Beyond Prozac: Natural Therapies for Anxiety and Depression
In any daily radio show on WOR- Radio, I get hundreds of calls from people who have heard about various natural products that can help with symptoms of anxiety and depression, and want to know what they are and if they can help. The calls that come to me are just the tip of the iceberg. In fact, I think we are seeing something approaching epidemic levels of anxiety and depression. If the magnitude were not enough, the problems of anxiety and depression are further complicated by doctors who are inadequately trained or who tend to prescribe a hot new anti-depressant like Prozac for everyone (whether they need it or not) or the standard Valium-type drugs that have addictive potential and potentially dangerous side effects.
The fact is, there are much better alternatives for people who suffer from chronic symptoms of anxiety or depression. In this article, we will look at the symptoms of anxiety and depression and how they have become pervasive in our modern world. We'll examine some of the remedies that conventional medicine has to offer, and detail some of their negative and dangerous effects. Finally, we'll discuss some of the safe and effective natural alternatives.
Anxiety and Depression: The Shadow Syndromes Haunting America
Millions of Americans suffer from biological illnesses that directly affect their emotional equilibrium and state of mind. At least 13 million Americans suffer from anxiety disorders including long-term chronic anxiety, panic attacks, and obsessive-compulsive disorders. Millions more suffer from depression.
There is new awareness as never before that anxiety is a pervasive health problem in the United States. The medical profession, psychiatric profession, and governmental agencies are taking action to alert people to the possibility that they may be suffering from an anxiety disorder.
While many who suffer from anxiety disorders or depression seek out help, many others suffer without ever getting the help they need. The stigma of mental illness keeps many from seeking help. People suffering from low-grade depression may feel that they should just "tough it out." Others may feel constantly on edge, stressed, and irritable on a daily basis. Yet they may never experience a crisis that causes them to seek help. Many may also feel skeptical of the ability of a psychiatrist or psychotherapist to help them. At the same time, they may feel that it's not appropriate to bring up depression or anxiety with their internist or primary care physician.
While doctors and clinics are increasingly attentive to anxiety and depression, there are questions about whether those who do seek out help really get the help they need. Only about eight percent of dollars spent on mental health goes for psychotherapy¢the overwhelming majority of the money is spent on office calls from the prescribing and monitoring of drugs. Many of these drugs¢antidepressants, tranquilizers, and the like¢are not prescribed by experienced psychiatrists or psychopharmacologists. And they are not prescribed on the basis of a careful, in depth diagnostic work-up. Rather, in most cases, they are dispensed by primary care physicians who on average spend just three minutes or less with their depressed patients. Beyond the issue of how much care and attention is given to the prescribing of standard psychoactive drugs, there are also questions about their safety and effectiveness.
The Shapes of Unhappiness
Anxiety disorders and depression have been classified and named to aid diagnosis and treatment. Some of the common disorders that may occur in full-blown form or as a "shadow syndrome" include:
Panic Disorder. More than 3 million Americans are estimated to suffer from panic disorders which are brief episodes of overwhelming physical symptoms, including chest pain, racing heart, difficulty breathing, and nausea. They may associate it with certain experiences, such as air travel or being in a crowded elevator.
Persistent Anxiety. Also known as generalized anxiety disorder (GAD). This condition affects more than 10 million Americans¢and it is associated with chronic worry and anxiety, without a clear external cause. It can go on for months for years.
Obsessive-Compulsive Disorder (OCD). People with OCD are plagued by recurring, obsessive thoughts and urges. They find themselves compelled to perform obsessive, repetitive activities. These urges and behaviors can cause unnecessary anxiety, distraction and frustration, and can interfere with work and daily life. People with persistent anxiety can experience emotional stress, constant worry, irritability, tension, jumpiness, feelings of being keyed up or on edge, feelings of helplessness, and difficulty falling asleep. The anxiety may or may not be tied to serious stress-causing events. It can persist as a constant state of low-level anxiety and fearfulness that seizes on the uncertainties of daily life and blows them out of proportion. People may even realize that they are "worrying for nothing," without knowing what to do about it. Or they may decide that perhaps they are just working too hard, and conclude that there is no reason to see a doctor or therapist. But they continue to suffer.
It is estimated that twelve million people in the United States and 1.2 million people in Canada suffer from depression and do not know it. There is an increasing public acceptance of clinical depression as a biological illness. At the same time, patients' denial of their predicament and primary care physicians' ignorance about it result in critical delays in treatment. Clinical depression is not the same as "feeling depressed," but is identified by such factors as: poor appetite/weight loss (or conversely, increased appetite and weight gain), decreased physical activity (or conversely, hyperactivity), loss of pleasure in usual activities, decrease in sexual drive, feelings of fatigue and loss of energy, feelings of worthlessness or guilt, difficulties concentrating or making decisions, recurring thoughts of death or suicide. Depression exists along a spectrum; there are more severe cases and milder cases. Mild depression is sometimes called dysthymia.
What is not commonly understood is that depression can be accompanied by extreme anxiety. The common picture of depression is of someone who sits motionless all day in a darkened room. Nevertheless, symptoms of nervousness, agitation, and insomnia are common to both depression and persistent anxiety, and can complicate diagnosis and treatment.
What Causes Anxiety and Depression?
