The World Health Organization has predicted that by 2030, more people will be affected by depression than any other health problem. Yet of all the dysfunctions of modern medicine, the way we treat depression may be the worst.
As I outlined in "Are You Depressed, Or Just Human?" normal changes in mood are often labeled as depression, leading to an overdiagnosis of the condition. But even if the patient is truly depressed, the prescribed treatment is almost always limited to a potent pharmaceutical. In other words, a complex, multifaceted problem is frequently treated with an oversimplified, expensive therapy that, sadly, is often ineffective.
The reason? Money. Our profit-driven medical system makes it difficult for doctors to spend enough time with patients to make a correct diagnosis and to craft truly individualized treatments. Also, patients themselves often demand the drugs they have seen advertised, and overworked, harried doctors frequently go along.
There is another reason for this regrettable situation. Many physicians are not trained in other treatment options for depression, though these can be safe, inexpensive and highly effective. So even if both physician and patient favor an alternative to drugs, they often lack the knowledge to employ it.
Whenever I write about mental health and integrative therapies, I am accused of being prejudiced against pharmaceuticals. So let me be clear - integrative medicine is the judicious application of both conventional and evidence-based natural therapies. For some mental health conditions, pharmaceuticals can literally be lifesavers, and they can be all or part of an integrative solution to mental health conditions. The point of integrative mental health is not to exclude pharmaceuticals but to make them one option out of many, so that each patient receives an individualized treatment plan that maximizes reward and minimizes risk. I believe that this commonsense approach will make integrative mental health treatment the preferred modality in the years to come.
At the Arizona Center for Integrative Medicine, the program I founded in 1994 at the University of Arizona College of Medicine in Tucson, we're working hard to promote this. Here are a few of the therapeutic options for depression that we teach.
- Omega-3 fatty acids: Studies suggest that omega-3 fatty acids found in fish oil may be helpful in relieving mild to moderate depression. Fish oil is an excellent source of docosahexaenoic acid (DHA), an essential fatty acid found in nerve and brain tissue. I recommend doses of fish oil supplements in the range of 2,000- 3,000 mg per day of EPA+DHA.
- Vitamin D: Deficiency has been associated with depression, as well as a host of other diseases. I now routinely recommend 2,000 IU of vitamin D daily, taken with the largest meal.
- St. John's wort: This herbal remedy that has long been used in Europe as a treatment for mood disorders. Standardized extracts have shown an effectiveness greater than that of a placebo in the treatment of mild to moderate forms of depression. It should not be taken with anti-retroviral medications, birth control pills, or antidepressant medications, especially SSRIs such as Prozac or Celexa. Try 300 mg of an extract standardized to 0.3 percent hypericin, three times a day. Its full effect will be felt in about eight weeks.
- SAMe: A synthetic version of a derivative of the amino acid L-methionine, S-adenosyl-L-methionine (SAMe) was judged "superior to placebo and is as effective as tricyclic antidepressants in alleviating depression" in a November, 2002, article by Harvard researchers published in the American Journal of Clinical Nutrition. It has the advantage of working more quickly than St John's wort. Use only the butanedisulfonate form in enteric-coated tablets, or in capsules. Try 400 - 1,600 mg a day on an empty stomach.
- B vitamins: The B vitamins, especially folic acid and vitamin B6, may be helpful in mild depression, and B vitamins can increase the efficacy of prescription antidepressants.
- In addition, follow an anti-inflammatory diet and include an antioxidant multi-vitamin/mineral supplement to ensure you are meeting your nutritional needs for all the essential nutrients.
- Aerobic exercise: For more immediate, symptomatic depression treatment, there is no better method than regular aerobic exercise. Several studies have demonstrated the efficacy of a daily workout for improving emotional health and boosting self confidence. I recommend 30 minutes of continuous activity, at least five days a week for best results.
- Phototherapy: Shorter daylight hours can affect sleep, productivity and state of mind. Light therapy, also known as phototherapy, may help. It uses light boxes emitting full-spectrum light to simulate sunlight. Phototherapy has been shown to have positive results for people with Seasonal Affective Disorder (SAD), women with severe premenstrual syndrome, bulimics, and as a non-drug treatment for pregnant women and others suffering from depression. A meta-analysis has supported modest benefit when compared to placebo for non-seasonal depression.
- Acupuncture: The World Health Organization has recognized acupuncture as effective in treating mild to moderate depression.
- Massage: Massage therapy has been shown to relieve depression, especially in people who have chronic fatigue syndrome; other studies also suggest benefit for other populations.
- Psychotherapy: Find a psychotherapist, mental health professional or grief counselor who can help you explore the factors that may be contributing to your depression, and who can suggest methods of understanding and changing habitual thought patterns to facilitate recovery. Cognitive behavioral therapy can be especially helpful.
- Other mind-body therapies: Yoga, hypnosis, meditation, mindfulness training, "news fasts" and conscious efforts to socialize and bond with people and companion animals may all be of value, and are low-risk.
I don't want to trivialize these approaches by implying that they can be adequately conveyed in one blog post - the information listed above is by no means complete, it is meant only as an overview of some therapies for further exploration and inquiry. Also, keep in mind that while depression may be on the way to becoming the most often-diagnosed mental health problem worldwide, integrative specialists are also investigating the diagnosis and treatment of other mental health conditions including anxiety, psychosis, dementia, substance abuse and sleep disturbances.
So for those who seek in-depth knowledge in the broad, burgeoning field of integrative mental health, here are three resources I recommend highly:
- Textbook of Integrative Mental Health Care by James Lake, M.D. The prime reference in this growing field. Dr. Lake's book brilliantly summarizes evidence-based integrative interventions that may be unknown to many physicians.
- 2010 Integrative Mental Health Conference, March 22-24, 2010, Phoenix, Arizona. This is the first conference of its kind to assemble leaders in integrative mental health, creating a new field and framework in which to promote mental wellness.
- The "Depression," chapter in David Rakel, M.D.'s, excellent reference text Integrative Medicine.