More than a decade ago, a new generation of antidepressant drugs emerged with great fanfare, promising quick relief for the blues. But as the ranks of patients taking pills such as Prozac and Zoloft rose to 7 million, so did accounts of debilitating side effects and lack of efficacy. As a result, many of the 19 million Americans with depression—especially those with the mild to moderate form of the disease—now seek relief at natural products stores rather than pharmacies.
"Think of it this way," says Rita Elkins, a master herbalist and author of Solving the Depression Puzzle (Woodland Publishing, 2001). "With all the drugs out there like Prozac, why is there still this huge demand for natural alternatives?" The reason, she says, is simple: Patient experience and clinical trials prove herbs and supplements can work for many people with few or no side effects.
The rate of clinical depression has been increasing in each succeeding generation born since 1915, according to Elkins. "This condition often flies below the radar screen," she says, but the increased incidence among children and the elderly, coupled with rising numbers in the general adult population, are cause for concern. To add to that, depression can also impact other health conditions, and can even result in suicide, Elkins says.
According to the Mayo Clinic in Rochester, Minn., two main factors characterize clinical depression: a loss of interest in daily activities; and a mood described as "sad, helpless and hopeless." In addition, a person may experience symptoms such as sleep disturbance, difficulty concentrating and low self-esteem nearly every day for at least two weeks.
"There are many, many physiological causes for depression," says Mary Markow, N.D., M.S., L.Ac., of the Special Care Holistic Wellness Connection, a member of the Hospital for Special Care Community in New Britain, Conn. "For instance, a hormone imbalance can cause it, as in the case in postpartum depression or pre-menstrual syndrome. Anemia, thyroid problems, dietary imbalances, even allergies may also be to blame."
Brain chemicals such as serotonin and endorphins help regulate mood, she explains. When the signals they generate become blocked—which can be a side effect of a common illness—the brain's chemistry is compromised, and depression can result.
Once a patient receives a clinical diagnosis, the next step often involves pharmaceutical treatment. Drugs such as tricyclic-, MAO- and selective serotonin re-uptake inhibitors (SSRIs) target chemical centers in the brain that precipitate depression. They represent an aggressive approach that's required in severe cases, such as mitigating a suicide risk and easing intense anguish.
But what about mild to moderate depression? "In these cases, patients have several great reasons to go with natural alternatives," says Pierre Brunschwig, M.D., of the Helios Health Center in Boulder, Colo.
"First of all," he says, "the side-effect profile of antidepressants is something to avoid, if possible." Antidepressants can invite unwanted effects such as nausea, dry mouth, decreased libido, tremors and headaches—all of which may be acceptable for severely depressed patients, but not for those with milder cases. "In addition, many want to choose natural therapies for themselves, taking charge of their own health rather than relying on a doctor for a prescription."
He also points to the bevy of actions herbs provide, in contrast to drugs, which usually target a single problem, such as blocking a particular brain chemical. "Herbs are gentler and have a more synergistic, whole-body effect," he adds.
And if that weren't enough, there's the recent University of Connecticut study that showed drugs such as Prozac are only slightly more effective than placebos for mild to moderate depression (Prevention and Treatment, 2002).
Natural Treatment Options
When retailers think "depression," St. John's wort first comes to mind, and for good reason. Despite recent negative media attention over a study showing it (and the drug Zoloft) ineffective for severe depression (Journal of the American Medical Association, 2001), St. John's wort continues to have a strong clinical track record for more mild forms of the disease. The herb remains one of the most prescribed therapies in Germany, a country with a sophisticated and clinically based herbal system.
But St. John's wort is just the beginning when it comes to stocking the shelves with antidepressant products. In fact, for Elkins, other treatments come first. "If you're lacking in just one vitamin or mineral, for instance, you can become chronically depressed," she says. "Before doing anything, cover your bases with a vitamin B complex, which relieves stress, as well as a multivitamin and mineral supplement."
After vitamin therapy, the next step in her "core protocol" for depression is a form of tryptophan called 5-HTP (see Depression Supplements Checklist). "It boosts serotonin without some of the negative side effects of antidepressants." She then suggests adding ginkgo (Ginkgo biloba), which increases blood flow to the brain capillaries and omega-3 essential fatty acids, which maintain the health and efficiency of the brain's nerve cells.
Only when a patient has incorporated these supplements in his daily routine will Elkins recommend the last step: choosing either SAMe, St. John's wort, NADH, tyrosine or DLPA. She warns that both SAMe and St. John's wort can increase the effects of antidepressant drugs, so they should not be used together. For all cases, retailers should research the products they buy, says the Special Care Community's Markow. "Be confident in and familiar with your manufacturer—and make sure the product has been tested by an independent lab."
Given the complexities of the disease, healing from depression greatly benefits from a group effort. Competent care providers make the diagnosis; patients take charge of their own treatment; and informed retailers offer advice on navigating the field of options. Indeed, a retailer's knowledge and product suggestions can go a long way in helping those customers with depression find lasting relief, naturally.
Jennifer Barrett is a health writer and editor of The Herb Quarterly magazine (www.herbquarterly.com). She lives in West Hartford, Conn.
Natural Foods Merchandiser volume XXIII/number 10/p. 62, 72
Natural Foods Merchandiser volume XXIII/number 10/p. 72
Natural Foods Merchandiser volume XXIII/number 10/p. 72