February 25, 2011
Supplements for Depression
We’ve updated our info sheet on supplements and depression–see below. See the NYBC entries for further information on DHEA; 5-HTP; SAMe; St. John’s Wort;
Fish oil (Max DHA); Tryptophan.
In recent years there’s been a lot of well-designed scientific research about the effectiveness of dietary supplements for depression. The supplements studied have ranged from the herb St. John’s Wort, which has a long tradition of use, to molecules like SAMe, L-Tryptophan, and 5-HTP, which play a role in the body’s production of neurotransmitters (such as serotonin) connected with mood and cognitive function. Other developments in depression research involve the steroid DHEA and fish oil.
DHEA (Dehydroepiandrosterone). In a study sponsored by the National Institute of Mental Health, DHEA was found to be an effective therapy for mild to moderate or severe midlife depression, on a par with some prescription drug treatments. Moreover, the NIMH research showed that taking DHEA promoted both a significant lifting of depressive symptoms and an improvement in sexual functioning. (On the other hand, inhibition of sexual function remains one of the chief troublesome side effects of prescription anti-depressants). Note that dosing recommendations vary for men versus women, and DHEA is not recommended for those diagnosed with prostate problems or cancer.
SAMe (S-adenosyl-l-methionine). First studied by Italian researchers in the 1950s, SAMe is produced naturally in the body from the amino acid methionine. Supplementing with SAMe increases concentrations of the neurotransmitters serotonin and L-dopamine, which are related to mood. Several studies show SAMe having an anti-depressant effect comparable to that of some prescription drugs. A dose of 400-800mg/day has been studied for mild to moderate depression, and 800-1600mg/day for the moderate to severe condition. As of 2007, SAMe was being compared with the prescription drug Lexapro® in a 5-year NIH-funded study. SAMe generally has fewer side effects than prescription anti-depressants. However, it should be avoided in people with bipolar disorder, and should be used cautiously with other anti-depressants, because the combination may push serotonin levels too high. Taking a B-complex vitamin while using SAMe can counter build up of homocysteine, which is associated with heart disease. (It’s best to take them separately.) SAMe also supports joint health and liver function, so may have positive effects for overall health if taken over the long term.
St. John’s Wort is a widely used herb with clinically demonstrated (multiple, well-controlled studies, mostly in Europe) anti-depressant effects for mild to moderate depression – generally without the side effects of prescription antidepressants. High doses of the herb may cause a sensitivity to light (phototoxicity), so avoid direct sunlight or sunbathing while using. Do not take St. John’s Wort with 5-HTP, serotonin re-uptake inhibitors (like Prozac), or with protease inhibitors, as it my affect beneficial liver enzymes. St. John’s Wort may also have activity against Epstein-Barr and herpes infections.
L-Tryptophan and 5-HTP (5-hydroxy L-tryptophan): These closely-related supplements are converted in the body to serotonin and to melatonin. (Specifically, L-Tryptophan converts to 5-HTP, which then converts to serotonin or melatonin.) Their use as antidepressants has been studied, and they have also been found to aid sleep and suppress appetite. (To minimize appetite suppression, try taking the supplement an hour before bedtime.) Mild gastrointestinal side effects have been reported with both. For best absorption, take with water or juice, and separately from protein-containing foods and dietary supplements. Although L-Tryptophan and 5-HTP are close relatives, people may respond somewhat differently to them. Thus, if encountering unwanted side effects or lack of effect from one, it may still be worthwhile to try the other.
The suggested dosage for 5-HTP is wide, ranging from 50 and 500 mg daily. It can be used together with other anti-depressants, in which case an effective dose could be quite low. The best approach is to start at the low end of the range and increase as needed. Like 5-HTP, L-Tryptophan has been used in combination with other anti-depressants, and has also been employed with lithium for bipolar disorder. An added benefit: 5-HTP may also decrease symptoms of fibromyalgia and migraine headaches.
