Depression is a common condition, affecting about 121 million people worldwide, according to the World Health Organization. In the United States an estimated 21 million American adults -- or 9.5 percent of the population -- have depression at some point. Many brain regions are involved in depression, and studies show that several different types of treatment, including drugs and cognitive therapy, are usually needed before patients can be cured. More natural options include exercise, yoga, herbs, diet, better sleep suggestions, and nutritional supplements. In most patients, regular exercise may work as well as medication in improving symptoms of major depression.

Depression is a feeling of intense sadness; it may follow a recent loss or other sad event but is out of proportion to that event and persists beyond an appropriate length of time. After anxiety, depression is the most common psychiatric disorder. An estimated 10 percent of the people who see their doctors for what they think is a physical problem are actually experiencing depression. Depression typically begins in the 20s, 30s, or 40s. An episode of depression typically lasts for 6 to 9 months, but in 20 percent of the people, it lasts for 2 years or more. Episodes generally tend to recur several times over a lifetime. Craving for sweet rewards is increased by depression in both animals and humans.  Exercise, proper diet, relaxation techniques, and yoga can help fight depression.

Nutrients and herbs for depression. How would one know which one to use?
Treating depression is difficult, whether through drugs or supplements. Each person is unique in terms of the causes for the depression and their response to medicines or supplements. However, we can make some generalizations that you can discuss with your doctor. If the depression is associated with low energy and motivation, then SAM-e could be helpful since this nutrient can perk someone up pretty quickly. However, high doses can cause overstimulation and mania. If the depression is associated with restlessness, anxiety and rapid, incessant thoughts, 5-HTP is a good option since it converts into serotonin which has a calming effect. Somewhere between these two effects is St. John's wort which is not as stimulating as SAM-e, but not as calming as 5-HTP. And it's quite likely that as the depression progresses, some people who at first benefited from one supplement may find it is no longer helpful and another supplement is more appropriate. We think part of the reason for the failure of depression treatment lies in the fact that patients or doctors don't adjust the dose or medicine to reflect the biochemical, life circumstance or lifestyle changes that are going on within or outside the individual as the weeks and months go on. Another nutrient that influences mood is tryptophan. Tryptophan has some aspects that are similar to 5-HTP.

There are several supplements and herbs that can lift depression.
Our favorites are SAME-e, St. John's Wort, and 5-HTP.
5-HTP can start within hours. 5-HTP converts into serotonin, and important brain chemical involved in mood, appetite, and impulse control. 5-HTP suits those whose depression is associated with anxiety, restlessness, or racing thoughts. A disadvantage of 5-HTP is that it reduces sexual drive.
SAM-e a powerful nutrient that starts working within hours. A recent study found SAM-e was helpful even in depressed patients who did not respond well to Prozac and other SSRIs. SAM-e is best suited for those whose depression is associated with low energy, low motivation, and no anxiety. For those whose depression is associated with anxiety, 5-HTP is a better option. There is a risk for overstimulation with SAMe use, hence dosage should be kept low and it would be good to take a day or two off when one notices overstimulation. SAM-e is not advised for manic depression. Find more s-adenosylmethionine research here. SAM-e is very potent and should be used carefully in low dosages since it can cause insomnia or a manic phase.
St. John's wort usually takes a couple of days. For more St. John's wort research.
B vitamins including pantothenic acid have a mild influence on depression. Lower folate, lower vitamin B12 and raised homocysteine levels are risk factors for late-life depression.
Tryptophan has helped many people with depression symptoms
Fish Oils can help stabalize mood. Eating fish is a good option.
Acetyl-l-carnitine can lift mood and enhance mental activity
CDP-choline has a short mood lift effect.
DMG is short for dimethylglycine.
NADH to be used occasionally, not daily, more nadh info
TMG trimethylglycine a cheap methyl donor similar in some ways to SAM-e, does not work as well, but it's good
DHEA in low doses in older individuals who are hormone deficient
Pregnenolone in low doses in older individuals who are hormone deficient
Cordyceps mushroom extract
Maca is an herb from the Andes.
Muiria Puama takes two or three days
Rhodiola herb
Schisandra plant

I am now off Prozac but would like to switch to a natural supplement. Dr. Hyla Cass recommends 5htp or St. john's wort. I am wondering what is a good purchase as Prozac did work for my dysthymia but had side effects. I do use Synthroid for hypothyroidism and some of my mood issues are related to this. I am also on a low carb diet so I eat a lot of protein but have trouble losing weight but I seem to have even more weight problems when I eat whole grain breads and pastas. Sugar is out for me as it make me feel sick and packs on pounds. So I was thinking of ordering 5htp or maybe St. John's. Dr. Hyla Cass suggests either one.
   It is difficult to know which natural antidepressant will work in any one person, sometimes it takes trial and error to find out.

