My treatment plan for anxiety and/or depression involves a multifaceted approach that is actually very simple. Many lifestyle changes that can help mood often seem out of reach to people who feel paralyzed by their seemingly overwhelming stress and resulting symptoms. Intervention with nutritional supplements is often the first place to start. Just the addition of a B complex with 100 mg of the B vitamins and 2-5 mg of sublingual B12 (in the form of methylcobalamin) can provide some relief of symptoms and improved energy.

Then instituting lifestyle changes in the form of increased exercise and dietary changes, especially reducing the intake of processed carbohydrates (bakery products, high sugar foods) and increasing fresh fruit and vegetables and protein sources every few hours in the day can set the stage for a stronger foundation and better mood.

In my experience the most effective treatment for anxiety and depression involves a targeted nutritional supplement program guided by tests of neurotransmitter and hormone levels. There are many neurotransmitters that effect brain function and these can be measured with a simple urine test. Hormones can be measured with a saliva or blood test. Both research studies and clinical experience have proven the accuracy of this method. Neurotransmitters can be broadly classified into two types: calming chemicals that create a state of relaxation and help people sleep (serotonin being one of these), and stimulating neurotransmitters that keep people alert and active (adrenalin or epinephrine being one of these). These two types of neurotransmitters function in a balance to maintain focus, alertness, calmness, and peace of mind. If any of these neurotransmitters are deficient or excessive a resulting imbalance can result in symptoms of anxiety, depression, sleep disturbance, attention problems, or irritability. Hormones produced in the adrenal gland (cortisol) or the sex hormones can also contribute to these symptoms if they are outside of normal range. Once the balance of these brain chemicals is understood, then specific amino acids or herbs can be prescribed to alter their levels and create more harmonious internal patterns and function . This can then provide relief of symptoms, often in a short period of time and for the long term. For more information about neurotransmitters and this method of treatment you can look at the site http://www.neurorelief.com.

The medical systems of Chinese herbs, acupuncture, and homeopathy may also play a valuable role in the holistic treatment of mood disorders. Often a problem with mood reflects an underlying imbalance in health that is accompanied by physical symptoms as well. It is common for stress to also result in digestive problems, headaches, and immune system disorders of various kinds that need to be addressed as well in a holistic treatment plan to achieve optimum health. And in many people the presence of persistent physical symptoms is in itself a contributor to discouragement and frustration and stress.

Of course, developing an understanding of stress reactions, relationship problems, and personal development through counseling or therapy can provide important self-help tools for creating a healthier attitude, but most patients that I see have already done many of these with limited success because of an underlying chemical imbalance. Others have tried psychiatric medications including antidepressants and anti-anxiety drugs with mixed results.

A holistic plan can be initiated at any stage of the process of illness. I see many patients who are taking prescription medications and looking for a better, more natural method. Holistic methods can be started in tandem with existing medications as long as the practitioner is experienced in managing these symptoms. Sometimes parents are concerned about their child’s attention and focus or behavior problems and reluctant to start down the road of prescribed drugs. Whatever the situation, holistic treatment can provide a balanced approach that looks at the whole person and lead to a higher state of overall health.

The Traditional Chinese Medicine (TCM) approach to anxiety problems is to treat them as disorders of Shan You Si, which are believed to affect the Zang Organs. The Heart Zang stores the Shen or spirit and each Zang Organ is responsible for one’s emotions. The Liver Zang is tied to anger, the Spleen Zang to excessive worry, the Kidney to fear, and the Lung with grief and anxiety. A disturbance in one or more of these Zang Organs can cause an imbalanced emotional state.

TCM classifies the cause of a specific mental disorder according to how much each Zang Organ has been disturbed and how its Qi is affected. The flow of Qi or energy can be interrupted by several factors, including anxiety, stress, anger, fear or grief. Acupuncture seeks to restore any imbalance between Yin and Yang. By inserting needles into the fine points of energy, the body’s own healing process is stimulated to restore its natural balance. Treating depression and related conditions such as seasonal affective disorder or dysthymic disorder (chronic depression) with TCM requires the proper evaluation of the signs and symptoms of these conditions. Specific acupuncture techniques are advised to treat each condition. Changes in lifestyle and the adoption of self-help recommendations are also part of the healing process.

