By Dr. Mercola
Vitamins, minerals and herbal supplements not only have a significant amount of evidence supporting their use for the prevention and treatment of mental health problems typically treated with drugs, they also have an admirable safety record.
The same cannot be said for antidepressants, the side effects of which run the gamut from sexual dysfunction to lack of emotions or "emotional flatness," sleep disturbances, brain damage, and even to suicide and homicide.
Antidepressants have also been shown to increase your chances of worsening depression, turning what is often a temporary condition into a lifelong struggle.
One in 20 Americans over the age of 12 struggles with depression1 and 11 percent of the U.S. population over the age of 12 are on antidepressant medication.2
Considering the prevalence of depression and the risks associated with antidepressants, we really need to reevaluate how we approach this problem. Depression is undoubtedly a serious issue that should not be dismissed, but I urge you to consider your options before taking the drug route.
Antidepressants Are Not Science-Based Medicine
If you believe in following the recommendations of science-based medicine, you wouldn't take an antidepressant. Studies have repeatedly shown that these drugs work no better than a placebo. As noted in a 2014 paper on antidepressants and the placebo effect:3
"Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain. Indeed, their supposed effectiveness is the primary evidence for the chemical imbalance theory.
But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect ...
Analyzing the data we had found, we were not surprised to find a substantial placebo effect on depression. What surprised us was how small the drug effect was. Seventy-five percent of the improvement in the drug group also occurred when people were give dummy pills with no active ingredient in them.
The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future."
FDA Data and Unpublished Trials Show Antidepressants Don't Work
That 2014 paper is well worth reading if you still doubt the claim that antidepressants' effectiveness is on par with placebo. The author, Irving Kirsch, Ph.D., is a psychotherapist who has performed a number of analyses on antidepressants.
In 2002, his team filed a Freedom of Information Act to request to the Food and Drug Administration (FDA), asking for the trial data provided by drug companies as part of the drug approval process. There were several benefits to using this data:
FDA requires drug companies to provide data on all clinical trials they've sponsored, including unpublished trials. As it turned out, nearly half of all clinical trials on antidepressants had never been published.
Only 43 percent of trials (published and unpublished) showed a statistically significant benefit of drug over placebo. In the majority of trials — 57 percent — the drug showed no clinical benefit over placebo.
Moreover, the placebo response actually accounted for 82 percent of the beneficial response to antidepressants. These results were reproduced in a 2008 study4 using another, larger, set of FDA trial data. According to Kirsch, "once again, 82 percent of the drug response was duplicated by placebo."
• All of the trials used the same primary measure of depression, the Hamilton depression scale — a 17-item scale with a possible score of 0 to 53 points. The higher your score, the more severe your depression.
This made the drug-placebo differences easy to identify, compare and understand. Importantly, the mean difference between drug and placebo was less than two points (1.8) on this scale, which is considered "clinically insignificant."
To illustrate just how tiny a difference this is, you can score a six-point difference simply by changing sleep patterns without any reported change in other depressive symptoms.
As noted by Kirsch, "thus, when published and unpublished data are combined, they fail to show a clinically significant advantage for antidepressant medication over inert placebo."
• The drug company data sent to the FDA is the basis upon which antidepressants were approved, which makes these trials particularly important.
If there were significant flaws in the studies — which is a common complaint when someone doesn't agree with the results — the FDA should never have approved them in the first place.
Vitamins and Supplements Boost Effectiveness of Antidepressants
Considering the fact that antidepressants have the clinical effectiveness of a placebo, is it any wonder that nutritional supplements can "boost" their effectiveness? That's exactly what a recent study found.
The meta-analysis, published in the American Journal of Psychiatry, looked at 40 clinical trials in which supplements were added to the drug regimen.5,6,7
The following four supplements were found to improve the impact of the medication — which included serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants — compared to medication only:
- Fish oil
- Vitamin D
- Methylfolate (an effective form of folic acid)
- S-Adenosyl methionine (SAMe)
Fish oil — specifically the fat EPA — produced the most significant improvement, which isn't so surprising if you understand the importance of animal-based omega-3 for brain health.
In fact, it would have been far more interesting to see how these supplements might have fared without the use of medication, as the supplements could very well have been the true benefit.
After all, studies have shown that both omega-3 and vitamin D can help improve mental health all on their own, and if the medication doesn't add anything of real value, why risk your health and wellbeing by taking it?
Lowering Inflammation Is Important for Mental Health
Studies have linked depression to chronic inflammation and dysfunction of the gut-brain axis.8 Depression is often found alongside gastrointestinal inflammation, autoimmune diseases, cardiovascular diseases, neurodegenerative diseases, type 2 diabetes, and cancer.
One likely theory as to why certain nutrients work so well for depression is because they are potent anti-inflammatories. Indeed, many studies have confirmed that treating gastrointestinal inflammation helps improve symptoms of depression.9 The gut-brain connection is well-recognized as a basic tenet of physiology and medicine, so this isn't all that surprising, even though it's often overlooked.
