January 31, 2012
American Psychiatric Association Task Force on supplements for major depression
The American Psychiatric Association recently commissioned a task force to study the state of “alternative and complementary” therapies for major depression. This follows widespread interest from the scientific community and a considerable accumulation of research to date. The Task Force reported in a 2010 article that focused special attention on these supplements: omega-3 fatty acids (commonly taken as fish oil supplements), St John’s Wort (the botanical Hypericum), Folic acid (a synthetic form of folate, a B vitamin found in leafy green vegetables, citrus fruits, beans, and fortified breads and cereals), and S-adenosyl-L-methionine (SAMe).
We welcome this acknowledgment by the mainstream US medical establishment that supplements have a role to play in treating a disabling condition that affects millions of people per year, and is not always easily treatable. (Only one-third of adult patients newly diagnosed with major depression achieve complete symptom relief when taking one antidepressant, so there is often an extended search for the right combination of drug and other treatment needed for remission.)
Below is a brief recap of some of the latest thinking on these key supplements for depression. Of course NYBC recommends that you use these supplements in consultation with your healthcare provider. More information on these supplements can be found by following the links to the NYBC website.
Omega-3 Fatty Acids (fish oil) recommended as a stand-alone treatment for people concerned about side effects, such as those with multiple medical conditions. It has also been combined with other antidepressants as an adjunct therapy. Fish oil’s blood-thinning property makes it problematic for doses above 3g/day. Added benefit: fish oil supports cardiovascular health.
St. John’s Wort is an herb widely studied and used, especially in Europe, for mild to moderate depression, though it hasn’t proved effective for major depression. Those taking protease inhibitors or certain other drugs should avoid St. John’s Wort because it interferes with their action.
SAMe (S-adenosyl-l-methionine). Supplementing with SAMe increases concentrations of neurotransmitters that influence mood, and multiple studies have confirmed its antidepressant effect. A dose of 400-800mg/day has been studied for mild-to-moderate depression, and 800-1600mg/day for moderate-to-severe. Studied as a stand-alone treatment, or as an adjunct treatment. Added benefit: SAMe supports joint health and liver function.
When combined with an antidepressant, folic acid supplements can improve symptoms, particularly in women. However, folic acid supplements are not a stand-alone treatment for depression. The safe upper limit is 1,000 mcg per day.
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.
December 1, 2010
SAMe for osteoarthritis
We were interested to see in the recently published Mayo Clinic guide to alternative medicine a fairly strong statement supporting the use of SAMe (s-adenosylmethionine) for osteoarthrititis. So we checked with what regard as one of the best online resources for such questions, the University of Maryland Medical Center. Here’s their report, updated in 2009, which basically backs up the Mayo Clinic view:
A number of well-designed clinical trials show that SAMe may reduce pain and inflammation in the joints, and researchers think it may also promote cartilage repair, although they are not clear about how or why this works. In several short-term studies (ranging 4 – 12 weeks), SAMe supplements were as effective as nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen in adults with knee, hip, or spine osteoarthritis. SAMe was as effective as these medications in lessening morning stiffness, decreasing pain, reducing swelling, improving range of motion, and increasing walking pace. Several studies also suggest that SAMe has fewer side effects than NSAIDs. Another study compared SAMe to celecoxib (Celebrex), a type of NSAID called a COX-2 inhibitor, and found that over time SAMe was as effective as celecoxib in relieving pain.
From: http://www.umm.edu/altmed/articles/s-adenosylmethionine-000324.htm
Read more at the NYBC entry for SAMe:
http://nybcsecure.org/product_info.php?cPath=57&products_id=207
August 20, 2010
SAMe helps depression
While this is not a study involving people living with HIV, there is good reason to believe that SAMe may be helpful in the depression that may arise with HIV disease.
S-Adenosyl Methionine (SAMe) Augmentation of Serotonin Reuptake Inhibitors for Antidepressant Nonresponders With Major Depressive Disorder: A Double-Blind, Randomized Clinical Trial
George I. Papakostas, M.D., David Mischoulon, M.D., Ph.D., Irene Shyu, B.A., Jonathan E. Alpert, M.D., Ph.D., and Maurizio Fava, M.D.
