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:

Tryptophan

SAMe

5-HTP

Rosavin (Rhodiola)

B Vitamin Complex (B-right)

Fish oil (omega-3 fatty acids)

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SAM-e (S-Adenosylmethionine) studied for depression in people with HIV

Elsewhere on this blog, we’ve reported on a new NIH-funded trial of SAM-e for depression being conducted at Massachusetts General and Butler Hospitals. One of the aims of the study is to compare SAM-e to the prescription anti-depressant Lexapro.
We also want to call attention to earlier research that focused specifically on SAM-e as a anti-depressant for people with HIV, who have been shown to have higher rates of depression than the general population. This research was organized by the AIDS Community Research Initiative of America, which has long been a leader in promoting new and significant studies that respond to the needs of people with HIV/AIDS.
The ACRIA study was published in the peer-reviewed journal, BMC Psychiatry (www.biomedcentral.com/bmcpsychiatry) in 2004. The results of this pilot study were promising and, as the organization stated in its Winter 2004/2005 news bulletin, offered findings of particular interest to people with HIV, who may find it easier to add a dietary supplement to their regimens rather than “yet another drug with potential side effects.”

More on this dietary supplement on the NYBC website:

SAM-e

Massachusetts General, Butler Hospital testing SAMe for depression treatment: Promising nutritional supplement being compared with SSRI, placebo

This news release was accessed by us on the Massachusetts General Hospital website.
We noted with interest that the sponsor of this five-year study is the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health–the principal dietary supplement research agency of the US government. NYBC has followed earlier, promising studies of SAMe as an anti-depressant, and we’re glad that there is now a significant research project underway to further investigate the properties of this molecule as a treatment for depression.

Mass. General, Butler Hospitals testing SAMe for depression treatment:
Promising nutritional supplement being compared with SSRI, placebo

BOSTON/PROVIDENCE- June 26, 2007 – Massachusetts General Hospital (MGH), in collaboration with Butler Hospital in Providence, is currently undertaking a clinical trial examining the effectiveness of the nutritional supplement S-adenosyl methionine (SAMe) as a treatment for depression.

A naturally occurring substance found in every human cell, SAMe is known to play a role in the synthesis of serotonin and other brain chemicals involved in the regulation of mood. Nutritional supplements containing SAMe have been used to treat depression, and more than 45 clinical studies have suggested that it may be as effective as the older tricyclic antidepressants for some patients. Current studies, like the MGH/Butler trial, are focused on comparing SAMe with the newer selective serotonin reputake inhibitor (SSRIs) antidepressants.

“SAMe appears to be a promising treatment for depression,” says David Mischoulon, MD, PhD, of the MGH Department of Psychiatry, one of the trial’s investigators. “It’s looking like SAMe supplementation may allow the body to maintain higher levels of critical neurotransmitters that could reverse a depressed state.” Mischoulon is an assistant professor of Psychiatry at Harvard Medical School.

The five-year trial is designed to test the safety, effectiveness and tolerability of SAMe compared with the SSRI escitalopram (Lexapro) or a placebo…

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Note: an overview of information on SAMe, including recommendations concerning B-complex supplementation for those taking this supplement, is available on the NYBC website:

SAMe product description