TCM methods to treat depression and anxiety also involve the use of Chinese herbal medicine. These have slowly been accepted in the West, primarily because of the non-toxic nature of the treatment. Chinese medicines have been used to treat stress and to reduce the effects of the body’s aging process. Herbal medicines are combined in creams, gels, ointments, serums, powders, and tonics.

For more information on Traditional Chinese Medicine and anxiety, please call 800-729-0941.

Most of us are looking for a diagnosis when we seek medical attention for symptoms that range from weight gain to insomnia, depression, fatigue and memory problems.

Instead of a diagnosis that uncovers the underlying causes of these health challenges, we most often wind up with a pill and sometimes a patronizing pat on the head.

Overweight, fatigue, memory loss, depression, joint pain and stomach upsets aren’t diseases. They are symptoms. Unless you can get to the underlying causes of those symptoms, long-term relief will elude you.

Prescription drugs like may address your symptoms temporarily, but they aren’t going to solve the underlying problems or give you long-term relief from your symptoms. In fact, so many pharmaceutical drugs cause side effects that, after your doctor writes those prescriptions, you’re likely to end up with an even larger list of symptoms than you had at the outset.

The truth is that many doctors don’t have the time or even the training to delve into the reasons for your symptoms. Did you know that your doctor only received a handful of hours of nutrition education during four years of pre-med and four years of medical school? That’s shocking considering the large numbers of health challenges that are based on nutritional deficiencies.

That’s just the tip of the iceberg. So many doctors have become so reliant on pharmaceuticals that they don’t even consider other treatments that are frequently more effective and cause fewer side effects.

Here’s a typical case from Dr. Cass’ files:

“I remember Jean, a 55-year-old college professor whose story is pretty typical. She was being treated by her internist for high blood pressure, osteoporosis and heart palpitations. She as referred to me, a psychiatrist by training, because of her anxiety, depression and insomnia.

I could find no obvious psychological explanation for these symptoms, except maybe for the stress of her physical illness.

She was taking an array of medications, with their attendant side effects. Based on some simple lab tests and my own clinical experience, I determined that magnesium deficiency was a likely cause of her symptoms.

After a brief trial on this inexpensive and common mineral, together with a multi-vitamin formula and essential fatty acids, Jean was able to decrease her medications. Encouraged by this results, she trusted me enough to eliminate some foods to which she was allergic, which helped her even more.

In a short time, not only were her anxiety, depression and insomnia gone, but she was soon medication-free, depending instead on a list of supplements to restore her normal body chemistry.

Situations like Jean’s leave me with some questions:

1. Why had Jean’s internist been unaware of her mineral deficiency, or even of its possibility? Why hadn’t he at least given her a basic multi-vitamin formula?
   
2. Why give the prescription drugs first? This approach is like unplugging the noisy fire alarm instead of looking for the fire!”
   

If your doctor is “unplugging the fire alarm instead of looking for the fire,” the 8 Weeks to Vibrant Health program can help you make some powerful discoveries about yourself and your health.

The first teleseminar offers the basics:

• Starting a Wellness Journal (with online resources)
  
• Getting enough sleep
  
• Drinking enough water
  
• Choosing the right kind of exercise and creating an exercise program that works for you.
  

You can join in these no-cost teleseminars by registering at:

www.8WeekstoVibranthealth.com.

It all started so promisingly, when drugs like Prozac first came on the market in the 1980s. Here at last, we were told, was a new class of antidepressants that would transform the world of psychiatry.

Out would go the old ‘dirty’ psychiatric drugs of the 1950s, and in would come a set of drugs honed by science to target the biochemical core of depression in the brain.

These new drugs had a very scientific-sounding name—‘selective serotonin reuptake inhibitors’—which neatly morphed into the catchy acronym ‘SSRIs’. They are among the most successfully marketed drugs in history, so much so that the brand leader Prozac is almost a synonym for antidepressants, just like Hoover is for vacuum cleaners.

But now, some two decades later, the world of psychiatry has finally discovered it has been largely taken for a ride with SSRIs, by both drug companies and lax regulators.

