It's winter. You're in a mental/physical place that is hard to define. You're not so depressed you want to jump out the window, but you're not happy. Everything is an effort and nothing is fun. Life is, well, blah. Those blahs are a sign of low-level depression. What to do? Prozac, Zoloft, Paxil? Maybe. But you should also consider putting into place some fairly obvious lifestyle changes along with taking supplements known as natural mood enhancers.
"There is a time and place, where one needs the big guns to save the proverbial bacon," says Dr. Chris D. Meletis, lead author of the Clinical Natural Medicine Handbook. "If the depression is persistent, worsening or life threatening talk to your doctor right away. Yet assuming you are feeling just a little melancholy, and are not wondering whether life is worth it, then natural mood enhancers are often an excellent choice." Natural substances like tryptophan, St. John's Wort, 5HTP, SAM-e, Rhodiola rosea, valerian root and others can and do improve mental outlook—the way you take on the world—without relying on prescription pharmaceuticals. These substances work in a variety of ways, including boosting levels of the brain's feel-good chemicals and better regulating your body's natural sleep rhythms. And, if used wisely, they are safe. They may also serve as a way to get off prescription mood enhancers.
The key word is wisely. Most doctors will tell you, with good reason, that self-medication is risky. On the upside, natural mood enhancers do not produce many of the common side effects of prescription antidepressants, things like suicidal tendencies, sexual dysfunction, urinary retention, constipation, blurred vision, headache, weight gain, gastrointestinal disturbance and on down a long, depressing list that ends with plain old dry mouth. On the other hand, mood-altering substances are serious things; they alter your body's chemistry. Depending on which ones you choose, these substances work to boost neurotransmitters, to regulate better your body's natural sleep rhythms, to prevent glandular atrophy and even to reduce the inflammation that has been linked to depression.
The fundamental starting point for successfully using natural mood improving supplements, according to Dr. Patricia Gerbarg, co-author of How to Use Herbs, Nutrients and Yoga in Mental Health Care, is that different supplements do different things. "You need to know what you are looking for. Some are better for energy, others improve stress resistance, says Dr. Gerbarg. "One size does not fit all. Learn about the supplements from credible sources, not just from the companies that are trying to sell their products."
To know what to take, it is necessary to define the problem, and a good place to start is with an understanding of the brain's neurotransmitters. These are the chemicals that relay, amplify, and modulate signals between a neuron and another cell in your brain, and their levels have a lot to do with how you feel. There are quite a few of them—about 50 identified so far—flowing in your head, but the most important for our discussion are serotonin, noradrenaline and dopamine.
Serotonin is the brain's feel-good neurotransmitter. It promotes feelings of wellbeing, resilience, calm, personal security, relaxation, confidence and concentration. Many people suffer from various degrees of brain serotonin deficiency, leading to a host of mental, emotional and behavioral problems, including depression, especially the agitated, anxious, irritable type. According to Dr. Meletis, serotonin deficiencies have been linked to a number of conditions, including anxiety, suicide, alcoholism, violent behavior, PMS, obesity, compulsive gambling, insomnia, carbohydrate craving, SAD (seasonal affective disorder), and migraine headaches.
Clearly, keeping serotonin levels up is vitally important. One way to increase serotonin is with supplements containing the amino acid called 5-hydroxytryptophan. 5-HTP is the immediate precursor in the production of serotonin from the essential amino acid L-Tryptophan. It can be taken with meals and your body converts it to serotonin.
Another important neurotransmitter is noradrenaline. It helps to promote motivation and drive. Derived from dopamine, it is involved with "positive" stress states such as being in love and other exhilarating and stimulating pursuits. Without it, one pulls the covers over one's head, and doesn't want to do much of anything. A third key neurotransmitter is dopamine. It is the primary neurotransmitter involved in the reward pathways in the brain. Drugs that increase dopamine signaling may produce euphoric effects. It is the neurotransmitter involved in the "pleasure-ability" of recreational drugs such as cocaine and amphetamines. Problems with dopamine neurotransmission play a role in a variety of disorders, including Tourette's syndrome, Parkinson's disease, schizophrenia, attention-deficit hyperactivity disorder (ADHD), and drug and alcohol dependence.
