Safe and Effective Non-medication Ways to get Through the Winter Blues

Dealing with depression over the holidays

Many people who struggle with chronic depressed feel more depressed as the holidays approach, the weather gets colder, and the days get shorter. If you currently take an antidepressant but you are having disappointing results or side effects, and you’re interested in learning about evidence-based non-pharmacologic treatments of depressed mood, research findings show that select natural supplements and other complementary and alternative (CAM) approaches may help you feel and function better.

Complementary and alternative therapies for depressed mood

This is the first in a series of blog posts on complementary and alternative (CAM) treatments of depressed mood. This post is offered as an overview of natural supplements and other CAM approaches widely used to treat depression. Future posts will focus on specific CAM modalities including natural supplements such as St. John’s wort (Hypericum perforatum) S-adenosyl-methionine (SAMe), 5-hydroxytryptophan, Omega-3 fatty acids, mind-body approaches, acupuncture, EEG-biofeedback, and others. In addition to reviewing the evidence for particular CAM modalities, I will comment on emerging research findings for combining specific natural supplements or other CAM modalities with antidepressants aimed at improving response or mitigating adverse effects.

Available mainstream treatments often fail to alleviate depressed mood

Depression is one of the most serious and costly health problems facing the world today. Because of the high incidence of suicide and other medical or mental illnesses in depressed individuals, depression is regarded as the leading cause of death and disability from adolescence through middle age. Although available mainstream treatments such as medications and psychotherapy are often beneficial, existing conventional approaches fail to alleviate depressed mood in many cases. These problems have resulted in ongoing debate over the efficacy and safety of antidepressants in the medical community and in the public at large.

Research findings on the efficacy of antidepressants are inconsistent and disappointing. Several independent analyses have concluded that most trials of antidepressants sponsored by pharmaceutical companies fail to show significant response differences between antidepressants and placebos. It is estimated that in United States, the U.K., and West European countries more than two thirds of depressed patients never receive adequate treatment with antidepressants. This is due to both inadequate screening of depressed mood by physicians and under-reporting by patients. Over half of all patients who take antidepressants are not treated by psychiatrists and have never been formally diagnosed with depression. Among those who are diagnosed and receive recommended doses of antidepressants, between 40% and 70% fail to respond.

Select CAM modalities have been validated as effective treatments of depression

Several non-pharmacologic treatment modalities used to treat depression and other mental health problems have been empirically investigated in well designed placebo-controlled studies and fulfill biomedical criteria for efficacy and safety but are not in widespread use in Western countries because of economic, social or ideological factors, including limited post-graduate training in the evidence-based use of complementary and alternative (CAM) therapies in mental health care, and widespread prescribing of antidepressants by physicians. Many CAM modalities are widely used to treat or self-treat depressed mood, and–as is true for widely used antidepressants–CAM therapies have limitations and drawbacks. However, select natural products and other non-pharmacologic treatments have been substantiated by consistent positive findings from large, well-designed placebo-controlled, double-blind studies, and in some cases, systematic reviews and meta-analyses.

Examples of empirically validated CAM treatments of depressed mood include St. John’s Wort, S-adenosyl methionine (SAMe), the amino acid 5-hydroxytryptophan (5-HTP), a form of the B vitamin folic acid, the essential fatty acid ecosapentanoic acid (EPA), and to a lesser extent, the amino acid Acetyl-L-carnitine and the pro-hormone dehydroepiandrosterone (DHEA). Placebo-controlled double blind studies and meta-analyses show that SAMe has equivalent or superior anti-depressant efficacy compared to tricyclic antidepressants. In contrast CAM therapies with a known biological mechanism of action, mindfulness, mind-body approaches, and other CAM modalities that do not have a clearly defined biological mechanism of action, have not been as rigorously examined by Western science, and therefore have relatively weaker empirical evidence supporting claims of efficacy.

Integrative strategies may be more effective than single conventional or CAM treatments

In addition to the use of single CAM therapies, emerging research findings support that taking an antidepressant while engaging in a mind-body practice, exercising, using bright light exposure therapy, or taking certain natural product supplements may accelerate the rate of treatment response or improve overall outcomes. This is the perspective of integrative mental health care, which is the focus of all my posts.

You can find out more about CAM and integrative treatments of depression by reading my e-book “Depression: The Integrative Mental Health Solution.”

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