A previous article10 titled "Are Probiotics the New Prozac?" reviews some of the supporting evidence. For example, animal research has linked changes in gut flora to changes in affective behaviors, and in humans, probiotics (beneficial bacteria) have been shown to alter brain function.11 According to lead author Dr. Kirsten Tillisch:12
"Time and time again, we hear from patients that they never felt depressed or anxious until they started experiencing problems with their gut. Our study shows that the gut–brain connection is a two-way street ... When we consider the implications of this work, the old sayings 'you are what you eat' and 'gut feelings' take on new meaning."
Previous research has also shown that certain probiotics can help alleviate anxiety. For example, the Journal of Neurogastroenterology and Motility13 reported the probiotic known as Bifidobacterium longum NCC3001 normalized anxiety-like behavior in mice with infectious colitis by modulating the vagal pathways within the gut-brain.
Other research14 found that the probiotic Lactobacillus rhamnosus had a marked effect on GABA levels — an inhibitory neurotransmitter that is significantly involved in regulating many physiological and psychological processes — in certain brain regions and lowered the stress-induced hormone corticosterone, resulting in reduced anxiety- and depression-related behavior. (It is likely other lactobacillus species also provide this benefit, but this was the only one that was tested.)
Important Brain Nutrients
Part of the reason why depression is so rampant may well be linked to the fact that vitamin D and omega-3 deficiencies are rampant as well, and both of these nutrients are really important for optimal brain function and mental health. Consider this: your brain is made up of about 60 percent fat,15 and vitamin D receptors appear in a wide variety of brain tissue, suggesting vitamin D has an important role to play in your brain.
Omega-3 fats are important for mental clarity and focus. The 2001 book, "The Omega-3 Connection," written by Harvard psychiatrist Dr. Andrew Stoll, was among the first works to bring attention to and support the use of omega-3 fats for depression. Omega-3s have also been shown to improve more serious mental disorders, including schizophrenia, psychosis, and bipolar disorder.16
There is no set recommended standard dose of omega-3 fats, but some health organizations recommend a daily dose of 250 to 500 milligrams (mg) of EPA and DHA for healthy adults. If you suffer from depression, higher doses may be called for. In one study,17 an omega-3 supplement with a dose range of 200 to 2,200 mg of EPA per day was effective against primary depression.
As for vitamin D, researchers have suggested vitamin D may play a role in depression by regulating brain chemicals called monoamines, which include serotonin.18 As a general rule, depressed individuals have lower vitamin D levels than non-depressed people.19
Having a vitamin D level below 20 ng/ml can raise your risk of depression by 85 percent compared to having a level greater than 30 ng/ml.20 Among seniors, low vitamin D levels have been shown to raise the risk of depression by as much as 1,100 percent!
A double-blind randomized trial21 published in 2008 also concluded that: "It appears to be a relation between serum levels of 25(OH)D and symptoms of depression. Supplementation with high doses of vitamin D seems to ameliorate these symptoms indicating a possible causal relationship."Vitamin B12 deficiency can also contribute to depression, and affects about 1 in 4 people.
The Importance of Exercise
Besides nutrition, exercise is one of the most potent anti-depressants at your disposal. Research has confirmed it actually outperforms drug treatment. It's also a key treatment strategy for anxiety disorders. Exercise combats depression in a number of different ways, including by:
- Helping to normalize your insulin levels, which reduces inflammation
- Boosting "feel-good" hormones in your brain
- Eliminating kynurenine, a harmful protein associated with depression.22 (Confirming the link between inflammation and depression, your body metabolizes kynurenine primarily via a process activated by stress and inflammatory factors)
- Increasing brain-derived neurotropic factor (BDNF), which tends to be critically low in depressed individuals
- Activating mitochondrial biogenesis
Putting Treatment Options for Depression Into Proper Perspective
If you suffer from mental health problems, be it depression, anxiety, seasonal affective disorder (SAD) or any other mental or emotional disturbance, it's really important to reassess your diet and general lifestyle. Your body and mind are closely interrelated, and physical dysfunction can easily take a toll on your mental health. Your gut health, especially, can play a significant role.
One thing's for sure. Antidepressants fail miserably in addressing the cause of people's mental health problems. The booming market of "booster" drugs or "antidepressant add-ons" like ABILIFY (originally developed to treat schizophrenia and mania23) is just another sign that antidepressants really don't work as advertised.
While adding one or more supplements to the treatment protocol would be a step in the right direction, it still falls short, as the side effects of these drugs can be worse than the original complaint. For these reasons, I recommend avoiding drug treatment unless absolutely necessary.
There are instances where they can be useful and lifesaving, especially when dealing with more serious psychological disorders like schizophrenia and psychotic episodes, but for run of the mill depression, the long-term answer is more likely to be found in your kitchen than in your medicine cabinet.
Remember, studies show antidepressants are on par with placebo in terms of effectiveness, so by forgoing them you're not turning your back to a science-based cure.
It's really unfortunate that psychiatry has been so resistant to changing its treatment recommendations based on the scientific evidence, because if it did, antidepressants would no longer be among the top selling drugs in the U.S. (ABILIFY nabbed second place among the top 10 best-selling brand name drugs in 2015, with a total of 8.3 million total prescriptions written that year.24)
Overcoming Depression Without Drugs
Research tells us that the composition of your gut flora not only affects your physical health, but also has a significant impact on your brain function and mental state, and your gut microbiome can be quickly impacted by dietary changes — for better or worse.