Diet and depression
Many people do not realize the crucial role diet plays in depression and mood disorders. If a patient goes to their doctor and reports feelings of depression, it is quite unlikely that their physician will do a dietary history. Most likely the prescription pad will be taken out and the words Prozac, Zoloft, Paxil, or another antidepressant will be jotted down before you can even spell 'd e p r e s s i o n.' There are many causes for depression, and diet is one cause that is often overlooked. As we understand the complexity of brain biochemistry, scientists are realizing that inflammation in the brain plays a role in depression. Certain chemicals called cytokines cause inflammation in the brain which influences mood. If you ever had low mood or felt depressed during or after a bad case of the flu, then you realized first hand how these cytokines released by the immune system effected your brain. It is interesting to note that this is a typical case of a body-brain influence. The body, in this case the immune system, releases chemicals called cytokines into the bloodstream. These in turn enter brain tissue cause inflammation, leading to low mood. In addition to depressed mood cytokines also cause loss of appetite, altered sleep patterns and fatigue. 
   Fortunately cytokines, and other substances that cause inflammation, are influenced by diet. When you eat lots of fish or foods with omega-3 fatty acids, your body will make fewer inflammatory cytokines.

Exercise for depression
Exercise can lift mood. Exercise enhance activity in the gene for a nerve growth factor known as VGF. Nerve growth factors are small proteins important in the development and maintenance of nerve cells. When researchers infused a synthetic version of VGF into the brains of mice, it produced an antidepressant effect. Nerve growth factors are small proteins important in the development and maintenance of nerve cells.

The causes of Depression
The causes of depression aren't fully understood. A number of factors may make a person more likely to experience depression, such as a heredity, side effects of certain medications, an introverted personality, poor self image, and emotionally upsetting events, particularly those involving a loss. Depression may also arise or worsen without any apparent or significant life stress. Having a mother who has experienced depression can double a child's chances of becoming depressed.
   Depression that follows a traumatic event, such as the death of a loved one, is called situational depression. Some people become temporarily depressed in reaction to certain holidays (holiday blues) or meaningful anniversaries, such as the anniversary of a loved one's death. Depression without an apparent precipitating event is called endogenous depression. Football players who have repeated head concussions are more likely to have depression.

Poor health habits
Depression and anxiety are associated with obesity and poor health behaviors like smoking, drinking, and physical inactivity.

Childhood abuse
Depression in young adulthood is an important consequence of childhood abuse and neglect. For many abused or neglected children, depression sets in during childhood.

Situational depression
Depression that follows a traumatic event, such as the death of a loved one, is called situational depression. Some people become temporarily depressed in reaction to certain holidays (holiday blues) or meaningful anniversaries, such as the anniversary of a loved one's death. Depression without an apparent precipitating event is called endogenous depression.

Medical conditions predispose depression
A combination of heart disease, obesity, and diabetes risk factors known as the metabolic syndrome is a predisposing factor for the development of depression. Depression may also occur with, or be caused by, a number of physical diseases or disorders. Physical disorders may cause a depression directly (such as when thyroid disease affects hormone levels, which can induce depression) or indirectly (such as when rheumatoid arthritis causes pain and disability, which can lead to depression). Various prescription drugs, most notably drugs used to treat high blood pressure, can cause depression. A number of psychiatric conditions can predispose a person to depression, including certain anxiety disorders, alcoholism and other substance abuse disorders, schizophrenia, and the early phase of dementia.

Patients with more severe depression within a few weeks of myocardial infarction or other acute coronary syndrome, as well as those whose depression does not improve shortly after the event, are at increased risk of dying over the next several years. Arch Gen Psychiatry 2009;66:1022-1029.

