How Come They're Happy and I'm Not? (15 page)

In this study, ten patients with atypical depression were started on a low dose of 400 mcg to 600 mcg a day. The other five patients took a placebo. An impressive 70 percent of the patients on the chromium responded positively to the treatment where none of the placebo patients had a positive response. The chromium picolinate was well tolerated with no noticeable side effects.

A second study in 2003 from Duke University looked at 113 patients with atypical depression for eight weeks who received either 600 mcg of chromium or a placebo. Unlike the earlier smaller study, there was no difference in mood itself, but issues with appetite, eating, carbohydrate craving, and mood variation all improved. The patients experiencing carbohydrate cravings had the best results of all. These two studies leave us unsure whether chromium by itself can create healing for depression, but it is pretty clear to me that it can address the blood sugar and appetite aspects of mood, which can play a strong role in moving you toward your healing goals. If you have carbohydrate cravings or have been diagnosed with atypical depression, chromium is certainly worth trying as part of your overall naturopathic protocol.

Chromium has no known side effects at the standard dosage of 400 to 600 mcg per day. It may be dosed higher under supervision of your doctor.

Onions, romaine lettuce, and tomatoes are top chromium sources. Brewer's yeast, liver (I am sure everyone reading this loves liver), bran cereal, and oysters are also good sources. If you do purchase liver, choose meat that comes from naturally raised animals to avoid toxins that the liver can store.

B vitamins play an important role in your brain's ability to produce neurotransmitters and your body's ability to make good feeling prostaglandins like PGE1 (see the GLA section in this chapter).

Known for its effectiveness as a treatment in anxiety conditions, vitamin B
₃
(niacinamide) is known to inhibit the enzyme tryptophan pyrrolase, thereby helping the body produce serotonin for your brain. Vitamin B
₃
is also responsible for helping convert tryptophan to 5-hydroxytryptophan. So it helps in at least two ways to make the mood-elevating neurotransmitter serotonin.

Vitamin B
₆
(pyridoxine) is a main cofactor in converting L-tryptophan to serotonin, so vitamin B
₆
deficiency contributes to low mood and depression. I should mention that one study found little improvement using solely supplementation with vitamin B
₆
versus placebo. This suggests that B
₆
deficiency is not a likely sole cause.

B vitamins are water soluble and generally safe. Taking 100 mg of B
₃
several times daily with meals may also enhance the effectiveness of tryptophan doses. Dosage of vitamin B
₆
is usually 20 mg twice a day. Prolonged high doses (200 mg or more a day) of vitamin B
₆
may cause a tingling feeling in the hands and feet
along with fatigue. Do not use more than 100 mg per day of B
₆
to be safe.

Excellent sources of vitamin B
₃
include tuna and mushrooms. Sources of vitamin B
₆
include bell peppers, bananas, turkey, salmon, spinach, turnip greens, garlic, kale, brussels sprouts, and cod.

Known as a mineral cofactor, zinc is responsible for many aspects of our health, including wound healing as well as immune and nervous system balance. For people who are depressed, the lower their zinc levels, the higher their depression severity. Like folic acid, lower serum zinc might help drugs that are not working be more effective (see
chapter 7
for more information). One study suggests that zinc may protect brain cells by blocking the toxic effect of glutamate.

Optimal zinc dosage is 15 to 30 mg a day. It should be taken with food due to the possibility of gastric upset. If you are taking zinc for more than two months, it's best to take 1 to 2 mg of copper every day, for extra zinc can cause the body to lose some copper.

Known to accompany animal protein, zinc can be found in beef, lamb, turkey, chicken, pork, crabmeat, lobster, clams, and salmon. The highest vegetable source is pumpkin seeds.

Magnesium is one of my all-time-favorite nutrients. Though known to be beneficial to the heart, relaxing to the muscles, and calming to the mind, it's rarely thought about for low mood and depression.
However, I have relied on magnesium for my own mood balance, and I consider it a strong ally for many of my patients.

Although generally unrecognized, magnesium deficiency has been reported in up to 80 percent of depressed patients, with suicidal patients showing low levels in spinal fluid. Magnesium is an essential trace mineral that is often quite low in the standard American diet, as we strip away many nutrients from our food when they are processed. For example, only 16 percent of the original magnesium remains in refined flour, and magnesium has been removed from most drinking water supplies. Furthermore, carbohydrate consumption and mineral flushing can contribute to low magnesium levels in the body. Simple carbohydrates like white flour bread, cake, and cookies are dangerous; not only do they lack good quality nutrients, but they also cause blood sugar dysregulation and deplete minerals from the body.

One recent study of 5,708 Norwegian people aged forty-six to seventy-four years found that the lower the magnesium intake, the worse the mood. Four published case studies showed that patients recovered from major depression in less than seven days when they took 125 to 300 mg of magnesium (in the forms of glycinate or taurinate) with each meal and at bedtime.

Magnesium deficiency can also contribute to inflammation. Nervous tissue becomes damaged easier, thus increasing inflammation and compounding the chance of depression. other studies have shown that low magnesium causes inflammation and raises CRP (see
chapter 4
).

Typical dosages of magnesium range from 300 to 700 mg a day. Magnesium is quite safe. However, supplementation is not recommended for patients who have kidney problems. sometimes magnesium causes a looser stool, and non-chelated forms such as magnesium sulfate (as found in Epsom salts), oxide, hydroxide, or chloride typically encourage diarrhea sooner than the chelated
malate, citrate, or glycinate forms. For patients with mood issues, I typically recommend the magnesium glycinate form over other types.