‘Miracle’ science

In the brain, messages are passed between brain cells (neurones) across a tiny gap called a ‘synapse’. This gap is filled with chemicals, which have the job of controlling the communication between brain cells, transmitting information from one neurone to the other. Hence, these chemicals are called ‘neurotransmitters’. When one neurone communicates with its neighbour, it floods the synapse with a cocktail of neurotransmitters, one of which is serotonin.

By the 1970s, it had been discovered that some prescription drugs can cause depression as a side-effect, a problem traced to low brain levels of serotonin. It was then argued that, if a way could be found to increase serotonin in the brain, it would reduce depression.

It’s already known that the brain naturally conserves neurotransmitters by allowing the transmitting cell to reabsorb them from the synapse (a process that is called reuptake). So, if a way can be found to stop (or inhibit) this reuptake, the synapse would remain constantly bathed in neurotransmitters. But only one neurotransmitter—serotonin—is involved in depression, which means that only serotonin needs to be selectively isolated from the rest of the neurotransmitter cocktail.

So, in the mid-1970s, the pharmaceutical companies set themselves the task of finding a drug that would select out serotonin, and inhibit its reabsorption by the transmitting neurones. Ten years later, the family of SSRIs was created.

The first SSRI appeared in the mid-1980s from the Swedish pharma company Astra. The drug’s chemical name was zimelidine, but it was quickly withdrawn from the market when patients developed Guillain–Barré syndrome (a serious auto-immune condition involving damage to the peripheral nerves). Soon after-wards, a second SSRI, a French drug called indalpine, was also stopped after it was found to damage blood cells.

These straws in the wind didn’t deter other drug companies, however —although the SSRI’s hoped-for lack of side-effects had been intended to be a major part of their sales pitch.

The first SSRI to come to market was fluvoxamine (see box, page 8),
but its manufacturer Solvay Pharmaceutical, based in Georgia, lacked marketing clout, making its launch a bit of a damp squib.

It took the marketing power wielded by the giant US (and international) drug company Eli Lilly to collar most of the SSRI public relations when it launched fluoxetine in 1987, under the memorable trade-name Prozac. Newspapers were quick to swallow the company’s sales pitch, with headlines describing Prozac as a “happiness pill”. Even normally cynical journalists described Prozac as a valuable, quick, emotional fix, and a panacea for the stresses of the 20th century.

But the marketing dream soon turned into a PR nightmare as patients began to complain of unpleasant side-effects such as nausea, sexual dysfunction, insomnia and gastrointestinal bleeding. Worse, Prozac some-times caused violent, irrational behaviour. In one infamous case, a middle-aged factory worker became homicidal while taking Prozac, killing five people and wounding 12 others at his workplace.

In another example of horrific behaviour as a result of taking this drug, a female patient attacked her mother by biting her so viciously that she managed to rip away 20 chunks of her mother’s flesh. Eli Lilly was ordered to pay substantial damages.

After SmithKline Beecham (now GlaxoSmithKline or GSK) weighed in with their own SSRI, Seroxat (paroxetine), similar side-effects were seen with their drug, too. Even doctors began to express some concerns. “Physicians are seeing long-term side-effects from SSRIs far in excess of what was expected from the clinical trial data,” Dr Norman Sussman, a psychiatrist at New York University Medical Hospital, told the press in 1998 (Clin Psychiatr News, 1998; 26: 1).

Within a few years, Seroxat was following Prozac into the courts. In June 2001, GSK was ordered to pay $6.4m to the family of Donald Schell, who, after just two days on Seroxat, killed his wife, daughter, grand-daughter, and finally himself. Although GSK tried to claim that the drug wasn’t to blame, the British expert witness Dr David Healy, of Bangor University in North Wales, told the court he had uncovered early Smith-Kline Beecham documents which acknowledged that serious symptoms of agitation could occur after taking the drug for just a few days.

Whistleblower

Dr Healy, now a professor of psychiatry at the North Wales Department of Psychological Medicine, has recently been in the news again, after publishing an article in the scientific literature accusing drug companies and their official regulators of dirty tricks (BMJ, 2006; 333: 92–5).

