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Omega-3 essential fatty acids (oils), which include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are found primarily in fish (such as mackerel, lake trout, herring, sardines, albacore tuna, and salmon) and some plants. While they are necessary for the proper functioning of our bodies, the levels necessary for health benefits are more than can readily be achieved through diet alone. These oils are used as supplemental treatments for an array of conditions including heart disease, diabetes, and arthritis. These oils also play a role in brain development and function.

There is strong evidence from epidemiological (population) studies that cultures which eat large amounts of fish containing these oils have a low incidence of depression. These population studies have been followed up with randomized double-blind experiments (highly controlled studies that use an active and non-active medicine; both the patient and the experimenters are unaware of which patients receive the active medicine and which do not). While many of these later highly-controlled studies suggested a relationship between treatment with Omega-3s oils and the lessening of depression, other studies produced contradictory results. In other words, not all of these studies suggest positive treatment effects. Some study subjects showed a 50% reduction in scores (lower scores indicate less depression) on a common depression rating test (the Hamilton Depression Rating Scale) while other subjects receiving fish oils were no different than people who received a placebo (a preparation which contains no active ingredients).

Because EPA and DHA play many essential roles in the body and brain, CAM practitioners, and the American Heart Association, suggest that most people should supplement their diets with these oils. Overall, the evidence suggests that EPA/DHA is also a good supplement for people with depression. However, additional studies are needed to fully understand what role these oils play in treating depression.

Safety and Dosing

Normal dosing for the omega-3 fatty acids is between 1-4 grams a day. Results have been achieved with as little as 1 gram of a good-quality supplement. Most fish-oil supplements contain about 18% EPA/DHA, so to get a gram of the EPA/DHA one should take approximately five 1-gram supplements.

Fish oils have been shown to both lower cardiovascular (heart) disease risk and raise cholesterol in some people. Likewise, EPA and DHA lowers blood sugar in diabetics while raising it in other people. If you are taking medications for diabetes, your dosing may require adjustment. If you are considering taking more than 1 gram of EPA/DHA a day, and are on medications for diabetes or cardiovascular disease, you should consult with your health professional.

Side Effects of Omega-3 Oils

Most side effects from taking fish oils are mild. Fish oils may act as an anticoagulant (blood thinner), so consult with your health provider if you are taking any other blood-thinning medications.

Exercising as little as three hours a week can have a profound effect on the symptoms of depression. Researchers are puzzled about the exact reason for the benefits, but studies conducted with animals suggest that exercise increases brain neurotransmitters that have an impact on mood, such as serotonin, dopamine and norepinephrine. Exercise also releases endorphins, chemicals naturally produced in the body which reduce the experience of pain and enhance a sense of well-being.

Numerous studies in human beings have shown that a variety of exercises, such as weight training and aerobic exercise (exercise where you breathe hard) can improve mood. This effect is especially noticeable in older adults, but works in other age groups as well. Is some studies, exercise was as effective as (and sometimes more effective than) psychotherapy and standard medications for certain individuals with symptoms of depression.

Consult with your health care provider before starting an exercise program. Your program should incorporate both strength (such as lifting weights) and cardiovascular training (anything where your heart rate is increased for an extended period).

Always start slow and progress gradually. Most health practitioners suggest that exercising 20-30 minutes a day, three times a week, is a good place to start. Gradually move up to the point where you can exercise for a full hour, three times a week, or 30 minutes six times a week. The goal is at least 3 total hours of exercise each week.

St. John’s Wort has been used for thousands of years, and is currently one of the top selling herbs in the United States. More prescriptions are written for St. John’s Wort in Germany than many prescription drugs (such as Prozac). The herb was once considered magical because the plant’s red sap resembles blood. Legend suggests that the herb got its name because the plant first “bled” red in the Middle Ages after St. John the Baptist was beheaded. Also, the flowers of this plant bloom around late June, coinciding with the feast of St. John. The term “wort” refers to any plant used for medicinal purposes.

There are many active chemical constituents in St. John’s Wort. These chemicals, called hypericin, pseudohypericin, and hyperforin, have all been investigated for their anti-depressant properties. However, the reason why St. John’s Wort successfully treats depression is not entirely clear. The first studies found that St. John’s Wort was a weak inhibitor of monoamine oxidase (MAO). One group of antidepressants (so-called monoamine oxidase inhibitors such as Marplan, Nardil, and Parnate) work by this same mechanism. MAO is a substance that breaks down various neurotransmitters (chemical messengers in the brain and nervous system). Inhibiting MAO, or keeping it from breaking down the neurotransmitters which control mood (such as dopamine, serotonin and noradrenaline), allows these chemicals to stay working in the brain for longer periods of time and thus subsequently improving mood.

More recent studies showed that St. John’s Wort may activate adenosine, gamma-aminobutyric acid (GABA), and glutamate receptors (receptors are chemical channels designed to receive certain brain chemicals). Activation of adenosine receptors is thought to produce a feeling of calm and contentment. Malfunctioning GABA receptors can cause depression and anxiety; therefore, activation of these receptors regulates mood. Disturbances in glutamate activity at receptors can lead to depression and suicidality; activating these receptors can decrease these feelings.

