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Herbs and Supplements for the Treatment of Depression - Do They Work and Are They Safe?

Doug Bremner

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There are a number of natural herbs and supplements that are advocated for the treatment of depression. I talked about St John's Wort in another publication. Here I cover some other alternatives.

S-Adenosylmethionine (SAMe) is a molecule found in all human cells that is also promoted as a supplement for the treatment of depression. It plays a role in methylation reactions, including gene expression, maintenance of cell membranes, and neurotransmitter synthesis. Administration of SAMe has been shown to increase levels of serotonin in the brain. A meta-analysis from Italy that pooled data from several small studies concluded that SAMe was better then placebo and equivalent to tricyclic antidepressants in efficacy with fewer side effects. However there was considerable variability in the studies conducted. Studies have also not had adequate long-term followup to determine long-term benefits of SAMe for depression, although it does not appear that SAMe has potential long term toxicity.

Kava (or Kava-kava) is an extract of the roots of the Polynesian plant Piper methysticum used in the South Pacific for its sedative, aphrodisiac, and stimulatory effects. Active compounds include the kava pyrones, which may have effects on the brain. Several controlled trials have shown that Kava reduces anxiety in patients with anxiety disorders. One study looked at 24 subjects with stress induced insomnia treated for six weeks with kava 120 mg daily followed by two weeks off treatment and then Valerian for another six weeks. Both Kava and Valerian improved sleep (decreased onset, longer sleep time) and reduced stress severity. Side effects of Kava include dizziness, dry mouth, gastric disturbance, diarrhea, dizziness, drowsiness, depression, and more rarely liver failure, which has caused it to be banned in some countries. Because of the very real risk of liver failure and possibly death I do not recommend Kava for the treatment of mood disorders. Kava is potentially lethal and should not be used.

These is one study I know of that has looked at the effects of omega-3 fatty acids on symptoms of bipolar disorder. Thirty patients with bipolar disorder were randomized to receive four months of omega-3 fatty acids in the form of fish oil capsules or placebo. Patients in the omega-3 group had a significantly longer period before remission of bipolar symptoms than patients on placebo. It is possible, however, that patients on omega-3 treatment could smell the “fishy" smell of their supplements (a problem that cuts across many studies of herbs and supplements) and that had a placebo effect. Although interesting this study is an isolated study and little else has been done to look at the relationship between omega-3 fatty acids and mood.

In summary these natural health remedies for depression don't have significant downsides, with the exception of kava, so it you want to try them go ahead. Ultimately if your depression persists I recommend consultation with a psychiatrist. We don't bite!

J. Douglas Bremner, MD, is a researcher and physician and author of ‘Before You Take That Pill: Why the Drug Industry May be Bad for Your Health: Risks and Side Effects You Won't Find on the Label of Commonly Prescribed Drugs, Vitamins and Supplements. ’


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