Objective: Despite the progressive increase in the number of antidepressants, many patients with major depressive disorder continue to be symptomatic. Clearly, there is an urgent need to develop better tolerated and more effective treatments for this disorder. The use of S-adenosyl methionine (SAMe), a naturally occurring molecule that serves as a methyl donor in human cellular metabolism, as adjunctive treatment for antidepressant nonresponders with major depressive disorder represents one such effort toward novel pharmacotherapy development.
Method: Participants were 73 serotonin reuptake inhibitor (SRI) nonresponders with major depressive disorder enrolled in a 6-week, double-blind, randomized trial of adjunctive oral SAMe (target dose: 800 mg/twice daily). Patients continued to receive their SRI treatment at a stable dose throughout the 6-week trial. The primary outcome measure for the study was the response rates according to the 17-item Hamilton Depression Rating Scale (HAM–D).
Results: The HAM–D response and remission rates were higher for patients treated with adjunctive SAMe (36.1% and 25.8%, respectively) than adjunctive placebo (17.6% versus 11.7%, respectively). The number needed to treat for response and remission was approximately one in six and one in seven, respectively. There was no statistically significant difference in the proportion of SAMe- versus placebo-treated patients who discontinued the trial for any reason (20.6% versus 29.5%, respectively), due to adverse events (5.1% versus 8.8%, respectively), or due to inefficacy (5.1% versus 11.7%, respectively).
Conclusions: These preliminary results suggest that SAMe can be an effective, well-tolerated, and safe adjunctive treatment strategy for SRI nonresponders with major depressive disorder and warrant replication.
Am J Psychiatrya 2010; 167:942-948
(published online July 1, 2010; doi: 10.1176/appi.ajp.2009.09081198)
© 2010 American Psychiatric Association
June 25, 2010
B6 and methionine against Lung Cancer
Vitamin B6 (also known in the bioavailable form of pyridoxal-5-phosphate or P5P) along with methionine was shown to protect against lung cancer when levels were high in the blood. The study that undertook the effort reviewed charts of 400,000 people in 10 European countries over 8 years.
Whether taking vitamin B6 or methionine will increase blood levels and provide the same protection is not yet known. Of course, it does not take a rocket scientist to know that continuing to smoke increases the risk of lung cancer, period. The most effective harm reduction approach is to stop smoking. Short of that, it may be wise to use some B-complex to try to further reduce risk.
B vitamins are very important for a variety of body functions. Other data have shown benefits of B-vitamins such as B1 (thiamine) and B2 (riboflavin) for conditions ranging from lactic acidosis to reducing the risk of premature or low birthweight babies among HIV+ pregnant women.
With regard to methionine, it can be somewhat hard on the liver. However, NAC, which has myriad other potential benefits, may have the more biologically relevant benefits. In addition, S-adenosylmethionine is possibly a more active agent which appears to be good for both the liver and for depression. Methionine converts into SAMe and subsequently cysteine in the body naturally.
Whether taking NAC or B6 can help reduce the risk of lung cancer needs to be evaluated in a clinical trial setting. But again, of course, what we know reduces risk is to quit smoking. Duh.
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.
October 8, 2008
Nutritional supplements for depression: recommendations from an expert on integrative/holistic health
NYBC has been following recent developments in the use of dietary supplements for depression for quite some time now, and we’d like to recommend a recent guide to this topic by Hyla Cass, which appears in her book, Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition.
Dr. Cass, a practicing physician and an expert on integrative (“holistic”) health, devotes a chapter of her 2007 book to depression. The core elements of her recommendations are the B vitamins, Folate, Omega-3 fatty acids, Calcium, and Vitamin D (especially in winter). She also discusses SAMe, a natural mood enhancer essential for the manufacture of neurotransmitters (like serotonin), and two botanicals that have a history of use as anti-depressants, St. Johns Wort and Rhodiola.
Dr. Cass’ account is particularly good at reviewing the role of neurotransmitters in depression, and explaining how supplements and nutrition have an impact on them. For example, tryptophan, eaten together with carbohydrates, will raise levels of serotonin, the neurotransmitter that makes you feel happy and calm and helps you sleep well. The amino acid 5-HTP, meanwhile, can also help the brain produce more serotonin, though unlike tryptophan it does not need the carbs for it to enter the brain.
