The Better Mood Recovery Program, Week 4
ANTIDEPRESSANTS AND THEIR ALTERNATIVES
Fourth Week Overview
In this week you will learn about the benefits of antidepressants (such as Prozac) as well as natural alternatives (such as St. John's wort).
Sooner or later anyone who suffers from depression is faced with the question, “Should I go on antidepressants?” This is not an easy question to answer. Most people's initial reaction is that they are wary of “becoming dependent” on drugs or experiencing their unwanted side effects. Yet for many, these medications can be likened to a “penicillin for the mind,” a miracle drug which puts them on the road to emotional stability.
In modern psychiatric medicine, antidepressants have become the treatment of choice for people with major depression. Before World War II, these drugs did not exist. In the 1950s two drugs, one an antipsychotic and the other a tuberculosis medication, were accidentally found to elevate the moods of depressed individuals. Since then, a host of new substances has been synthesized, specifically for the treatment of depression. Most recently, medications have been developed that specifically target the particular neural pathways of depression, with less generalized neural impact, and therefore far fewer side effects.
Current theory links the biochemical causes of mood disorders to a deficiency of three of the brain's neurotransmitters—serotonin, norepinephrine and dopamine. Antidepressants don't actually create more serotonin, norepinephrine and dopamine. Instead, they are believed to limit the reabsorption of these chemicals into the brain's nerve cells, thereby increasing the amounts of neurotransmitters available in the space (synapse) between the sending and receiving cells. This in turn causes a better neural transmission from cell to cell, resulting in an elevation of mood.
In the following pages, I will offer some answers to the most commonly asked questions about antidepressants.
What Are the Major Antidepressants?
There are three groups of antidepressants. The first and oldest group is the tricyclics; examples include Imipramine (Tofranil) and Amitriptyline (Elavil). Like the other antidepressants, tricyclics take two to four weeks to begin working, and six to eight weeks to achieve full effectiveness. Their side effects may include dry mouth, blurred vision, sexual dysfunction, fatigue, weight gain, constipation, and abnormalities in the cardiovascular system. Such discomforts can often deter a person from staying on the medication long enough for the beneficial effects to be felt.
The second group of antidepressants is called monoamine oxidase (MAO) inhibitors, or MAOIs for short (examples are Nardil and Parnate). Monoamine oxidase is an enzyme that breaks down neurotransmitters. Hence, by inhibiting the production of MAO, these drugs increase the amount of neurotransmitters retained in the synapses. Unfortunately, the MAOIs have cumbersome dietary restrictions. They cannot be taken with foods that contain the amino acid tyrosine—such as aged cheese, beer, wine, chocolate and liver.
The third and most recently developed class of antidepressants is known as the SSRIs—selective serotonin reuptake inhibitors. This group, which includes Prozac, Zoloft, Celexa and Paxil, is as effective as the tricyclics in treating depression, but generally has fewer and milder side effects. Nonetheless, the SSRIs may be highly agitating for some patients (producing anxiety and insomnia), who thus may require additional sleeping medications.
Finally, there exists a class of atypical antidepressants that includes Serzone, Effexor, and Wellbutrin.
No one class of antidepressant is better than any other, as different medications work for different people, depending on the complex interaction between an individual's biochemistry and the drug's pharmacology. This is why finding the right medication is often a matter of trial and error and good medical follow-through.
Antidepressants do not get you “high;” neither are they addictive. They work by reestablishing the right proportion of neurotransmitters in your brain so that nerve impulses can be effectively communicated from cell to cell.
What Should I Expect When I First Take an Antidepressant?
Unlike most other drugs, antidepressants do not take effect immediately. Usually there is a 4-6 week period for their beneficial effects to be fully felt, although some people have reporeted improvement within the first week. Hence, while waiting for the medication to take effect, you may have to endure side effects which may (or may not) be temporary, before you know if the antidepressant will work for you. Moreover, since art of prescribing psychiatric medicine is an inexact science (each person has a unique body-brain chemistry), it may take several trials on different drugs before you find the right one. This is where you will need to increase your self-care and seek moral support.
Once you find a medication that provides relief from the hell of depression, enduring the side effects may seem a small price to pay. Moreover, in many instances the side effects are temporary and fade with continued usage.
It is also important to note that in a small minority of cases, some people experience a recurrence of depression while still on medication, a phenomenon known as “Prozac poop-out.” When this occurs, you usually can obtain relief by changing medications or dosages under careful medical supervision.
