Alternatives To Drugs
Alternatives to drugs to treat depression
We have explored a side of parenthood that is rarely discussed seriously: the weariness, irritability, low mood, and health problems that can develop when the hard work and stresses of parenting are not balanced by lots of replenishing resources. A physical state of depletion often results -- especially for mothers, who face unique physiological demands and psychological stresses -- in which important building blocks of the body have been drained and key systems have been dysregulated.
In our last column, we discussed some of the ways that parents can lift their mood, the all-pervading experience that colors every waking moment. In addition to exercise, recreation, good company, and a positive focus -- which most people can do on their own -- the best known methods used clinically to raise mood are psychotherapy and anti-depressants such as Prozac. Therapy and anti-depressants seem to have about the same efficacy for depression, and combined treatments may be even better.
Additionally, there is also a less well-known class of approaches that is drawing increasing attention and research: the use of naturally occurring substances such as herbs (including St. John's Wort) or chemicals normally present in the body (such as 5-hydroxytryptophan). Even Larry King is endorsing a combination of St. John's Wort and Ginseng. Our purpose in this column is to summarize available information on these approaches; they have pros and cons.
But before we dive in, we need to make some important points. The word "natural" can endow a substance with a sort of halo; just because something is "natural" does not necessarily mean that it is safe: poisonous mushrooms are natural, too. Natural substances can have strong main effects as well as side effects. They should be used in consultation with a licensed professional who has experience with them.
A chemical is a chemical is a chemical, and the bottom-line consideration should be clear-eyed and pragmatic, weighing the specific pluses and minuses of various options in your case. Most research is essentially about the averages of groups, and generic findings or recommendations often do not apply to particular individuals. We will be describing information available in the public domain, and that is no substitute for professional health care in your own individual case.
In particular, it is unwise to think that you can self-medicate moderate or severe mood disorders (such as depression or bipolar disorder) with natural remedies; do not let a health food store clerk substitute for a psychiatrist if that is who you really need.
The biochemistry of depression
Let's start with a little experiment. Think about your child giving you a hug, and then notice the emotions and body sensations that follow. Now let all that go, and we'll try something different. This time, just for a moment, think about hungry children in refugee camps, and notice the emotions and body sensations that follow. And then let all that go.
In each case, your thought probably led to a palpable change in your experience. That entire process involved the workings of the nervous system, comprised of billions of nerve cells. Whether a conscious thought leads to a depressive feeling, or painful memories cast a shadow over one's present state of mind, or a black mood smothers the life out of any moment that by every reason should be happy -- nerve cells are the means by which we experience life.
Nerve cells, also called neurons, are organized in a fantastic network that has been called the most complex object yet known in the universe. Your brain has about 1.1 trillion neurons, and 100 billion of these comprise the "gray matter" that is principally involved in thinking, feeling and acting. A typical cell will connect with 100 to 10,000 other cells at junctions -- each one a neurological crossroads -- called synapses. A synapse looks a little like the picture of God reaching out to Adam painted in the Systine Chapel: two fingers almost touching.
Neurons communicate with each other by sending chemical messengers known as neurotransmitters across the gap. An average neuron can fire one hundred times per second. In other words, somewhere between a billion and a trillion or so synaptic events involving neurotransmitters have occurred in your brain -- in the time it took you to read this sentence.
So you can probably see why neurotransmitters are so important. In order to feel good -- or to have anything function very effectively in the body -- the system of neurotransmitters must be in top working order. Several neurotransmitters -- notably serotonin, norepinephrine and dopamine -- are known to be involved with the regulation of a mood, as well as many other functions.
For example, if there is a relatively low concentration of serotonin in the rich chemical soup that bathes the synapses of the nerves that have to do with emotion, an individual will probably start to feel depressed.
The supply of serotonin can become low for various reasons that are largely biochemical; (these reasons are distinct from psychological causes whereby negative experiences or thought patterns affect mood). There may be a genetic tendency toward low serotonin, as with individuals who have a family history of depression. Stressful life experiences -- such as having children -- may place an increased demand for serotonin so that the supply drops. The body may be receiving insufficient quantities of the nutrients needed to build neurotransmitters.
How anti-depressants work
Anti-depressants generally work by influencing the concentrations of neurotransmitters at the synapse. For example, the latest generation of anti-depressants, the "selective serotonin reuptake inhibitors" (SSRIs), do so by slowing the reabsorption of serotonin that is released into the synaptic cleft, so that a higher concentration remains. Herbal supplements contain more types of molecules than most pharmaceuticals, so they generally act in more complex ways. This increases the chances of unpredicted effects, but it also may enable the herb to act through multiple pathways for a more comprehensive benefit.
Whether it's Serazone or St. John's Wort, biochemical interventions require
little personal effort, insight or change in behavior. If the root cause of
the depressive mood is biochemical -- and it often appears to be -- that may
be alright. But if the root cause of a person's glum mood is psychological,
interpersonal, or circumstantial (ie. racism or poverty), a biochemical
intervention may simply mask the true causes, rob the individual of a growth
opportunity, or allow the real causes to remain unchecked.