The target of his concern was the fact that the drugs cause some people to commit suicide: indeed, these highly sophisticated drugs apparently can precipitate the fatal behaviour that psychiatrists spend their lives trying to prevent.

The first warnings of this effect were sounded as early as 1991, when researchers looked at the placebo-controlled clinical evidence for fluoxetine, and discovered a spike of suicides (BMJ, 1991; 303: 685–92).

Drug companies glossed over such findings, and even complained that placebo-controlled trials were unethical, as SSRIs were self-evidently both effective and safe. However, as Professor Healy revealed in his British Medical Journal article, he “obtained access” to some of the original drug-company data, which gave the lie to their official PR line. He was able to confirm that, in the evidence presented to the licensing authorities, “every antidepressant licensed since 1987 [showed] an excess of suicides”.

The companies, he said, had “obscured” the suicide evidence by fudging the data, a practice euphemistically referred to as ‘recoding’.

When Healy challenged Pfizer (which makes sertraline, marketed as Zoloft) and GSK with his bombshell discovery, they didn’t deny that recoding had occurred, but noted that “the FDA [Food and Drug Administration, the US’ ‘watchdog’ regulatory body] has neither criticised these data or the report as inappropriate, nor required additional analyses”.

However, documents obtained under the Freedom of Information Act reveal that FDA regulators were fully aware of the recoding but, says Healy, told the pharma industry that they did not see the SSRI–suicide connection as “a real issue, but rather as a public relations problem”.

And yet, no fewer than four clinical studies published between 1990 and 2000 have shown SSRIs to cause “an increased risk of suicidality”, culminating in a British report entitled ‘Deliberate Self-Harm and Antidepressant Drugs’. This was a survey of the Accident & Emergency case notes from one UK hospital area that revealed a five-and-a-half times extra risk of suicides among people taking SSRIs (Br J Psychiatry, 2000; 177: 551–6).

Slow-acting regulator

Healy showed that there has been collusion between the authorities and the drug companies in putting as good a gloss on the data as possible.

For example, the FDA had a back-door agreement with Pfizer that the sertraline suicide data should be analysed as if it were a constant hazard, even though they knew the evidence clearly shows that suicides peak in the first few weeks of use.

This averaging-out is outright “manipulation of data”, says Healy, because it disguises the true extent of the suicide problem. His own analysis shows that the latest data for paroxetine indicates as much as a fivefold increase in suicide risk, a statistic consistent with previous findings.

Another area of concern is children. Astonishingly, SSRIs have been given to kids as young as two years old, and the figure is rising exponentially for older children, too. For example, sertraline prescriptions for youngsters aged two to 19 tripled in just the 10 years from 1988 to 1998—from 40 million prescriptions to 120 million—after the introduction of fluoxetine (Pediatrics, 2002; 109: 721–7).

Equally surprisingly, very few SSRIs have actually been formally licensed for use by children, so all of this prescribing to them has been ‘off-label’. This term is used to describe when doctors prescribe drugs that have been officially approved for one purpose to treat other, unauthorized conditions.

In fact, few drugs are ever tested

on children. The reasoning behind this practice is that children are simply ‘little adults’, so the hazard profile of a drug may safely be applied to them so long as the appropriate reductions in dosage have been made to accomodate their smaller size.

But this is not necessarily true. For example, Ritalin—the infamous hyper-activity drug—appears to act as a depressant in children, but is a stimulant when taken by adults.
So we know that children can react totally differently from adults, particularly when mood-altering drugs are concerned.

Indeed, in the case of SSRIs, it was largely children’s violently self-harming reactions to the drugs that alerted psychiatrists to the suicide problem in the first place.

In 1991, Yale University doctors reported the case notes of six children, aged 10 to 17, who developed “intense self-injurious ideation or behaviour” while taking Prozac. For example, after three weeks on the drug, one 14-year-old girl, who had never been suicidal before, began cutting and otherwise injuring herself. She told hospital staff, “I’m just waiting for the opportunity to kill myself,” and chanted, “Kill, kill, kill; die, die die; pain, pain, pain” (J Am Acad Child Adolesc Psychiatry, 1991; 30: 179–86).