Still other studies have investigated the effects of St. John’s Wort on additional neurotransmitter receptors. The herb seems to downregulate (reduce the number of) beta-adrenergic receptors and upregulate (increase the number of) serotonin receptors. Beta-adrenergic receptors are designed to receive a nerve stimulating hormone called epinephrine (also called adrenaline), which has the effect of increasing heart beat and blood pressure, and preparing skeletal muscles to work. Downregulating these beta-adrenergic receptors has a calming effect. Epinephrine has less opportunity to stimulate the receptors (because there are fewer chemical channels to receive it) which activate those muscles.

Why does St. John’s ability to upregulate serotonin matter? Both depression and anxiety have been linked to a lack of serotonin. Upregulating or increasing the number of serotonin receptors can allow the serotonin that is already present to have more opportunity to stimulate the related neurons (nerve cells). The net effect is a decrease in depression or anxiety.

Like so many other herbs, it is difficult to uncover the exact mechanism by which St. John’s Wort works. Most herbs are a complex mixture of chemicals, each with their own properties. The effect of St. John’s Wort is probably related to the combination of chemicals rather than just one chemical acting in one part of the brain.

St. John’s Wort has been the subject of multiple treatment studies. The first human studies using St. John’s Wort to treat mild depression demonstrated that this herb was as effective as prescription antidepressants. Later studies showed that St. John’s Wort was also effective in treating major depression. Recent studies, that were perhaps better designed, revealed mixed results for the effectiveness of St. John’s Wort. Since standards vary for the production of herbal supplements (many of these studies have used different formulations of St. John’s Wort), the results are difficult to interpret.

On the whole, it appears that a good quality St. John’s Wort supplement is a good substitute for many prescription antidepressant medications. However, the use of St. John’s Wort in high doses (what one would find in a typical supplement), is not without its cautions. While there are very few actual side effects to taking the herb, it does have the potential to interact with other medications (see below).

Safety and Dosing

A typical dose of St. John’s Wort is between 500 and 1,100 mg a day of a standardized herbal extract containing at least 0.3% hypericin.

St. John’s Wort is relatively safe. In a review of over 20 trials, St. John’s Wort had only mild side effects (see box), which are often less less noticeable than side effects caused by traditional antidepressant medications. The most common side effect for St. John’s Wort is an increased sensitivity to sunlight. People who experience this photosensitizing effect should use extra sunscreen and limit sun exposure while taking St. John’s Wort.

Side Effects of St. John’s Wort:

St. John’s Wort can interfere with many prescription and non-prescription drugs. This herb can change how quickly the liver processes drugs, which can cause another prescription medication to leave the body more quickly than it should. It can also directly interfere with the action of another drug (adding or subtracting from its effects).

For example, St. John’s Wort has the ability to reduce the effectiveness of many drugs including cyclosporin (an immune-suppressing drug), warfarin (used to prevent or treat blood clots), digoxin (heart medicine), theophylline (used to treat asthma and other respiratory diseases), HIV protease inhibitors (used to treat HIV/AIDS), anticonvulsants (used to prevent seizures), oral contraceptives (birth control pills) and more. It also has the potential to increase the effects of antidepressant medications such as monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs). The herb also increases the risk of a rare condition called serotonin syndrome (or serotonin toxicity) that produces mental confusion, agitation, headache, shivering, sweating, hypertension (high blood pressure), tachycardia (fast heart rate), and other symptoms.

The list of drugs that St. John’s Wort can interfere with is long, and future research may discover other medications that should not be mixed with this herb. Therefore, it is best to check with your health care provider before trying St John’s Wort, especially if you are taking any prescription medications.

WARNING: The use of St. John’s Wort has been linked to manic episodes in people with bipolar disorder (manic depression). As mentioned previously, a manic episode, the high energy component of bipolar disorder, is characterized by a euphoric (joyful, energetic) mood, hyperactivity, a positive, expansive outlook on life, a hyper-inflated inflated sense of self-esteem, impulsive/risk-taking behavior, and a reduced need for sleep. While the number of these cases is low, it is best to avoid St. John’s wort if you suffer from bipolar disorder or if you aren’t sure if you have bipolar disorder vs. conventional unipolar depression. If you use St John’s wort, begin treatment only under the supervision of a licensed professional health care provider.

Everyone experiences sadness and unhappiness at some point in their lives. Clinical Depression, however, is more intense and of longer duration than typical sadness or grief, which interferes with a person’s ability to engage in daily activities. The symptoms of depression can include: loss of interest or pleasure in previously enjoyable activities, major changes in appetite (either significantly reduced or increased), sleep problems (sleeping too much or too little), fatigue, a feeling of worthlessness or hopelessness, problems with concentration and making decisions, and thoughts of suicide.

There are two main types of depression, major depression (or major depressive disorder) and dysthymic disorder. A person diagnosed with Major Depression has experienced the previously mentioned symptoms for longer than 2 weeks. These symptoms either can occur repeatedly (called episodic) or only once; but they are typically severe. A Dysthymia diagnosis means that depressive symptoms are less severe, and they have been present for at least 2 years on more days than not.

