Natural Alternatives To Antidepressant Medication
Statistics on prescription antidepressant use are alarming. An October 2011 report by the National Center for Health Statistics, reported a 400% increase in antidepressant use over the previous two decades. In addition, the 2011 National Health and Nutrition Examination Survey reported that 1 in 10 people take antidepressant medication.
Have you wondered why antidepressant use is on the rise? Are people more depressed than they were prior to 1987 when Prozac was first made available in the United States? Perhaps it has to do with the fact that pharmaceutical companies spend millions marketing the benefits of these medications to the public.
Prior to the introduction of Selective Seratonin Reuptake Inhibitors (SSRIs), such as Prozac, Paxil, and Zoloft, physicians were less likely to prescribe antidepressants to patients reporting extended periods of sadness. The first-generation antidepressant drugs available were MAOIs (monoamine oxidase inhibitor) and TCAs (tricyclic antidepressants), which had side effect profiles that were less desirable than the second-generation antidepressants (SSRIs and SNRIs). Physicians had to worry about adverse affects when MAOIs were taken with certain foods. Many people who were put on TCAs didn’t stay on them long due to soporific effects and weight gain. At that time, these classes of antidepressants were generally reserved for those who had intractable Major Depressive Disorders for whom psychotherapeutic interventions were insufficient. During this era, physicians were much more likely to recommend psychotherapy along with medication. Unfortunately this practice has changed since the 1980s.
Since the advent of SSRI drugs, rather than referring patients for therapy, health care professionals have tended to prescribe antidepressant medications for less serious depressive diagnoses, such as Dysthymic Disorder, a chronic low-grade depression, which could potentially be resolved with lifestyle changes, or Adjustment Disorder with depressed mood or anxiety, which is a situational depression that could be resolved with therapy. With the advent of second-generation anti-depressants, many physicians are more apt to prescribe anti-depressants than to refer patients for psychotherapy to see if their mood issues will resolve without medications. If those who suffer from mild to moderate depression were willing to invest in a few months of psychotherapy with a competent therapist, develop self-awareness and insight into their problems, and learn skills to cope with the psychosocial problems contributing to their depression and anxiety, many people would be able to avoid dependency on pharmaceutical interventions as well as the side effects that accompany them.
These second generation drugs have seemingly become a panacea for people who are unhappy with their life circumstances. Given the choice to confront problems or take a magic pill, many will opt for the latter. Rather than resolving their issues in therapy, they would prefer to take medication that will allow them to become numb to the circumstances causing their depression. I once had a psychotherapy client who referred to Prozac as the “I don’t give a crap pill.” She was able to feel numb to the problems in her unhappy marriage, and it allowed her to tolerate her circumstances and to be less emotionally reactive to her situation.
Addressing normal life trials and tribulations with medication can be seen as a band-aid approach of sorts. If people go on an antidepressant when life throws them a curve ball, the medication may help them to cope with the issue at hand, but far too many people stay on the medication after the crisis has passed. If they go off the antidepressant without having developed coping skills to deal with their psychological distress, they are likely to feel unhappy once the medication is discontinued.
Getting to the Root of the Depression
It is important to explore the source of the depression, because it may be due to a medical condition, such as a thyroid dysfunction, diabetes, adrenal exhaustion, or inflammatory bowel disease. If this is the case, antidepressant medication may simply mask the symptoms of the source of problem. Situational depression that is the result of a personal crisis related to a major life transition or death of a loved one are best treated with psychotherapy. Depression can be brought on by normal hormonal changes or dietary issues that affect hormonal balance, such as cholesterol levels that are too low or insulin levels that are too high due to an overabundance of sugar in the diet. Moreover, you may be inadvertently doing something that lowers the levels of the neurotransmitters that support positive mood, such as consuming substances that promote depression.
Alcohol is a depressant. So if you are taking an antidepressant to improve your mood, you are counterbalancing the effect of this medication by consuming alcohol. Depression is a side effect of many medications, especially tranquilizers, such as Valium, Xanax, Ativan, and Klonopin (aka: downers). Opioid pain medications, such as Oxycontin, Percocet, Codeine, and Morphine will cause depression, especially if taken for extended periods of time. This is why many people who are on prescription pain management become irritable after being on these medications for a short duration. Even antibiotics can induce depression, so check your medication side effect profile and notify your health care provider if this is a concern for you.
Natural Mood Enhancers
It is important for you to know that there are natural alternatives for treating depressed mood without all the harmful side effects. There are many ways to influence the neurotransmitters in the brain without pharmaceutical preparations.
It is important to mention that you should not take these substances in conjunction with an antidepressant medication, as this may induce manic symptoms or cause serotonin syndrome, characterized by marked lethargy. While these substances may be as effective as antidepressant medications for some, they may not be effective for everyone.