How Long Will I Be On Medication?
The short answer is “as long as you need it.” This will depend on how well your body can rebalance its biochemistry on its own. Some people have only one major episode and never need treatment again (just as some individuals suffer just one heart attack or one bout with cancer).
Others heal from depression, go off medication and continue to feel well until a later date when the depression returns. This usually requires going back on medication and/or engaging in other forms of treatment until the episode passes.
Finally, some folks discover that as soon as they stop medication, their symptoms return. These people usually need to take antidepressant medication on a long-term basis in order to correct underlying biochemical imbalances.
What About Adverse Side Effects?
“People vary greatly in their sensitivity to drugs. One person's remedy may be another person's overdose.”
If you have read my personal narrative, you know that my depressive episode was triggered by an adverse reaction to a antidepressant drug. While such instances are rare, they have been documented in the literature. In addition, many antidepressants have the potential to induce a manic episode in individuals who have a bipolar disorder. If after taking an antidepressant you experience extreme symptoms such as intense emotional or physical agitation, anxiety, violent thoughts, mania, or suicidal thinking, tell your prescriber immediately! Most likely lowering the dose will result in a diminishing of the symptoms.
There are a number of ways to reduce the risk of shaving an adverse or “paradoxical reaction” to an antidepressant.
Roger's Story: Finding the Right Medication
From time to time in my life I've gone through periods of anxiety, fear and despair—from moderate to severe. The most recent lasted for eight months and culminated during a a two week period when I became so immobilized that my wife took me to the emergency room. There, the doctor prescribed for me the antidepressant Wellbutrin.
I started the medication that night, and within a few days began to feel my energy and motivation return. I took on a project that I had been putting off for months—and finished it with confidence and ease. It was as if someone had pushed the “on” switch inside my brain. As the days progressed and the anxiety decreased, I was no longer distressed by my old fears. I felt like myself.
I've now been taking the medication for a month and it continues to work well. Because I am job hunting and am under financial pressure, I still have mild bouts of anxiety. The difference is that before, I would have been overwhelmed. Now I am able to do temp work while looking for a full time job. I am also using cognitive therapy to respond rationally when I worry excessively about the future.
1) If you are thinking of going on medication, find a well-trained pharmacologist who is up to date on the latest research and can carefully monitor the drug's known and unknown side effects.
2) Always read the package insert that comes with antidepressant to learn about potential contraindications. Ask your pharmacist for a free insert. If you see a particular side effect that you have experienced before in a negative way, tell your prescriber.
3) Another way to diminish the risk of a negative reaction is to start with a very low initial dose, especially if you are sensitive to medication. Ask your prescriber if you can begin with one half the minimum dose. (You can cut the pill in half to do this). Then you can slowly adjust the dose upwards. The table on the next page will also give you more helpful information on selecting the right dose.
Personally, I have found that it is preferable to begin a new medication during the day. At night my defenses are down and my unconscious is open, making me more vulnerable to adverse reactions. I suspect that this may be true of a percentage of other people who suffer from depression and are prone to anxiety.
How Big a Dose? Ask the Patient2
Before writing a prescription, doctors should give every patient a questionnaire to determine whether he or she needs the standard dose. Here are some sample questions.
1. Are you sensitive to any prescription or nonprescription drugs?
2. How are you affected by alcohol?
3. Do some drugs make you tired or sleepy: cold or allergy remedies or antihistamines? Tranquilizers or anticonvulsants? Motion-sickness remedies or antinausea agents?
4. Do some drugs give you energy or cause anxiety or insomnia: coffee, tea, chocolate, other caffeine-like substances? Appetite suppressants (prescription or nonprescription)? Cold or allergy remedies or decongestants?
5. Have you ever had a reaction to epinephrine (adrenaline chloride, often injected by dentists along with pain-numbing medication)?
6. Have you every had any side effects from any other prescription or nonprescription drugs (like impaired memory or coordination, blurred vision, headaches, indigestion, diarrhea, constipation, dizziness, palpitations, rashes, swelling, ringing in the ears, other reactions)?
7. Overall, how would you describe yourself with regard to medication: Very sensitive? Not particularly sensitive? Very tolerant—i.e., you usually require high doses?
What If I Am Reluctant to Take Medication?