Fish Oil. Epidemiological studies have suggested that populations that eat fish regularly have low rates of depression. More recently, research has found fish oil supplements (omega-3 fatty acids being the significant component) of benefit in treating depression and bipolar disorder. It’s also worth noting that fish oil can be taken with other anti-depressants as an adjunct therapy. Doses found effective in treating depression are quite high, 3 to 9 grams per day, so be aware of potential problems related to the supplement’s blood-thinning properties. Added benefit: as has been widely reported, fish oil can have a beneficial impact on cholesterol regulation and in supporting cardiovascular health.
_____________________________________________________________________________References:
REFERENCES: Christian R. Dolder, “Depression,” in Natural Products: A Case-Based Approach for Health Care Professionals, ed. Karen Shapiro, published by the American Pharmacists Association, Washington, DC (2006), pp. 97-114.
Shaheen E Lakhan and Karen F Vieira. “Nutritional therapies for mental disorders” in Nutrition Journal (2008), 7:2doi:10.1186/1475-2891-7-2. Accessed 10/7/2009 at http://www.nutritionj.com/content/7/1/2
Schmidt PJ, et al. “Dehydroepiandrosterone Monotherapy in Midlife-Onset Major and Minor Depression,” Archives of General Psychiatry (February 2005): Vol. 62, No. 2, pp. 154–62.
Hyla Cass, “Prescriptions for Depression,” in Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition. Basic Health Publications (2007), pp. 113-128.
May 24, 2010
COMPLEMENTARY THERAPY USE IN HIV-POSITIVE PEOPLE: AN ONLINE COMMUNITY SURVEY
An online survey conducted by our friend, Nelson Vergel and published in Antiviral Therapy. Here is the abstract:
COMPLEMENTARY THERAPY USE IN HIV-POSITIVE PEOPLE: AN ONLINE COMMUNITY SURVEY Antiviral Therapy 2009; 14(Suppl. 2):A34 (abstract no. P-11)
NR Vergel
Program for Wellness Restoration, Houston, TX, USA
OBJECTIVES: To assess the use and types of complementary therapies (CT) and their perceived benefits in a sample of HIV-positive members of a community online health listserve.
METHODS: Members of pozhealth at yahoogroups.com were sent a link to a 13 point questionnaire related to demographics, length of HIV infection, type of CT use, and reasons and perceived benefits of CT use.
RESULTS: The majority of the 135 survey participants were white males over 40 years of age who live in the USA and with least 15 years of HIV infection. The top reported CTs and their perceived benefits were exercise, nutritional supplements, herbs, massage, prayer/ spirituality, meditation, acupuncture, chiropractic and yoga. The most popular supplements and their perceived or studied benefits were fish oils (improved lipids), coenzyme Q-10 (stamina), multivitamins (general health), selenium (immune system protection), N-acetyl cysteine (immune system protection), alpha lipoic acid (improved insulin sensitivity and neuropathy), niacin (improved lipids), whey protein (lean body mass enhancement), acetyl-l-carnitine (improved lipids, neuropathy and cognitive function), DHEA (stamina and sexual function), probiotics (gastrointestinal health and diarrhoea), calcium (bone health and diarrhoea), vitamin D (bone health) and milk thistle (liver protection). A total of 84% believed that they were benefitting from CTs, and 87% informed their physicians about their CT use. CTs were personally funded by 72% of patients, whereas the rest had access to them via community programmes.
CONCLUSION: The majority of this sample of HIV-positive people used CTs and derived perceived benefits. Unfortunately, there are little to no efficacycontrolled data available for most CTs. Also lacking are interaction studies between most nutritional/herbal supplements and HIV antiretrovirals (ARVs). As CT use seems to be common and pervasive in the self-management of adverse events and quality of life, the HIV-positive community would benefit from more controlled studies on popular CTs and supplement interaction data with ARVs.
DISCUSSION: There are obvious limitations to this survey. The majority of participants were long-term survivor/white males over 40 years of age, which might represent those who access HIV-related health listserves on the internet. It is suggested that more information is obtained from other HIV patient populations via other outreach venues. A larger survey sample will be available at the conference.
