Light therapy for depressed mood and insomnia

How light therapy works

Light of different intensities and colors is used in conventional biomedicine and many nonconventional systems of medicine to treat both medical and psychiatric disorders. Diverse mechanisms of action are probably involved, including regulation of melatonin and neurotransmitters. Entrainment of sleep–wake cycles by external bright light cues and the associated suppression of melatonin production by the pineal gland is the established mechanism of action underlying the therapeutic benefits of light exposure on sleep and daytime fatigue.

Bright light therapy for depressed mood

Exposure to natural sunlight, especially in the early morning, has significant antidepressant benefits and may reduce the length of hospital stays in severely depressed patients who are hospitalized. A systematic review of controlled studies confirmed an antidepressant effect of bright light (10,000 lux) exposure therapy in seasonal depressed mood but provided only limited evidence supporting bright light as a treatment of nonseasonal depressed mood. A more recent meta-analysis of controlled studies concluded that bright light exposure or dawn simulation for seasonal depressed mood and bright light exposure (but not dawn simulation) for nonseasonal depression had comparable efficacy to antidepressants. Findings of a small randomized controlled trial suggested that bright light therapy may be an effective alternative to antidepressants in pregnant depressed women.

Dim red or blue light for seasonal depressed mood

Recent studies suggested that regular exposure to dim red or blue light might be as efficacious as bright light, especially in the management of seasonal depressed mood. In a 4-week single-blind study (57 subjects), patients diagnosed with seasonal affective disorder (SAD) were randomized to daily bright light versus dim red light exposure. Both groups experienced an equivalent and significant (40 percent) reduction in symptoms. Preliminary findings suggest that antidepressant effects of early-morning exposure to narrow spectrum blue or green light may be equivalent to benefits obtained from full-spectrum bright light exposure. Exposing depressed patients to low-intensity artificial light approximately 2 hours before they would naturally be exposed to early-morning daylight increased the speed of response to conventional antidepressants. Thirty depressed inpatients treated with citalopram at 40 mg per day were randomized to early-morning dim green light, 400 lux, versus a sham, non–light-emitting device during the first 2 weeks of drug treatment. Patients in the combined citalopram–light exposure group reported significantly greater and more rapid improvements in mood compared to the citalopram only group. No adverse effects have been reported with regular exposure to dim light.

Light therapy for sleep disorders

An expert consensus report on light treatment for sleep disorders concluded that there is compelling evidence for the efficacy of bright light exposure in the management of circadian rhythm sleep problems but not for other types of insomnia. Most protocols recommend 30 to 40 minutes of bright light exposure daily for beneficial effects in shifting circadian rhythms and changing sleep–wake cycles. Beneficial effects of bright light exposure therapy are usually noticeable within a few days, and an appropriate treatment plan often resynchronizes the patient’s sleep–wake cycle with his or her time zone in 2 to 3 weeks. Correct timing of light exposure is essential for successful treatment of circadian sleep problems, and bright light exposure between the hours of late morning and late afternoon probably has no effect on circadian rhythm phase. Preliminary findings suggest that melatonin used in conjunction with bright light exposure may achieve more rapid normalization of the sleep–wake cycle.

Safety issues

Individuals interested in trying light therapy for depressed mood or a sleep disorder should avoid using sun lamps (which emit harmful ultraviolet rays) and keep the eyes open while viewing the light fixture at an oblique (approximately 45 degrees) angle to avoid excessive eye strain. Some individuals exposed to bright morning light at 10,000 lux on a regular basis report transient side effects, including mild jitteriness or headaches (10 percent) and mild nausea (16 percent). Sporadic cases of hypomania have been reported, especially in winter depressives or bipolar patients exposed to early-morning bright light. Almost two-thirds of patients who use bright light exposure therapy in the evening report insomnia.

Ginkgo for cognitive decline and dementia: the verdict is still out

How Ginkgo works

Ginkgo (Ginkgo biloba) extract is used in Europe and North America to treat dementia and other neurodegenerative diseases. Most commercially available preparations are standardized to two active ingredients: flavone glycosides and terpenoids. The flavonoid constituent is a strong antioxidant and is believed to have a general neuroprotective benefits. The terpenoid fraction interferes with platelets and helps individuals recover following a stroke by decreasing the risk of blood clots in the brain and reducing nerve cell death associated with stroke. Constituents of Ginkgo may also inhibit neurotoxicity and nerve cell death caused by nitric oxide.