If you need to stay on medication to remain well, try not to think of this as a personal weakness. When your body requires assistance to remain in balance, it is no different than having any other illness that requires medication (e.g., insulin for diabetes, antihypertensive drugs for high blood pressure, cholesterol-lowering drugs for heart disease).
Unfortunately, most people have mixed feelings about taking psychiatric medication. Many of my clients tell me, “I should be able to lick this on my own. Why do I have to be dependent on a pill?” (Meanwhile they see no problem in taking insulin or antihypertensive medication.) Some folks never do get used to the side effects, while others complain of feeling “flat” or “emotionally removed.”
My reply to these concerns is that taking medication is a trade off. While some of the side effects may be bothersome, their discomfort is tiny compared to the agony of experiencing a clinical depression. Nonetheless, even people who are helped by medication display ambivalence about being “dependent” on these drugs.
Not surprisingly, studies show that 70 percent of patients prematurely discontinue their medication—or discontinue their medication abruptly rather than gradually. Such premature or abrupt cessation is associated with a 77 percent increase in the rate of relapse or recurrence of the depressive episode. The moral of the story is clear: do not make any changes in your medication regimen without first consulting your physician/prescriber.
Knowing Your Medication
To increase the likelihood that a medication will work well, patients and families must actively participate with the doctor prescribing it. Questions you should ask include:
Alphabetical Listing of Medications by Trade Name
Antidepressant medications |
|
| Trade name | Chemical or generic name |
| Adapin | doxepin |
| Anafranil | clomipramine |
| Asendin | amoxapine |
| Aventyl | nortriptyline |
| Celexa | citalopram |
| Cymbalta | duloxetine HCL |
| Desyrel | trazodone |
| Effexor | venlafaxine |
| Elavil | amitriptyline |
| Ludiomil | maprotiline |
| Luvox | fluvoxamine |
| Marplan | isocarboxazid |
| Nardil | phenelzine |
| Norpramin | desipramine |
| Pamelor | nortriptyline |
| Parnate | tranylcypromine |
| Paxil | paroxetine |
| Pertofrane | desipramine |
| Prozac | fluoxetine |
| Serzone | nefazodone |
| Sinequan | doxepin |
| Surmontil | trimipramine |
| Tofranil | imipramine |
| Vivactil | protriptyline |
| Wellbutrin | bupropion |
| Zoloft | sertraline |
Antimanic medications |
|
| Trade name | Chemical or generic name |
| Cibalith-S | lithium citrate |
| Depakote | divalproex sodium |
| Eskalith | lithium carbonate |
| Lithane | lithium carbonate |
| Lithobid | lithium carbonate |
| Tegretol | carbamazepine |
Antianxiety medications |
|
| Trade name | Chemical or generic name |
| Ativan | lorazepam |
| Azene | clorazepate |
| BuSpar | buspirone |
| Centrax | prazepam |
| Dalmane | flurazepam |
| Klonopin | clonazepam |
| Librium | chlordiazepoxide |
| Paxipam | halazepam |
| Serax | oxazepam |
| Seroquel | quetiapine |
| Tranxene | clorazepate |
| Valium | diazepam |
| Xanax | alprazolam |
- What is the name of the medication and what is it supposed to do?
- When and how often do I take it, and when do I stop taking it, if at all?
- What, if any, food, drinks, other medications or activities should I avoid while taking the prescribed medication?
- What are the potential side effects, and what should I do if they occur?
- What written information is available about the medication?
To help you identify and research your medication, the table on the opposite page lists the most commonly prescribed drugs for depression, bipolar disorder, and anxiety by their generic (chemical) names and trade (brand) names. If your medication's trade name does not appear, look it up by its generic name, or ask your doctor or pharmacist for more information.
What If the Medication Doesn't Work?
There is no single panacea for depression. As helpful as antidepressants can be, they do not work for everyone. In 1999, Steven Hyman, director of the National Institute of Mental Health, was quoted as saying, “Given how common depression is, it is a major public health threat that 20 percent of people don't get more than a modest benefit from any of our therapies.”3 Psychiatrists I have interviewed say that the number of people who don't respond to drugs is closer to 10 percent. Nonetheless, if you are one of those one in ten, please do not give up. In the next section, we will be exploring natural antidepressants whose side effect profile is lower and thus may be more well tolerated by you. (This is the case with my wife Joan who finds that she can tolerate St. John's wort much better than the synthesized drugs.) In addition, if you are extremely depressed, electroconvulsive therapy (ECT) can be a major lifesaver (see the chapter on Crisis Management). There are also less intrusive methods of stimulating the brain (such as RTMS and Vagus nerve stimulation) that show very favorable outcomes in the initial studies. Moreover, depressive episodes are usually time-limited so that often resolve on their own. Sometimes a period of rest is all that is needed.