October 9, 2009
Supplements for Depression: Updated Info Sheet from NYBC
We’ve updated our info sheet on Supplements for Depression, reflecting some additional supporting evidence that has accumulated for these applications, plus new references. See www.newyorkbuyersclub.org for detailed product information.
In recent years there’s been a lot of well-designed scientific research about the effectiveness of dietary supplements for depression. The supplements studied have ranged from the herb St. John’s Wort, which has a long tradition of use, to molecules like SAMe, L-Tryptophan, and 5-HTP, which play a role in the body’s production of neurotransmitters (such as serotonin) connected with mood and cognitive function. Other developments in depression research involve the steroid DHEA and fish oil.
DHEA (Dehydroepiandrosterone). In a study sponsored by the National Institute of Mental Health, DHEA was found to be an effective therapy for mild to moderate or severe midlife depression, on a par with some prescription drug treatments. Moreover, the NIMH research showed that taking DHEA promoted both a significant lifting of depressive symptoms and an improvement in sexual functioning. (On the other hand, inhibition of sexual function remains one of the chief troublesome side effects of prescription anti-depressants). Note that dosing recommendations vary for men versus women, and DHEA is not recommended for those diagnosed with prostate problems or cancer.
SAMe (S-adenosyl-l-methionine). First studied by Italian researchers in the 1950s, SAMe is produced naturally in the body from the amino acid methionine. Supplementing with SAMe increases concentrations of the neurotransmitters serotonin and L-dopamine, which are related to mood. Several studies show SAMe having an anti-depressant effect comparable to that of some prescription drugs. A dose of 400-800mg/day has been studied for mild to moderate depression, and 800-1600mg/day for the moderate to severe condition. As of 2007, SAMe was being compared with the prescription drug Lexapro® in a 5-year NIH-funded study. SAMe generally has fewer side effects than prescription anti-depressants. However, it should be avoided in people with bipolar disorder, and should be used cautiously with other anti-depressants, because the combination may push serotonin levels too high. Taking a B-complex vitamin while using SAMe can counter build up of homocysteine, which is associated with heart disease. (It’s best to take them separately.) SAMe also supports joint health and liver function, so may have positive effects for overall health if taken over the long term.
St. John’s Wort is a widely used herb with clinically demonstrated (multiple, well-controlled studies, mostly in Europe) anti-depressant effects for mild to moderate depression – generally without the side effects of prescription antidepressants. High doses of the herb may cause a sensitivity to light (phototoxicity), so avoid direct sunlight or sunbathing while using. Do not take St. John’s Wort with 5-HTP, serotonin re-uptake inhibitors (like Prozac), or with protease inhibitors, as it my affect beneficial liver enzymes. St. John’s Wort may also have activity against Epstein-Barr and herpes infections.
L-Tryptophan and 5-HTP (5-hydroxy L-tryptophan): These closely-related supplements are converted in the body to serotonin and to melatonin. (Specifically, L-Tryptophan converts to 5-HTP, which then converts to serotonin or melatonin.) Their use as antidepressants has been studied, and they have also been found to aid sleep and suppress appetite. (To minimize appetite suppression, try taking the supplement an hour before bedtime.) Mild gastrointestinal side effects have been reported with both. For best absorption, take with water or juice, and separately from protein-containing foods and dietary supplements. Although L-Tryptophan and 5-HTP are close relatives, people may respond somewhat differently to them. Thus, if encountering unwanted side effects or lack of effect from one, it may still be worthwhile to try the other.
