Lesson 4: Alternative Therapies
Natural Treatments
Since 1994, when new laws went into effect virtually removing supplements from FDA control, supplement sales have grown by nearly 80 percent, from $8.8 billion to an estimated $16 billion for 2000. A lot of this represents people experimenting on themselves, usually without telling their doctors, and using products sometimes spiked with dangerous contaminants.
St John's Wort
St John's wort represents perhaps the greatest do-it-yourself temptation, but is potentially as dangerous as any drug. Because St John's wort affects the way drugs are metabolized in the liver, the FDA in 2000 warned against the risk of dangerous interactions with protease inhibitors to treat AIDs as well as drugs to "treat conditions such as heart disease, depression, seizures, certain cancers or to prevent conditions such as transplant rejection or pregnancy."
A major US study in 2000 and one just published in 2002 found the weed to be ineffective against major depression, but many European studies have found it effective for mild depression. If you decide to try St John's wort, buy only from a reputable supplier, use only with a doctor's permission and tell him what other drugs you may be taking, and don't expect immediate results.
Sam-e
SAM-e - short for S-adenosylmethionine - is a molecule found in our bodies and is vital to a process called methylation, where one molecule passes a methyl group (one carbon and three hydrogen atoms) to another molecule. It's a transaction essential to more than a hundred processes in the body, from the brain to the bones. Levels of SAM-e are notably lower amongst depressed people of all ages.
Forty studies - virtually all European - involving 1,400 depressed patients typically show SAM-e working in a matter of days (as opposed to four to six weeks with antidepressants) with virtually no side effects. The major downside is it sells from anywhere between $16 and $38 for a bottle of 20 pills, which at the rate of two a day represents a considerable out-of-pocket expense (don't expect your HMO to pick up the tab).
Omega-3
In 1996, the Journal of the American Medical Association published a study comparing the prevalence of depression across ten nations. Among other things, the study found a strong correlation between depression and fish consumption, with the higher consuming populations experiencing less depression.
The working ingredient of fish oil is omega-3, a polyunsaturated fatty acid which is also found in certain plants such as flaxseed, pumpkin seed, and walnuts. According to Joseph Hibbelin of the NIMH: "In the last century, [Western] diets have radically changed and we eat grossly fewer omega-3 fatty acids now. We also know that rates of depression have radically increased by perhaps a hundred-fold."
A pilot study published in the Archives of General Psychiatry in 1999 on 30 patients with bipolar (still on their meds) yielded such surprising results that the study was stopped after four months instead of going on for nine. Larger trials are underway.
You can increase your omega-3 consumption through diet (do not buy farm-raised fish) or omega-3 supplements. Until we know more, omega-3 should be regarded as a complement rather than replacement to one's medications.
Natural Supplements
According to William Walsh PhD, Senior Scientist at the Health Research Institute and Pfeiffer Treatment Center in Illinois, writing on Safe Harbor's Alternative Mental Health On-Line website:
"The brain is a chemical factory that produces serotonin, dopamine, norepinephrine, and other brain chemicals 24 hours a day. The only raw materials for their syntheses are nutrients, namely, amino acids, vitamins, minerals, etc. If the brain receives improper amounts of these nutrient building blocks, we can expect serious problems with our neurotransmitters."
Orthomolecular medicine and similar therapies seek to uncover and replenish various vitamin and mineral deficiencies in patients, such as vitamin B6, which is involved in the synthesis of serotonin, and magnesium, which plays an important role in the brain's chemistry. The catch is finding a dedicated physician willing to put in the time and effort it takes to track down your particular deficiencies, if any. The other approach is to simply carpet-bomb the brain with a mix of supplements.
The Dec 2001 Journal of Clinical Psychiatry published a six-month open pilot study using a 36-supplement mixture on 14 bipolar patients still on their medications which found most showed 55 to 66 percent improvement in their symptoms. In an accompanying editorial, Charles Popper MD of Harvard, who has successfully treated 19 of 22 patients with the supplement mixture, wrote: "In view of the 50 years of experience with lithium, the notion that minerals can treat bipolar disorder is unsurprising ... Depending on how this line of research develops, [we] may need to rethink the traditional bias against nutritional supplementation as a potential treatment for major psychiatric disorders."
Hopefully, the Journal of Clinical Psychiatry study will encourage other researchers to investigate the relationship between mood and vitamin and mineral deficiencies. In the meantime, our ignorance far outweighs our knowledge, which means you are largely on your own. If you choose to go down the supplement path and have a setback, you won't find an emergency room physician who will rescue you by switching you to say chromium and vitamin C. Ten years from now may be a different story. For the time being, however, supplements should be regarded for serious players only, for those willing to put in the time and effort to be fully informed, and not for dabblers.
Acupuncture
According to the National Institute of Health: "Acupuncture is believed to balance yin and yang, keep the normal flow of energy unblocked, and restore health to the body and mind."
Acupuncture points stimulate the central nervous system, releasing chemicals into the muscles, spinal cord, and brain, promoting the body's natural healing abilities. In the words of the NIH: "Studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones in a good way."
In 1998, the NIH-funded a 16-week study at the University of Arizona that tested 34 seriously depressed women. One group of women were treated according to a protocol that targeted certain "depression points" on the body. The others were given dummy treatments with needles in nonspecific places. The acupuncturists administering the treatment had no idea whether they were using the real plan or the dummy plan.
Following the treatment, the depression-specific groups experienced a 43 percent reduction in their symptoms compared with a 22 percent reduction for the dummy group. More than half no longer met the criteria for clinical depression. Only five people dropped out of the study - two who moved away, one who became pregnant, and two who didn't like the needles. The dropout rate was much lower than for studies using medications. A larger study is now underway.
Your doctor is a good source for acupuncturists. Some 70 to 80 percent of insurers in the US cover acupuncture treatments. Cost per treatment tends to range between $30 and $100. Physician acupuncturists may charge more than non-physician practitioners. Please don't throw away your meds once you booked your first appointment. Like all other natural and alternative therapies, acupuncture should be regarded as a complement rather than a replacement to your meds unless you hear otherwise from your doctor or psychiatrist.
Conclusion
The next lesson is about coping with your depression.
