How Come They're Happy and I'm Not? (17 page)

Oats are known to have a calming effect on the body, and they also contain some melatonin. However, to get the same amount of melatonin that is found in a supplement pill, you would need to eat about twenty bowls of oats. Sweet corn and rice are also sources. Ginger, tomatoes, bananas, and barley contain small amounts of melatonin too.

The World Health Organization estimates that 80 percent of the world population uses plants medicinally to treat common ailments. About 25 percent of pharmaceuticals have plant origins. Not surprisingly, the botanical pharmacy has a number of strong options for working with depressive illness. Plant medicines are potent allies for patients with depression and are typically less risky than pharmaceuticals.

Honored as the most-studied herb of all time, Saint-John's-wort is a five-petal yellow flowering plant notable for its effectiveness
in treating mild to moderate depression. Saint-John's-wort was originally gathered to ward of evil spirits; in fact, its Latin name,
Hypericum perforatum
, means “above a ghost.” It is now becoming one of the world's standard antidepressant treatments, according to an article in
CNS Drugs
.

Despite numerous studies, researchers still don't fully understand why Saint-John's-wort effectively treats depression. Initially it was believed to work like the first drugs used for depression, monoamine oxidase inhibitors (MAOIs), which act by slowing the breakdown of neurotransmitters. But later studies suggested it stops the breakdown of the feel-good neurotransmitter acetylcholine, has a serotonin-like activity, or acts like a weak SSRI with fewer side effects. It also gently balances other neurotransmitter levels, including norepinephrine and dopamine, as well as the calming gamma-aminobutyric acid (GABA). It may also encourage production of thyroid hormone. And still other studies show this wonderful herb to have digestive, anti-inflammatory, and nerve-protective properties. Saint-John's-wort produces many helpful changes throughout the body and likely addresses multiple problems that can collectively cause low mood.

While Saint-John's-wort is best known as an antidepressant, it's history has been to help digestion and the nervous system for a variety of issues. The best depression-related use of this herb is for chronic low mood, the kind that keeps you from being happy but not so bad that you can't get out of bed in the morning. The medical term for this is dysthymia.

Two well-publicized clinical studies suggest Saint-John's-wort is worthless for depression. When these studies came out, the media gleefully reported that Saint-John's-wort does not work for depression. One of these studies was an eight-week trial that used low doses of 900 mg per day for patients with severe depression. If there was no response to the treatment, doses were increased to 1,200 mg per day. A similar study used 1,800 mg to reach any improvement.

Given that these trials were funded by a company that manufactures antidepressants, and after a strong history of positive Saint-John's-wort studies, I doubt these publicized studies are valid. My sense is the odds were stacked against the herb by the use of severely depressed patients, the short term of the studies (Saint-John's-wort can take up to twelve weeks to become fully effective), and the small doses. A second eight-week study from 2002 made a similar low dose error. A valuable note in this study is that the comparison drug, sertraline (Zoloft), a drug with a much stronger side-effeet profile, was still not any more effective than the underdosed Saint-John's-wort or the placebo.

The most recent meta-analysis of Saint-John's-wort is a 2008 study from Munich. It reviewed twenty-nine high-quality trials that included a total of 5,489 patients with major depression and compared extracts of Saint-John's-wort with placebo or standard antidepressants including fluoxetine (Prozac), sertraline (Zoloft), imipramine, eitalopram (Celexa), paroxetine (Paxil), and amitriptyline (Elavil). The studies came from many countries and tested several different Saint-John's-wort extracts. The Saint-John's-wort extracts tested were superior to placebo, and were at least as effective as standard antidepressants. Furthermore, patients given Saint-John's-wort extracts were less likely to drop out of trials due to adverse effects. A very recent study goes on to suggest that side effects of pharmaceutical antidepressants are between ten and thirty-eight times higher than those of Saint-John's-wort.