The suggested dosage for 5-HTP is wide, ranging from 50 and 500 mg daily. It can be used together with other anti-depressants, in which case an effective dose could be quite low. The best approach is to start at the low end of the range and increase as needed. Like 5-HTP, L-Tryptophan has been used in combination with other anti-depressants, and has also been employed with lithium for bipolar disorder. An added benefit: 5-HTP may also decrease symptoms of fibromyalgia and migraine headaches.Fish Oil. Epidemiological studies have suggested that populations that eat fish regularly have low rates of depression. More recently, research has found fish oil supplements (omega-3 fatty acids being the significant component) of benefit in treating depression and bipolar disorder. It’s also worth noting that fish oil can be taken with other anti-depressants as an adjunct therapy. Doses found effective in treating depression are quite high, 3 to 9 grams per day, so be aware of potential problems related to the supplement’s blood-thinning properties. Added benefit: as has been widely reported, fish oil can have a beneficial impact on cholesterol regulation and in supporting cardiovascular health.
References:
Christian R. Dolder, “Depression,” in Natural Products: A Case-Based Approach for Health Care Professionals, ed. Karen Shapiro, published by the American Pharmacists Association, Washington, DC (2006), pp. 97-114.
Shaheen E Lakhan and Karen F Vieira. “Nutritional therapies for mental disorders” in Nutrition Journal (2008), 7:2doi:10.1186/1475-2891-7-2. Accessed 10/7/2009 at http://www.nutritionj.com/content/7/1/2
Schmidt PJ, et al. “Dehydroepiandrosterone Monotherapy in Midlife-Onset Major and Minor Depression,” Archives of General Psychiatry (February 2005): Vol. 62, No. 2, pp. 154–62.
Hyla Cass, “Prescriptions for Depression,” in Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition. Basic Health Publications (2007), pp. 113-128.
March 24, 2008
HIV and Depression: the ACRIA study on HIV and aging, and some recommendations from NYBC
We’ve spoken recently about the study of HIV and aging produced by ACRIA, a non-profit, community-based AIDS medical research and treatment education organization.
A main finding of the 2006 study is the prevalence of depression among older adults with HIV. In its survey of about 1000 older HIV+ adults, ACRIA researchers found that they experienced depression at a rate almost 13 times as higher than the general population. And for people with HIV, the consequences of depression are associated with many physical issues, far beyond just “feeling down”:
“By suppressing the immune system, depression may render people more vulnerable to infectious diseases. Stress and depression have harmful effects on cellular immunity, including those aspects of the immune system affected by HIV. Body cell mass depletion is associated with significant increases in fatigue, global distress and depressive symptomatology, and reduced life satisfaction. Elevated symptoms of depression are associated with a faster progression to AIDS and a higher risk of mortality. Depressive symptoms, especially in the presence of severe stress, are related to decreases in CD4 cell count and declines in several lymphocytes.”
These study findings and other related research motivated NYBC to assemble up-to-date information on dietary supplements and depression. See, for an overview, this information sheet:
More information on the individual supplements is also available on the NYBC website, at www.newyorkbuyersclub.org, as well as on this Blog, under “Depression.”
January 23, 2008
FAQ on nutritional supplements
This post runs a little long, but we think it’s worthwhile to put up the FAQ about nutritional supplements recently posted by the New York Buyers’ Club. It answers a lot of (sometimes anxious) queries about supplements, and also gives a quick rundown on some of the top uses of supplements among the NYBC membership.
What are supplements?
A nutritional or dietary supplement (or just plain supplement), as defined by the Dietary Supplement Health and Education Act (DSHEA) of 1994, is “a product (other than tobacco) that is intended to supplement the diet and that contains one or more of the following: vitamins, minerals, herbs or other botanicals, amino acids, or any combination of the above ingredients,” and can be taken in tablet, capsule, powder, or liquid form.
NYBC specializes in supplements for those with HIV, hepatitis C, and other chronic conditions. Our Supplement Fact Sheets contain information on more than 100 supplements commonly used by our Members. Our nonprofit purchasing co-op stocks these supplements on a regular basis, and can also special-order many other supplements on request.
Why take supplements?
