Depression

Note that over-the-counter supplements and remedies are not likely to make much difference to the symptoms of clinical depression. However they may be suitable for low mood conditions or as part of a wider programme to manage depression.

For safe use of over-the-counter medicines, herbal remedies and supplements:
– if you have a serious medical condition
– if you are breast-feeding, pregnant or planning to become pregnant
– if you suffer from allergies

consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement.

Registered herbal medicines (these bear the THR logo) will have a package insert. Read this before taking the product.

Avoid taking the product if you think you may be allergic to any of the ingredients.

Do not combine over-the-counter medicines, remedies or supplements with prescribed medicines unless you have first checked with your prescriber or a pharmacist.

Seek advice from your doctor or pharmacist:
– If your symptoms do not get better
– if your symptoms get worse
– if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

Many modern drugs started as medicinal plants and people have been using herbs to treat illnesses for thousand of years. Some of these remedies have been tested against the toughest health conditions, and plants with the strongest reputations across many cultures deserve a close look.

From the way they have been described in old texts, and from what we now know of the action of many plant constituents, it is possible favourite plant remedies work particularly by nudging better function in digestion, circulation, and eliminatory processes: helping the body help itself rather than directly attack a disease. Women also favoured plants in managing their health and childrearing needs.

Researchers are now discovering that many herbal medicines have useful benefits for the body, including in healing and repair, in stabilising hormonal responses (including stress hormones, insulin and sex hormones), and in reducing long-term inflammation.

See below for various ways herbs have been used to help people with depression.

Over-the-counter medicines are those you can buy without a prescription, from pharmacies, supermarkets or general stores.  

There are none which are likely to help with depression.

Summary
When daylight and sunlight are in short supply many people suffer from seasonal affective disorder (SAD).

Many people say their mood improves when they get more light. It has been estimated that approximately 5% of the UK population suffers from SAD. Research has shown that bright light boxes and dawn simulation lights (light alarms) can help lift depression. You have to sit close to the light for about 30 minutes a day if you use one of the very bright boxes.

Evidence
There is good evidence that light therapy helps people with winter depression or low mood. It also seems to be helpful for other types of depression, although the effects are less noticeable.

Safety
Light therapy can make some people slightly over-excited and they may have problems getting to sleep at night. You should therefore use your light in the morning.

Cost
A special light therapy box can help and they are available from specialist retailers. These lights are expensive but this is a one-off purchase.

More information
A special light therapy box can help and they are available from specialist retailers. These lights are expensive but this is a one-off purchase.

Summary
There is growing evidence to link depression and low mood with a lack of fatty acids, of which omega-3 seems to be the most important. Oily fish is a good source of omega-3, which is also found in flax seeds, pumpkin seeds and walnuts.

Evidence
Research suggests that omega-3 supplements do help some people with depression. But people in the studies tended to take high doses, and they sometimes had problems with nausea, diarrhoea and a fishy aftertaste.

Safety
Omega-3 thins the blood slightly, so get a doctor’s advice if you take anti-coagulants, aspirin or other blood-thinning medicines.

Cost
There are many varieties of Omega-3 supplements available, differing in cost.

Summary
Rhodiola is used in traditional medicine across northern Europe and Russia to increase endurance and work performance, longevity, tolerance to high altitude sickness, and to treat fatigue, weakness, impotence, and other nervous system disorders.

Evidence
Mostly laboratory evidence points to a range of promising effects on transmitters associated with depression.

Safety
Rhodiola is increasingly used as a prescription medicine in Europe and has been found to be safe with minimum interactions.  To be sure of correct dose and quality standards it is also wise to use products with independently confirmed quality (as provided by registered traditional herbal medicines or THR’s – see the list of these – and other registered herbal medicines for symptoms of depression –  currently on the market in the UK).

Cost
Rhodiola THRs can cost between £15 per month.

Summary
According to the available research, St John’s Wort is a valuable treatment for mild to moderate depression. It can also ease the sleep problems and tension that often go with depression. It does not help everyone (though it helps perhaps two people out of three) and it takes up to six weeks to start working.

If you think you are depressed, and you’re considering taking St John’s Wort, you should ask your doctor’s advice. It is definitely not a major treatment for more serious types of depression. Overall it is safer than conventional anti-depressants. No serious harm has been reported by doctors in Europe, where St John’s Wort has been used very widely and in large doses for many years. But it would be unwise to take it if you are already on prescribed anti-depressants. You should wait at least one month after you have stopped taking them. St John’s Wort may also interfere with certain prescribed medicines.

Evidence
There is some very good research showing that St John’s Wort is as good as standard anti-depressant medicines (such as Prozac) for mild to moderate depression. But there are some concerns about safety and what the best dosage might be.

Safety
You should always get medical advice before taking St John’s Wort while on other medicines, including antidepressants. Risks are especially critical if you are taking: warfarin (anti-coagulant), digoxin (for heart failure), oral contraceptive, protease inhibitors for HIV infection, chemotherapy or transplant drugs, or anti-schizophrenia drugs. Otherwise St John’s Wort is generally safe. To be sure of correct dose and quality standards it is also wise to use only independently confirmed quality St John’s Wort (as provided by registered traditional herbal medicines or THR’s – see the list of these – and other registered herbal medicines for symptoms of depression –  currently on the market in the UK).