These neurotransmitters work together in a delicate balance. Serotonin circuits help counterbalance the tendency of the other two to encourage over-arousal, fear, anger, tension, aggression, violence, obsessive-compulsive actions, overeating, anxiety and sleep disturbances. Both antidepressant drugs and natural supplements aim to enhance and rebalance mental interactions. Making any natural mood enhancers work for you is a juggling act that most likely will require behavioral and lifestyle changes: things like dropping the diet soda and artificial sweeteners; sleeping more regularly and actually exercising purposefully for at least two hours a week. For certain you need to think way beyond the "just take a pill" mind set.
Before you head off to the pharmacy, health food store, or computer to buy any supplements, you should consider enlisting the world's cheapest mood elevator: sleep. "America is a sleep deprived country," says Dr. Richard Brown, clinical psychiatry professor at Columbia University and co-author of How to Use Herbs, Nutrients and Yoga in Mental Health Care. Chronic lack of sleep, he says, predisposes us to diabetes and a host of other ailments. He points out that traditional Chinese doctors often tell patients they need to sleep better. "They recognize that different areas of the brain do their recovery and repair work at different times in the night."
On this point Drs. Brown and Meletis agree. It is good to give yourself permission to get enough sleep. "Make sure you are getting your eight hours of sleep," says Dr. Meletis, winner of the 2003 naturopathic physician of the year award from the American Assn. of Naturopathic Physicians. "After all, the first four letters of restoration are REST. Without rest, your body will not work well. Indeed, lack of sleep is a fool-proof way to void your body's warranty and lead to an overall systems failure, or at the least a sputtering down the road of life."
Of course, a measure of just how complex this all is—as well as how individualized solutions may be—is that for some people sleep itself is a big deal. Not being able to sleep because of anxiety calls for an entirely different solution than sleeping too much because of depression.
Eating Right All three docs agree on the importance of nutrition in restoring a sense of wellbeing. "Just like the 1970's Saturday Morning cartoons said, 'You are what you eat, from your head to your feet,'" says Dr. Meletis. "Junk in equals junk out. According to the American Journal of Preventive Medicine, spring 2007, only 11 percent of Americans get their five to seven servings of fruits and veggies. That means 89 percent of us are missing the mark. It would be like putting the low octane grade of gas in a high performance car and wondering why it is not performing."
"The basic keys," Meletis says, "are drink 64 ounces of filtered, non-chlorinated, non-fluorinated water daily. Avoid Mountain Dew, orange Gatorade and other beverages that contain brominated vegetable oil, which can rob your body of iodine that will contribute to altered chemistry in your body. Also avoid excess carbs. Otherwise your brain, which runs largely on glucose, will be on a non-stop rollercoaster." One food additive almost everyone agrees is counter-productive is aspartame. It's the artificial sweetener in diet colas. Multiple studies have shown it depresses serotonin levels. People with a history of mood disorders or depression have been linked to bad reactions after consuming aspartame.
Good news: Changes in diet are not all about doing without things you may crave. It may also involve eating more of some things you enjoy. One of the most potent mood enhancers is found in some very common foods: chocolate, whole grain pasta, figs, fish, peanuts, milk, turkey, chicken, cottage cheese, avocados and bananas are rich in an essential amino acid called tryptophan. Guess what? It breaks down into serotonin.
Dr. Brown says he sees a lot of men in their 30s coming to him complaining of "low energy, mental fogginess and low libido." He often finds they have low levels of testosterone. What happens, he says, is that when men stop exercising and start putting on weight their bodies start producing more of the hormone estrogen, which is more associated with women than men. Regular exercise—both for strength and cardio—brings up the testosterone level, which is important for that elusive feeling of wellbeing. And, it turns out that exercise also increases serotonin levels.