There is a great deal of research showing that supplements can help people manage serious chronic conditions such as HIV and hepatitis. Supplements can also be useful in addressing many common health issues, such as high cholesterol, diabetes, depression, arthritis pain, gastrointestinal disorders, etc. (see our short list of specifics below). Some supplements are derived from ancient traditions of use (for example, the botanicals of India’s Ayurvedic tradition), while other items (such as vitamins or amino acids) have been isolated and used as supplements much more recently. The scientific study of supplements has blossomed in recent decades, so we now have better evidence about many of them—even traditional botanicals—than we ever did in the past.
Are supplements considered “medicine”?
While supplements may have medicinal properties, they are not regulated in the same way that prescription drugs are, and are therefore accompanied by the disclaimer: “These statements have not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”
The fact that supplements are not regulated in the same way that prescription drugs are naturally gives rise to concerns about purity, efficacy, and safety – so it’s good to have a knowledgeable ally like NYBC on your side! Collectively, we have many years of experience in using supplements, in researching information on them, and in evaluating suppliers to obtain the best quality product.
Are supplements “safe”?
Under current US regulations, supplements are assumed to be safe on the basis of their history of use, or because they are found in the food supply (like the microorganisms in yogurt or the vitamins and minerals in foods). The US Food and Drug Administration is responsible for removing supplements from the market if it finds evidence that they are unsafe, but it’s worth noting that this happens quite rarely. (The removal from the market of ephedra [aka the Chinese herb Ma huang], used at high dosage as a diet pill, is practically the only significant example since 1994). However, while supplements may be “assumed to be safe,” everyone who takes them needs to pay attention to the recommended dosage and any cautions or warnings. If you exceed the recommended dosage of certain supplements, there may be side effects, sometimes serious. Furthermore, a supplement may have negative interactions with other medications you are taking, or a particular supplement may not be a wise choice for you due to other health concerns. That’s why it’s always important to discuss your supplement use with your doctor.
Here are just a few examples of potentially dangerous supplement-medication interactions (from the National Center for Complementary and Alternative Medicine’s website) – further proof that consulting your physician about supplement use is crucial:
• St. John’s Wort can increase the effects of prescription drugs used to treat depression. It also dangerously interferes with drugs used for HIV, cancer, birth control, and rejection of organ transplants
• Ginseng can increase the stimulant effects of caffeine (as in coffee, tea, and cola). It can also lower blood sugar levels, creating the possibility of problems when used with diabetes drugs
• Ginkgo, taken with anticoagulant or antiplatelet drugs, may increase the risk of bleeding. Ginkgo may also interact with certain psychiatric drugs and with certain drugs that affect blood sugar levels
Of course, doing your own “homework” is also encouraged. Be sure to bring any notes or printouts from your research to share with your healthcare provider. That way, you’ll both be literally on the same page.
Identity, Purity and Potency
Safety is also a matter of product quality. Is the product what it claims to be on the label (that is, is it really fish oil)? This is the product Identity. Does the product contain any unwanted contaminants like heavy metals, insect parts, rodent droppings? All foods and medicinal products face these issues of Purity. And finally, does it have as much of the claimed amount of a substance? For example, if it says 100 mg of niacin, does it have that amount? This is the product’s Potency. These issues are of ongoing concern. NYBC has done everything possible to assure that products meet these standards. Websites such as www.consumerlab.com can help. Also indications of quality such as USP or other labels further add assurance. The good news is that the vast majority of products tested by consumerlab, for example, pass their tests. Still, NYBC believes an appropriately funded agency of the FDA could do more rigorous, routine and comprehensive testing.
What is CAM?
CAM is an acronym for complementary and alternative medicine. The use of supplements is considered CAM. Some prefer the term integrative medicine.
The National Center for Complementary and Alternative Medicine (NCCAM), a division of the US National Institutes of Health, defines CAM as “a group of diverse medical and health care systems, practices and products that are not presently considered to be part of conventional medicine.” NCCAM, like the US Office of Dietary Supplements, came into being after passage of DSHEA, and marks the federal government’s decision to commit funding to research and education about CAM. Over a billion dollars in your tax dollars have been spent by these agencies since their start.