Another study carried out 10 years later again found that SSRIs increased suicidal behaviour in children (J Am Acad Child Adolesc Psychiatry, 2001; 40: 1364–5).

And yet, it wasn’t until 2003 that the British Medicines and Healthcare Products Regulatory Agency (MHRA) finally recommended that SSRIs not be given to children—and this only after being shamed into action by media reports of teen suicides caused by Seroxat.

Why did they take so long? According to Healy, there were two main reasons: a “lack of statistical expertise” on the part of the MHRA (and the FDA, too); and a mindset which “overstates the benefits and underestimates the risk of drugs”.

As a result, both the British and the American regulatory bodies, he says, insist on such cast-iron statistical proof of harmful effects that they demand “an all but unreachable threshold”.

The crowning irony of this official intransigence came in May of this year, when GlaxoSmithKline themselves sent a letter to doctors, warning them that paroxetine could cause a sixfold increase in the risk of suicides—a figure that neither the FDA nor the MHRA has so far acknowledged.

“Many people expect drug companies to be slow to concede that a drug causes hazards,” commented Healy dryly, “but we do not expect
our regulators to be even slower.”

Major side-effects

Excess suicides are just the beginning. There are also major issues of side-effects and efficacy. After 20 years of experience with SSRIs, it now turns out that these super-sophisticated drugs that were once hoped to be relatively free of side-effects are, in fact, potentially more dangerous than the crude tricyclic antidepressants (TCAs) of the 1950s they were meant to surpass (see box, page 6).

But the SSRI scandal stretches even beyond that. The only reason SSRIs were allowed onto the market in the first place was that the drug companies claimed they were far superior to the existing TCAs. In the heady days of the 1980s, figures of 80 per cent effectiveness were confidently bandied about—this was three times better than with TCAs, said SSRI manufacturers.

But those claims have since turned out to be highly optimistic. Study after study has shown that SSRIs are actually little better than the TCAs. Recently, researchers have pulled together 15 to 20 years’ worth of statistics, including previously sup-pressed data amassed by the drug companies themselves, as a sort of final overall verdict on the SSRI experience.

These huge clinical ‘meta-analyses’ have looked at SSRI use by a variety of patient groups. Here, for example, are direct quotes from what researchers have found in three different types of patients:

• people with mild depression: “. . . no differences between TCAs and SSRIs” (Cochrane Database Syst Rev, 2000; 4: CD001130)
  
• depression in general: “There are no clinically significant differences in effectiveness between SSRIs and TCAs” (Cochrane Database Syst Rev, 2000; 2: CD001851)
  
• The elderly: “. . . SSRIs and TCAs are of the same efficacy” (Cochrane Database Syst Rev, 2006; 1: CD003491).
  

The anger in response to this revelation among the psychiatric profession is now palpable. Even normally conservative medical journals have spoken out against the drugs. An article in a major psychiatric journal recently concluded that drug-company-sponsored research is no longer reliable: “Caution is needed in interpreting drug company sponsored trials given the evidence of selective reporting and publication bias” (Curr Opin Psychiatry, 2005; 18: 21–5).

Similarly, another peer-reviewed journal revealed that, if the true data for these drugs had not been suppressed, it would have served as evidence that they don’t work:

“We learned that pharmaceutical companies selectively released data that reflected positively on their products, and that combining sup-pressed and published data suggested that most of these medications had questionable efficacy” (J Clin Psychol, 2006; 62: 235–41).

Any residual confidence in the SSRIs is now likely to be permanently eroded. However, most of the large pharmaceutical companies that produced the SSRIs will not receive any negative fallout on their share prices. After all, most of the SSRI patents have now expired (see box, page 8). So, it would seem that the drug giants have already made whatever money they can and can now do a runner—a kind of smash-and-grab raid on the world of psychiatry.

Nevertheless, their future share in this lucrative market may be damaged. Pharma-industry analysts warn that “the world antidepressants market is in serious trouble”, with revenues of “only” $7 billion a year—50 per cent down from their peak (The World Market for Antidepressants, 2006).

