Complementary and Alternative Treatments for Depression

Complementary Versus Alternative

What is complementary treatment versus alternative treatment? We hear them so often linked together, we don’t tend to think about what those terms actually mean. Some people might think they mean “woo woo” type treatments and some people prefer only using complementary and alternative treatments in order to avoid medications.

Complementary means you use another treatment in addition to a treatment and alternative means you use a treatment instead of another treatment.

This post will cover both. Just know that by discussing these, I am not saying the will or will not work.  The key is to find out what is best for you. Remember that even if there is a complementary or alternative treatment, it does not mean there is no risk, so do your homework before you try anything and talk to your doctor. That includes talking to your doctor about exercise and diet as we will see. Also, something can be both complementary and alternative, so you have to decide what is best. I’m of the mind that the least invasive and least risky is the best medicine.

Diet and Exercise

There is no particular diet that promises to improve depression; however, a diet high low in refined foods and sugars has been found to be helpful for depressive symptoms. I have eluded to in the past, healthy foods such as meats, fish and seafood, fruits, vegetables, nuts and legumes, dairy and other healthy choices are necessary in order to produce the neurotransmitters needed for a balanced system. In a study done in 2017 by Jacka & Opie et al. found that people with moderate to severe depression who did 12 weeks of nutritional counseling called the SMILES program, were found to have significant improvement in their depressive symptoms compared to a group who did not receive the same counseling. The study had 166 people enrolled. Meta-analyses have also shown confirmation of this as well.

Vitamins and minerals particularly important for depression include selenium, vitamin D, omega 3 fatty acids, antioxidants (vitamins A, C, and E), the B vitamins, zinc, proteins, and probiotics. Foods which are recommended to be avoided include alcohol, refined foods, processed oils, and caffeine (Wait! I’m not giving up coffee!).

Exercise 

Exercise has been shown to have a moderate impact upon depressive symptoms; however, it does not seem to last if exercise is stopped. The recommendations for exercise include 150 minutes of moderate exercise per week (30 minutes for a total of 5 days per week). Moderate means your heart rate is up, but you can still talk. These could include housework, walking, yoga, shooting a basketball, slow dancing, or any other similar exercise. I tell my patients that if they can only walk for 10 minutes while on a break at work, then try to get 10 minutes three times per day. When people are depressed, motivation can be difficult, so finding someone to go with you may be helpful.

Yoga

Yoga has been scientifically shown to help depressive symptoms. A lot of people of the Christian faith tend to stay away from yoga as it has roots in Hinduism; however, it is positive to do the stretching while meditating on the Word of God. We have freedom in Christ. It’s okay to avoid going to classes that lead others into their own spiritual practices. YouTube has some Christian Yoga which can help strengthen your walk with God and give you the stretching that is important. In an article by Ali Patterson at Christian writer, she writes: “I have a friend who feels differently: she feels like she can be there and simply not participate in those pieces. She says she talks to Jesus when she’s told to do something else. I have another friend who attends only yoga classes led by Christian instructors. I have yet another friend who completely avoids yoga altogether and advocates that others do the same. I believe yoga is an issue where we are free to reach different decisions alongside others who are following Jesus.”

Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation is also known as TMS. It is a non-invasive treatment in which a magnet is placed on the head and stimulates the neurons of the brain to be activated. The activation of the neurons creates more connections allowing for more neurotransmitters. This procedure is very safe with very few rare side effects. Rare side effects include headaches, discomfort during the procedure, hypomania, and feeling faint. Studies show that about half of all people  who have had poor response to medication, experience a clinically meaningful response with TMS. About one-third of these individuals experience a full remission, meaning that their symptoms go away completely. With some people the results don’t last but they can have a “booster” which can again help with remission. The difficulty with TMS is it requires treatment for 20 minutes per day five days per week. The treatment lasts six to eight weeks.

S-Adenosyl-L-Methionone (SAM-e)

SAM-e is made in the body. According to the Mayo Clinic, “SAM-e helps produce and regulate hormones and maintain cell membranes.” It appears to help depression by increasing serotonin in the body.  In the United States this is a supplement which is found over-the-counter and in Europe, it is obtained only be prescription. It should not be taken with antidepressants unless given an okay by your doctor. The reason for this is you can get too much serotonin. Too much serotonin can contribute to serotonin syndrome. There is some evidence SAM-e can be effective but so far they are not very robust studies and the sample sizes were small. Beside serotonin syndrome, more common side effects include, nausea, diarrhea or constipation, difficulty with sleep, dizziness, irritability, anxiety, and headache. Often these more minor side effects will dissipate after a few days to a week.

St. John’s Wort 

St. John’s wort is a supplement that has been studied and has shown to be effective in mild to moderate depression. It may also have some positive effects for menopause and wound healing but enough studies have not been completed to know for sure. St. John’s wort seems to work similarly to an SSRI which increases the amount of serotonin available to the neurons. If you and your provider decide St. John’s wort is appropriate for you, it is safe to take for up to 12 weeks.  Often SSRI’s have sexual side effects and St. John’s wort does not seem to have these effects as often; however, it interacts with different medications including birth control, HIV medications, cyclosporine, statin medications, some heart medications, antidepressants, and blood thinners.  This is a reason to talk with your provider about whether or not, St. John’s wort is for you. St. John’s wort  also contributes to sun sensitivity so wearing long sleeves, a hat, and sunscreen is imperative. Just like an antidepressant, it can take up to 4-6 weeks for you to notice the full effect.

Other supplements

There are many other vitamins, minerals and supplements that are used as complementary and alternative treatment. Some of these include, citicocholine, chromium, DHEA, folate, ginko biloba, inositol, kava, melatonin, rhodiola, Tryptophan/5-HTP, and valerian. Some of these have some studies behind their suggestion; however, many of them are not found to be effective in studies. Again, it is important to be educated about these supplements, minerals, and vitamins before you use them. Many of the side effects can be worse than taking a standard SSRI.

More….

This is by no means an exhaustive list of complementary and alternative treatments. If there are topics you’d like me to cover, I would be happy to address them. Please write in the comments.

References:

Jacka, F.N., O’Neil, A., Opie, R. et al. A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med 15, 23 (2017). https://doi.org/10.1186/s12916-017-0791-y

https://www.medicalnewstoday.com/articles/318428#outlook

https://www.crossroads.net/media/articles/can-christians-do-yoga

https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625

https://www.mayoclinic.org/drugs-supplements-same/art-20364924

https://www.nccih.nih.gov/health/st-johns-wort