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Using Supplements
What supplements can I use to improve my immune system?
Agents such as a potent multivitamin, NAC (N-acetyl cysteine), alpha lipoic acid and whey can all help offset oxidative stress and nutrient losses caused by HIV as well as the free radical generation and inflammation-related damage that some antiretroviral drugs cause.
For those with HIV, supplementation can be a valuable assist in restoring the body’s immune system, as evidenced by many studies, such as Dr. Jon Kaiser’s HIV Micronutrient Study, which showed a significant increase (26%) in the CD4 counts of the subjects who maintained a supplement regimen in addition to their regular medications. FYI: NYBC offers a “MAC Pack” (Micronutrient – Antioxidant Combination Pack), a product very similar to the one used in the study.
What supplements can be used to improve gut function?
Acidophilus or bifidus, glutamine, whey proteins, Saccharomyces boulardii (Florastor) and a good multi can all be important to offset gastrointestinal problems, whether HIV-related or of other origin.
What supplements can I use to manage my blood fats (cholesterol and triglyceride levels)?
“Bad cholesterol” (LDL) and triglycerides can be reduced with agents such as carnitine, pantethine, and fish oils. Niacin may be an excellent option which can also help increase HDL (“good cholesterol”). For heart health in general, aside from diet and exercise, CoEnzyme Q10 may also be of help (may also be useful in countering statin-related side effects).
What supplements are used to improve mental function and/or mood?
Acetylcarnitine, 5-HTP, tyrosine, ginkgo biloba, fish oils, SAM-e, DHEA, theanine, or St. John’s Wort may help mental function and alleviate depression, though each of these must be taken with some care (and not all together!)
See also: a full dossier on Memory Loss and Other Brain Problems from our Health+HIV section of Recommended Reading on the website www.newyorkbuyersclub.org; also recommended is the NYBC info sheet on Depression and supplements on this blog, under “Depression.”
What supplements can I use to combat fatigue?
Various conditions can cause fatigue, but in general, B12 (methylcobalamin) and Eleuthero (used to be “Siberian ginseng” – don’t use with high blood pressure!) may all help to improve energy. A good start may also be as simple as a good multivitamin!
For more information about the causes and treatments for fatigue, see our Fatigue Fact Sheet on the NYBC website.
What supplements can I use to stabilize my weight?
For those experiencing weight loss, whey proteins, carnitine and creatine plus CLA may all help – but of course especially in conjunction with a good diet and routine exercise! And we agree with Dr. Jon Kaiser and many others: resistance exercise remains an important component of a successful HIV management plan.
What supplements are used to treat nausea?
NYBC recommends ginger; marijuana, while effective, is not carried by the NYBC, as it is not yet approved for medical use in New York. For detailed information about the causes and treatments for nausea, see Health+HIV section of Recommended Reading on the NYBC website.
What supplements are used to improve liver function?
Liver function can be impaired due to several reasons, including disease, alcohol abuse, and the effects of some cholesterol-lowering drugs (statins).
While making sure there aren’t any interactions with your meds, supplements like milk thistle (Silymarin), NAC, alpha lipoic acid, Hepato-C or Hepato-Detox, Hepatoplex I or II, Ecliptex, SAM-e and Clear Heat are options to consider (again, not all at once!)
What supplements can be used to treat diarrhea?
NYBC suggests supplementing your diet with glutamine and calcium. For more information about the causes and other possible treatments, see our Fact Sheet about diarrhea in Recommended Reading, at www.newyorkbuyersclub.org.
What supplements can combat neuropathy?
Much scientific evidence now points to acetylcarnitine as an effective approach to countering neuropathy (numbness, tingling, or pain, usually in the extremities, which can be caused by HIV, diabetes or by some medications).
November 16, 2007
DHEA and depression
Here are citations for two well-designed recent studies on DHEA and depression. The first was undertaken by the NIH/National Institute of Mental Health and used DHEA as the sole therapy with a group of men and women aged 45 to 65 who were experiencing major or minor midlife-onset depression. The researchers concluded that DHEA was an effective treatment for this group. Note: a further item of interest is that DHEA therapy was also found to be associated with improvement in sexual function. (Contrast with certain prescription anti-depressants, which shall remain nameless!)