All of my major depressive episodes have resolved without medication. In my most recent episode, I was healed through the power of prayer. Many people whose memoirs are listed in the bibliography got better without drugs (authors William Styron and Jeffrey Smith are examples). Thus, while antidepressants should be your first line of treatment in major depression, please know that you still can get better even if they do not work for you.
Natural Alternatives to Pharmaceuticals
In many respects, antidepressants have revolutionized the treatment of depression. By rebalancing the neurotransmitters in the brain, they impact mood at the biochemical level and allow the tormented sufferer to achieve emotional equilibrium. However, not everyone responds to these drugs favorably. For some people, the side effects are too harsh, while others fail to experience the desired relief.
Fortunately, nutritionally oriented doctors and herbalists have researched a number of “natural” therapeutic substances such as herbs, vitamins and amino acids that may alleviate depression. What follows is a brief summary of the most commonly used alternative modalities. While I did not use these remedies during my depressive episode, I have since used St. John's Wort and fish oil and have heard positive anecdotal reports from other patients. Although scientific studies of St. John's Wort have been done in Germany, many of the other remedies have not been subjected to the same rigorous double-blind studies that are used with pharmaceutical drugs. This is largely because no one has put up the millions of dollars that would be needed to research the safety and effectiveness of these compounds.
Because even “natural” substances can produce strong reactions in sensitive individuals, anyone taking these remedies should do so under the supervision of a nutritionally oriented physician (psychiatrist, family doctor, chiropractor, naturopath, etc.). As with antidepressants, it is important to try one natural remedy at a time until you discover what works. Moreover, you should not switch from a prescription antidepressant to any of these supplements without first consulting your health care provider.
St. John's Wort
St. John's Wort (Hypericum perforatum) is the star attraction in the field of natural alternatives to Prozac. The yellow flowering tops of St. John's Wort have been consumed for centuries in tea or olive oil extract for a variety of “nervous conditions.” In 1994, physicians in Germany prescribed 66 million daily doses of St. John's Wort, making it the country's medication of choice for the treatment of mild to moderate depression.
Patients who respond to St. John's Wort show an improvement in mood and ability to carry out their daily routine. Symptoms such as sadness, hopelessness, feelings of worthlessness, exhaustion, and poor sleep also decrease. In one study, St. John's Wort was as effective as the prescription antidepressant Imipramine for treating mild to moderate depression (it is less effective for major depression). Moreover, St. John's Wort is relatively free of side effects when compared to pharmaceutical antidepressants (common side effects are gastrointestinal symptoms, allergy, fatigue, and increased sensitivity to light).
The standard dosage of St. John's Wort prescribed by the European doctors is a 0.3 percent extract of the active ingredient, hypericin, taken in 300 milligram capsules, three times a day. A person using St. John's Wort should be monitored for four to six weeks before evaluating its effectiveness. In addition, St. John's Wort should not be taken along with the traditional antidepressants. If you are already taking Prozac or another antidepressant and would like to try St. John's Wort, consult with a psychiatrist or other medical practitioner and wean yourself from the pharmaceutical before you start the St. John's Wort.
5-Hydroxy-Tryptophan
L-tryptophan is an amino acid that serves as a precursor to the neurotransmitter serotonin (the one that is affected by SSRI drugs such as Prozac, Zoloft and the like). L-tryptophan was quite popular in treating depression and insomnia during the 1980s. However, in 1990 the substance was deemed responsible for a number of deaths and was pulled from the market in the United States. Although the deaths were later attributed to a contaminated non-pharmaceutical-grade product made by one particular manufacturer, L-tryptophan is currently available only by prescription in the United States. (Ironically, just four days after L-tryptophan was banned, the March 26, 1990, issue of Newsweek announced “Prozac: A Breakthrough Drug for Depression.”)