Again, Dr. Meletis agrees: "Having just written a book on male menopause, I can say clearly that one of four guys have low testosterone levels at the age of 30. So, just like women have hormonal fluctuations, guys can too and you don't have to wait until you are 50 to go through male-menopause. Signs of low testosterone are often depression, sleep disturbances, decreased muscle mass or increased body fat. Weaker erections can also occur. The key is to get tested and never self medicate with testosterone."
Light Me Up
When you notice a low mood occurring every year between November and March, it may be due to Seasonal Affective Disorder (SAD). Many people living in northern latitudes get depressed when deprived of adequate sunlight during the winter. A 10,000-lux SAD light box, the natural solution, delivers primarily blue-green light. Exposure for 30 to 60 minutes every morning convinces the biological clock that it is summer and elevates mood.
Dr. Meletis also suggests that a person feeling sluggish should get his thyroid levels tested. "Signs of low thyroid include depression and slower thinking relative to your individual capacity," he says. Dr. Brown in turn stresses that symptoms of low energy, sexual dysfunction, foggy head and low-level depression can have many causes, and that the absolute best bet for fixing things is to see your doctor. "Each person is unique. To get a complete picture it is necessary to get a complete history and work up. There are lots of kinds of depression and it often comes with a range of other problems: post-traumatic stress disorder, obsessive/compulsive disease, etc. Depression can be related to your thyroid, substance abuse or any number of things."
Dr. Brown recognizes that for many people signing on for a whole-scale diagnostic is, itself, a big deal, especially for a mere set of blahs. Lots of people would rather try self-medicating first. He doesn't see this as necessarily all bad. "When a person takes some action, they are getting the ball rolling," Dr. Brown says.
But first a caution: caveat emptor, let the buyer beware. Dr Gerbarg puts it this way: "Because the natural supplement business is not closely regulated, the quality of products varies widely. It is important to do some research to be sure you are getting a product that is of good quality, properly manufactured and standardized for active ingredients, and without contaminants. "
Dr. Meletis suggests finding supplement companies that are CGMP (Certified Good Manufacturing Practices) certified. "This certification," he says, "can be compared to a restaurant in a way. If they have an A rating great, you know that you will get what you paid for and have no surprises."
Yeah, Yeah, But What Do I Take?
Having read this far, you may still be wondering where to begin. Dr. Brown's recommendations—with cautions - for supplements to go with are Rhodiola rosea and SAM-e. Rhodiola rosea (also known as Golden Root, Roseroot, Arctic Root) is a plant in the Crassulaceae family that grows in cold regions of the world. Dr. Brown believes it can be effective for improving mood and alleviating depression. Pilot studies on human subjects show that it improves physical and mental performance, reduces fatigue, and even minimizes high-altitude sickness. Dr. Brown says he has seen it be effective across several fronts: sexual functioning, athletic performance, weight reduction and mood elevation.
SAM-e (short for S-adenosylmethionine) is curious in that it stakes a claim for treating both depression and osteoarthritis. It is believed that SAM-e increases the availability of neurotransmitters serotonin and dopamine. SAM-e is an essential metabolite that is already present throughout the body. SAM-e is effective in treating mild to severe depression if taken in adequate doses. Because SAM-e readily reacts with oxygen, it is critical to get only the best quality brands. Only a few laboratories manufacture it properly. Bargain brands tend to be ineffective and cause more side effects. SAM-e also comes with some cautions. For example, people with bipolar disorder, anxiety disorders and other psychiatric conditions should only use SAM-e under supervision. Dr. Gerbarg says some people report feeling nausea.
Dr. Meletis offers this: Supplements to consider in general include: 5 HTP and St. John's Wort—but only if you are not taking conventional drugs of any sort. "My patients routinely start on either 5 HTP or St. John's Wort, or a combination called Positrol, offered by Complementary Prescriptions," says Dr. Meletis. "Positrol offers both 5 HTP and St. John's Wortt in combination with B6. Vitamin B6 is important for the conversion of 5 HTP in the brain to serotonin. The Positrol is often used for those with melancholy but good overall energy and Syncholamine confers a little pick me up as well."