Cost
St John’s wort THRs can cost between £10-16 per month.

Summary
It isn’t likely that taking extra vitamins will make much difference to low mood or depression. It is true that many people don’t get quite enough B, C and D vitamins in their food. And it’s also true that the brain and nervous system need these vitamins. Because they don’t get stored in the body, our daily diet has to supply them. Research has shown that people with low blood levels of the B vitamin folic acid are more likely to be depressed and less likely to do well on anti-depressant medicines. So, if you are eating a very poor diet, taking extra vitamins just might help. It’s also worth remembering that alcohol, refined sugars, nicotine and caffeine all take these vitamins out of the body. Yet most people who feel depressed probably won’t benefit from taking vitamins alone. To ensure that you get a good balance of these vitamins, try to eat more whole-foods, fruits, vegetables, nuts and seeds.

Some people say that taking high doses of vitamin C (1-2 g and more a day) helps lift their mood. There is a little research to support this and none showing that high doses of vitamin C actually help clinical depression. Vitamin C levels fall after surgery or inflammatory disease. The body needs more vitamin C when coping with stress, pregnancy and breast feeding. Aspirin, tetracycline and contraceptive pills take vitamin C out of the body. Smokers also need extra vitamin C because nicotine removes it. Fresh fruit and vegetables are the best sources of vitamin C.

Doctors are increasingly concerned about low vitamin D, especially in the Asian community. A lack of vitamin D can lead to depression. Oily fish and dairy products are good sources of vitamin D, and sunlight helps the body make vitamin D. Do you get enough sunshine and eat a good diet? It is estimated that worldwide over 1 billion people get too little vitamin D.

Evidence
Taking supplements of vitamins B and D might help some people, whose diet is poor, but more research is needed.

Safety
Very high doses of vitamins and minerals can upset the body and cause side-effects. Get medical advice if you intend to take large doses. To ensure that you get a good balance of these vitamins, try to eat more whole-foods, fruits, vegetables, nuts and seeds.

Cost
If your diet is poor and you don’t get into the sun, ask your doctor about a vitamin D blood test. If it’s normal, there’s no point in taking vitamin D. If it’s low, your GP will prescribe it for you or you can buy a vitamin D supplement.

Summary
Depression has been well recognised through human history, although many different descriptions have been used for it.

One revealing example is the term melancholia. This means black bile in Greek and reflects the ancient view that what we consider mental problems were also physically based. In this case the liver was seen as the seat for emotions and treatments for depression were directed at the liver and its most obvious manifestation, bile. Now that we know how central the liver is to hormonal and biochemical metabolism this is not such a primitive idea.

A consistent theme through the ages was that depression was marked by a wider depletion of energies, and most favoured remedies were classified as ‘tonic’. A classic example is St John’s Wort, reviewed elsewhere in this section, which was consistently understood to be a tonic remedy, especially in convalescent recovery from illness or injury (note the possible interactions between St John’s wort and conventional antidepressants). Other consistently favoured tonic remedies used in depression include the following.

Ashwagandha (Withania somnifera) – a very popular remedy in India and around Asia, including as restorative tonic, tissue healer.

Brahmi (Bacopa monnieri) – another widely used calming tonic from India

Ginseng (Panax ginseng) – with almost fabulous reputations for building energy in depleted states, sometimes used to relieve symptoms of depression in such circumstances.

Safety
There are few known risks in taking most of the herbs above. Apart from St John’s wort there are unlikely to be interactions with conventional antidepressants. However they should always be seen as part of a bigger picture.

It is also advisable not to buy herbs online unless from suppliers with prominent reputation (they will be concerned to protect this by ensuring quality for their products). Unfortunately there are few controls on herbal sales and many cases of adulterated or wrong products. It is always a good policy to look for a registered herbal medicine, with the THR logo on the pack. This will have its quality independently assured.

A good approach in choosing traditional herbal approaches for depression is to see a qualified herbal practitioner. You will find well trained practitioners from a number of traditions from the website of the main umbrella body the European Herbal and Traditional Practitioners Association. This will entail extra costs but will allow you to have herbs you might not find elsewhere, and tailored to your needs.

Cost
Most herbs should be inexpensive and can be bought from specialist suppliers. A registered herbal medicine (THR) if available, will cost more – round £15 per month.  Seeing a practitioner may cost around £50 for a first visit.

Further information
There is a wide ranging review of the evidence for many of the herbs listed above in depression in the following paper.

Herbal medicine for depression, anxiety and insomnia: a review of psychopharmacology and clinical evidence.
Sarris J, Panossian A, Schweitzer I, Stough C, Scholey A. Eur Neuropsychopharmacol. 2011 Dec;21(12):841-60.
A  wide-ranging review of the literature to ascertain mechanisms of action of various  herbal remedies, with a systematic review of controlled clinical trials for the herbal treatment of mood, anxiety and sleep disorders.
Link to Abstract