Saint-John's-wort dosage usually ranges between 900 mg and 1,800 mg of standardized extract, divided into three doses throughout the day. However, some literature suggests one or two doses a day can be as effective. Common tincture doses range from
20 to 60 drops three times a day of a 1:5 tincture (1:5 stands for the concentration of the whole herb in the liquid). Extracts (which are more concentrated forms) from fresh herb are typically dosed 5 mL two to three times a day. Please check the label of what you are using to check for the type of medicine and concentration.

I typically recommend my patients use a capsule or tablet form standardized for 0.3 percent hypericin. Your label mentions this if it's prepared this way. While hypericin is useful as a standardization, there are many important chemical constituents in this herbal medicine. I enjoy using liquid tincture forms of herbs. If you do too, then look for a liquid tincture that reveals a deep-red color and a nice, potent aroma.

For elderly patients or those with preexisting conductive heart dysfunction, high-dose hypericum extract has been found to be safer with regard to cardiac function than tricyclic antidepressants.

Side effects of Saint-John's-wort are minor, especially when compared to antidepressant medications. Although not reported as a concern with Saint-John's-wort, symptoms of serotonin syndrome (see the discussion in the tryptophan section) should be considered and monitored when combining Saint-John's-wort with antidepressant medication, tryptophan, or 5-HTP.

It has been shown that Saint-John's-wort can either enhance or reduce the circulating levels of other drugs. As a result, it's important to check with your doctor or pharmacist before you start Saint-John's-wort if you are taking medications. There are many medications that may interact that we do not know about, so I recommend against using Saint-John's-wort if you are not sure. Saint-John's-wort is known to impede the effectiveness of the following medications:

Anticoagulants: Phenprocoumon, Warfarin (Coumadin)

Anti-anxiety medications: Xanax (alprazolam)

Antidepressants: Elavil (Amytriptyline)

Antihistamines: Fexofenadine

Birth control pills

Blood pressure medications: Verapamil

Cancer drugs: Irinoteean, Topo II-poison chemotherapy regimens

Cholesterol-lowering medications: Simvastatin

Diabetes drugs: Tolbutamide

Heart medications: Digoxin

HIV medication: Indinavir, Nevirapine, Protease inhibitors

Immune suppressors: Cyelosporine, Tacrolimus

Opiates/addiction drugs: Methadone

Respiratory drugs: Theophylline

Sedatives: Midazolam

On the other hand, new research reports that Saint-John's-wort may even be helpful with certain medications. Plavix is a drug given to many patients who have heart problems to lower clotting effects. About 20 percent of patients who use it do not find any benefit. One study gave 300 mg of Saint-John's-wort three times a day to patients who hadn't been responding to Plavix and found it helped the drug work 36 percent better. This study also noted that patients on medications to lower cholesterol had no negative changes in their cholesterol levels.

Historically, Saint-John's-wort is particularly useful for patients with feelings of isolation, lack of community, and separation from the rest of the world. It's a wonderful wound healer and gently calms nervous individuals. In my practice, I find that depression dysthymia patients often do the best with this herb. If you can get out of bed and function at a job but are generally low in mood, self-esteem, and zest for life, this may be a good herb for you.

Used principally as an aromatic essential oil for relaxation, lavender oil in a daily bath can improve mood, reduce aggression, and aid with a more positive outlook. Oral forms of lavender taken with the antidepressant Tofranil (imipramine) were found to be more effective in the treatment of depression than either approach alone, according to a double-blind randomized control trial. This study's double-treatment group took 100 mg of imipramine plus 60 drops of a lavender tincture per day. The findings of this study suggest that taking a moderate amount of lavender may help reduce the amount of tricyclic antidepressants needed to treat depression, leading to fewer side effects. Other studies show taking 80 mg a day of lavender extract is a potent anti-anxiety remedy, comparable to Ativan. Lavender taken orally has also been used traditionally to help spur motivation in people with low mood.

