- Yoga and Meditation
Exercise. Depressed people tend to be less physically active than their happier counterparts. Part of the problem is that to the depressed person everything seems futile, hopeless, and requiring too much energy. Hard as this sounds, if you feel sad and can make yourself get off the couch and move, chances are you will feel better.
Several studies have shown that both aerobic exercise and strength training significantly reduce depressive symptoms. Unfortunately, habitual physical activity has not been shown to prevent the onset of depression (Paluska et al. 2000). In one of the most impressive testaments to the healing power of exercise, researchers from Duke University Medical Center divided 156 depressed men and women into three treatment groups: aerobic exercise (using a treadmill or stationary bicycle for 30 minutes, 3 times a week); antidepressant treatment with Zoloft (sertraline); or combined exercise and medication. Initially, people who took Zoloft improved faster, but after 16 weeks of treatment, all three groups experienced similar benefits. In other words, exercise was ultimately as effective as antidepressant therapy (Blumenthal et al. 1999).
Six months after the trial ended, the researchers checked in with these volunteers and found that the benefits of exercise endured. People from the exercise-only group had significantly lower relapse rates than either those in the Zoloft-only or Zoloft-plus-exercise groups (Babyak et al. 2000). Why taking a pill undermined long-term benefits is not clear. Perhaps the people who exercised felt a greater sense of control and satisfaction. A study of a small group of obese women found that a 6-month program of exercise and relaxation training, although it did not significantly shed pounds, significantly improved depression (Hayward et al. 2000). Among breast cancer survivors, women who regularly exercise have significantly less depression and anxiety than those who do not (Segar et al. 1998).
Does exercise have to be aerobic to boost mood? No. Martinsen et al. (1998) compared aerobic to nonaerobic exercise and found that both treatments signficantly improved depression, with no significant difference between the two.Yoga and Meditation.
Several studies have shown that various types of yoga and meditation can reduce symptoms of anxiety and stress. In many people, stress triggers depression and anxiety accompanies low mood. It makes sense that yoga and meditation might lift depression. A study randomly assigned 45 hospital inpatients with newly diagnosed depression to one of the treatment groups. One group took six sessions a week of Sudarshan Kriya Yoga (SKY) for 4 weeks. This type of yoga alternates three cycles of rhythmic hyperventilation with normal breathing, then finishes with a quarter hour tranquil period. The second group received electroconvulsive therapy (ECT) three times a week for the 4 weeks. The third group received 150 mg of imipramine a day for 4 weeks. All three treatments significantly lowered measurements of depression, with greatest benefits for those receiving ECT. The authors concluded, "although inferior to ECT, Sudarshan Kriya Yoga can be a potential alternative to drugs in melancholia as a first line treatment" (Janakiramaiah et al. 2000).
In another study, researchers assigned a group of 87 college students to take one of three classes: swimming, yoga, or a lecture (which served as the control treatment). Compared to sitting in a lecture, yoga and swimming reduced both depression and also feelings of anger, tension, fatigue, and confusion. This study not only reinforces the psychologic benefit of yoga, but also shows again that exercise need not be aerobic to enhance mood (Berger et al. 1992).
In addition to reducing anxiety, meditation seems to buoy mood. In a study involving patients enrolled in a "happiness enhancement program," half of the people also learned to meditate. This group improved significantly more than the group who did not meditate (Smith et al. 1995).Relaxation.
One study compared the relative effectiveness of cognitive behavioral therapy (examining and repatterning one's thoughts and actions), relaxation training, and a tricyclic antidepressant. Both non-drug treatments were superior to the tricyclic antidepressant medication. Cognitive behavioral therapy was slightly, but not significantly better than relaxation training (Murphy et al. 1995).
Receiving a massage is a wonderful way to unwind. Among its other virtues, massage therapy diminishes depression and stress (Field 1998).Acupuncture.
Traditional Chinese Medicine seeks to restore the body's balance, chiefly through the use of acupuncture and herbs. One study found that acupuncture significantly improved symptoms in patients with depression or anxiety (Eich et al. 2000). Another study found that patients who received acupuncture plus an antidepressant improved more than those who received only the drug (Roschke et al. 2000).SUMMARY
Although depression is a serious illness, it is sometimes possible to treat the underlying cause without taking synthetic drugs. Several natural remedies have brought relief to many people who have depression:
- SAMe, a natural substance derived from the amino acid methionine, works faster than the tricyclic antidepressants, but with far fewer side effects. Dosages typically range from 400-1600 mg daily. Some practitioners recommend gradually increasing the dosage to avoid mild and transient nausea occasionally seen at the start of treatment. Joseph Pizzorno, N.D. (author of Total Wellness and coauthor of Encyclopedia of Natural Medicine) recommends 200 mg twice a day for 2 days, then 400 mg twice a day on days 3 through 9, then 400 mg three times a day on days 10 through 19, then 400 mg four times daily thereafter.
- The usual dosage for St. John's Wort is 300 mg of the herb, three times a day, standardized to 0.3% hypericin, one of the active ingredients. Take either a 300-mg dose at breakfast, lunch, and dinner or take two of the 300-mg doses in the morning and the third with dinner. Not everyone needs a total of 900 mg a day; two studies found a mere 500 mg of St. John's Wort extract equivalent to imipramine and fluoxetine.
