Shake a Magic 8 Ball and ask: "Are (prescription) card-carrying members of the Prozac Nation shopping in the aisles of natural products stores?" In the 1980s the answer likely was: "Reply hazy; try again." Today the answer is: "It is decidedly so."
The National Institutes of Health estimates that 15.3 percent of American adults, 8.3 percent of teens and 2.5 percent of children are depressed, and 80 percent of these people are taking antidepressants. A 2002 study in the Journal of the American Medical Association indicated that physicians are ramping up on prescribing antidepressants. The researchers suggested that physicians were turning to antidepressant prescriptions in lieu of recommending psychotherapy, deemed a more time-consuming and costly alternative.
But despite these statistics, there is a niche for naturals retailers in the antidepressants market. They can offer vitamin, mineral and herbal supplements that alleviate unpleasant symptoms associated with prescription antidepressants. Health-and-beauty department managers and clerks are not privy to the contents of every customer's medicine cabinet, but they are wise to recognize some of the side effects of prescription antidepressants and to understand that an increasing number of customers may be taking prescribed medications.
And for those customers who pledge their allegiance to the state of St. John's wort rather than the Prozac Nation, there are natural ways of combating depression, including vitamin and mineral therapy and Asian herbs.
Still, "It's just very important that people make sure to always, always double-check with their health-care providers before beginning any kind of new therapy," says Julia Holman, a licensed acupuncturist practicing in Seattle.
No License? Don't Prescribe
The most prescribed treatments for depression are antidepressants called selective serotonin reuptake inhibitors. Antidepressant brand names such as Prozac, Paxil, Zoloft and Celexa are as familiar as Tylenol to most Americans.
SSRIs work by increasing the availability of a neurotransmitter, serotonin, in the brain. People who take SSRIs experience the benefits of the drug within six to eight weeks; side effects may begin earlier.
One of the most common problems for men and women who take SSRIs is a low sex drive. There are several herbal tonics for the male reproductive system. Most include damiana, Siberian ginseng, saw palmetto and yohimbe. Women, however, may have more difficulty finding products.
"Female sexual response has three phases: desire, arousal and orgasm," Moskowitz says. "We have an oral tablet product that works primarily to increase feelings of desire, or libido. We also have a topical gel cream that works to increase the blood flow to the genitals; this is basically what occurs naturally when a woman is aroused."
Herbs in Emerita's oral product include Panax ginseng and damiana, Muira puama—also known as potency wood—and Ginkgo biloba. The Emerita topical cream contains ginger, licorice, rosemary, cinnamon, bergamot and niacin.
"People are sometimes surprised to see niacin on the label," says Moskowitz. "But when you apply it topically you can actually see the flushing of skin, which is just dilated blood vessels."
Still Kava After All These Years
For those scared off by the sexual lethargy and other side effects of SSRIs, there are herbal alternatives for relief from stress and anxiety.
Although neither should be taken in conjunction with SSRIs or any psychotropic medications, kava kava and St. John's wort are still the best-selling mood enhancers among natural products consumers, says Tom McGowian, herbal consultant at The Herbalist in Seattle.
"The most popular herbal formula we sell for calming the mind and spirit is a kava kava mixture with Siberian ginseng and St. John's wort, oats and skullcap," he says. "For panic attacks, I recommend an anti-spasmodic mixture for nervous system support with black cohosh, valerian, skullcap, passionflower and a little bit of lobelia."
Feverfew is still a popular herb for migraine headaches, says McGowian. He recommends the more subtle action of lavender and valerian for headaches associated with stress. Ginger and anything in the mint family, including peppermint, are the best herbs to soothe nausea associated with a nervous stomach, he says.
Has McGowian seen any kind of change in sales for these products? "Absolutely not," he says. "These plants have been around a lot longer than we have."
Bs Beat The Blues
Certain vitamins and minerals are clinically proven to enhance mood and energy levels, particularly in women. Women are more likely to be deficient in serotonin than men, due in part to hormones and neurological anatomy, according to Marie-Annette Brown, a professor of nursing at the University of Washington in Seattle. Brown reviewed recent scientific research on a variety of nutritional supplements and published the results in When Your Body Gets the Blues (Rodale, 2002). Brown's book, co-authored with Jo Robinson, details a three-step, drug-free treatment plan that includes vitamin supplements in conjunction with an outdoor exercise program and light therapy.
"Vitamins are the building blocks that help the body make adequate amounts of serotonin," she says. "In our review of the literature, we found six supplements that were shown to boost mood. We were looking only at scientifically valid, placebo-controlled studies that focused on one ingredient."
Brown's LEVITY program includes taking daily supplements with vitamins B1 (thiamine), B2 (riboflavin) and B6 (pyridoxine) as well as vitamin D, folic acid and selenium. B vitamins are frequently referred to as anti-stress vitamins. According to Brown's research, they also have been shown to boost the efficacy of SSRIs. Vegetarians, vegans and older women are more likely to be deficient in vitamin B1, found in pork, yeast, legumes, whole grains and enriched breads.
"It's very difficult to get enough of these B vitamins from dietary sources alone," says Brown. "Many women are deficient and don't even know it. For instance, researchers reported in 1997 in the British Journal of Nutrition that 78 percent of women 68 to 90 years old who were participating in the study did not have sufficient amounts of vitamin B2 in their diets. That's an astonishing number."
Brown says vitamin B6 helps combat depression because "The human brain is 60 percent fat, and one of the most important fats in the brain is DHA [docosahexaenoic acid]. DHA is in some fatty fish. But when you have enough vitamin B6, your body can make DHA from a number of other sources."
Folic acid has been shown to enhance the antidepressant action of Prozac in women and older patients, Brown says.
She also makes a correlation between our increasingly indoor-based society and depression.
The Chinese Prozac
While a growing number of scientific studies investigate vitamin supplements in relation to mood and interaction with SSRIs, the same kind of research evaluating herbal remedies and Asian medicine is still elusive.
"Many naturopaths and acupuncturists would recommend against using any herbal supplements when a patient is already taking antidepressants," says Seattle acupuncturist Holman. "I would only recommend Oriental medicines for patients who are not taking antidepressants. Keep in mind, some of the antidepressants have a withdrawal period of up to six months."
In Eastern medicine there are three types of depression, each associated with a particular imbalance of the heart, spleen or liver. There are many formulations for the different combinations of symptoms, and the first step, Holman says, is to get a good diagnosis from a practitioner.
"Patients typically have a combination of liver-and-heart or liver-and-spleen depression," she says. "Liver depression causes headaches and anger—it is associated with [premenstrual syndrome]. Heart depression is related to sadness and restlessness and may result in insomnia. Spleen-type depression is associated with a worrier who frequently feels overwhelmed and has digestive problems."
For general depression, Holman frequently recommends Wu Wei Zu (Schisandra chinensis) for calming the heart and mind, and albizzia (also known as mimosa) to patients seeking a more natural antidepressant.
"Albizzia is the Chinese Prozac," she says. "It's also called the happiness herb."
Pamela Wyngate is a freelance writer in Seattle.
Natural Foods Merchandiser volume XXIV/number 10/p. 32, 36, 38