Depression in women
Women are twice as likely as men to experience depression, though the reasons aren't entirely clear. Studies show that women tend to respond to adversity by withdrawing into themselves and blaming themselves. In contrast, men tend to deny adversity and throw themselves into activities. Of biologic factors, hormones are the ones most involved. Changes in hormone levels, which can create mood changes shortly before menstruation (premenstrual tension) and after childbirth (postpartum depression), might play some role in women. Similar hormonal changes may occur with the use of oral contraceptives in women who have experienced depression. Abnormal thyroid function, which is fairly common in women, may also be a factor.

Depression and diabetes
Elderly people who have depression are more likely to become diabetic than those who are not. Depression may play a role in causing the most common form of diabetes.

Depression is associated with physical changes in the brain. There is decreased blood flow in the brain's emotional centers, abnormal metabolism, shrinking of certain brain regions, and changes in neurons and dendrites. Therefore, it is unrealistic to tell someone with depression to "just snap out of it." Depression is as much of a physical illness as diabetes and heart disease.

Depression may also occur with, or be caused by, a number of physical diseases or disorders. Physical disorders may cause a depression directly (such as when thyroid disease affects hormone levels, which can induce depression) or indirectly (such as when rheumatoid arthritis causes pain and disability, which can lead to depression). Various prescription drugs, most notably drugs used to treat high blood pressure, can cause depression. A number of psychiatric conditions can predispose a person to depression, including certain anxiety disorders, alcoholism and other substance abuse disorders, schizophrenia, and the early phase of dementia.

Medical Therapy for Depression
The most commonly used pharmaceutical agents are the SSRIs such as Prozac, Paxil, Zoloft, and others, are often effective in fighting depression but have a high rate of side effects including headache, loss of sex drive and sensation, nausea, insomnia, and upper gastrointestinal bleeding.

I am a 61 yr old woman. I exercise 2 times a week. I generally to eat healthy foods avoiding toxins and processed foods. I am looking for a supplement and foods to take so I can stop taking Nortriptyline 50 mg. It causes leg cramps, raises my blood sugar ( I have been told I am pre-diabetic) and severe constipation. Yet it works best for my depression. I have taken other antidepressants that work on seretonin but they cause migraines. This tricyclic one that works on noreprinephrine works great for the depression but causes these other side effects. What do you recommend? I also take 1mg clonazepam and 15mg of temazepam to help me stay asleep. I have tried other natural supplements including melatonin (causes nightmares) and a host of others. I can fall asleep but I wake up in the middle of the night and my mind is too busy to go back to sleep. Do you have any suggestions. I would really appreciate a response for you and your team.

Depression and heart disease
Depression appears to increase the development of blood vessel plaques, known as atherosclerosis, a condition that can lead to heart attack, stroke, and a host of other cardiovascular problems.

Treatment of depression during pregnancy
The choice of depression medication options in women who are pregnant is limited. Doctors can recommend psychotherapy and bright light therapy in the winter. Bright light therapy has been found to be effective for seasonal affective disorder. Prescription drugs are widely used for depression and include antidepressants from various drug classes. Some examples include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepineph rine reuptake inhibitors (SNRIs), and tricyclic antidepressants. All available antidepressants are considered to be equally effective for uncomplicated depression, and the choice of agent depends on safety, side-effect profile, potential drug interactions, patient preference, and cost. Treatment goals should focus on remission of patient symptoms and restoration of function. A doctor may also consider recommending natural supplements such as 5-HTP, SAM-e, and St. John's wort, and the lowest dosages should be used for the briefest period of time necessary for these natural supplements to be effective. The safety of the fetus have to be balanced with the wellbeing of the mother.

Postpartum depression
First-time mothers remain at risk of postpartum depression and mental illness 4 or 6 weeks or longer after the length of time suggested in reference manuals. Furthermore, although new fathers are exposed to some of the same stressors as mothers -- lifestyle changes, sleep deprivation -- their risk of psychiatric illness and depression does not increase during this time.
   Close female friends help women through depression -- Nearly all women say they get depressed, stressed or anxious at some point in their lives, and most turn to their female friends for support during these and other tough times. For information on suicide.

Depression study
Close female friends help women through depression -- Nearly all women say they get depressed, stressed or anxious at some point in their lives, and most turn to their female friends for support during these and other tough times.