Caution: Do not combine with antidepressant medication. Because St. John's Wort can speed the liver's breakdown of drugs, talk to your physician before combining this herb with any prescription medications. If you are taking SAMe, you do not need to take St. John's Wort.
- Omega-3 fatty acids seem to influence neurotransmitter function. Depressed people tend to have low levels of omega-3 fatty acids in their diet and in their cell membranes. You can take between 400-1000 mg of DHA and 400-1000 mg of EPA. Mega EPA provides 800 mg of EPA and 600 mg of DHA in two softgels.
- Ginkgo biloba improves circulation to the brain and stabilizes and protects nerve cells. Studies show it improves cognition and may also help relieve depression in older people. The recommended dosage is 120 mg daily of a standardized extract.
- DHEA is a natural hormone that enhances brain functioning and promotes well-being. Dosages typically range from 15-75 mg. (Refer to the DHEA Replacement Therapy protocol for safety information.)
- Natural progesterone applied subdermally is recommended over synthetic formulas that present increased risk of side effects. Natural progesterone should be considered as part of a natural hormone replacement regimen in menopausal women. Pro Fem is a natural progesterone made from soy and applied to the soft tissue areas of the body. It may be used by both men and women under different dosing regimens. Follow directions on label for initial treatment and maintenance. Pro Fem is also recommended in the treatment of osteoporosis.
- Pregnenolone is another natural hormone that is often found in below-normal amounts in people with depression. Pregnenolone can be taken in doses of 50-200 mg daily. If more than 50 mg of pregnenolone is taken, it should be in divided doses.
- DMAE (found in sardines and other foods) has been shown to elevate mood and is even more effective when taken with vitamin B5 (pantothenate). Recommended dosage is 300-900 mg daily depending upon stimulation tolerance.
- L-Carnitine is an amino acid that can alleviate depression in some people in doses of 1000 mg twice a day. Acetyl-L-carnitine is better absorbed.
- NADH (nicotinamide-adenine dinucleotide) enhances brain cell energy and has alleviated depression in studies of people who took 5-10 mg daily.
- Phenylalanine and tyrosine are two amino acids that the body uses to make neurotransmitters. Phenylalanine comes in two chemical forms, L-phenyalanine and its mirror image D-phenylaline. When using a 50/50 mix of both forms, called DL-phenylalanine, the typical dosage is 500-1000 mg daily. For tyrosine, the typical recommended dosage is between 500-1500 mg daily. Do not take these amino acids if you have cancer or suffer uncontrolled hypertension.
- Folic acid (a B vitamin) deficiency is common in many people with depression; 400 mcg a day is the RDA; however, people who are depressed may want to take 800 mcg a day.
- Vitamin B12 (cobalamin) helps fight depression by inhibiting monoamine oxidase (MAO), an enzyme that "attacks" and destroys certain neurotransmitters that help to elevate mood; 500 mcg sublingually, twice a day is recommended.
- Vitamin B6 (pyridoxine) is also needed for conversion of tryptophan to serotonin. A deficiency of B6 is often found in pregnant or lactating women, in women taking oral contraceptives, and in alcoholics. Doses of 100-300 mg a day are recommended.
- Vitamin B1 (thiamin) deficiency can lead to depression and fatigue; 100 mg daily is recommended. You can also find this amount in most B-complex formulas.
- Vitamin B3 (niacin) converts tryptophan into serotonin, an important neurotransmitter that helps us stay happy. The safest bet (and one that does not require a physician's blessing) is to take a balanced B-complex that contains 50 mg of niacin and eat niacin-rich foods such as torula or brewer's yeast, brown rice, whole wheat, seeds, nuts, peanuts and other legumes.
- Vitamin B2 (riboflavin) deficiency can lead to depression; 50 mg daily is recommended or a balanced B-complex that contains this amount.
- Choline plays an important role in learning and memory; 2000 mg daily in divided doses is recommended.
- Inositol is a B vitamin relative shown to improve depression and anxiety. Although studies have used 12,000 mg daily, some psychiatrists find that 1,000 mg twice daily is often effective.
- Vitamin D supplementation was shown to improve seasonal affective disorder or "winter blues." It can be taken as 400 IU daily. Because it is a fat-soluble vitamin and can accumulate in tissues, do not exceed 1400 IU daily.
- Vitamin C (ascorbic acid) deficiency has been found in depressed people. A 1000-mg supplement is a good place to start. Also eat plenty of vitamin C-rich fruits and vegetables.
- Potassium is a mineral that has been linked to depression. Unless levels are dangerously low in the body, potassium should by replenished by natural foods such as bananas, nonfat milk, oranges, and fresh peas.
- Testosterone levels may decrease in men over 40. Low levels of testosterone may lead to depression. (Consult the Male Hormone Modulation Therapy protocol for indications and dosing recommendations. Women should consult the DHEA Replacement Therapy and Female Hormone Replacement Therapy protocols for more information on hormone levels and depression.)
- Alcohol, caffeine, and sugar, known to cause abrupt changes in energy and mood, should be avoided.
- Exercise, yoga, meditation, and relaxing activities such as massage can buoy mood. Consider incorporating them into your lifestyle.
Many of the vitamins and minerals recommended in this protocol can be obtained in the Life Extension Mix multi-nutrient formula.
For more information, contact the National Depressive and Manic Depressive Association (800) 826-3632.