Ginkgo may improve cognitive functioning in both healthy and cognitively impaired non-demented adults

Two placebo-controlled trials found that a compound herbal product containing both Ginkgo biloba (160 or 320 mg) and Panax ginseng (400 mg) resulted in transient improvement in recall performance in healthy adults. Enhanced cognitive functioning appears to reach its peak approximately 6 hours after the herbal preparation is taken. Preliminary findings suggest that combining Ginkgo with another traditional Chinese herbal, dangshen (Codonopsis pilosula), may improve cognitive performance in healthy adults more than either herbal alone. A meta-analysis of 11 clinical trials on standardized ginkgo extracts in elderly cognitively impaired individuals who did not meet full criteria for dementia suggested consistent cognitive enhancing effects.

Inconsistent findings for Ginkgo as a treatment of dementia

Early systematic reviews of randomized controlled trials on ginkgo in dementia concluded that ginkgo preparations in doses between 120 and 600 mg per day taken over several weeks to 1 year result in modest improvements in memory, general cognitive functioning, and activities of daily living in mild to moderate Alzheimer dementia and multi-infarct dementia. However, a systematic review of all randomized controlled trials published up to 2006 on ginkgo in the treatment of dementia and other types of acquired cognitive impairment found inconsistent evidence, noting that early trials were generally small or methodologically flawed, including the absence of standardized preparations and the use of different dementia rating scales across studies. In a 24-week, double-blind placebo-controlled trial, patients with mild to moderate dementia were randomized to a standardized ginkgo extract (160 mg per day) versus the cholinesterase inhibitor donepezil (5 mg per day) or placebo. At 24 weeks, patients taking ginkgo and donepezil experienced equivalent improvements in cognitive performance and global functioning. The findings of one study suggest that the rate of overall cognitive decline is moderately slowed in severe dementia.

Ginkgo has safety issues related to interference with normal blood clotting

Ginkgo is generally well tolerated. Mild transient adverse effects include upset stomach, dizziness, and headaches. Cases of spontaneous bleeding have been reported. Ginkgo should be avoided in individuals taking aspirin, or anticoagulants like warfarin, or heparin. G. biloba preparations should be discontinued at least 2 weeks prior to surgery. G. biloba may cause elevation of hepatic enzymes, and there are case reports of possible serotonin syndrome when taken with SSRIs.

Omega-3s in Mental Health Care: Part 2

Part 1 reviewed the evidence for omega-3 supplementation in the treatment of depressed mood. This post concisely reviews the evidence for omega-3s in treating schizopohrenia, dementia, ADHD, PTSD and borderline personality disorder.

Omega-3s for symptoms of schizophrenia and other psychotic disorders

Augmentation with the omega-3 fatty acid EPA may be an effective preventive strategy in individuals at high risk for developing schizophrenia or in the early phase of psychotic illness but not as a treatment of established cases of schizophrenia. The neuroprotective role of omega-3s during the early so-called prodromal phase of schizophrenia may be related to general effects on the brain’s antioxidative intracellular defense mechanisms or direct interactions between EPA and the glutamate receptor system. EPA augmentation may be especially appropriate for younger or antipsychotic naïve individuals in the early phase of illness or cases in which metabolic or sexual adverse effects may result in poor medication adherence and symptomatic worsening. Limited findings suggest that a combination of EPA and DHA may reduce the rate of progression to full-blown schizophrenia in high-risk populations including individuals who chronically abuse substances or already have impairments in neuropsychological functioning. In contrast to positive findings of studies on EPA augmentation in the prodromal phase of schizophrenia, a meta-analysis of placebo controlled studies on EPA augmentation on symptom severity in patients with chronic schizophrenia or other psychotic disorders found no evidence for greater benefit of EPA augmentation over antipsychotic medications alone. All studies included in the meta-analysis lasted 12 weeks and used EPA doses between 2 and 3 g per day. Possible explanations of reported negative findings include small study size, absence of clinical efficacy of EPA supplementation in chronic schizophrenia, a “ceiling effect” on response to EPA augmentation associated with concurrent treatment with antipsychotics, combinations of different fatty acids may be more effective than EPA alone, and dietary differences and other socio-demographic factors that may have confounded findings.