People who are genetically predisposed to depression and anxiety and are refractory to treatment should exercise caution in switching from a pharmaceutical treatment to a natural supplement. I strongly recommend that you consult your health care professional before discontinuing your antidepressant or anxiolytic medication, as there may be a withdrawal syndrome associated with cessation of these drugs.
Exercise, particularly the aerobic variety, can be as effective as antidepressant medication for those with mild to moderate depression. However, this antidepressant therapy requires a commitment to exercise on a regular basis. Benefits of regular exercise extend far beyond mood elevation and anxiety reduction. Improvement in overall health is the best reason to commit to a regular exercise program.
SAMe (Sadenosyl-L-methionine) is a naturally occurring substance in the body with higher concentrations in the liver, brain, and adrenal glands. It was used as a prescription treatment for osteoarthritis in Europe as early as 1979. During medication trials it was discovered that it not only improved arthritis symptoms, it also improved mood. Additionally, SAMe can be effective in treating mood symptoms related to Premenstrual Dysphoric Disorder (PMDD). You can read more about this at the National Institute of Health (NIH) website, Medline Plus.
5HTP (5-hyroxytryptophan) is an amino acid that is a precursor to serotonin production helps to elevate mood, reduce anxiety, promote healthy sleep and weight loss. If you choose this, I recommend getting the timed-release formula for once a day dosing. It is best to take the amino acid L-Tyrosine with this, and the benefit of this is that it supports brain function.
St John’s Wort, a well-studied herbal supplement has been proven to elevate mood. However, it is also aids digestion, supports thyroid function, balances the neurotransmitters, GABA, norepinephrine, serotonin, and dopamine, and has anti-viral, anti-inflammatory properties. It requires twice a day dosing.
Saffron, a Persian spice used to heal the digestive system, also elevates mood. It has been shown in comparative studies to be as effective as Prozac and Imipramine with fewer side effects. Saffron supplements are available in capsule form.
Vitamin D deficiency is much more common than previously thought and has been linked to depression. Simply spending 20 minutes a day in the sun without sunscreen, which can block Vitamin D synthesis, can positively influence mood, so those who run, bike, play golf or tennis outdoors are getting their daily dose of Vitamin D (unless they are covered in sunscreen). Many people, especially those in northern latitudes, may need to take a 2000-5000 mg Vitamin D-3 supplement during the winter months when they are less likely to spend time in the sun. Ask your doctor to check your Vitamin D levels, and take a supplement if you are deficient.
Omega-3 fatty acids, such as those found in fish oil and flaxseed, are precursors to serotonin production. Many studies have demonstrated significant benefits of Omega-3s for psychiatric and neurological disorders. Research has shown that it can even reduce the number of break-through psychotic episodes in schizophrenics. It is important to get a high quality fish oil in order to avoid the mercury found in many of the less expensive fish oils. The one I recommend is called Vectomega. It isn’t oil based and therefore doesn’t go rancid. It is a higher dose Omega 3 so in order to get the 4000 mg dose daily, you need only take 2 of these daily rather than 4 or of the oil based pills. Because it isn’t oil based, it doesn’t have a fishy taste and you won’t have the nasty fish oil burps.
Melatonin is a substance produced by our brain’s pineal gland during periods of darkness. Because poor sleep habits can negatively influence mood, it is important to get the optimal number of hours of quality sleep to improve mood. If you have insomnia, you may want to try a melatonin supplement in the evenings to try to regulate your circadian sleep cycle. Several companies produce a timed-release melatonin that is a healthier alternative to pharmaceutical sleep medications, which are sedative-hypnotic drugs. Furthermore, a study by Oregon Health and Science University found that melatonin relieved the winter blues, also known as Seasonal Affective Disorder (SAD).
Acupuncture can be very effective at relieving anxiety and depression. For those who choose to discontinue anti-depressant medication, acupuncture is an effective way to help make this transition.
According to a government report, less than one third of those taking antidepressants have seen a mental health professional in the past year. This is concerning, because many patients may have avoided becoming dependent on prescription anti-depressants if they had engaged in therapy, where they might have learned to reframe negative thoughts that are contributing to their depression as well as learn coping skills to effectively deal with stress-related events. It has become routine practice for many health professionals, rather than making a referral to a therapist, to employ the band-aid approach and write prescriptions that ultimately benefit the pharmaceutical industry and create dependence for patients. Regardless of the etiology of the depression or anxiety, I encourage you to seek out a competent therapist to help you resolve the problems that underlie anxiety or dysphoric mood.
In good health,
Valerie Folsom-Martin, MSW, LCSW, CIMHP, CCTP, FDN-P, CHHC
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