Helping You Understand Nutritional Supplements for Depression and Anxiety
Amino Acids, Vitamins, Minerals, and Herbs for Depression and Anxiety
First, the basics: I am not a doctor. I cannot recommend or prescribe any over the counter supplements. What I can do is share with you what I’ve learned from reading, research, seminars, and my own and many of my clients’ use of many of these supplements. I strongly encourage you to check with your doctor before taking anything. While the safety profile of over the counter supplements tends to be quite good, herbs in particular are powerful substances and any of these supplements can interact with medications you may already be taking.
Next, why am I writing so much about vitamin/mineral/herbal and amino acid supplements? What about just taking a standard antidepressant or antianxiety medication that a doctor would prescribe? If you do, and it works for you, that’s great, and I am wholeheartedly on board. But over the years I’ve had many clients come to me and say from the outset, “Susan, don’t even think of mentioning to me that I go on medication. I tried that stuff and it didn’t work/made me feel worse/ I couldn’t tolerate the side effects so I’m not going to do it.” When I mention that there might be help to be had from the local health food store or Amazon, people are often intrigued and willing to try these kinds of things. I’ve had the same conversation so many times with people that I thought it might be useful to just post a lot of it here.
In all honesty, I have seen many people go on a pharmaceutical medicine and do very well: the medicine “works,” the person feels better, side effects are not an issue. I can’t really speak much about medications because I don’t know that much about them, and I can’t prescribe anyway since I am not a doctor. So if you want to go to a doctor and try medication, or are already on it, I will offer only one thought and that is that I think in general, psychiatrists do a better job of prescribing psychotropic medications than general doctors do. Brain chemistry is complicated, and psychiatrists have a depth of knowledge that general doctors simply can’t have because they have to focus on so many other parts of the body as well.
Two books that I would highly recommend are
Depression Free for Life by Gabriel Cousens:
The Way Up from Down by Priscilla Slagle:
Dr. Slagle’s book is also available as an e-book on her website:
http://www.thewayup.com/upfrmdwn.htm
Both Dr. Slagle and Dr. Cousens are psychiatrists, and both struggled personally with depression. Both believe that faulty brain chemistry is at the root of depression, anxiety, OCD, and addictions (for simplicity, I will just say depression from now on but am really referring to anxiety and OCD as well), but that pharmaceutical medicines are not the best way to address the chemical imbalances. The explanations are more in depth in the books, but the very simplified version is that standard medications such as those in the SSRI (selective serotonin reuptake inhibitor) family don’t actually provide your brain with more serotonin (or norepinephrine, dopamine, or whatever neurotransmitter is being targeted. I will say serotonin here for simplicity but am referring to all neurotransmitters.) What they do is move the serotonin that you already have into the synapses. This maneuver allows your brain to register that your serotonin “tank” is all filled up, and in the best case scenario, you then feel better: able to smile and laugh and enjoy life. But everything in the body is a regulated by feedback mechanisms and “tricking” the brain into thinking that it is full of serotonin results in the body slowing its production of serotonin, so a person who was already deficient in serotonin, after taking medication for a period of time, becomes even more deficient. This response is why people find it difficult to wean off of such medications, and also why many people initially find that a medication works quite well, easing their symptoms and providing relief, but then after a period of time find that it isn’t working as well and may need a medication increase or a change of medication.
Treating the depression with amino acids and vitamin and mineral cofactors allows the body to actually produce more serotonin (and/or other neurotransmitters), thus actually “filling up the tank,” rather than simply tricking the brain into believing it has more than it actually does. Amino acids tend to be very safe, side effects are minimal to nonexistent, and if a dose is missed, there is no immediate ill effect as there can be with prescription drugs. Thus this avenue can be a very safe and effective way to treat depression/anxiety/other mental health problems.
I encourage you to look at some of the books and websites available on this topic; to read about each supplement, including any contraindications, warnings, or instructions for dosage; and to ask your doctor before taking anything new. Health food stores carry these supplements as well as http://www.amazon.com/ , www.iherb.com, www.banyanbotanicals.com, and http://www.pennherb.com/ . So without further ado, here is a laundry list of supplements that are useful for depression, anxiety, and OCD:
Supplements for Depression
L-Tryptophan – an amino acid that is a precursor to serotonin, meaning that the body takes tryptophan and synthesizes serotonin from it.
Frequent response: “But Susan, tryptophan is in turkey, right? Can’t I just eat turkey and be done with it?”