DHA supplementation for treatment of cognitive decline and dementia

Systematic reviews and meta-analysis of studies on the effects of omega-3 supplementation on cognitive development, function, and decline throughout the life span concluded that omega-3 supplementation—especially DHA—may significantly improve cognitive development in infants but not in children, adolescents, adults, or the elderly. Omega-3 supplementation was not associated with a reduced rate of cognitive decline in healthy elderly adults or with a slowing in the rate of progression of Alzheimer disease.

Inconclusive evidence for omega-3s in ADHD

Although individual studies on omega-3s in ADHD report positive findings, a systematic review and meta-analysis of placebo-controlled trials on omega-3s in the treatment of ADHD in children and adolescents reported inconclusive findings due to methodological problems including small sample sizes, variability of selection criteria, and type and dosage of supplements and short-term follow-ups.

Recent studies have investigated the role of omega-3s in PTSD. These studies are based on the observation of increased rates of neuronal regeneration in the hippocampus soon following trauma. It is hypothesized that increased neuronal regeneration following trauma may result in more rapid clearance of fear memories and prevent immediate post-trauma memories from becoming long-term memories, reducing the risk of developing PTSD. In fact, animal studies support that omega-3 fatty acids increase hippocampal neurogenesis. Studies done in Japan following the 2011 tsunami investigated the effectiveness of pre-treatment with omega-3s in preventing the development of PTSD following exposure to trauma in first medical responders.

Symptoms of borderline personality disorder may improve with omega-3 supplementation

In a small, 8-week controlled trial (N = 30), women diagnosed with moderately severe borderline personality disorder randomized to ethyl-EPA (1 g per day) versus placebo reported less severe symptoms of aggression and depressed mood compared to the placebo group.

Omega-3s have few mild safety issues

Omega-3 fatty acids are generally well tolerated and pose few safety issues. Transient mild gastrointestinal distress is sometimes reported by patients who take omega-3 fatty acids. There is one case report of possible hypomania induced by omega-3 fatty acids. Rare cases of increased bleeding times have been reported in patients who take aspirin or anticoagulants together with omega-3s.

The amino acid L-theanine has beneficial effects for generalized anxiety

L-theanine increases brain levels of several neurotransmitters

The amino acid l-theanine found in green tea is widely used in China, Japan, and other Asian countries to treat anxiety and depressed mood. Animal studies confirm that l-theanine increases brain levels of serotonin, dopamine, and gamma-amino-butyric acid (GABA) (an important inhibitory neurotransmitter) and may have general neuroprotective effects.

L-theanine reduces anxiety by increasing alpha brain wave activity

Anxiety-reducing effects of l-theanine are believed to be mediated by enhanced alpha brain wave activity in the occipital and parietal regions that are dose dependent and similar to EEG changes observed during meditation. Calming effects may last 8 to 10 hours and are usually experienced within 30 minutes following ingestion of l-theanine at doses between 50 and 200 mg.

Promising research findings need to be confirmed

However, findings of clinical research studies on l-theanine in anxiety are inconsistent. In one small placebo-controlled study (16 patients), healthy adult volunteers randomized to the prescription medication alprazolam (1 mg) versus l-theanine (200 mg) or placebo experienced equivalent and non-significant anxiety reducing effects during an experimentally induced anxiety state. In another small placebo-controlled study (12 patients), individuals taking l-theanine experienced relatively greater reduction in acute stress response as measured by changes in heart-rate variability (HRV) and salivary immunoglobulins (s-IgA) compared to the placebo group. These findings suggest that stress-reducing effects of l-theanine may be mediated by inhibition of cortical neuron excitation. In a crossover study, healthy adults were randomized to l-theanine (250 mg) alone or in combination with caffeine (150 mg). Compared to the l-theanine–only group, the combination group experienced improved visual information processing, reduced mental fatigue, faster reaction time and faster working memory, generally increased alertness, and fewer headaches. Moderately severe anxiety symptoms may respond to l-theanine taken at a dose of 200 mg twice daily however more severe anxiety may require doses up to 600 to 800 mg per day divided into 200-mg increments every 3 to 4 hours. ​Large well designed placebo-controlled studies on l-theanine are needed before more definitive comments can be made about its anti-anxiety benefits.