You can find magnesium in mineral water. In fact, many experts believe it's the French's affinity for mineral water that keeps their hearts healthy despite their tendency to eat richer foods. Also, Swiss chard, summer squash, blackstrap molasses, spinach, mustard greens, halibut, turnip greens, and seeds (pumpkin, sunflower, and flax) are good sources.

Amino acids play a special role in helping mood. While most vitamins and minerals act as helpers in the production of neurotransmitters, amino acids are the building blocks of neurotransmitters, and they play a central role in helping change your mood for the better.

Tryptophan is an amino acid precursor to serotonin and may be one of the most popular amino acids for mood and sleep. It is a potent antioxidant. Research shows that tryptophan is significantly lower in depressed subjects than in normal controls. And, expectedly, it has been found that depleted levels of 5-hydroxytryptophan (5-HTP), which is made from tryptophan, may increase the risk of a suicide attempt in depressed patients.

Tryptophan → 5-HTP → Serotonin → Better Mood

The desired therapeutic effect of antidepressant drugs known as serotonin reuptake inhibitors (SSRIs) is to increase levels of serotonin by slowing the brain from breaking it down. Supplementing with tryptophan or 5-HTP gives the body more building blocks to
make more serotonin. Many natural medicine practitioners believe using tryptophan or 5-HTP is a better method of achieving the same goal as antidepressant drugs, for it allows the body more control over this process and may avoid side effects common in SSRIs.

When supporting serotonin, it's vital to consider the role and health of the digestive tract. As we discussed in
chapter 4
, digestive dysfunction, abnormal serotonin levels, and psychiatric illness are linked. Effectively treating digestive dysfunction and combining foods to optimize tryptophan uptake may rebalance tryptophan and serotonin levels, thus working to alleviate depressive illness. The naturopathic notion of “treating the gut” may be of important use in treating depression by increasing overall serotonin levels.

Despite anecdotal evidence, relatively few studies have used tryptophan and 5-HTP. With drug popularity, much of the research on these has been discontinued. One recent meta-analysis looking at 108 studies of tryptophan and 5-HTP found only two studies, with a total of sixty-four patients, that met sufficient quality criteria. These studies did suggest 5-HTP and L-tryptophan are better than placebos at alleviating depression. This is a better score than antidepressants get, for antidepressants don't work as well as placebos. still, more quality research on a large number of individuals is very welcome.

If patients want to use natural remedies and avoid medication, I highly recommend supplementing a high-quality-grade tryptophan or 5-HTP. If considering one or the other, I recommend starting with 5-HTP, which has been shown to be more effective at crossing the blood-brain barrier to get into the brain. Also, if 5-HTP is taken orally, the process of converting to serotonin absorbs 70 percent of 5-HTP versus only about 3 percent of tryptophan, so you can take significantly less.

Doses of 5-HTP can start at 100 mg three times a day and work up to 200 mg three times a day taken on an empty
stomach. Because more research is needed to optimize dosing schedule and amounts, it may be best to start with 500 mg per day of tryptophan on an empty stomach and work up to 2 g per day, if needed. If you have trouble staying asleep at night, I often recommend 500 or 1,000 mg of tryptophan taken with some simple carbohydrates, such as a slice of apple, about thirty minutes before bed.

When dosed accordingly, both tryptophan and 5-HTP are quite safe and effective. In 1989, eosinophilia-myalgia syndrome (EMS) caused concern in the United States after about one thousand individuals taking a tryptophan supplement experienced muscle and joint pain, high fever, swelling of the arms and legs, weakness, and shortness of breath. Sadly, there were about thirty deaths. Although the supplement itself was originally blamed and then banned in the United States, contaminants were actually at fault—it had nothing to do with the tryptophan. It had all to do with a company with poor quality control that had no business making supplements. Today, tryptophan is back on the market, and there are no toxicity issues.

One concern with tryptophan and 5-HTP is serotonin syn-drome—a condition in which multiple SSRI drugs or an SSRI drug combined with a natural therapy may increase serotonin levels. This syndrome can be characterized by agitation, confusion, hallucinations, fast heartbeat, blood pressure changes, feeling hot, coordination issues, hyper reflexes, or gastrointestinal tract symptoms like nausea, vomiting, and diarrhea. Severe cases can cause rapid fluctuation of temperature and blood pressure, mental status changes, and even coma. Serotonin syndrome was reported in a 2005 study of four elderly patients who combined Tramadol and Remeron, two antidepressant drugs. The use of two antidepressant drugs at the same time caused this syndrome, but studies of drugs and tryptophan have been safely conducted.

One eight-week randomized, controlled trial of thirty patients with major depression found that combining 20 mg of Prozac with 2 g of tryptophan daily at the outset of treatment for major depressive disorder appeared to be a safe protocol. It had both a rapid antidepressant effect and a protective effect on slow-wave sleep, with no need for monitoring drug levels.

Although most psychiatrists are afraid to mix natural medicines like tryptophan with conventional medication, this study shows that when done appropriately, the two can be used together successfully and safely. At this time, there are no studies using 5-HTP with an SSRI drug, although in my clinical experience, low doses used with medication are an effective way to avoid raising drug dosage and to help wean patients off from medication (see
chapter 7
).

With careful dosing of SSRI drugs and tryptophan, supplementation may prove a side effect-free and useful integrative approach to depression. Of course, it's good to let your prescribing physician know if you are working with natural supplements. You can use this book to guide the discussion with your doctor.