologically active constituents found in the extract of this herb, but researchers are most interested in hypericin and pseudohypericin. The exact mechanism of the herb's ability to alleviate depression and anxiety remain largely unknown, but a recent study may provide some clues. The action of hypericin at alpha receptor sites, known to be involved in the role of MAOs and 5-HTP reuptake inhibitors (a metabolite of L-tryptophan in the synthesis of serotonin), lends support to the herb's universal reputation as a mood elevator and sedative. The extract (standardized to 0.3%) is usually given at 300 mg three times per day with meals. Note: This herb can sometimes cause mild stomach irritation. Hypericin can also increase photosensitivity and has been recently linked with the formation of cataracts with long-term use.

Kava (Piper methysticum)
This herb has a long history of use in reducing anxiety, but is relatively new in the treatment of anxiety-related depression. Several European countries have approved kava for the treatment of insomnia, nervous disorders and depression. In the U.S., kava preparations are available as dietary supplements. The beneficial agents of kava are kavalactones found in the dried rhizome of the plant. Several studies have shown that kava effects a GABA-receptor-binding capacity and an ability to block norepinephrine uptake.  In a 1997 German study, 101 subjects suffering from non-psychotic anxiety took part in a 25 week placebo-controlled, double-blind trial with an extract of kava. The researchers concluded that kava is comparable to treatment with benzodiazepines but without unwanted side effects. The recommended dosage (standardized to 30-70%) is 45-70 mg three times per day. 

Nutritional Guidelines
L-tryptophan is the metabolic precursor of serotonin and melatonin, neurotransmitters with sedative qualities and useful in the treatment of depression symptoms. However, L-tryptophan was banned in the U.S. due to an incidence of contamination and the Food and Drug Administration isn't likely to allow it back on the market any time soon. But, a newly available supplement, 5-hydroxytryptamine (5-HTP), may be even more effective. Unlike L-tryptophan, 5-HTP is readily bioavailable since it does not require a transport molecule or compete with other amino acids in the system. While it was necessary to take L-tryptophan on an empty stomach, 5-HTP can be taken with meals. In addition, 5-HTP is biochemically closer to serotonin, chemically known as 5-hydroxy tryptamine. Studies have also shown that 5-HTP elevates beta-endorphins, the "feel good" hormones. The usual dosage is 200 mg. per day.

According to the American Journal of Clinical Nutrition, there is a clear association between depression and a diet lacking in sufficient fatty acids, specifically, omega-3. The brain depends upon fatty acids to ensure membrane fluidity and nerve cell function, factors that effect neurotransmitter synthesis and transmission. Low omega-3 levels also influence the action of monomine oxidase, the enzyme responsible for breaking down serotonin, epinephrine and dopamine. The best sources of omega- fatty acid are cold water fish, such as salmon, halibut, etc., consumed 1-2 times per week. Supplementation with fish oil, a rich source of omega-3, should include docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA). Follow the manufacturers dosage recommendations.

Recommended Books:
Getting Your Life Back : The Complete Guide to Recovery from Depression by Jesse Wright et al.
Beating Depression by Maga E. Jackson-Triche et al.
Understanding Depression: What We Know and What You Can Do About It by Raymond J. Depaulo, et al.

© 2000 Karyn Siegel-Maier, Originally published at Suite101.com

Karyn Siegel-Maier is an herbal researcher and writer for numerous web sites and national magazines including Natural Living Today, Better Nutrition, Your Health, Let's Live and others. She is also a member of the International Aromatherapy and Herb Association and the author of "The Naturally Clean Home" and "50 Simple Ways to Pamper Your Baby" (Storey Books). Visit her web site at http://herbalmusings.com.

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