Smoking
More than 40 percent of U.S. adults who have depression are also smokers, meaning people need help with both if they want to quit, according to a U.S. government survey. The survey found more than half of middle-aged men with depression were also smokers, while half of women under age 40 who were depressed also smoked. Laura Pratt and Debra Brody of the National Center for Health Statistics, April 2010.

Depression natural therapy emails
Q. This past year I decided to go to a naturopath for treatment of depression and anxiety that I've had trouble with for most of my life. I had been going to counselling and taking prescription medications for depression for a long time but found the drugs caused either really uncomfortable side effects or a kind of emotional numbness. Exercise and diet changes, especially cutting out any refined sugars and overly processed food has definitely helped some, but a lot of the symptoms are still there. The doctor I went to see for depression recently prescribed Fish oil (2 grams daily), SAMe (200mg daily), Tyrosine (1000mg daily), 5htp (200mg daily), acidophilous (1 capsule daily), a multivitamin ( once daily),
Canchelaqua (10 drops daily), and Bach Mustard flower ( 4 drops daily). I was also supposed to take 1 gram of L-theanine a day. It seemed like way too much stuff and then pretty high doses of some of them too, which it sounds like, after reading on your website, was the case with the 5htp especially. I know you can't give any dosage recommendations for depression or anything, but I'm wondering if you have any advice or insight?
   A. We suggest you mention to your naturopath to read some of the information on the natural supplements for depression discussed on the website. Perhaps your naturopath may not be fully aware that sometimes lower dosages work well, too. We wish you optimal healing, sometimes it takes trial and error to find the right supplements in the right dosages and combinations.

Q. This past year I decided to see a naturopath for treatment of depression and anxiety. It's been a lifelong problem and I've already tried some different antidepressants, Effexor being the most recent and longest. I wanted to try something different as the pharmaceuticals tended to either cause a lot of uncomfortable side effects, or as with Effexor a kind of emotional numbness. The naturopath I recently went to see recommended Fish oil, SAMe, Theanine, L-Tyrosine, 5htp, Mustard flower, a multivitamin and acidophilus for every day! It seemed like a lot, and as I'm reading on your website, I'm seeing my suspicions are justifiable, especially with the amounts of 5htp (200mg daily), Tyrosine (1000 mg daily), SAMe (200mg daily). I haven't been taking anything lately because it just seemed kind of crazy to take all of that. Exercise and diet are definitely helping some, but I'm still having a lot of trouble with mood, difficulty concentrating, making decisions, staying focused, and poor sleep. I know you can't really make any recommendations about what to take or dosages, but I'm wondering if you can offer any advice or insight.
   A. One recommendation is to try each supplement by itself for a period of time to see how it works by itself for depression before mixing it with another one. Only through trial and error will you find the best supplement or the best combination. Ask you doctor to read some of the cautions on high dose use of supplements.

Q. I consulted with my GP and he prescribed Zoloft for my depression. The dosage was increased from 50mg /day to 250mg /day by doubling at roughly one month intervals (i.e., 50, 100, 200). At the highest dosage I finally discerned a therapeutic effect; in fact, I felt like a sack of cement had been lifted from my chest. Nothing, however, until the highest dosage was reached. At approximately the same time I read a book which raised concerns with me about Zoloft and other SRI drugs used for depression. I researched on the internet and decided to switch to a regimen of amino acids instead: glucosamine and phenylalanine. When my prescription for Zoloft ran out I simply declined to refill it; I experienced none of the withdrawal symptoms which I later came to realize were common with SSRIs. More importantly, I lost none of the perceived depression therapeutic effect, and I believe continued to experience improvement. I also began taking 5-htp and melatonin. I take one capsule of 5-htp (50 mg L-5-Hydroxytryptophan and 10 mg. B6) and one 650 mg. capsule of inositol in the morning and evening. I take 1 mg of melatonin if I want to ensure an optimum evening of sleep; I have not noticed any effect from a lower dose. I took SAM-e for a period of time, then stopped to evaluate; I may go back to it in order to address some anxiety issues (more accurately, short temper) but that's just me. I applaud your efforts to educate on the natural and wholistic approaches to addressing the effects of depression. I tell people to set aside their preconceptions and think of it as depression of normal neurotransmitter levels; that stress depletes neurotransmitters just as heat and exertion deplete hydration levels. No amount of "will power" or "strong character" will rehydrate you when you've been walking through the desert for 10 hours.