No safety problems

l-Theanine is generally well tolerated, and there are no published reports of serious adverse side effects or interactions with other natural products or conventional prescription medications

Widespread Use of Complementary and Alternative Medicine

In the North America, Europe, and other industrialized world regions, an increasing percentage of the population is using complementary, alternative, and integrative approaches to treat or selftreat medical and mental health problems. A large patient survey (N = 7,503) found that females, college graduates, and persons who believed that they received poor health care were more likely to use CAM, and only one-half of individuals who used CAM notified their health care providers. The majority of CAM users are well educated, committed to personal growth, satisfied with the conventional care provided by their physician or other health care provider, and use both prescription medications and CAM approaches for the same problem. An increasing number of medical schools, nursing schools, and psychology graduate programs offer courses on CAM. Symposia on CAM modalities are included in the annual meetings of the American Medical Association (AMA), the American Psychiatric Association (APA), and other professional medical associations. Approximately half of US physicians—and the majority of European physicians—believe that acupuncture, chiropractic, and homeopathy are valid therapeutic modalities and refer patients to practitioners of these therapies. Increasing numbers of primary care physicians are becoming certified to practice massage, acupuncture, herbal medicine, homeopathy, and other nonallopathic modalities.

Widespread Use of Alternative Therapies for Mental Health Problems

Persons diagnosed with a major psychiatric disorder are significantly more likely to use CAM treatments than the general population, and the majority of people who use CAM to self-treat a mental health problem take prescription medications concurrently. Almost one-half of persons diagnosed with major depressive disorder or panic disorder use at least one CAM treatment, compared to less than one-third of the general adult population. Roughly two-thirds of severely depressed or anxious persons who use CAM therapies consult with a mental health professional and 90 percent of the time this is a psychiatrist. The majority of persons who use CAM therapies for a mental health problem do not disclose this to their mental health care provider. This trend is alarming in view of potentially serious safety problems that can result when combining certain herbals or other natural products with pharmaceuticals. More than one-half of persons who self-treat severe depression or anxiety using CAM while concurrently taking a pharmaceutical believe that CAM treatments and conventional medications are equally efficacious.

Meditation and mindfulness training reduce symptoms of generalized anxiety

Meditation practices are widely employed to reduce anxiety and to maintain optimal psychological and spiritual health. Meditation has been extensively studied as a treatment of anxiety. Beneficial physiological effects of meditation include decreased oxygen consumption, respiratory rate and blood pressure, as well as long-term beneficial changes in brain electrical activity that result in increased calmness. Mindfulness-based stress reduction (MBSR) is an integrative approach pioneered by Kabat-Zinn that has been validated as highly effective for reducing the physical, emotional and mental consequences of chronic stress. MBSR incorporates elements of different Eastern meditation practices and western psychology. Its methods are now widely employed in group therapy in large health-maintenance organizations in the U.S.

Research findings show that the regular practice of mindfulness meditation, in which the individual practices detached self-observation, significantly reduces generalized anxiety and other anxiety symptoms. Almost 100% of individuals who started a 10-week MBSR program successfully completed it, and the majority reported significantly decreased physical and emotional distress, improved quality of life, a greater sense of general well-being, increased optimism and increased feelings of control. Persons diagnosed with Irritable Bowel Syndrome (IBS), a frequent complaint of generalized anxiety, experienced significantly fewer symptoms of both IBS and anxiety when they engaged in two brief (15 min) daily sessions of mindfulness meditation.

You can find out more about meditation, mindfulness training, MBSR and other safe and effective complementary and alternative treatments of anxiety, and learn practical tips for using them in “Anxiety: the Integrative Mental Health Solution,” by James Lake M.D.

