Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change.  (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

This week, Dr. Pat has asked Megan Riddle, M.D./Ph.D.— a psychiatry resident at the University of Washington and a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional M.D.-Ph.D. Program—to answer the questions of a woman who wonders about alternative medicine’s effectiveness in the treatment of depression.

Dear Dr. Pat:

I am 45 and still have regular periods and no symptoms of menopause.  I had my first child four years ago, after fertility treatments that worked quickly, and I have loved being a mother.  I had no problem adjusting to being a new mother, breast-feeding, or going back to work after a six-month maternity leave. I work full time at a job where I am appreciated; I do work that is rewarding, and the stress is manageable. I am allowed flextime and do a lot of work from home.  I have a supportive husband and good help with childcare.  I should be the happiest woman in the world, but I have been dealing with a low mood for some time now.  It takes a lot of energy for me to get out of bed and to go to work—at a job I once loved. Now I just go through the motions to do what I have to do—and then I come back home and get done what I need to around the house.  Everything has become an effort.  Sometimes I can’t even concentrate enough to read—something I used to enjoy.  My husband encouraged me to go to my doctor, and she gave me a clean bill of health, but diagnosed me with depression.  She gave me a list of therapists in the area and offered me an antidepressant. I took the list, but said I’d pass on the medication at this point.  I am not completely anti-meds, but like to avoid them whenever I can.  However, I do feel as if I need to do something to help me get my spark back.  I’ve heard there are natural options out there for treatment of depression.  What are your thoughts on going this route?  Do they work?  I didn’t really want to bring it up with my doctor, since I wasn’t sure how she would react.

Thanks,
Sandi

Dr. Riddle Responds:

Dear Sandi:

I am sorry you have been struggling.  Depression is a debilitating illness, and I am glad you are seeking treatment.  Yes, there are a number of options for treating your depression that are outside the more conventional antidepressant-plus-therapy equation.  This is a field of treatment outside the mainstream; it is referred to as “Complementary and Alternative Medicine” (CAM). It includes a variety of interventions, such as herbs, supplements, sleep modification, and light therapy. Although many of these options are available without a prescription, it is important to work with your doctor as you explore these interventions; she can help you monitor symptoms, be on the lookout for side-effects, and advise on any possible interactions with other medications you may be taking.  When you share your interest in these treatments with your provider, together you can establish a treatment plan that incorporates your beliefs and principles.  Medical education is slowly beginning to address the importance of incorporating an awareness of complementary treatments into mainstream practice.  If your provider is not comfortable with these alternative treatments, she can refer you to someone with more expertise.

A wide range of CAM treatments for depression are available.  A challenge of the field is determining how well these treatments work.  Unlike the case with pharmaceuticals, where there is money to be made in drug discovery, CAM treatments often lack the large-scale studies we rely on for more conventional treatments.  However, as interest has grown, so has the number of well-done (albeit smaller) studies.  Below is a brief description of a number of different treatment options for which there is data supporting their use for depression.  Wherever possible, I specify whether the treatment has been shown to be effective alone, or is better combined with other treatments.  This list is not exhaustive; I have focused on the more popular and better-studied options.  

St. John’s Wort (Hypericum): The herb St. John’s wort is one of the better-known alternative treatments for depression. It is quite popular in Europe.  Study results have been somewhat mixed, but several have shown that it is better than placebo, and for many its efficacy is similar to that of traditional antidepressants.  For those with mild to moderate depression, St. John’s wort is typically well tolerated and may offer relief.  However, it is very important to discuss your use of this herbal treatment with your doctor prior to trying St. John’s wort, because it interacts with many other medications.  It increases the rate that some medications are broken down in the liver, making them less effective.  These include commonly used medications such as oral birth control, hormone replacement therapy, anticoagulants, and chemotherapy.  Thus, this may be a good option for individuals with mild to moderate depression who are not taking other medications.

S-adenosyl-L-methionine (SAMe): SAMe is a small molecule that your body makes and uses while carrying out a number of important functions.  It is sold as a nutritional supplement. A series of well-controlled studies showed SAMe to be as effective as, and better tolerated than, the older tricyclic antidepressants, and the majority of studies show it to be more effective than placebo.  It can be used on its own for the treatment of depression.

Omega-3 fatty acids: Omega-3 fatty acids, the kind of fat found in fatty fish, walnuts, flaxseed, and soybean and canola oil, have gained increasing popularity for their various health benefits.  These include reducing the risk of clots, decreasing atherosclerosis, and reducing inflammation.  Evidence now suggests that we can add treating depression to that list.  Initial epidemiological studies showed an association between higher levels of fish consumption and lower levels of depression.  While the results of using omega-3s alone have been mixed, well-controlled trials have suggested that they are effective when added to other treatments.  For example adding omega-3s to Prozac was more effective than either treatment alone.  Thus, the best evidence supports using Omega-3s in conjunction with mainstream treatment.