Anti-depressant prescriptions, as Dr. Cass notes, are among the top sellers among US pharmaceuticals, with 60 million prescriptions written per year at a cost of $10 billion. And while “antidepressants may be enormously helpful, even life-saving for some people,” she continues, “they are often overprescribed, at too high a dose, over too long a time, and often before a good medical evaluation has been done.” (p. 117) Hence her timely guide to using supplements to help maintain the “nutritional balance necessary for good mental health,” or to create “neurotransmitter balance in depression.”
Reference: Hyla Cass, M.D. “Prescriptions for Psychological Health,” in Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition. (Basic Health Publications, 2007)
See also the NYBC entries on supplements mentioned above:
August 15, 2008
Lecithin and Your Liver
Lecithin has quite a deal of clinical data showing benefit for liver function, especially for alcohol-related liver damage. Supplementation with Lecithin improves glutathione levels as well as increasing plasma methionine and S-adenosylmethionine (SAMe) levels–all of these being key markers to good liver function and health. (By the way, Lecithin supplementation is a lot less expensive way of raising SAMe levels than taking SAMe itself!) Other recent data suggest that Lecithin can help with elevated lipid levels (which are associated with cardiovascular disease) and type II diabetes (Nutr Metab Cardiovasc Dis. 2006 Sep;16(6):395-404.). A small study also showed possible improvement in kids with cystic fibrosis (Am J Clin Nutr. 2007 Mar;85(3):702-708).
Simple to take, too: one way is just to mix with other powders, such as protein powders, when making a nutritional shake.
For more on this dietary supplement, including dosing suggestions and certain cautions, see the entry on LECITHIN.
Here’s a brief quote from the entry:
“This may be an excellent product for people with hepatitis B or C, according to one well-designed study using 3 grams per day. Other benefits may be for mood enhancement for those with neurological disorders, to enhance cardiovascular health (in the context of a better diet) and possibly preventing or treating gallstones.”
July 17, 2008
SAM-e for Depression: ACRIA study
A study of 20 individuals living with HIV was conducted by the AIDS Community Research Initiative of America (ACRIA). In the study, they evaluated the use of escalating doses (for some) of S-adenosylmethionine (SAM-e) in the management of depression.
Depression can be a serious complication of HIV disease and has been reported at higher rates than in the general population. They evaluated patients using two scores obtained from the Hamilton Rating Scale for Depression (HAM-D) and the Beck Depression Inventory (BDI). The study lasted 8 weeks, however it was not placebo-controlled or randomized, limiting the interpretation. Patients received 200 mg of SAM-e twice per day along with 1,000 mcg of vitamin B12 and 800 mcg of Folic Acid. The dose was increased to 800 mg twice per day in patients not reporting side effects. All but one patient were not using any other antidepressant medication.
Both BDI and HAM scores dropped significantly over the 8 weeks of treatment among the 15 individuals who completed the study. 14 of 15 patients achieved a HAM-D score below 7, indicating that they experienced a remission of the depression. That is, they got better!
While future, better controlled studies are warranted, this is an encouraging study that provides a potentially valuable alternative to antidepressant medications which may have side effects or result in interactions with HIV medications.
The study may be found, free, here:
http://www.bmj.com/cgi/content/full/337/jul08_1/a718?eaf
For additional information on this supplement, see the NYBC entry:
Also mentioned in this study:
March 12, 2008
SAMe (S-adenosyl-methionine) for osteoarthritis
We’ve discussed SAMe’s use as an anti-depressant on this Blog, as well as its potential to support liver health. But over the past twenty years there has also been much research into SAMe to counter osteoarthritis pain. In a number of trials in Europe and in the US, SAMe has equalled the effect of nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen in decreasing pain and improving function. Furthermore, it is better tolerated than NSAIDS, which cause clinical concern about side effects especially when taken at high doses over long periods of time.
Here’s one drawback to SAMe for osteoarthritis: trials have shown this supplement to have a slower onset of action than NSAIDs–an initial starting use of about 4 weeks is needed for full effectivesness. In the meantime, some patients may continue to take NSAIDS, gradually reducing the dose.
See the NYBC description of SAMe for additional information, including our recommendation to take adequate B-complex along with this supplement.
For further reading and references on SAMe for osteoarthritis, we recommend Natural Products: A Case-Based Approach for Health Professionals (American Pharmacists’ Assoc., Washington, DC: 2006), pp. 37-49