Dementia and mild cognitive impairment (MCI): the integrative perspective

Dementia and mild cognitive impairment: overview
Dementia is a chronic condition characterized by severe persisting impairments of short-term and long-term memory and severe deficits in other areas of cognitive functioning such as abstract reasoning, language, impaired capacity to perform routine daily tasks, and loss of ability to recognize familiar objects, places or people. Alzheimer’s disease, the most common form of dementia, is a progressive neurodegenerative disease that accounts for two thirds of all cases of dementia. It has been estimated that roughly one half of all individuals over the age of 85 have Alzheimer’s disease. Genetic risk factors, chronic nutrient deficiencies, toxic injury to the brain, coronary artery disease, chronic stress and prolonged social isolation or restricted intellectual activity increase the risk of developing Alzheimer’s disease. The degenerative changes in the brain that lead to Alzheimer’s disease are related to deposits of an abnormal brain protein called amyloid-beta which sets off wide-spread inflammation and the formation of free radicals that damage or destroy neurons.

Medical causes of dementia include vascular disease that affects the arteries of the brain, Parkinson’s disease, other neurodegenerative disorders, traumatic brain injury (TBI), HIV/AIDS, severe cerebro-vascular accidents (i.e. ‘stroke’), and the cumulative toxic effects of chronic alcohol or substance abuse. Diets high in saturated fats are associated with increased risk of developing Alzheimer’s disease while diets high in fish are associated with relatively reduced risk. Moderate wine consumption (1-2 glasses/day) reduces the risk of Alzheimer’s disease but chronic alcohol abuse probably increases the risk of dementia.
It is important to distinguish the progressive and irreversible changes seen in dementia from the temporary and reversible changes in cognition associated with a state of acute confusion called ‘delirium.’ Serious medical illnesses or acute intoxication with alcohol or drugs often manifest as delirium in which cognitive functioning is grossly impaired. Successful treatment of the underlying cause or causes of delirium restores the brain to its healthy state and cognitive functioning rapidly returns to normal. Anyone who is experiencing rapidly progressing decline in cognitive functioning should be referred urgently to the nearest hospital emergency room or urgent care center to rule out medical causes of these symptoms.

Many individuals experience moderate or severe cognitive impairment as an indirect result of other mental health problems such as severe depressed mood, anxiety, bipolar disorder, psychosis, chronic sleep deprivation, or chronic alcohol or drug abuse. The successful treatment of a mental health problem that is impairing cognitive functioning often results in a return of normal cognitive functioning.

Mild cognitive impairment (MCI) is a less severe form of cognitive impairment that is often temporary but may progress to Alzheimer’s disease or other severe irreversible forms of dementia. MCI sometimes takes place with normal aging, chronic nutritional deficiencies, less severe strokes, thyroid disease, and chronic alcohol or narcotic abuse. Correcting the underlying medical cause or causes of MCI usually results in rapid improvement of symptoms of cognitive impairment.

Limitations of conventional treatments of dementia and mild cognitive impairment
Most currently available pharmacologic treatments of Alzheimer’s disease work by inhibiting the enzyme that breaks down the neurotransmitter acetylcholine, thus increasing available levels of this molecule which plays a critical role in learning and memory. These so-called cholinesterase inhibitors have significant adverse effects, and are only effective against mild or early symptoms of Alzheimer’s disease, but not other forms of dementia. Early promising results of studies on tacrine, the first commercially marketed acetylcholinesterase inhibitor, were offset by findings of significant hepatotoxicity. Second generation acetylcholinesterase inhibitors (donepezil, rivastigmine and galantamine) are no more effective than tacrine but require less frequent dosing and have fewer associated safety issues. Other drug classes that have been investigated for possible cognitive enhancing benefits in dementia include the monoamine oxidase inhibitors (MAOI), estrogen replacement therapy (ie, in cognitively impaired post-menopausal women), naloxone, and various neuropeptides including vasopressin and somatostatin. Most studies on prescription drug treatments of dementia and mild cognitive impairment have yielded equivocal or negative results. Promising novel biomedical treatments of Alzheimer’s disease currently being investigated in clinical trials include a vaccine that may immunize individuals against formation of amyloid beta, secretase inhibitors, anti-inflammatory agents and statins.

Individuals who are severely cognitively impaired frequently experience depressed mood, anxiety and psychotic symptoms. Contemporary biomedical management of such mixed symptom patterns relies on combinations of drugs increasing the risk of adverse effects and toxic interactions. Behavioral disturbances, including agitation and aggressive behavior toward care-givers, are commonly encountered in demented individuals. Even though cholinesterase inhibitors offer only transient improvements in the early stages of dementia, these drugs have become standard-of-care biomedical approach to Alzheimer’s disease and other forms of dementia in Western countries because of consistent findings of reduced agitation. In addition to pharmacological management, behavioral interventions, environmental enrichment and social support mitigate some of the cognitive and behavioral symptoms of dementia.