Answer: Not really. If the tryptophan in your dietary protein was sufficient, then you wouldn’t be anxious and depressed. Also, turkey and other proteins have tons of other amino acids in them – all of which are important and great for your overall health. But for serotonin synthesis, you need the tryptophan to cross the blood brain barrier without other amino acids competing for absorption. So because of this, it is best to take tryptophan several hours apart from any proteins. Carbohydrates are not a problem and will in fact boost the effect. Fats are neutral. But if you ingest protein at the same time as the tryptophan, you won’t get the same serotonin punch. So a good strategy is to eat dinner, wait several hours, and take tryptophan at bedtime as it can make you sleepy (and also helps with sleep).
5-HTP is also used to raise serotonin levels. Typically one takes either tryptophan or 5-HTP, not both together.
L-Tyrosine – an amino acid which is a precursor to norepinephrine and dopamine. Norepinephrine and dopamine are the neurotransmitters that help with oomph and motivation. Tyrosine can be stimulating – it helps with energy and mental focus – so it is often taken in the morning, an hour before eating any protein.
SAM-E – stands for s-adenosylmethionine, which is a substance produced in the body. People produce less as they age, and some younger people (especially those with MTHFR (see www.mthfr.net), which is common in the population in general and even more common in people with strong family histories of depression)don’t produce enough. So rather than being a precursor to a particular neurotransmitter, SAM-E impacts a process called methylation. Methylation is way too complex and vast a topic for me to try to cover, but it is vital to many processes that occur all over the body. SAM-E is touted as being useful for depression, liver disease, and joint pain. A number of studies have compared it to pharmaceutical drugs for treating depression, and it did quite well.
St. John’s wort – St. Johns wort is an herb that is commonly used in Europe to treat depression. The mechanism of action is believed to be similar to that of an SSRI. It’s important to note that in Europe, a prescription is required for usage and thus European St. John’s wort is standardized to a certain potency, while supplements available in the U.S. may not have the same potency. In addition, there are two active compounds that have been identified in St. john’s wort: hypericin and hyperforin. Researchers now believe that it is the hyperforin that impacts depression. A majority of the supplements that are on the market in the U.S. have only hypericin, not hyperforin, present. So if you decide to use this supplement, check to make sure that the brand you purchase has hyperforin. St. Johns Force is one such brand. St.Johns wort can cause photosensitivity. Eyes and skin must be protected from bright sunlight, and use of a light box to treat depression should not be undertaken while using St. John’s wort because of the potential for harm to the eyes.
Ashwanganda is an ayurvedic (from ancient India) herb used to treat depression and anxiety. It is considered an adaptogen, meaning that it is an overall strengthening tonic in the body. The effects are fairly immediate.
Rhodiola rosea, Eleutherococcus senticosus (Siberian ginseng) and Panax ginseng (Korean ginseng) are all herbs from diverse parts of the world used to treat depression.
Myo-inositol:
Also see the Vitamins, Minerals, and Co-Factors Section below
Supplements for Anxiety and Insomnia
DHHB – this is an extract from magnolia bark. Studies show it to be as effective as benzodiazepines (such as Ativan, Klonopin, etc) without the harmful side effects and addiction potential
L-Theanine –an amino acid that works on the Gaba receptors in the brain, ie, the same place where the benzodiazepine drugs work . It is found naturally in green tea and in fact was discovered when researchers were trying to understand why green tea tends to calm people when most caffeinated beverages raise anxiety. L-theanine has a calming effect and also lowers glutamate levels – a glutamate level that is too high will cause anxiety, so it may be worth asking your doctor to check your glutamate level. Another issue that can cause anxiety and insomnia is if you have excess ammonia in your system, which can be the result of a fairly common gene mutation known as CBS. See:
http://ghr.nlm.nih.gov/gene/CBS
The amino acid l-ornithine is used to reduce excess ammonia levels in those who have the CBS mutation along with the herb yucca root and a short term restriction dietary protein (because the ammonia is formed when protein is consumed and broken down in the body).
L-Tryptophan is also a good one to try as low serotonin levels are typically implicated in anxiety. See the description and instructions for use above in the section on supplements for depression.
Ashwanganda and Brahmi or Bacopa are Ayurvedic herbs that are often used for anxiety. These herbs have an immediate effect, so you can take them either as needed or on a regular basis.
