Ronald Elson, MD, has been a practicing psychiatrist in Berkeley for 30 years. He is on the staff at University of California, Berkeley, University Health Services and consults with local medical groups. Here, he talks about non-prescription options for combatting mild depression.
Other than talk therapy, what are the most effective non-prescription treatments for depression?
There are a number of options, including herbal remedies and nutritional supplements, as well as lifestyle tweaks like exercise, sleep, diet, and getting more exposure to light, especially during the darker winter months.
These lifestyle and alternative treatments may benefit people with mild depression; and are useful adjuncts to psychotherapy and antidepressants for more severe depression. Remember that any substance, even a supplement from the health food store, can cause side effects or interact with something else you might be taking. I like to say that if it does something, it does something. So it’s important to work closely with your doctor regarding anything you try.
How effective is something like St. John's Wort or other plant-based remedies?
St. John’s Wort is interesting. We don’t know its exact mechanism of action, but it seems to work much like selective serotonin reuptake inhibitors (such as Prozac or Celexa). It’s approved in Europe as a treatment for mild to moderate depression.
If you are thinking of trying St. John’s Wort, don’t combine it with SSRI antidepressants you may be taking, since it seems to work on the same neurotransmitter system. Also avoid it if you are taking triptan medications for migraines.
Keep in mind that just because St. John’s Wort is an herb, that doesn’t mean it’s healthier or gentler or that it won’t have side effects. After all, many prescription medications are derived from plants—the heart medicine digitalis, for instance, comes from foxglove. And the downside with all herbal remedies is that it can be difficult to standardize the dose. You’re not getting the pure chemical, like you would in a prescription medication. Having said that, St. John’s Wort is reasonable to consider.
What about supplements such as SAM-e, or fish oil, folic acid, and vitamin D?
It’s worth trying any or all of these for mild depression. They generally won’t hurt you, as long as you take recommended doses, don’t take them with other medications for depression, and keep your doctor informed. There’s no hard evidence that these supplements resolve serious depression, but they may help when used as an adjunct to talk therapy.
I often suggest that my patients try upping their intake of folic acid, which is found in green leafy vegetables and lentils, and their Omega-3 fatty acids, found in fish. While the research on these nutrients’ effectiveness for treating mood disorders is mixed, they won’t hurt you. You can get these nutrients in food, but if you take a supplement be sure to check the labels for dosage. Follow the instructions and don’t simply decide that if one dose is good, two doses are better. If you’re using fish oil for mild depression, look for odorless capsules that contain at least 60 percent EPA (eicosapentaenoic acid) versus DPA (Docosapentaenoic acid), which is mainly for heart health.
It also might make sense to try vitamin D. It’s good for a bunch of things, including bone health, and many people have less than optimal levels. You can try taking 2000 to 4000 mg a day, but if you’re taking higher doses than that, be sure to have your blood serum checked for vitamin D levels. It’s possible, though rare, to end up with unwanted calcium deposits.
Finally, SAM-e, a chemical found naturally in the body and also made in the lab, seems to help mild and even moderate depression, as well as ease inflammatory conditions such as fibromyalgia and osteoarthritis. It’s approved for treating depression in parts of Europe. I have patients who swear by it, though studies are mixed. Like St. John’s Wort, be sure to discuss SAM-e with your doctor, and don’t mix it with SSRI antidepressants because SAM-e has a direct effect on the serotonin system. Some reports recommend that if you take SAMe, you combine it with B-complex vitamins and lecithin.
Can junk food or, conversely, a healthy diet affect a person’s mood?
Well, of course, there’s vitamin chocolate, which I call Vitamin Choc. Chocolate does seem to have a beneficial effect on mood, especially for women. But, more seriously, a diet high in junk food is associated with depression—and obesity—though it’s hard to know which comes first. When we are depressed, we often spend our time sitting in front of the TV and eating junk. We see our friends less, exercise less, so it’s tough to separate cause and effect. But while I don’t know of any double-blind studies, there’s a general sense that a healthy, whole-food-based diet is linked with reduced depression. People may eat less, or eat less well, when depressed, so this vicious cycle is worth attending to. Coffee may actually improve mood. And there’s some evidence that tryptophan in the diet—from foods such as turkey or oatmeal—may increase serotonin in the brain.
If you could recommend a single lifestyle change for people who are depressed, what would it be?
Sleep is truly critical, whether you have mild, moderate, or more severe depression. It’s important to get on a regular sleep schedule, to wake up and go to bed at the same time every day, even on weekends as much as possible. The students I work with at UC Berkeley’s health services tend to have really erratic sleep schedules. I strongly recommend that they get to bed at a reasonable hour, ideally before midnight, and shut down all electronics at least an hour or two before sleep. That’s because light from all these screens tends to be stimulating and can keep you awake.
What about other lifestyle factors, like getting enough light?
Extra exposure to light definitely helps people with Seasonal Affective Disorder (SAD), and some studies suggest it helps in more typical depression. Using a light box with full spectrum light for an hour in the morning can improve mood. A regular incandescent light bulb or an LED bulb won’t substitute. If you want to try a light box, read the instructions on how to use it. In general, just turn it on when you wake up and keep it near you while you’re reading or having coffee.
Is exercise important for lifting depression?
Clearly, exercise is good for us, for every reason in the world, not least that people feel better when they are moving as opposed to being sedentary. Overall, studies do seem to show an inverse relationship between exercise and depression—the more you exercise, the less depressed you feel. But again, it’s hard to know what causes what. A good rule of thumb: Try to get in 30 minutes of moderate exercise three to five times a week, and if using devices like step-counters motivate you, all the better.
It’s also worth trying more mindful activities like meditation and yoga. With practice, they can help people learn to sit with difficult thoughts and feelings, and recognize that they’re a part of life and will pass. The problem, study-wise, is that both of these require learning and practice to get the benefits, so it’s tough to assess how effective they are in a brief trial. But anecdotally, most people report positive results.
Anything else to keep in mind?
Maintaining social contact, relationships, and activities is quite important. They help support us, and reduce social isolation and depression. Often when we are depressed, it’s difficult to motivate ourselves to keep up social contact. So extra effort is required.
Whatever your level of depression, watch your alcohol intake. People often use alcohol to self-medicate—and it may even work in the short term. But medically, alcohol is a depressant. So using alcohol to ease your depression isn’t a good idea.
Many people report help from traditional Chinese medicine—acupuncture and other approaches—but we don’t have controlled studies to support their effectiveness. Stay tuned: Additional studies come out regularly.
This opinion does not necessarily reflect the views of the UC Berkeley School of Public Health or of the Editorial Board at BerkeleyWellness.com.