The Alternative Remedy Frenzy
To read the volumes of ever-increasing information on this subject, the latest “natural” miracle cure is either on the horizon or already here. There are many claims to fame in this regard, but most of them fall by the wayside when subjected to scientific research.
Of the literally hundreds of herbals, supplements, vitamins and nutrients that are touted as being effective, four of them have emerged with various levels of documented efficacy in the treatment of mental health disorders. This is by no means a complete list, and many experts disagree on the definitions of efficacy, but these are the ones that demonstrate credible evidence to back up their claims.
St. John’s Wort
This humble yellow wildflower, named after St. John the Baptist, has risen to the top as the most often utilized herbal remedy for the treatment of depression. It is effective for very mild to mild depression only. It is similar in action to the selective serotonin reuptake inhibitors, leading to its nickname, “nature’s Prozac.”
Because of its pharmacology, St. John’s Wort should not be used in combination with prescription serotonin reuptake inhibitors – Prozac, Zoloft, Lexapro, etc. This combination can lead to a condition known as “serotonin syndrome,” with symptoms of mania, hypomania, anxiety, agitation, rigidity and fever.
St. John’s Wort is also associated with a high incidence of drug-drug interactions. Studies show that this herbal can reduce the anticoagulant effect of the blood thinner warfarin and can lower plasma concentrations of the cardiac medication digoxin. It is also known to decrease the efficacy of oral contraceptives. The most frequently reported side effect of St. John’s Wort is photosensitivity, or an abnormal sensitivity to bright light, especially of the eyes. The usual adult dose is 300 mg taken three times daily.
SAMe is considered by many to be one of the best natural antidepressants in the treatment of mild depression. SAMe (S-adenosylmethionine) is a substance found in the body that helps in the production of neurotransmitters and hormones aided by the amino acid methionine. Ordinarily, the brain manufactures all the SAMe it needs, but in depression, methionine synthesis is impaired.
SAMe has been the subject of more than 100 trials around the world. Some of these studies show that it likely mimics the action of the selective serotonin reuptake inhibitors (SSRIs), which are instrumental in the treatment of depression. In some recent studies, SAMe has performed as well as the SSRIs. Although there is no standard dose, SAMe appears to be effective in mild depression at doses of 400 mg per day.
In 2004, researchers from Harvard Medical School found that SAMe was beneficial in treatment-resistant depression when combined with conventional antidepressants for those whose symptoms had not responded to the antidepressant alone.
Due to its high cost, SAMe has never really taken off as a treatment for depression in the United States. A one-month supply in its oral form can run as high as $60.00. SAMe is contraindicated in bipolar disorder as it may possibly induce manic or hypomanic episodes. The most frequently reported side effects of SAMe are nausea, stomach upset, insomnia and anxiety.
Melatonin can potentially be your best friend if you have difficulty getting to sleep. It is a hormone manufactured from the amino acid tryptophan by the pineal gland – a small endocrine gland in the brain. Melatonin is thought to regulate the circadian rhythm sleep cycle. This hormone is synthesized and released during darkness and is primarily used to manage insomnia and “jet lag” associated with long air travel.
According to the National Institute of Mental Health (NIMH), multiple human studies have measured the effects of melatonin on sleep. The weight of scientific evidence suggests that melatonin decreases the time needed to fall asleep and increases feelings of sleepiness. For insomnia, a dose of 0.3mg-3.0mg at bedtime, preferably about one hour before retiring, is sufficient. The most frequently reported side effects of melatonin are gastrointestinal symptoms, drowsiness and lethargy.
Omega-3 fatty acids
“Fat” is a bad word in our society, but omega-3 fatty acids are one of the superstars when it comes to improving nerve conduction. High levels of omega-3 fatty acids in the brain also reduce neuroinflammation, a factor commonly seen in people with depression. Cell membranes consist partly of omega-3s, which make it easier for the neurotransmitters norepinephrine, serotonin and dopamine to pass through cell membranes. This is an essential fatty acid, which means it is not produced by the body and must be obtained via foodstuffs or through supplementation. Foods high in omega-3 fatty acids include: salmon, tuna, cod, mackerel, sardines, walnuts and flaxseed. One to two grams daily of fish oil as a supplement to a balanced diet is advisable, especially for those susceptible to depression.
A parting shot: Alternative remedies are not closely regulated by the FDA. As a result, side effects and drug interactions with these agents can occur without prior knowledge or warning. As surprising as this seems, many people harbor the erroneous belief that all over-the-counter products are safe, and they often don’t share information about the alternative remedies they are taking with their therapists, counselors or prescribers. It is therefore important for clinicians to conduct a thorough medication analysis that includes questions regarding herbals, supplements and nutrients. Doing so just may help avoid an “accident waiting to happen.”
Joe Wegmann is a licensed clinical social worker and a clinical pharmacist with over 30 years of experience in counseling and medication treatment of depression and anxiety. Joe’s new book, Psychopharmacology: Straight Talk on Mental Health Medications is available at www.pesi.com. To learn more about Joe’s programs or to contribute a question for Joe to answer in a future article, visit his website at www.thepharmatherapist.com, or e-mail him at firstname.lastname@example.org.