Q. I was under suspected depression treatment for the last 18 years. All the while I knew I didnt have any mental problems. I was always mentally stable and oriented. I tried many Ayurvedic treatments but all in vain. I was taking prescription tablets for depression. It put me to sleep for long hours but nothing else. 5HTP is really a miracle tablet for my depression.

Q. I have dealt with depression for too long and need the following tests done before I go down another dead end
road. Could you direct me to the right resources? I need a muscle biopsy measuring the level of ATP. I need a brain scan to determine my neurotransmitter levels.
   A. We have not seen any medical research that would indicate how the results of a muscle biopsy for ATP would help determine the course of therapy. A brain scan does not determine neurotransmitter levels. Neurotransmitter levels can be measured by scientists through a spinal tap, but it is difficult to determine what medicines or supplements are useful based on neurotransmitter levels which can fluctuate during different times of day, changes in diet, stress levels, etc.

Q. I have used Prozac, Paxil, Celexa, Effexor XR over a 15 year period. I am presently 61 and my sexual desires have decreased gradually from the time I started using the drugs. Now, I have almost none. I still have never gotten to a place where the depression is eliminated completely.

Q. I am a long time sufferer of moderate depression that co-insides with some anxiety. I have tried Lexapro, Zoloft, Serzone, Paxil, Celexa, Trazedone and Remeron. NONE of these ever had a benefit because I cannot tolerate any of the side effects which always include (some worse than others) Nausea, spacey feel, weight loss, diarrhea, insomnia, weird dreams etc. I have a large family history of depression and for most of them they have found a medication that works. I REALLY have tried all of them giving them a couple of months. I have been reading for a couple weeks about 2 natural products used for depression that "may" have fewer side effects. SAM E and 5 HTP. It looks to me that SAM E has a better profile, but states that should not be taken if you have anxiety because it makes it worse. I think my anxiety is a result of my depression though. You don't know me, and cannot prescribe. However, given what I told you above, would you suggest one above the other?
   A. It is not possible to know for sure which supplement will work for depression and in what dosage until they are tried. It is a good idea to use low dosages at first, not exceeding 50 mg of 5htp taken in late afternoon or early evening on an empty stomach for a week then higher dosages if needed. With SAM-e, the dosage would be half a 200 mg tablet daily in the mornings for a week or so. It is best to try them separately rather than together.

Does  tongkat ali help with depression?
   We don't this this herb would be helpful, it can cause aggressiveness.

I have to admit to being overwhelmed by all the information on the web site and while I understand the need to caveat information I was hoping you could help guide me. I suffer from moderate chronic depression and atypcial situational anxiety. I was put on Clonazepam, Lexapro and Wellbutrin at the same time, high dosages of each. Between sexual side effects, weight gain and dizziness it was not a good combination and I would much rather
take natural supplements. What is considered a reliable non-stimulant anti-depressant and/or anti-anxiety supplement? I have read SAM-e is good but is a powerful stimulant while Kava can be good for anxiety but can cause
depression? Please help in any way you can. Also, what are the general thoughts around Holy Basil and rhodiola
regarding anxiety and depression?
    It is difficult to predict which product a person will respond to. SAM-e is stimulating, 5-HTP is not stimulating and can also help with anxiety. We have not seen much research on holy basil and depression. Rhodiola may help some people but it could also be stimulating.

I take choline and inositol for depression and it gives me loose stools. I take tumeric, ginger, acidolphilus / bifudus, and cinnamon - is there anything else that I can take?
   We suggest reading the options on this depression natural alternatives herbal therapy page and discuss the options with your doctor.