The brain does not usually learn very much from a biochemical intervention. Therefore, biochemical interventions are perhaps best used as a means to the end of freeing up the individual to take effective action -- psychologically, interpersonally, and materially -- to improve her experiencing and her functioning.
Having said this, let us also say that skillful biochemistry can be a godsend. Millions of people have been helped by herbal mood-lifters over the centuries, and millions more by anti-depressants in the last few decades. Let's take a look at two of the most widely used natural substances that can boost mood: St. John's Wort and 5-hydroxytryptophan.
St. John's Wort
The most common herbal treatment for depression is Hypericum perforatum, also known as St. John's Wort. There is evidence that this plant has been used for more than 2,000 years. Various clinical studies have shown it to be often helpful in the treatment of depression. In Europe, St. John's Wort is available both over the counter and by prescription. It is commonly prescribed by physicians for mild to moderate depression. Overall, studies have found it to be effective in 50 to 80 percent of these cases. (For research information, a good source is Hypericum & Depression (Prelude Press, 1996) ).
In various studies, 2 to 10 percent of individuals taking St. John's Wort had side effects, which compares favorably with the rate of side effects reported for anti-depressants. The most common side effect was mild gastrointestinal upset, and in some cases the herb seemed to cause a sensitivity to light or an increase in blood pressure. A small percentage of people had an allergic reaction, and they stopped taking the herb immediately. Few individuals taking St. John's Wort report feeling either sedated or restless, which compares favorably with the fraction of patients on anti-depressants reporting these side effects.
Although any type of St. John's Wort may work for some people, it is mainly the formulations that have been "standardized" to contain 0.3 percent hypericin (one of the active ingredients) that have been researched. Read the label carefully to make sure that all of the herb has been standardized.
Unfortunately, there is no formal quality control of herbal products in this country. For this reason, it is best to use a reputable botanical company. Because St. John's Wort accumulates slowly in the body, it may take six weeks or so before its full effectiveness is clear. The dosage that has been used in most of the studies is 900 milligrams (mg.) of standardized St John's Wort, usually divided into two or three doses across the day. Dosage suggestions are available on the labels off of the bottles available at health food stores or supermarkets. The dose that works best for an individual will vary, and anyone trying St. John's Wort should consult with a licensed health professional.
One rule of thumb is, if you can't pronounce it, don't take it. So we better start there: Five-high-drock-see-trip-toe-fan. Or 5-HTP for short. 5-HTP is a substance that is naturally found in the body. The biochemical pathway to serotonin begins with the amino acid tryptophan, which is converted into 5-HTP, and then to serotonin. (Turkey has relatively large amounts of tryptophan, which is one of the reasons that people may experience an elevated mood when they push back from the Thanksgiving table -- although there are plenty of other reasons as well!)
Taking 5-HTP thus increases the raw materials available for the manufacture of serotonin. 5-HTP has been relatively well researched, with studies showing a success rate of about 60 percent for mild depression. Because 5-HTP is normally produced by the body, there is an established pathway to break the substance down and eliminate it, which is often not true of pharmaceutical drugs or every specific chemical within an herb.
A few people do report nausea as a side effect, which may be usually resolved by increasing the dosage slowly, sticking to a minimum dose, and taking it just before meals. Since serotonin also contributes to our ability to have a good night sleep, 5-HTP can be used for that purpose, and should be thought of when insomniais a part of the mood picture. Additionally, studies have shown 5-HTP to be sometimes effective for migraine headaches (one study reported that 25 percent of patients completely eliminated their migraines, and an additional 46 percent were more than 50 percent improved), and for fibromialgia, which is uncomfortable muscular pain throughout the body.
Additionally, 5-HTP has also been used to control appetite and promote weight loss. The breadth of these benefits underscores how important serotonin is to the well-being of the body. Results from 5-HTP tend to be rapid; some notice them within hours, and certainly within days. The dosage of 5-HTP commonly used in studies of depression is 300 mg/day, divided into 2 or three doses. However, smaller doses may be effective. As with St. John's Wort, consult with a professional before trying 5-HTP.
A word of caution
It is possible to have too much serotonin. This is called serotonin syndrome, and its symptoms can include confusion, fever, shivering, sweating, and muscle spasms. In very rare cases, serotonin syndrome can be fatal. Do not take excessive doses of St. John's Wort or 5-HTP, and make any changes in dosage gently. If you try either substance and begin to feel bad,STOP IMMEDIATELY and contact a licensed health care professional familiar with these substances.
In particular, do not take St. John's Wort or 5-HTP TOGETHER, OR along with anti-depressants or other psychoactive drugs OR HERBS, unless you are doing so under AN EXPERIENCED doctor's supervision. This is especially important if your anti-depressant is known as an MAO inhibitor. Even if you have recently stopped taking the MAO inhibitor, most doctors will require at least a full month off of that medication before trying any 5-HTP.
Like any tool, these natural substances can be used skillfully or
inappropriately. They are definitely not for children! But in Europe, and
increasingly in America, many people are finding them to be a useful
addition to their toolbox for health and well-being.