Individuals with bipolar disorder also display symptoms of depression. Bipolar disorder is a severe illness in which moods swing between ‘up’ states and ‘down’ states. Bipolar ‘up’ states, called mania, are characterized by a euphoric (joyful, energetic) mood, hyper-activity, a positive, expansive outlook on life, grandiosity (a hyper-inflated sense of self-esteem), and a sense that anything is possible. A person in the ‘down’ state of bipolar disorder experiences one or more of the depressive symptoms mentioned previously.

Complementary and Alternative Therapies for Depression

While the term “Depression” has only been around for a hundred years or so, historical evidence suggests that a sense of sadness or melancholy has long been a universal part of human experience. The science of treating depression has blossomed in the last 30-40 years, and anti-depressant medications are some of the most frequently prescribed drugs in America.

Research suggests that St. John’s Wort can be used as a stand-alone alternative treatment for depression. In parts of Europe, this herb is often the preferred remedy for treating depression. Preliminary research suggests that other therapies, such as exercise, 5-HTP, SAMe and Omega-3 oils may also be used as stand-alone treatments for depression. However, their benefits seem to depend on the severity of a person’s depression, as well as his or her individual reaction to such therapies. Additional research to further clarify the role of these CAM treatments for depression is necessary.

As mentioned earlier, according to many CAM practitioners, a combination of therapies will likely produce better treatment benefits. This is especially true for the treatment of depression; becoming more engaged and active in your therapy leads to better results. For example, consulting with a health care professional, taking Omega-3 Fatty acids and a B-vitamin, and exercising might help you gain control over your depression more quickly than solely relying on one treatment approach. Of course, a qualified CAM practitioner is the best person to determine which combination of treatments would be most beneficial for you.

The following chart summarizes the common natural treatments for depression and the degree of scientific study available today to support their use:

The following information describes a variety of other therapies for anxiety. Most of these therapies are mildly sedating, and have been used for years as successful anti-anxiety and calming remedies. There simply isn’t enough well-designed research to support their use as stand-alone treatments. Other therapies, like diet or acupuncture, may have a preliminary study supporting their effectiveness, but more research is necessary before fully recommending their use as anxiety treatments.

Herbs

There are many herbs that have been traditionally used for anxiety that are mildly sedating and calming. These herbs may be taken as a tea or in a pill form, and are often combined to enhance their calming effect (for example a tea may contain Skullcap, Hops and Chamomile).

• Skullcap (Scutellaria lateriflora)
• Chamomile (Anthemis nobilis)
• Hops (Humulus Lupulus)
• Motherwort (Leonurus cardiaca)
• Oats (oat straw) (Avena sativa)

Most of these herbs are safe even in very large amounts. The most common way to use them is to make a tea on an as-needed basis; perhaps 2-3 times a day.

Diet

Caffeine is a central nervous system stimulant (substance that increases mental or physical processes such as heart rate and blood pressure), and should be avoided in people with anxiety. Caffeine is found in coffee, tea, chocolate, some stimulant medications (for example, No-Doz), and sodas. Always check the labels of food, beverages and medications to determine whether caffeine is an active ingredient. People with anxiety seem to be particularly susceptible to the negative effects of caffeine, such as dizziness, racing heart, and restlessness.

Acupuncture

Acupuncture literally means ‘needle piercing” and is the practice of inserting very fine needles into the skin to stimulate specific anatomic points for therapeutic purposes. In addition to needles, acupuncturists can also use heat, pressure, friction, suction, or electromagnetic energy impulses to stimulate acupuncture points. Treatment is designed to to balance the movement of energy (called qi) in the body to restore health.

Acupuncture is an effective treatment for general anxiety. This therapy is also effective for people who are very nervous before operations and dental procedures. Obviously, acupuncture will probably not work for people who have fear of needles; however, the needles used in this therapy are extremely small. Most people report that they feel nothing but a slight twinge when the needles are inserted.

The specific course and duration of acupuncture treatment depends on the nature and severity of anxiety symptoms. A typical course of treatment might involve ten to twelve weekly sessions.

Exercise

Exercise is a commonly prescribed supportive treatment for anxiety. Many people note a drop in their level of worry and anxiety during and after exercising.

Starting an exercise program is something that should be discussed with your health provider. Always start slowly and progress gradually. Most health practitioners suggest that exercising 20-30 minutes a day, three times a week, is a good beginning. Exercise should incorporate both strength (such as lifting weights) and cardiovascular training (anything where your heart rate in increased for an extended period such as walking, bike riding, running, swimming, etc.).

Yoga

Similar to exercise, yoga has shown some promise as a treatment for anxiety. Deep breathing and stretching can lead to feelings of contentment and calm on their own. Many yoga practices incorporate deep breathing, stretching, and strengthening exercises along with a mild cardiovascular workout.

Yoga can be practiced at home, or you can find a class at a local community/recreation center, gym, or yoga studio. There are forms of yoga that incorporate slow stretching and others that are more active. If you are thinking of trying yoga, visit a class a few times to determine which teacher and style would best meet your needs.