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Natural Medicine for Depression By Peter Bongiorno ND, LAc Depression affects almost 10% of the population.1 The World Health Organization predicts depression will become the second most burdensome disease by 2020, which means it will cost lost days of work, money and overall challenge to society more than any other disease except heart disease.2 One-hundred and sixty million antidepressant prescriptions are written annually, despite the fact that meta-analyses show they are no more effective than placebos to treat mild to moderate depression3 —the most common condition for which they’re prescribed. This research also suggests that anti-depressant medications are shown to be effective in severe cases, and should still be considered in these cases. Research also reveals antidepressant medications can cause a host of problems including sexual side effects, infertility4, increased risk of weight gain and diabetes,5 blood pressure problems6 cardiac deaths,7,8 heart defects in unborn children9, and even increased rates of suicide. The Holistic Advantage for Depression Holistic medicine is at a distinct advantage when treating people with depression. Conventional medical solely focuses on medications to change neurotransmitter function. This situation is a bit like the old drunk man at night looking for his keys in a mostly dark saloon parking lot. After circling for hours in the same small but well-lit spot, he runs into another man who’s not inebriated who asks him, “How do you know your keys are here, when there’s the rest of this lot to check?” The drunken man answers, “Well, my keys could be out there somewhere too, but the light is better here.”

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It is the job of good holistic care to start shining the light in the other areas of depression’s parking lot. We have tremendous opportunity to start looking into other factors, including sleep problems, diet, lack of exercise, nutrient depletion, stress, toxicity, and getting the right nutrients to balance mood. Factors to Consider When Treating Depression Sleep Good sleep is vital to a great mood. As depression is often accompanied by sleep disturbances.10,11 it is best to get 7-8 hours per night. While some patients sleep too much, the vast majority with depression are actually not getting enough sleep, or have poor and interrupted sleep. Working on sleep rituals, and using supplements like melatonin and tryptophan can aid in falling and staying asleep. Foods An anti-inflammatory diet can help by lowering brain inflammation. While the best individual diet can vary from person to person, the Mediterranean Diet has been shown helpful to both prevent and treat depression.12 This diet is high in vegetables, fruits, nuts and seeds, beans, fresh fish and olive oil, while remaining very low in processed foods, red meats and meat products. Healthful eating also helps the digestive tract – and since most of the body’s serotonin (one of the ‘feel good’ neurotransmitters) is made in the digestive tract, this may be another reason why a healthy diet can help mood. Also, eating small meals at regular intervals to avoid blood sugar fluctuation can also balance mood. Exercise About 2500 years ago, Hippocrates was possibly the first physician to recommend regular exercise for low mood and depression.13 Exercise has been touted as good as any drug to beat both anxiety and depression. Besides improving blood sugar balance, cholesterol,

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and the health of the heart and blood vessels, exercise raises the ‘feel good’ molecules called endorphins, and helps the brain and body detoxify which can help lower inflammation to create best mood. Blood Tests and Nutrient Repletion Sometimes my patients are not feeling good enough to go exercise. In this case, checking ‘under hood’ with a good set of blood tests can help figure out which vitamins or nutrients might help spur their get up and go. Checking vitamin D, iron levels, testosterone, thyroid, and B vitamins can also suggest ways to support the body that might not otherwise be obvious. I also like to check serum carnitine,14 which is an amino acid that helps the body turn fat into energy, and is protective to the nervous system as well. Stress Most people with depression have imbalances in the stress hormone system. There’s an area in the middle of the brain called the hypothalamus, which regulates communications among the nervous, immune and hormonal systems. Too much stress input can throw these systems off, and create imbalances in stress hormones like cortisol, which contribute changes in the brain resulting in depression. Meditation may be the most elegant way to help change this system back to normal.15 Psychotherapy, yoga, walking, and calming supplements like theanine and gamma amino butyric acid (GABA) can also aid to calm and rebalance the hypothalamus and the stress effect on the body and brain. Toxicity Modern day exposure to plastics, phthalates (from perfumes and topical lotions), and heavy metals are also implicated in changes in the hormonal and nervous system, which can contribute to depression. For example, heavy metals have been shown to make it difficult for the brain to clear glutamate,16 a naturally occurring toxin that in high levels can contribute to depressive illness. Detoxification

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and chelation (clearing of metals from the body) using foods and supplements may aid in helping the patient with depression improve. Supplements for Mood Finally, certain supplements can help improve mood directly by helping balance neurotransmitters, and these can have positive effects without the side effects that their drug counterparts typically have. Some of my favorites include S- adenosyl-l-Methionine (SAMe), which helps increase neurotransmitter balance), 5-hydroxytriptophan (5-HTP) to help raise serotonin, and tyrosine, which helps the body produce epinephrine. The adaptogenic herb rhodiola17 can help with both anxiety and depression, and St. John’s wort18 can help digestion, while improving both low mood and anxiety at the same time. Certain nutrients like folic acid in form methyl-tetra-hydrofolate (MTHF), as well as zinc, and vitamin B12 may help drugs work better for patients who do not respond to medications. And ginkgo has been shown to be useful for some sexual side effects of medication. 19 Conclusion Overall, there are excellent choices from the natural medicine world to help balance the body, and heal depression. Holistic care can look into the underlying factors for each individual to help balance the brain and body, and create a much healthier mood.