Non-medication treatments of dementia and mild cognitive impairment
The limited effectiveness of available mainstream treatments of dementia and mild cognitive impairment invites serious consideration of non-medication approaches. Natural supplements used to treat mild cognitive impairment or slow the rate of progression of dementia, include certain B vitamins, Ginkgo biloba, idebenone, acetyl-L-carnitine (ALC), huperzine-A and other herbals.
Other alternative approaches that sometimes slow the rate of progression of dementia or decrease the severity of mild cognitive impairment or dementia, include regular exercise, bright light exposure therapy, music, access to ‘wander gardens,’ and a multi-sensory stimulation approach called ‘snoezelen.’ Regular physical activity reduces the risk of developing dementia but does not improve symptoms of cognitive impairment in demented individuals. Using weak electrical current to stimulate the brain may result in temporary improvements in word recall and face recognition in mildly demented individuals.

If you or a loved one are struggling with symptoms of mild cognitive impairment or dementia and taking a medication that isn’t helping, you are experiencing adverse effects, or you simply can’t afford to continue taking a medication that is working, you will benefit from my book Dementia and Mild Cognitive Impairment: The Integrative Mental Health Solution. The book provides practical information about a variety of non-medication approaches that will help you function better such as herbals and other natural supplements, whole body approaches, meditation and mind-body practices, and many others.

Dementia and Mild Cognitive Impairment: The Integrative Mental Health Solution
will help you:
• Understand dementia and mild cognitive impairment better
• Take inventory of your symptoms
• Learn about non-medication treatments of memory loss and other symptoms of cognitive impairment
• Develop a customized treatment plan that is right for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work

Click here to preview or buy my book, Dementia and Mild Cognitive Impairment: The Integrative Mental Health Solution.

Depression: the integrative perspective

Depression: overview
Depressed mood has many psychological and biological causes. Some people are born with genetic factors that significantly increase their risk of developing severe depressed mood. Known medical causes of depression include thyroid disease, heart problems and anemia. When an underlying medical problem is treated depressed mood often gets better. Chronic stress, over-work or sleep deprivation can lead to depressed mood. Some prescription medications can cause or worsen depressed mood including drugs used to control high blood pressure and many others. Symptoms of depressed mood can be mild, moderate or severe depending on how much distress they cause and to what extent they interfere with your ability to function at work, in school or in a relationship.

Some people hear voices or develop delusional beliefs when they are severely depressed. They may not be able to distinguish between reality and fantasy however this does not mean they are ‘crazy.’ Psychotic symptoms generally go away when severe depressed mood improves with treatment. Individuals who experience mood changes that alternate between feelings of depression and euphoria or an irritable mood have bipolar disorder. It is important to understand whether your problem is depression, bipolar disorder or another mental health problem before starting any new treatment because different medications and alternative treatments are used for different mental health problems and taking the wrong treatment can potentially worsen your symptoms.

Limitations of prescription antidepressants
Several independent analyses have concluded that most trials of antidepressants sponsored by pharmaceutical companies fail to show significant response differences between conventional antidepressants and placebos. In United States and West European countries more than two thirds of depressed patients never receive adequate treatment with conventional antidepressants due to inadequate screening by physicians and under-reporting by patients. Over half of all patients who use conventional antidepressants are not treated by psychiatrists and have never been formally diagnosed with depression. Of those who are diagnosed and receive recommended doses of conventional antidepressants, between 40% and 70% fail to respond. The issue of non-response to conventional antidepressants is complicated by reports of overall worsening of depressed mood with long-term treatment. Approximately one half of individuals who fully recover from an episode of severe depressed mood relapse within two years regardless of whether they are taking a conventional antidepressant. Approximately one third of patients who stop taking conventional antidepressants after responding to them subsequently fail to respond to the same antidepressant when it is resumed.