However, a product similar to L-tryptophan, 5-hydroxy-tryptophan, is currently available over the counter. 5-HTP is a metabolite of tryptophan and a precursor to serotonin that may work even better than tryptophan. In a head-to-head study conducted by German and Swiss researchers in 1991, 5-HTP and the antidepressant Luvox were shown to be equally effective in treating depression over a six-week period.4 Since then, 5-HTP has been used by many people to lower their current dosages of antidepressants or to replace them completely. Such adjustments should be made under the care of your psychiatrist or physician.
S-Adenosylmethionine (SAMe or SAM-e)
Along with 5-HTP, S-Adenosylmethionine (SAMe) is one of today's most popular natural antidepressants. SAM-e is a metabolite of the amino acid Methionine. All the major neurotransmitters that are thought to be deficient in depression—serotonin, norepinephrine and dopamine—need sufficient quantities of SAMe for their synthesis. Although they also need SAMe for their breakdown, it appears that therapeutic doses of SAMe boost levels of serotonin as well as norepinephrine and dopamine.
One of the advantages of SAMe is that its side effects are extremely well tolerated (in controlled trials people reported more side effects with the placebo). “It appears that S-Adenosylmethionine is a rapid and effective treatment for major depression and has few side effects,” wrote Kim Bell and her associates at the University of California.
Studies show that retarded depressions marked by lethargy, apathy, guilt and suicidal impulses may be the most responsive to SAMe. According to Richard Brown of Columbia University, patients report a dramatic increase in energy levels after taking SAMe. Brown also recommends SAMe for people suffering from SAD (seasonal affective disorder), postpartum depression, menopausal mood swings, sleep disturbances and PMS. As with 5-HTP, if you are on a conventional antidepressant, consult with your prescriber if you are thinking of taking SAMe.5
Kava extract
Kava (Piper methysticum) is a member of the pepper family native to the South Pacific. Its tuberous rootstock is used to make a beverage (also called kava) that is believed to make people happy and sociable. Hence, it has been used for hundreds of years in native ceremonies and celebrations. In recent years, many people in the Western cultures have prepared and ingested the beverage, reporting similar tranquilizing and uplifting effects.
Like St. John's Wort, kava extracts are gaining in popularity in European countries for treating depression and anxiety. The active ingredients in kava are the kavalactones, although several other components seem to be involved as well. In a number of double blind studies, individuals taking kava extract containing 70 percent kavalactones showed improvements in symptoms of anxiety as measured by several standardized psychological tests, including the Hamilton Anxiety Scale. In addition, unlike the benzodiazepines— such as Xanax and Ativan that are prescribed for anxiety—kava extract neither impairs mental functioning nor promotes sedation.
Another problem with benzodiazepines is that the body gradually adapts to their presence, so that it takes more of the drug to produce the same effect. This condition, known as tolerance, does not seem to occur with kavalactones.
Based on clinical studies, the recommended dosage for taking kava to reduce anxiety is 45 to 70 milligrams of kavalactones three times a day. For sedative effects, a dosage of 180 to 210 milligrams can be taken before bedtime. To put these dosages in perspective, the standard bowl of traditionally prepared kava beverage contains around 250 milligrams of kavalactones, and more than one bowl may be ingested at a sitting.
Finally, although no significant side effects have been reported from taking kava at the normal levels, some case reports suggest that kava may interfere with dopamine and worsen Parkinson's disease. Until this issue is resolved, kava should not be used by patients who have this illness.6 In addition, Kava should not be combined with other tranquilizers such as alcohol.
Treating Underlying Metabolic and Endocrine Disorders
Untreated endocrine problems of all sorts are recognized as having the potential to cause mood difficulties. The most common of these is depression caused by hypothyroidism (underactive thyroid), which can be successfully treated using thyroid medication. Other medical conditions which may exacerbate or even cause depressive symptoms are chronic fatigue syndrome, candidiasis, reactive hypoglycemia, hormonal imbalances, vitamin and mineral deficiencies, and amino acid deficiencies.
Vitamin and Mineral Supplementation
Many clinicians believe that supplementing your food intake with certain vitamins, minerals and amino acids may also help to balance your brain chemistry.