The second study, by Judith Rabkin et al. at Columbia Univ., focused on people with HIV and examined DHEA as a therapy for non-major depression, especially among a group that was not in the best physical health. The finding: DHEA was an effective and useful therapy under these conditions.
For more information on DHEA, including recommendations for use, see the NYBC
description of
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Source: Arch Gen Psychiatry. 2005 Feb;62(2):154-62.
Dehydroepiandrosterone monotherapy in midlife-onset major and minor depression.
Authors: Schmidt PJ, Daly RC, Bloch M, Smith MJ, Danaceau MA, St Clair LS, Murphy JH, Haq N, Rubinow DR. Behavioral Endocrinology Branch, National Institute of Mental Health, Rockville, MD CONTEXT: Alternative and over-the-counter medicines have become increasingly popular choices for many patients who prefer not to take traditional antidepressants. The adrenal androgen and neurosteroid dehydroepiandrosterone (DHEA) is available as over-the-counter hormonal therapy and previously has been reported to have antidepressant-like effects. OBJECTIVE: To evaluate the efficacy of DHEA as a monotherapy treatment for midlife-onset depression. DESIGN: A double-blind, randomized, placebo-controlled, crossover treatment study was performed from January 4, 1996, through August 31, 2002.S ettings The National Institute of Mental Health Midlife Outpatient Clinic in the National Institutes of Health Clinical Center, Bethesda, Md.Patients Men (n = 23) and women (n = 23) aged 45 to 65 years with midlife-onset major or minor depression participated in this study. None of the subjects received concurrent antidepressant medications.Intervention Six weeks of DHEA therapy, 90 mg/d for 3 weeks and 450 mg/d for 3 weeks, and 6 weeks of placebo. MAIN OUTCOME MEASURES: The 17-Item Hamilton Depression Rating Scale and Center for Epidemiologic Studies Depression Scale. Additional measures included the Derogatis Interview for Sexual Functioning. Results were analyzed by means of repeated-measures analysis of variance and post hoc Bonferroni t tests. RESULTS: Six weeks of DHEA administration was associated with a significant improvement in the 17-Item Hamilton Depression Rating Scale and the Center for Epidemiologic Studies Depression Scale ratings compared with both baseline (P<.01) and 6 weeks of placebo treatment (P<.01). A 50% or greater reduction in baseline Hamilton Depression Rating Scale scores was observed in 23 subjects after DHEA and in 13 subjects after placebo treatments. Six weeks of DHEA treatment also was associated with significant improvements in Derogatis Interview for Sexual Functioning scores relative to baseline and placebo conditions.CONCLUSION: We find DHEA to be an effective treatment for midlife-onset major and minor depression.
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Source: American Journal of Psychiatry. 2006 Jan;163(1):59-66.
Placebo-controlled trial of dehydroepiandrosterone (DHEA) for treatment of nonmajor depression in patients with HIV/AIDS
Authors: Rabkin JG, McElhiney MC, Rabkin R, McGrath PJ, Ferrando SJ.
New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
OBJECTIVE: Subsyndromal major depressive disorder is common among HIV-positive adults. This study was designed to assess the efficacy of dehydroepiandrosterone (DHEA) as a potential treatment. METHOD: One hundred forty-five patients with subsyndromal depression or dysthymia were randomly assigned to receive either DHEA or placebo; 90% (69 of 77) of the DHEA patients and 94% (64 of 68) of the placebo patients completed the 8-week trial. The primary measure of efficacy was a Clinical Global Impression improvement rating of 1 or 2 (much or very much improved) plus a final Hamilton Depression Rating Scale score <or=8. Outcome was assessed by using intent-to-treat analysis, followed by completer analysis. Safety was assessed by queries about side effects at every study visit plus measures of CD4 cell count and HIV RNA viral load at baseline and week 8. DHEA dosing was flexible (100-400 mg/day). RESULTS: On the basis of clinicians’ ratings, DHEA was superior in the intent-to-treat analysis, where the response rate was 56% (43 of 77) for the DHEA group versus 31% (21 of 68) for the placebo group. In the completer analysis, the response rate was 62% (43 of 69) for the DHEA group, compared to 33% (21 of 64) for the placebo patients. The number needed to treat was 4 on the basis of intent-to-treat data and 3.4 on the basis of completer data. Few adverse events were reported in either treatment group, and no significant changes in CD4 cell count or HIV RNA viral load were observed in either group.