Prescription antidepressants may have limited efficacy because they do not address impairments in neuroplasticity or neurogenesis that may underlie chronic depression. These findings suggest that future antidepressant agents with neurotrophic or neuroprotective effects may be more effective than currently available drugs that target specific neurotransmitters but do not stimulate synaptic growth or reduce nerve cell loss or atrophy believed to be associated with chronic depressed mood. The high cost of prescription drugs has become an important issue for many patients who take antidepressants. In this context it is significant that the cost-effectiveness of more expensive SSRIs and SNRIs is equivalent to that of the older inexpensive tricyclic antidepressants.

Non-medication approaches used to treat depressed mood
The limited effectiveness of available mainstream treatments of depression invites serious consideration of non-medication approaches. Natural supplements used to treat depressed mood include certain vitamins, minerals, herbals, amino acids and essential fatty acids. Depressed individuals may respond better to antidepressant medications when they are combined with certain natural supplements including folate and omega-3 essential fatty acids. St. John’s wort (Hypericum perforatum) is an effective treatment of moderate depressed mood but is much less effective for more severe depressed mood. The omega-3 essential fatty acid called EPA in particular may have beneficial effects against depressed mood when taken alone or in combination with conventional antidepressants. Extensive research has been done on S-adenosyl-methionine (SAMe) for depressed mood and have concluded that SAMe is as effective as prescription antidepressants. 5-HTP is a naturally occurring amino acid found in many foods and is the immediate precursor of serotonin that may be safely combined with prescription antidepressants increasing their effectiveness.

In addition to natural supplements there is considerable evidence for antidepressant effects of regular exercise. Early morning bright light exposure often reduces the severity of depressive mood symptoms. Depressed persons who exercise or use bright light therapy while taking an antidepressant may also improve faster than persons who use either approach alone. Exposure to high-density negative ions may be as effective for depressed mood as early morning bright light exposure. Emerging findings suggest that a specialized biofeedback approach that ‘shapes’ the brain’s electrical activity in the context of a computer game (i.e. EEG biofeedback) may have beneficial antidepressant effects. Other non-medication approaches that have beneficial antidepressant effects include acupuncture, music therapy, meditation, and yoga.

If you are struggling with depression, taking a medication that isn’t helping you feel better, experiencing adverse effects, or you simply can’t afford to continue taking an antidepressant that is helping, you will benefit from my book Depression: The Integrative Mental Health Solution. In the book I provide practical information about a variety of safe, effective and affordable non-medication alternatives that will help you feel and function better such as herbals, vitamins and other natural supplements, whole body approaches, meditation and mind-body practices, and energy therapies.

Depression: The Integrative Mental Health Solution will help you
• Understand depression better
• Take inventory of your symptoms
• Learn about a variety of non-medication approaches for treating depression
• Develop a customized treatment plan that makes sense for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work

Click here to preview or buy my book on

Insomnia: getting better sleep using integrative strategies

Insomnia: overview
Sleep and wakefulness are regulated by many neurotransmitters including the brain’s principle inhibitory neurotransmitter gamma-amino-butyric acid (GABA). Changing brain levels of GABA and other neurotransmitters are believed to be related to normal changes in sleep with healthy aging. What constitutes ‘normal’ sleep varies considerably between different cultures and demographic groups. For example healthy elderly individuals sleep less at night compared to young and middle-aged individuals, and may make up for reduced night-time sleep by spending more time napping during the day.

Chronic insomnia affects at least one third of the world’s population. Insomnia and daytime sleepiness are major public health issues because they result in enormous losses in work productivity and significantly increase the risk of work-place and motor vehicle accidents. Diverse social, cultural, psychological and biological factors affect sleep and most cases of insomnia are caused by multiple factors. Approximately two thirds of individuals treated for any mental health problem complain of chronic insomnia. Individuals who struggle with depression or anxiety or who abuse alcohol or drugs are especially at risk of insomnia. Depending on the particular drug insomnia may be a direct result of substance abuse or a symptom of withdrawal following a prolonged period of abuse.

Insomnia is a core symptom of bipolar mania and post-traumatic stress disorder (PTSD). Insomnia frequently accompanies diverse medical problems such as chronic pain, sleep apnea, diabetes, lung diseases, thyroid disease, dementia and neurological disorders. Sleep apnea is a medical condition in which difficulty breathing when asleep causes frequent waking episodes throughout the night resulting in severe daytime sleepiness. Sleep apnea is associated with a significantly increased risk of depressed mood, overweight and heart disease. Insomnia is a frequently reported adverse effect of many prescription medications. Individuals who do shift-work (i.e. whose work schedule begins late night and continues until early morning) or travel extensively across many time-zones often experience insomnia related to a disturbance in their ‘biological clock.’ Elderly persons who have serious medical or mental health problems are especially at risk of chronic insomnia.