Dr. Gerbarg points to the value of some other dietary supplements as places to begin: "There are certain nutrients that are critical for maintaining normal transmission and cellular repair in the neural pathways involved in mood regulation. Anyone who is prone to depression could benefit from supplementing their diet with B vitamins, folate, and omega-3 fatty acids (from fish oil)."
Summing It Up
Bottom line: what are the things you should keep in mind when deciding to try out a mood supplement to combat light depression? Dr. Gerbarg gives these evaluation questions:
- What are my symptoms: low mood, low energy, feeling overwhelmed by stress?
- Am I getting enough sleep, exercise and good nutrition?
- How can I reduce my stress?
"At the same time you can begin trying natural and complementary treatments as well as lifestyle changes. These will enhance your recovery but they may have a more gradual effect. If the natural treatments work well for you, it may be possible to reduce or taper off of the prescription drugs faster."
And if your doc, like mine, isn't really up on mood-enhancing supplements, tell 'em to get the books by the docs quoted in this story. In the meantime, here's a chart to get you started on supplement shopping.
|MOOD SUPPLEMENTS: A SHORT GUIDE|
|DL-phenylalnine||An amino acid that has analgesic and anti-depressant qualities related to the creation of the neurotransmitter dopamine.||Research is incomplete and absorption by the body from supplements is not guaranteed.|
|GHB||Marketed in the early '90s as a dietary supplement for inducing sleep, releasing growth hormone, enhancing sexual activity and athletic performance, and relieving depression, it also gained favor as a recreational drug, and was used for date rape, because of its intoxicating effects.||Extreme caution: The only legitimate uses are in the treatment of narcolepsy and sleep problems in fibromyalgia. Otherwise high mortality rates are reported in Sweden.|
|Kava kava||Kava is a tranquilizer primarily consumed to relax without disrupting mental clarity. kava extract can provide relief for stress, insomnia, and anxiety.||Safety concerns have been raised over liver toxicity.|
|L-tryptophan||An amino acid that calms and cheers found in some very common foods: chocolate, whole grain pasta, figs, fish, peanuts, milk, turkey, chicken, cottage cheese, avocados and bananas.||Widely available, the main issue here is getting it from a reputable source so that the product is free from potentially damaging impurities.|
|Lithium Orotate||Can be used to treat recurring depression, PTSD, Alzheimer's and other ailments. Lithium orotate also has been found useful in subjects with alcoholism.||Can be expensive and self-treatment is potentially dangerous, since lithium is toxic in high doses. Should only be used under supervision of a physician who can check serum levels and monitor kidney and thyroid function.|
|Melatonin||Resets the body's "sleep clock" and can help the process of getting to sleep and staying asleep.||Effectiveness is questioned, but sustained release forms work better.|
|Tyrosine||Sleep too much? Chronically depressed people can enhance mood and motivation, and reduce cravings for addictive substances.||Effectiveness is questioned under normal circumstances. Even if it helps, the effect wears off soon.|
|Rhodiola Rosea||Improves physical and mental performance, reduces fatigue, and minimizes high-altitude sickness.||No apparent side effects from recommended doses.|
|SAM-e||Has been shown effective for alleviating mild to severe depression, osteoarthritis and liver disease.||People with bipolar disorder, anxiety disorders and other psychiatric conditions should only use SAM-e under the supervision of their healthcare provider. SAM-e has been associated with hypomania and mania.|
|St. John's wort||Can be effective for mild depression.||Potential interactions with a variety of other meds. It has been associated with hypomania and mania in bipolar patients.|
|5HTP||Boosts serotonin levels.||Effects not completely studied; potential for negative interactions with other meds.|
|Valerian Root||Valerian root is a calming herb that can help you sleep.||Long-term safety studies not complete.|