Vitamins B6 and B3
The entire vitamin B complex is known to maintain and promote normal mental functioning. Deficiencies of any or all of these vitamins can produce significant symptoms relating to depression, e.g., anxiety, irritability, lethargy, and fatigue. Although the research remains inconsistent, several studies indicate that vitamin B6 supplementation (100 to 300 milligrams per day) helps alleviate depression associated with premenstrual syndrome. Since oral contraceptives can deplete the body of vitamin B6, women taking birth control pills need to supplement their diets with B6 as well. In addition, niacinamide, a form of vitamin B3, has shown some success in alleviating both depression and anxiety.
Folic acid
A large percentage of depressed people have low levels of the B vitamin folic acid (British Journal of Psychiatry; 117:287-92). Anyone suffering from chronic depression should be evaluated by a nutritionally oriented doctor for a possible folic acid deficiency. Folic acid is usually taken with vitamin B12 and is best supervised by a physician. Large doses of folic acid may contribute to mania. Thus anyone with a bipolar disorder should be evaluated by a qualified health care provider before trying this supplement.
Omega-3 Fatty Acids and Fish Oil
In a study published in 1999, Andrew Stoll, M.D. of Harvard University found that fish oil proved so therapeutic for patients with bipolar disorder that he ended the study early to put everyone on the fish oil regimen. Stoll found that 90 perccent of the subjects given high doses of fish oil experienced a significant reduction of their symptoms of depression.
The therapeutic aspect of fish oil consists of Omega-3 essential fatty acids. Omega-3 fatty acids are integral components of the brain's cellular membranes, including the crucial synapses where chemical messages are transmitted from cell to cell. Although other types of fatty acids (such as those from meat) are available, the brain prefers to use the long chain polyunsaturated essential fatty acids (EFAs) to build its neuronal membranes. Stoll and his colleagues believe that when the EFAs are incorporated into the neuronal membranes, the neurons become more electrochemically stable and less likely to “fly off the handle.” This effect both stabilizes people who suffer from bipolar disorder as well as prevents depression.
Stoll and other researchers believe that the increasing rates of depression in Western cultures correspond to a the loss of omega-3 fatty acids from the Western diet, due to modern farming and food processing. And in countries such as Japan where per capita intake of fish is 150 pounds (compared to 25 to 70 pounds in the US and Canada), the rate of major depression is thirty times lower.
To supplement your diet with omega-3 fatty acids, eat lots of deep sea old-water fish such as salmon and sardines. Michael Norden of the University of Washington speculates that omega 3s, which organisms produce more abundantly to adapt to cold weather, might be therapeutic for winter depression. This idea gains credence from the fact that the traditional Inuit people did not get depressed and suicidal during winters of total darkness. Their diet was filled with omega-3s from northern fish and marines animals.
In addition to eating lots of fish, you can take daily doses of fish oil from cod liver oil (my first choice) or from the many EFA fish oil supplements that are now on the market. For those who are strictly vegetarian, linseed oil and flax seed oil are also rich in EFAs. Make sure that you purchase unrefined oils that have been mechanically or expeller pressed from organically grown seeds.7
GABA (gamma amino butryic acid)
GABA is usually classified as an amino acid, although it actually serves as a neurotransmitter (there are more GABA sites in the brain than for other neurotransmitters, such as dopamine or serotonin). GABA basically acts as an inhibitory transmitter, keeping the brain and body from going into “overdrive.” Supplementation of GABA seems to be quite effective for anxiety disorders as well as insomnia (especially the type of insomnia where racing thoughts keep the individual from falling asleep). Hence, those suffering from depression exacerbated by anxiety might want to consider taking this supplement.
Other Amino Acids
L-tyrosine
L-tyrosine is an amino acid that serves as a precursor to the neurotransmitters norepinephrine and dopamine, which have been shown to be deficient in many depressives. The supplementation of this amino acid may help the body to form more of these substances during difficult times. Tyrosine may also be helpful in cases where clinical or subclinical thyroid disease is present.
L-phenylalynine and DL-phenylalynine
Phenylalynine is a precursor to tyrosine, and so exhibits many of the same effects. In addition, the supplementation of phenylalynine can help the body produce a substance called “phenylethylamine,” which is also present in chocolate and marijuana and is created by the body in greater amounts when the individual is “in love.” Phenylethylamine is supposedly present to a greater degree in the DL form of phenylalynine than the L form; however, the DL form may be more likely to increase blood pressure
Phosphatidylserine (PS)
PS is one of a class of substances known as phospholipids. The permeability of brain-cell membranes depends on adequate amounts of the substance. Some studies have shown PS to be an effective antidepressant in the elderly. PS may work by suppressing the production of cortisol, a naturally occurring steroid hormone whose levels are elevated in depressed people.