Limitations and safety issues associated with conventional treatments
Prescription sedative-hypnotic medications such as benzodiazepines are used to treat 80 to 90% of all complaints of insomnia in Western countries. This practice has led to over-prescribing or inappropriate prescribing of potentially addictive sedative-hypnotics to millions of individuals. Morning drowsiness, dizziness and headache are common adverse effects of benzodiazepines. Inappropriate long-term use or high doses of benzodiazepines frequently result in confusion, daytime somnolence and short-term memory impairment. Benzodiazepine use in the elderly is especially problematic because of the significantly increased risk of serious fall injuries associated with their use in this population. Many antidepressants including doxepin (Siniquan™), trazodone (Desyrel™), and mirtazapine (Remeron™) are moderately sedating, and their use in the management of insomnia has steadily increased since the mid 1980s. However, research findings suggest that antidepressants used to treat insomnia cause serious adverse effects more often compared to benzodiazepines, including elevated liver enzymes, dry mouth, nausea, weight gain, orthostatic hypotension, daytime sleepiness, and dizziness.

Diphenhydramine, an antihistamine, is frequently prescribed for insomnia because of its sedating side effects. In recent years atypical antipsychotics with sedating side effect profiles have been increasingly used to manage insomnia in the absence of FDA approval for this clinical application, and in spite of the absence of findings from controlled trials supporting the efficacy and safety of these drugs for the treatment of insomnia. Atypical antipsychotic agents frequently prescribed for insomnia include quetiapine (Seroquel™) and olanzapine (Zyprexa™). In many cases the conventional pharmacologic management of insomnia is inappropriate or potentially unsafe because of a non-disclosed history of alcohol abuse or prescription drug dependence, concurrent use of medications that interact with sedative-hypnotics, or the existence of medical conditions that make the use of benzodiazepines unsafe. Meta-analyses of conventional treatment approaches suggest that conventional drugs are probably more effective in the acute management of insomnia, while cognitive-behavioral approaches are more effective over the long term.

Non-medication approaches used to treat insomnia
The limited effectiveness and safety issues associated with available mainstream pharmacologic treatments of insomnia invite serious consideration of non-medication approaches. Simple changes in nutrition can significantly improve the quality of sleep and reduce daytime fatigue. Melatonin is especially effective for management of insomnia caused by disruption of circadian rhythms as in jet lag or shift work. Sustained-release preparations are most effective for increasing the duration of sleep while immediate-release formulations are most effective for individuals who have difficulty falling asleep. Valerian root extract is widely used to self-treat insomnia. A systematic review of placebo-controlled studies of valerian extract for insomnia concluded that 600mg to 900mg taken at bedtime improves the quality of sleep and has few adverse effects. The amino acids L-tryptophan and 5-hydroxytryptophan are sedating at certain doses and are widely used by naturopaths to treat situational insomnia. A special kind of electroencephalographic (EEG) biofeedback that employs alpha-theta training and provide feedback in the form of an individual’s unique “brain music” may be a more effective treatment of situational insomnia than progressive muscle relaxation. Other non-medication approaches to insomnia include taking a sauna or hot bath before bedtime, acupuncture and mind-body therapies.

If you are struggling with insomnia, taking a medication that isn’t helping you sleep better, experiencing adverse effects, or you simply can’t afford to continue taking a prescription sleep aid that is working you will benefit from my book Insomnia: The Integrative Mental Health Solution. In the book I provide practical information about a variety of non-medication alternatives that will help you sleep better such as herbals, vitamins and other natural supplements, whole body approaches, meditation and mind-body practices, and energy therapies.

Insomnia: The Integrative Mental Health Solution will help you:
• Understand insomnia better
• Take inventory of your symptoms
• Learn about non-medication treatments of insomnia
• Develop a customized treatment plan that is right for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work

Click here to preview or buy my book, Insomnia: The Integrative Mental Health Solution.