CONCLUSIONS: Nonmajor but persistent depression is common in patients with HIV/AIDS, and DHEA appears to be a useful treatment that is superior to placebo in reducing depressive symptoms. The low attrition rate in this group of physically ill patients, together with requests for extended open-label treatment, reflect high acceptance of this readily available intervention.
November 7, 2007
Fatigue, sleep disturbances, low energy, depression: dietary supplements may help address special health concerns for people with HIV
As we were mulling over the recent New York Times piece on the billions of dollars Americans spend each year on sleep aids that are only mildly effective (see today’s other post under “Melatonin”), we thought we’d reprint this article from the NYBC newsletter THE SUPPLEMENT, which appeared earlier this year. It deals with the constellation of health concerns, from fatigue to depression, that often affect people with HIV, and gives an overview of some of the dietary supplements that have been used to address these issues.
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Sleeping poorly? Energy low? Feeling down?
Dietary supplements may have something to offer
Sleep disturbances are the third most common complaint among people with HIV seeking medical attention. Everybody knows what it’s like to sleep poorly, then feel cranky and fatigued the next day. But persistent insomnia, followed by chronic fatigue, can become major medical issues for people with HIV (we’re talking about lower CD4 counts and poor medication adherence), so it’s worth reviewing options for dealing with these problems.
A 2005 research presentation suggested that melatonin supplements can improve sleep patterns in people with HIV. Melatonin, a hormone secreted by the pineal gland, has long been studied as a sleep regulator—levels increase in response to darkness, then fall during daytime. It’s also been investigated as an anti-cancer agent, where it has shown the capacity to combat solid tumors. (But melatonin should not be taken by people with cancers affecting immune cells, such as lymphoma or leukemia.)
Good news: a recent trial indicates that low-dose melatonin (0.5 to 1.0 mg) may be perfectly effective as a sleep promoter, making it a very inexpensive option for this purpose.
Fatigue can stem from other causes besides sleep disturbances. Anemia, a shortage of red blood cells, is another leading cause of fatigue among people with HIV, and is especially common among women. (A recent large study found that about 30% of people on HAART had moderate anemia. Women had an 80% greater risk of being anemic than men, and African-Americans had a risk of anemia 2.6 times higher than whites.) It’s important to learn the source of anemia in people with HIV (taking Retrovir, AZT, is a drug-related factor). Treatment options include increasing intake of iron, vitamin B12 and folic acid. Note that NYBC stocks multivitamins with iron for those concerned about their intake of this mineral. You’ll also find folic acid and B12 in our multis, and may want to consider adding a separate vitamin B supplement as well.
While for some people with HIV treating anemia can be a key to helping them overcome fatigue and its frequent companion depression, there are other cases where low energy is not connected to low red blood cell levels, and where the treatment options are therefore different. Particularly in HIV+ men, steroid hormones (testosterone and DHEA) have proven to be useful in combating the fatigue-depression combination. Recent federally-funded research on DHEA showed it to be an effective anti-depressant, with the added interesting feature that it can enhance sex drive (rather than undermining it, as do certain common prescription anti-depressants). And a Columbia University study of DHEA for fatigue and depression in people with HIV has found it to be a successful treatment for some, with the added bonus that, unlike some prescription energy boosters, it doesn’t carry the risk of addiction.