Research has also revealed there are a number of other safe, effective ways to address depression that do not involve hazardous drugs. So if you suffer from an anxiety- or depression-related disorder, please consider addressing the following diet and lifestyle factors before you resort to drugs:
✓ Eat real food, and avoid all processed foods, sugar (particularly fructose), grains, and GMOs
High sugar and starchy non-fiber carbohydrates lead to excessive insulin release, which can result in falling blood sugar levels, or hypoglycemia.
In turn, hypoglycemia causes your brain to secrete glutamate in levels that can cause agitation, depression, anger, anxiety, and panic attacks. Sugar also fans the flames of inflammation in your body.
In addition to being high in sugar and grains, processed foods also contain a variety of additives that can affect your brain function and mental state, especially MSG, and artificial sweeteners such as aspartame.
Gluten sensitivity is also a common, hidden cause of depression, so going on a gluten-free diet can be part of the answer.
Recent research also shows that glyphosate, used in large quantities on genetically engineered crops like corn, soy, and sugar beets, limits your body's ability to detoxify foreign chemical compounds.
As a result, the damaging effects of those toxins are magnified, potentially resulting in a wide variety of diseases, including brain disorders that have both psychological and behavioral effects.
✓ Increase consumption of traditionally fermented and cultured foods
Reducing gut inflammation is imperative when addressing mental health issues,25 so optimizing your gut flora is a critical piece.
To promote healthy gut flora, increase your consumption of probiotic foods, such as fermented vegetables, kimchee, natto, kefir, and others.
✓ Get adequate vitamin B12
Vitamin B12 deficiency can contribute to depression and affects one in four people.
✓ Optimize your vitamin D levels
Vitamin D is very important for your mood. Remember, Seasonal Affective Disorder is a type of depression related to sunshine deficiency, so it would make sense that the perfect way to optimize your vitamin D is through UV exposure.
Be sure to check your levels (via blood test) at least once or twice a year. You'll want to be within the therapeutic range of 40 to 60 ng/ml year-round.
If you cannot get sufficient sun exposure to maintain this level, taking an oral vitamin D3 supplement would be advisable. Just remember to also increase your vitamin K2 when taking oral vitamin D.
✓ Get plenty of high-quality animal-based omega-3 fats
Your brain is 60 percent fat, and DHA, an animal-based omega-3 fat, along with EPA, is crucial for good brain function and mental health.26,27
Unfortunately, most people don't get enough from diet alone, so make sure you take a high-quality omega-3 fat. I recommend krill oil, which has a number of benefits over fish oil, including better absorption.28
✓ Beneficial herbs and supplements: SAMe, 5-HTP and St. John's Wort
SAMe is an amino acid derivative that occurs naturally in all cells. It plays a role in many biological reactions by transferring its methyl group to DNA, proteins, phospholipids and biogenic amines.
Several scientific studies indicate that SAMe may be useful in the treatment of depression.
5-Hydroxytryptophan (5-HTP) is another natural alternative to traditional antidepressants. When your body sets about manufacturing serotonin, it first makes 5-HTP. Taking 5-HTP as a supplement may raise serotonin levels.
The evidence suggests 5-HTP outperforms a placebo when it comes to alleviating depression29 — more than can be said about antidepressants.
One caveat: anxiety and social phobias can worsen with higher levels of serotonin, so it may be contraindicated if your anxiety is already high. St. John's Wort has also been shown to provide relief from mild depressive symptoms.
✓ Evaluate your salt intake
Sodium deficiency actually creates symptoms that are very much like those of depression. Make sure you do NOT use processed salt (regular table salt), however.
You'll want to use an all natural, unprocessed salt like Himalayan salt, which contains more than 80 different micronutrients.
✓ Get adequate daily exercise
Studies have shown there is a strong correlation between improved mood and aerobic capacity.
There's also a growing acceptance that the mind-body connection is very real, and that maintaining good physical health can significantly lower your risk of developing depression in the first place.
Exercising creates new GABA-producing neurons that help induce a natural state of calm. It also boosts your levels of serotonin, dopamine, and norepinephrine, which help buffer the effects of stress.
✓ Get enough sleep
You can have the best diet and exercise program possible but if you aren't sleeping well you can easily become depressed.
Sleep and depression are so intimately linked that a sleep disorder is actually part of the definition of the symptom complex that gives the label depression.
✓ Energy psychology
Energy psychology techniques such as the Emotional Freedom Techniques (EFT), can also be very effective for reducing symptoms of depression or anxiety by correcting the bioelectrical short-circuiting that causes your body's reactions — without adverse effects.
Recent research has shown that EFT significantly increases positive emotions, such as hope and enjoyment, and decreases negative emotional states.
EFT is particularly powerful for treating stress and anxiety because it specifically targets your amygdala and hippocampus, which are the parts of your brain that help you decide whether or not something is a threat.30,31
For serious or complex issues, seek out a qualified health care professional that is trained in EFT32 to help guide you through the process.