Myo-inositol (a B-vitamin, see description above in section on supplements for depression)
Other herbs that tend to be calming, and also sleep inducing, are: Chamomile, Passionflower, Skullcap, Hops, and Valerian root. Many of the sleepy time teas that are available in grocery stores and health foods will have many of these present, and there are also many formulas found in health food stores and on-line that will include a blend of many of these ingredients. There are also combination products such as RelaxMax, which can be taken at bedtime or as needed during the daytime for anxiety.
Melatonin is worth mentioning because anxiety and insomnia often go hand in hand. Melatonin is a hormone produced in the body. We are cued to produce it by darkness, and even a slight reduction in darkness (such as the glow from a clock or electronic device) suppresses melatonin production in the body.
Seriphos is a compound that lowers cortisol levels, which can become elevated when there is prolonged stress in a person’s life. Cortisol levels are meant to naturally diminish over the course of the day, and an elevated cortisol level can exacerbate insomnia.
Vitamins, Minerals, and Co-Factors
(useful in depression, anxiety, and OCD)
Dr. Cousens and Dr. Slagle give a complete list of vitamins, minerals, and nutrients that they recommend for combatting depression. The following are some of the basic recommendations:
B-Complex B-complex helps with energy and depression. There are many forms on the market. Many people with depression have MTHFR and thus cannot break folic acid, one of the basic nutrients found in a B-complex vitamin, down into methylfolate, the substance that crosses the blood brain barrier and helps with depression. Methylfolate is sold by itself as a supplement; psychiatrists prescribe it under the name Deplin. See this link:
http://mthfr.net/l-methylfolate-methylfolate-5-mthf/2012/04/05/
for information as to which forms are biologically active/recommended. A company called Thorne makes a product called B-complex #12 which has the forms of the various B vitamins that can be utilized by people with MTHFR.
Methyfolate – see above, or make sure it is included in your b-complex or multi-vitamin.
Vitamin B-12 – found in many B-complex formulations. It is not well absorbed from the GI tract so buying the sublingual version and taking it separately may help you get more benefit. B-12 shots are available through doctors, pharmacies, and at some labs such as this one, in Springfield, where you can get a B-12 shot without a prescription for $25: http://www.anylabtestnow.com/.
NADH – a co-enzyme form of B3.
Magnesium – helps with relaxation and falling asleep as well as depression; deficiency is apparently widespread in the U.S.
Vitamin C
Fish Oil, Krill Oil, or some source of omega fatty acids.
Vitamin D (must take with K-2, fat soluble and therefore best taken with some dietary fat) Many people are deficient in Vitamin D because of where they live/lack of sunshine in the winter (Vitamin D is actually synthesizes in the body when skin is exposed to sunshine) and vigilant use of sunscreen. You can ask your doctor to test your blood level of Vitamin D.
A good quality multi-vitamin, multi-mineral supplement
Lithium Orotate- the word lithium will ring a bell for some people, so it’s worth explaining a bit. Yes, lithium (Lithium Carbonate) is what is used by psychiatrists to treat Bipolar Disorder and is available by prescription only. Lithium Orotate both is and isn’t the same thing. Lithium Carobonate is not well absorbed/utilized. A relatively high dose therefore needs to be prescribed in order for a fraction of the lithium to cross the blood brain barrier and work its magic in terms of stabilizing mood. The “orotate” part of Lithium Orotate apparently acts as a “carrier,” escorting the lithium across the blood-brain barrier to where it is needed. This means that a much smaller dose of lithium is needed than with Lithium Carbonate, and thus it does not have the same detrimental effect on the kidneys that Lithium Carbonate has. Lithium also acts as a carrier for B-12, escorting it to where it needs to go in the body. In areas where the natural lithium content is higher in the drinking water, rates of depression, suicide, and violent crimes are lower.
http://bjp.rcpsych.org/content/194/5/464.full
Inositol is part of the b-complex family. It has been found to be useful for bipolar disorder, panic disorder, and obsessive –compulsive disorder. It will be found in some but not all B-complex formulations. Here’s an interesting article summarizing some of the research:
http://www.med.nyu.edu/content?ChunkIID=21766
Other Things You Can Do To Combat Depression
There are lots of other strategies that have proven helpful in treating depression and anxiety.