About 3 days ago I began taking Serelax for mild depression (ingredients being: GABA, Passion flower powder, valerian root extract, l-theanine, kava kava, skullcap powder, chamomile powder, jujube date powder, wood betony powder, griffonia simplicifolia bean extract). I do not take other prescription meds but I do have a history of allergies. After taking it for 2 days I've been noticing I'm a quite itchy - obviously common when I'm allergic to something I ingest. I'm trying to figure out which one of these ingredients might be the most common allergen. The only one I know I don't have a problem with is Valerian. The other problem...I also had 2 glasses of wine yesterday and I'm assuming the combo was the reason I wanted to sleep for about 14 hours. Clearly not the smartest choice on my part. I'm not a huge drinker but I do enjoy the glass or 2 of wine once or twice a week. I'm looking to relieve a bit of depression, not take an intense sleeping pill. I suppose my overall question would be... do you have any advice on which of these herbal supplements would be a suitable combo that wouldn't produce such an intense drowsiness / allergic skin reaction?
    It is not possible for us to predict which herb or the combination caused such symptoms, or whether the fillers or additives in the product may have caused it.

I've been perusing your site often after having it been recommended to me by an employee at the VitaminShoppe. I have a question for you regarding what vitamins I should take. I have a long medical history that might warrant particular supplements. In 5th grade I was diagnosed with a brain tumor on the stalk of my pituitary gland. It was a slow growing tumor since I showed symptoms before kindergarten. I had to drop out of 5th grade to go through rounds of chemo and radiation. They got rid of it, but I had to take replacement hormones as a result. In my junior year of high school the doctors discovered that it had come back, so I had to drop out and go through more rounds of chemo and travel to Boston to receive proton beam radiation treatment. Hopefully they got it for good this time. I'll be starting my 5th year of college in the fall. Here are the medications I take: Desmopressin, 0.2MG, vasopressin replacement for my diabetes insipidus Hydrocortisone, 5MG, the stress hormone Levoxyl, 88MCG, my thyroid medicine Androgel, 50MG, for testosterone Genotropin MiniQuick, 0.6MG, for growth hormone My medicine schedule: When I get up: 1 Levo skipping Sundays, 1.5 Hydro, 1.5 Desmo: 1 shot of Geno. My current vitamin shedule: When I get up, taken with medicine: Natrol Alpha Lipoic Acid, 100mg, taken every other day After breakfast: 1 Rainbow Light Men's One multivitamin, 2 pills or 1/3 dose of Solaray Cal-Mag Citrate with Vitamin D (a full dose has 200IU D2, 1000mg Calcium Citrate, and 500mg Magnesium Oxide and Citrate) After lunch: 1 NatureMade 1000IU D3, 1 GNC Triple Strength Fish Oil (647mg EPA, 253mg DHA) ( I got this fish oil when I used to use GNC's Mega Men multivitamin. I plan to find a new brand when they run out.) After dinner: 2 pills of Solary Cal-Mag Citrate with Vitamin DI should probably mention my mood too. Sometime after the first tumor I seemed to have depressed symptoms; ups and downs, low energy, low motivation, but no anxiety. Last August my doctor doubled by Genotropin dosage to 0.8mg from 0.4mg. A month later I felt great. My self consciousness had totally disappeared and I was showing signs of mania; rapid speech, more energy, etc. A bloodwork revealed I had been getting too much, so my doctor dialed it down to 0.6mg. Now my igf level is at the top of the range of what it should be. I feel better than before, but I still lack the energy and motivation and tend to have negative thoughts. I noticed when I first started taking the vitamins I had more energy, but the effects seemed to wear off a bit. Is there anything you could recommend for me to take? Are the vitamins I'm taking now good enough? Should I take less, more? Is there anything that would help my energy and mood?

I'm a 32 year old male and have been battling depression which I believe is due to being out of work for awhile and being under an enormous amount of stress. Ihave lost a lot of interest, motivation, energy, and the ability to concentrate which makes it very hard for me to get things done. At other times my mind is racing and I have a bit of anxiety. I also get headaches and feel dizzy sometimes. I am currently trying omega-3s and St John's Wort. I'd like to stop St John's Wort and try either SAM-e or 5-HTP. I'm a little concerned about the safety of these. I read that SAM-e can increase homocysteine levels which may contribute to the hardening/narrowing of your arteries and may lead to heart problems, strokes, or liver damage. I read that 5-HTP is very new and there isnot enough evidence to determine it's safety...due to the conversion of 5-HTPinto serotonin by the liver, there's a possible risk of heart valve disease from serotonin's effect on the heart. What are your thoughts on these issues and the safety of these?

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