They also predict that “the world market will crash”, mainly because there are not enough new anti-depressants in the pipeline.

That may indeed be so, but the market may also crash for at least three other reasons, too. The trust that may have existed between psychiatrists and their patients and the pharmaceutical companies is likely to be permanently tarnished. With this whole sorry episode, the biochemical model of depression–and biochemical manipulation as a solution–is now in question. The result is that patients may be more willing to turn to the many safe, natural antidepressants that are available to them.

Tony Edwards

The vitamin like co-enzyme tetrahydrobiopterin is essential for the proper manufacture of neurotransmitters like serotonin, which regulate mood. Many patients with unexplained depression have been shown to have a reduced formation of tetrahydrobiopterin (Lancet, 1984, i: 163). Supplementing with vitamin C, folic acid and B12 can stimulate the production of this enzyme (J Ment Def Res, 1982; 26: 21-5).

Perhaps the most famous alternative remedy for depression is St John’s wort (Hypericum perforatum), which has been demonstrated to be safe and effective in numerous trials in prestigious medical journals. It has also been combined with Indian snakeroot (Rauwolfia serpentina), which reduces blood pressure, in a preparation marketed under the trade name ‘Hyperforat’ (Klein, FRG). (Arzneimittel-Forschung, 1971; 21: 1999).

However, even St John’s wort is not without unwelcome side effects; one constituent of the herb causes patients to be photosensitive, and so users should exercise caution in going out in the sun.

Siberian ginseng (Eleutherococcus senticosus) has been proven to help a variety of psychological disturbances, including clinical depression (Econ Med Plant Res, 1985, 1: 156-215).

In Oriental medicine, shiatsu may help to improve a deficiency in lung energy, which may be present in depression when there is hyperventilation or panic attacks (Ray Ridolfi, Alternative Health: Shiatsu, London: Optima/Macdonald & Co, 1990: 78-9).

In naturopathic medicine, kava kava, a beverage made from the root of the pepper plant (Piper methysticum), is widely consumed in Pacific Islands. In one randomised, double blind study, a group of patients with depression showed a significant reduction in anxiety, compared with a group of matched controls taking a placebo, after only one week. This difference between the two groups increased over the four week course of the study, demonstrating the effectiveness of kava kava in patients with anxiety disorders (Arzneimittelforschung, 1991; 41: 584-8). Do beware, though, that liberal, long term consumption of kava kava can affect the skin, causing peculiar fish scaly eruptions, possibly due to its interference with cholesterol metabolism (J Am Acad Dermatol, 1994; 31: 89-97).

The Touch Research Institute at the University of Miami School of Medicine is conducting studies of the effect of massage on depressed patients. Preliminary results show reductions in anxiety levels and a measurable decrease in depression (D di Domenico in L Bassman, The Whole Mind, Novato, CA: New World Library, 1998: 377-88).

In my own practice, the best results without adverse reactions or contraindications have been achieved with a French homoeopathic combination remedy, called ‘L.72 drops’ (Lehning, France). In an extensive, controlled double blind trial, this combination remedy compared favourably against diazepam (Valium) for many symptoms of anxiety and insomnia (Depis et al, Centre for Therapeutic Research and Documentation, Paris: Dr B Heulluy, 1998).

L. 72 is available at the NutriCentre in London (436-5122); Hyperforat may be obtained through Ludwig’s Apotheke in Germany (Fax: 49 89 260 4322).

!AHarald Gaier

Harald Gaier is a registered homoeopath, naturopath and osteopath

Anxiety and depression are common in patients with abdominal symptoms (Can J Psychi, 1993; 38: 475-9).Neuropsychiatric complications are evident in at least a third of Crohn’s sufferers, and more than half of these are thought to be the direct result of the disease. These can include headache, depression and eye problems (South Med J, 1997; 90: 606-10). Some Crohn’s sufferers are given tranquillizers as a matter of course, the use of which brings their own unwanted side effects. Though few conventional practitioners are equipped to work in this way, talking cures and effective stress management could be a more effective way of dealing with the emotional fallout of IBD.