Exercise has been shown to be as effective as antidepressants in studies. Even mild exercise such as walking is helpful. Yoga can be particularly beneficial because of the mind-body emphasis. It’s important also to get enough sleep, to spend time doing things that you enjoy, and to spend time with friends. Journaling, meditation or other spiritual practice, and spending time in nature can all be helpful. In general, try to do more of the things that you enjoy, or that bring you up, and try to do less of the things that drag you down.
Using a Lightbox – Using a lightbox is especially helpful when there is a seasonal component to the depression, ie: you feel worse in the shorter, dark days of winter. Typical use is daily for 15-30 minutes, preferably in the morning.
Using a Dawn Simulator – a dawn simulator is an alarm clock. It doesn’t sound an alarm immediately, however. Instead, the light comes on very dimly about 30 minutes before your wake up time and gradually gets brighter over the course of the 30 minutes, after which an alarm sounds. I’m not really sure why it works, but research has shown that using a dawn simulator is just as effective as a lightbox for seasonal depression.
Energy Tapping or Emotional Freedom Technique – a good book is Instant Emotional Healing by George Pratt and Peter Lambrou; u-tube videos demonstrating various tapping techniques abound.
Therapy – whether individual or group, the old fashioned “talk” type or one that incorporates some of the newer techniques such as EMDR, energy tapping, and the like, therapy is worth a try and helps many with depression.
A Separate Note about Thyroid Problems and Depression:
Thyroid problems are epidemic in the United States, particularly among women. Depression is one of the prominent symptoms of hypothyroidism; fatigue, feeling cold all of the time, and loss of hair are others. Treating a thyroid problem is the province of doctors, typically an endocrinologist (although, believe it or not, you can buy thyroid hormone over the counter). I do want to say this, though. I can’t tell you how many people say “don’t worry, they checked my thyroid, it was normal,” or “I’m already on Synthroid and they say my levels are good, so that’s not my problem.” If that’s as much as you know, that’s not enough! Consult the website www.stopthethyroidmadness.com – it is a treasure trove of information about thyroid problems. Often doctors will test only the TSH and the T4, with the assumption that if those are within normal range, then the T3 level will also be normal. T4 is simply a “storage hormone”: it has no active effect in the body. It needs to be converted (by the liver) into the biologically active T3, which is the hormone that allows the person to feel more energized, warmer, and less depressed. Some people will take Synthroid (synthetic T4) and feel much better – presumably, they have no difficulty with the process of conversion into T3. Some doctors will prescribe Cytomel, which is synthetic T3, in addition to or in lieu of Synthroid. Some will prescribe Armour or Naturethroid, which are derived from pigs and contain both T4 and T3. Some people who don’t feel well on Synthoid alone will feel much better on Armour, Naturethroid, or Cytomel. Bottom line: do your own reading and research. For any bloodwork done, ASK TO HAVE THE FULL PANEL DONE (ie, TSH, T4, T3, and the thyroid antibodies that indicate the autoimmune form of thyroid disease. ASK FOR YOUR RESULTS and look at them yourself. Perhaps your results are indeed “normal.” But if it you are in the low end of the “normal range,” it may still be worth a trial of thyroid hormone. Do you know how the “normal range” was derived? They pull a lot of people off the street, test their thyroid hormone, average out the results, and call where the bulk of the people fall on the test “normal.” “Typical,” in my opinion, would be a better way to describe that range. Typical does not mean the same thing as “optimal,” particularly in a country with rampant thyroid disease.
Surprisingly, a lot of patients ask their doctors to test the full thyroid panel and the doctor insists that it is not necessary, because the TSH and T4 were normal. In that case, you can seek another doctor who is more willing to allow patient input into the process of determining which tests are run. Another very empowering option that everyone should know about is that you now have the option to walk into a lab and request any blood or urine test that you want without a doctor’s prescription. Results will be sent to whoever you indicate: you alone, or you and any doctors you want to include. You will have to pay out of pocket for the testing as the lab does not contract with any insurance companies. The lab in this area that I am familiar with is in Springfield: http://www.anylabtestnow.com/.
Final Note
There is a LOT that can be done to treat depression, anxiety, and OCD. If you want to veer away from prescription medication, though, and explore some of the (very effective) over the counter options, you are going to have to educate yourself or go to a practitioner versed in this methodology. With some things that you try, you may notice immediate effects. It may be, however, that the effects of some things may be gradual and cumulative rather than immediate. Keeping a journal or brief mood log may help you to track your progress and note the effects of different supplements as you experiment.
Good luck in your journey!