If patients with depression also have significant anxiety, I recommend they place a few drops of essential oil in the bath with some Epsom salts and take a separate lavender tincture at 30 drops three times a day. Lavender can also be taken as a tea by using 1 or 2 teaspoons of dried lavender flowers per cup of water. This is especially good for a nervous, upset stomach.

Essential oils are not to be ingested. Tinctures and teas are effective oral forms of lavender. There are no problems with toxicity when lavender is in the proper form.

Adaptogens are plant substances that neutralize low or high levels of hormones and neurotransmitters. Classified as an adaptogen,
Rhodiola rosea
was originally observed in Russian literature as a
plant medicine useful to combat physical, biological, and chemical stressors. Looking at a very unique molecule in Rhodiola called rosavin, one mouse study published in
Phytotherapy Research
journal showed both antidepressant and anxiety-reducing effects.

One Armenian clinical trial assessed the efficacy of Rhodiola standardized extract for patients with mild to moderate depression. Over a six-week period, patients taking 340 mg to 680 mg per day found a striking reduction in overall depression over placebo. out of all the mood parameters tested, the only one not affected for the better was self-esteem (which is an important one). However, when the dose was increased to 1,340 mg per day, self-esteem also improved significantly. Other research used Rhodiola effectively with tricyclic antidepressant medications and demonstrated a significant reduction in medication side effects and a positive influence on psychopatho-logical symptoms in subjects with psychogenic depression.

Dosages of 340 mg to 1,340 mg a day have been used with no tox-icities reported. Rhodiola may be standardized for 1 percent of the molecule rosavin. Other studies have used Rhodiola for up to four months without side effects. Longer-term studies of this adaptogen are needed, but what we know so far seems to make rhodiola a great choice if you are feeling depressed, anxious, and burned out.

Traditionally used in Persia for depression, saffron is known for its vibrant color and flavor and also for being the world's most expensive spice. With a high amount of carotenoids (which give it its burnt orange color) and B vitamins, saffron has been traditionally used as a sedative, an antidepressant, and an anti-inflammatory. It also relaxes the muscles of the digestive tract, reducing spasms and helping digest food, and enhances appetite.

A number of recent studies indicate that the stigma of the plant (the top of the plant where the pollen is), which is technically
called the saffron, and petal of
Crocus sativus
plant both have antidepressant effects. In a double-blind, randomized trial, forty depressed outpatients were given either a 15 mg capsule of Crocus petal or 10 mg of fluoxetine (Prozac) in the morning and evening for eight weeks. At the end of trial, the Crocus was found to be as effective as the drug. There were no significant differences between the two treatments in terms of the percentage of responders. Fluoxetine (Prozac) had an 85 percent responder rate, and Crocus petal showed 75 percent. Another study compared Crocus petal to imipramine for six weeks and found a significantly better outcome with the herb.

While both petal and stigma have antidepressant effects, Crocus petal is less expensive than saffron. No toxicity has been reported at 15 mg dosages or when ingested in culinary amounts. One study showed that when very high levels of saffron were injected directly into rats' abdomens, the animals showed reductions in red blood cells as well as changed liver and kidney function. It should be noted that these are much higher doses than used clinically, and belly injection doses of any otherwise safe food could cause problems in the body. As a precaution, patients with liver and kidney problems may not want to use this herb if other treatment choices are available.

Mucuna Pruriens hails from traditional use in Ayurvedic medicine, the traditional medicine of India, and has been used since 1500 BC.

Also known as the velvet bean, this herb has not been studied as an antidepressant in people, but some animal studies suggest possible benefit. It is well-known to contain dopamine (more than any other source). Mucuna has been studied for its effectiveness in helping patients with Parkinson's disease, a condition in which the area of the brain that makes dopamine does not function. Three
studies had patients take an average of 45 g of mucuna seed powder extract (which is equivalent to about 1500 mg L-dopamine) per day and reported significant improvements in symptoms. Another study suggested mucuna might have fewer side effects than standard parkinson's medication.