Naturopathic doctor and acupuncturist Dr. Peter Bongiorno is co-director of InnerSource Natural Health and Acupuncture of New York City and Huntington, Long Island. Peter researched in neuro-endocrinology at the National Institutes of Health and Yale University, then attended Bastyr University for his naturopathic doctorate and acupuncture degrees. He teaches holistic medicine electives at the Mount Sinai School of Medicine, NYU, and serves as VP of the New York Association of Naturopathic Physicians. His latest book is entitled How Come I’m Happy and Their Not (Red Wheel 2012) and is available on Amazon(http://www.amazon.com/How-Come-Theyre-Happy-Not/dp/1573245801) .

He can be reached through www.InnerSourceHealth.com and www.drpeterbongiorno.com.

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Selected References 1 CDC: http://www.cdc.gov/features/dsdepression/ accessed on December 12, 2012 2 WHO, Mental health: New understanding, new hope, WHO, Geneva (2001) The World Health Report. 3 Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J. Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis JAMA. 2010;303(1):47-53. 4 Tanrikut C, Feldman AS, Altemus M, Paduch DA, Schlegel PN. Adverse effect of paroxetine on sperm. Fertil Steril. 2010;94(3):1021-6. 5 Andersohn F, Schade R, Suissa S, Garbe E. Long-Term Use of Antidepressants for Depressive Disorders and the Risk of Diabetes Mellitus. Am J Psychiatry. 2009; 166(5): 591-598. 6 Licht CM, de Geus EJ, Seldenrijk A, van Hout HP, Zitman FG, van Dyck R, Penninx BW. Depression Is Associated With Decreased Blood Pressure, but Antidepressant Use Increases the Risk for Hypertension Hypertension. 2009;53:631. 7 Whang W, Kubzansky LD, Kawachi I, et al. Depression and risk of sudden cardiac death and coronary heart disease in women. Results from the Nurses' Health Study. J Am Coll Cardiol 2009; 53:950-958. 8 Hamer M, David Batty G, Seldenrijk A, Kivimaki M. Antidepressant medication use and future risk of cardiovascular disease: the Scottish Health Survey. Eur Heart J. 2011;32(4):437-42.. 9 Pedersen LH, Henriksen TB, Vestergaard M, Olsen J, Bech BH. Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: population based cohort study BMJ. 2009; 339. 10 Ford DE, Kamerow DB: Epidemiologic study of sleep disturbances and psychiatric disorders: an opportunity for prevention? JAMA 1989; 262:1479–1484 11 Buysse DJ, Frank E, Lowe KK, Cherry CR, Kupfer DJ: Electroencephalographic sleep correlates of episode and vulnerability to recurrence in depression. Biol Psychiatry 1997; 41:406–418 12 Sánchez-Villegas Almudena; Delgado-Rodríguez Miguel; Alonso Alvaro; Schlatter Javier; Lahortiga Francisca; Majem Lluis Serra; Martínez-González Miguel Angel Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Archives of general psychiatry 2009;66(10):1090-8. 13 Buckworth J. Dishman RK. 2002. Exercise Pyschology, Human Kinetics, Champagne IL:133 14Soczynska JK, Kennedy SH, Chow CS, Woldeyohannes HO, Konarski JZ, McIntyre RS. Acetyl-L-carnitine and alpha-lipoic acid: possible neurotherapeutic agents for mood disorders. Expert Opin Investig Drugs. 2008 Jun;17(6):827-43

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15 Xiong GL, Doraiswamy PM. Does meditation enhance cognition and brain plasticity? Ann N Y Acad Sci. 2009;1172:63-9. 16 Allen JM. The consequences on methyl mercury exposureon interactive function between astrocytes and neurons. Neurotoxicology 2002;23:755-9 17 Darbinyan, V.; Aslanyan, G.; Amroyan, E.; Gabrielyan, E.; Malmstroumlm, C.; Panossian, A. Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression Nordic Journal of Psychiatry, Volume 61, Issue 5 2007 : 343–348 18 Butterweck V. Mechanism of action of St John's wort in depression : what is known? CNS Drugs. 2003;17(8):539-62. 19 Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther. 1998 Apr-Jun;24(2):139-43.