One came from a gentleman who has run a patient support group for 10 years, and he’s learned to tell the difference between chronic fatigue and depression. He uses three pointers for assessing the two conditions. 1) If you ignore the fatigue and press on regardless, it tends to get better if you have depression and worse if you have chronic fatigue (or ME). 2) If you have poor tolerance of alcohol, you’re more likely to have ME. 3) If you can’t tolerate a normal starting dose of antidepressants, you’re more likely to have ME.

Another reader, a teacher who suffers from chronic fatigue, has to stay in bed all weekend just to have enough energy to be ready for work on Monday. Her work colleagues don’t sympathise, but nor does her doctor.

Consider the following dietary measures:Irrational behaviour can sometimes be the result of food allergies (J Affective Disord, 1981; 3:291; Compr Psychiatr, 1976; 17:335). Individuals suffering from irritability, depression, hyperactivity, fatigue and anxiety need an immediate full medical physical check up and a complete test done to look for allergies which can cause mood changes.

Depression is a common symptom of folic acid deficiency (Biol Psych, 1989; 25(7): 867-72; Prog Neuropsy choparmacol Bio Psychiatry, 1989; 13(6): 841-63; Lancet, 1990; 336: 392-95). In addition to taking supplements of folic acid, supplements of vitamins B (Br J Psych, 1982; 141:271-2; Acta Med Scanda, 1965; 177: 688-9) and C (Am J Clin Nutri, 1971; 24: 432-3; J Orthomol Med, 1987; 2(4): 217-8) could help. Also deficiencies in calcium, iron, copper, magnesium, potassium and essential fatty acids have been implicated in depression. Blood tests and hair analysis can reveal if you are deficient in these substances.

A good wholefood diet will help the body manufacture serotonin and norepinephrine the important neurotransmitters (messenger cells which move between the nerve cells and the brain) which help to regulate moods. But these neurotransmitters are mainly derived from amino acids which it can be difficult for the body to manufacture in large enough amounts. You can try supplements of tryptophan (Psycho Med, 1978; 8: 49-58; Arch Gen Psych, 1990; 47: 411-8), L-phenylalanine (J Clin Psych, 1986; 47(2): 66-70) and the less widely available L-tyrosine (Adv Biol Psychiatry, 1983; 10:148-59). As you may require mega doses of these, they are best taken under the supervision of a nutritionist experienced in this area.

Thyroid problems either hypo or hyperthyroidism can often lead to mood swings which are swiftly but mistakenly labelled depression. Cutting down or eliminating iodized salt from your diet may produce results (see WDDTY, 1996 7(7): 2-5), as will cutting out caffeine and refined sugar.

Trace metals like lead cadmium and mercury in a person’s system can also lead to behavioural disorders. Chronic bouts of depression are among the most common symptoms of mercury poisoning from dental amalgam, according to Hal Huggins (It’s All In Your Head, Avery, 1993).

Therapy can help

There is plenty of evidence to show that “talking cures” can be an effective means of dealing with depression.

A recent survey showed that counselling with a view to problem solving was as effective as a course of antidepressants (BMJ, 1995; 310: 441-45).

Don’t rely on your GP for this; seek out an experienced counsellor.

Exercise regularly

An hour of aerobic exercise three times a week has been shown to significantly improve levels of depression (BMJ, 1985; 291: 109).

Consider herbal medicines

Hypericin, a constituent of St John’s Wort (hypericum perforatum) can boost the level of norepinephrine. In one trial of 15 women given a standardized extract of hypericin, all felt better and none suffered side effects (Arnzeim Forch, 1984; 34: 918). (See also BMJ, 1996; 313: 253-8).

Yohimbine, obtained from African tree bark, has demonstrated a positive effect on moods. One study of nine patients who had failed to respond to at least two anti depressant medication trials, which included fluvoxamine, were given yohimbine while continuing with the fluvoxamine.

Three of the patients experienced a marked improvement in mood. Side effects of insomnia and anxiety decreased as the dose of yohimbine was lowered (Biol Psychiatr, 1995; 38:765-7).

Compared with the placebo group, the group who had the supplements committed an average of 26 per cent fewer offences afterwards.

(Source: British Journal of Psychiatry, 2002; 181: 22-8).