Dehydroepiandrosterone (DHEA)
DHEA is a naturally occurring androgen produced by the adrenal glands. It is abundantly found in plasma and brain tissue and is the precursor of many hormones produced by the adrenals. DHEA seems to alleviate some of the effects of aging, such as fatigue and muscle weakness. Levels of DHEA may be lower in depressed patients, while supplementation with DHEA may reduce symptoms. However, since DHEA is a hormone, you should not take it without having your doctor check your blood level of the hormone. Also check with your physician before adding it to your diet if you are on an antidepressant, a thyroid medication, insulin, or estrogen.
Alternative Medical Therapies
In addition to the herbs, vitamins, minerals and amino acids listed above, there exist a number of alternative medical therapies. These include:
- acupuncture
- aromatherapy
- Bach flower remedies (and other flower essences)
- Chinese herbal medicine and other herbal remedies
- chiropractic
- homeopathy
- reiki healing
- therapeutic gemstones
Although these modalities lie outside of mainstream medicine, I have seen them alleviate depression in certain individuals, especially those people who are sensitive to subtle energies and for whom traditional medicine has not worked.
If you are interested in trying one or more of these alternative approaches, consult first with the health provider who is treating you for depression. Because of their non-invasive nature, you may be able employ these therapies at the same time that you are receiving standard treatment (medication and/or psychotherapy).
This Week's Goals/Assignments
Here are your assignments for the upcoming week:
1) Fill out the assessing medication inventory. If you have any questions or concerns about your current medication regimen, make it a goal to talk with you current prescriber.
2) Fill out your weekly goal sheet.
Ongoing Self-Care Activities
- Read your vision statement.
- Chart your moods in the daily mood diary.
- Meet with you buddy/coach.
- Exercise (3x or more a week).
- Drink 64 ounces of water, sipping throughout the day.
Assessing My Medication
1. What has been my previous history with psychiatric medication?
2. What psychiatric medications, both conventional and alternative, am I currently taking? If I am not taking currently medication what is the reason? Am I open to trying out medication?
3. What kinds of results am I getting from my current medications?
4. What aspects of taking my medication do I like? What would I like to see different?
5. What is my attitude about taking medication? Do I feel any shame, embarrassment or ambivalence? Would I be willing to discuss these feelings with my counselor or prescriber? (If so, make this your weekly goal.)
My Goal Sheet for Week 4
This week's starting date_____________My coach/buddy ____________________
Date/time we will connect _____________________________
Goal or Goals _______________________________________________________
___________________________________________________________________
___________________________________________________________________
Benefits of attaining this goal____________________________________________
___________________________________________________________________
___________________________________________________________________
Action plan _________________________________________________________
___________________________________________________________________
___________________________________________________________________
Ongoing goals (check off the ones as you accomplish them)
______ Read my vision statement daily (upon awakening or before bed)
______ Chart my moods in the Monthy Mood Diary
______ This was my average mood on the better mood scale.
How was my mood this week?
Record your moods below for each day of the week.
| Day | Mood | Comments |
| Mon | ||
| Tue | ||
| Wed | ||
| Thu | ||
| Fri | ||
| Sat | ||
| Sun |
1 Jay S. Cohen, “Ways to Minimize Adverse Drug Reactions: Individualized Doses and Common Sense Are Key.” Postgraduate Medicine, Sept. 1999, v. 106, pg. 163 (7)
2 Excerpted from Denise Grady, “Too Much of a Good Thing? Doctor Challenges Drug Manual,” New York Times, October 12, 1999, pg. D1.
3 As quoted in Schrof, Joannie M. and Stacey Schultz, “Melancholy Nation: Depression Is on the Rise, Despite Prozac. But New Drugs Could Offer Help,” U.S. News and World Report, March 8, 1999, Volume 126, Number 9, pg. 57.
4 Altern Med Rev. 1998 Aug;3 (4):271-80. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Birdsall TC.
5 Baumel, Syd, Dealing With Depression Naturally, pp. 116-118.
6 Murray, Michael, Natural Alternatives to Prozac, New York, William Morrow and Company, 1996, pp. 140-150.
7 Baumel, Syd, Dealing With Depression Naturally, pp. 104-110.