Increasingly, researchers are suggesting that when people suffer from anxiety and depression, it's because the biochemistry of the brain has somehow gone "out of balance." According to one theory, depression is caused by a biochemical deficiency in various amino acids that are components of the brain's chemical neurotransmitters. Studies suggest that neurotransmitter imbalance, especially a deficiency in serotonin, may contribute to disorders such as OCD.
Hormonal imbalances can also affect brain chemistry and the central nervous system, especially the hormones released by the adrenal glands, which include cortisol, DHEA, and the stress hormones, adrenaline and noradrenaline. The stress hormones seem directly involved in panic attacks, even if it is not entirely clear what triggers their release. Some people may simply be "wired differently," with a volatile, unstable adrenal response, as if set on a hair-trigger In the case of an exaggerated response, flooding their system with stress hormones. In seconds, these hormones can raise blood pressure, and produce dry mouth, cold hands and feet, a cold sweat, butterflies in the stomach, a racing heartbeat, shortness of breath, and feelings of anxiety. These scary symptoms can prompt an even greater release of stress hormones, producing a kind of meltdown of the nervous system that we call a panic attack.
Physicians are increasingly using psycho-active drugs that affect neurotransmitters in the brain in order to treat anxiety disorders as well as depression. Psychoactive drugs sometimes enhance the effects of neurotransmitters, and sometimes alter the process of breakdown and re-uptake. There are also a number of natural substances that appear to affect neurotransmitter balance in the brain. For example, the vitamin inositol is a component of other compounds linked to serotonin and adrenal signaling. Inositol may affect both brain chemistry and the activity of the adrenal response.
While the biochemical model of anxiety and depression is gaining dominance, other explanations persist. Freud's psychoanalytic theory, based on the influence of childhood and traumatic experience, was the first. Psychoanalysis offers intriguing explanations, and makes dramatic connection. Many people do seem to have been helped by "the talking cure." Still, psychoanalytic theory remains difficult to prove in the scientific sense. It is an interesting fact that psychiatrists are increasingly turning to the use of psychoactive drugs as an adjunct to analytic therapy.
Cognitive and behavioral scientists offer another explanation for anxiety and depression. They suggest that these disorders arise from a collection of bad mental habits, ingrown ways of thinking and reacting that produce emotional disturbance and physiological symptoms. While psychoanalysts try to figure out why a person got the way they are, behaviorists don't pay so much attention to this. Rather, they try to identify the present mental habits that cause the problems. Cognitive therapy retrains people to think differently about their experiences, so that they don't add to their own anxiety or depression. It has been especially useful in treating mild depression and anxiety disorders including panic disorder and phobias.
Recent behavioral research has produced some fascinating insights, including the "learned helplessness" model of depression. In the 1960s, Martin Seligman, Ph.D., performed a series of animal experiments that showed that animals that received an electric shock, but could somehow turn it off, could manage this kind of stress without ill effects. By contrast, animals that received the shocks but could not control them would just lie down without even making an effort to escape.
Further research revealed that the animals who had learned to be helpless actually showed changes in their brain chemistry. Giving them psychoactive drugs restored their neurotransmitter balance, and also caused them to try again to exert control over their environment. In these cases, an environmental influence had caused a persistent alteration in brain chemistry. In his book, Learned Optimism, Dr. Seligman offers a self-help plan based on cognitive therapy to help people overcome the depression that accompanies negative thoughts.
Finally, there may be underlying physical causes of anxiety or anxious depression that have to do with nutrition or metabolic imbalance. These can include:
Hypoglycemia or "Sugar Disease"
Food allergies and intolerances
Use of nicotine, caffeine, alcohol, and other drugs
A conscientious primary care physician should really consider all these factors when a patient appears speaking of depression or anxiety. Unfortunately, this cannot be done in the three to four minutes that it takes to prescribe a psychoactive drug!
Treating Anxiety and Depression -- What Conventional Medicine Has to Offer
Since the 1960s, a revolution has taken place in the conventional treatment of anxiety and depression¢a drug revolution. Prior to this time, "talk therapy" was the primary tool for treatment.
During the 1970s, cognitive therapy came into vogue. But the major shift was toward drug therapy with psychoactive drugs. New drugs, called benzodiazapines, were initially introduced to treat anxiety. Later came new drugs for depression, called tricyclic antidepressants. Psychiatrists gradually became more and more enamored of drug therapy. They were soon prescribing antidepressants and antianxiety drugs in record numbers. But in the 1990s, drug therapy became the primary medical treatment for anxiety and depression. This is partly a reflection of the harsh economic reality of managed care.
Types of Psychiatric Antidepressants
Tricyclic antidepressants (Tofranil, Elavil, Sinequan)
Monoamine oxidase inhibitors (MAOI) (Nardil, Parnate)
Selective serotonin reuptake inhibitors (SSRI's) (Prozac, Zoloft, Paxil)
Other agents (Wellbutrin, Effexor, Serzone)
Benzodiazapines (Valium, Librium, Xanax, Ativan, Restoril, Halcion)
Obsessive-Compulsive Disorder Treatment
Tricyclic antidepressant (Anafranil)
SSRIs (Prozac, Zoloft, Paxil, Luvox)
Non-benzodiazapine antianxiety drugs (BuSpar)
Monoamine oxidase inhibitors (Nardil)
Panic Disorder Treatment
Tricyclics (Tofranil, Norpramin, Pertofrane, Aventyl, Pamelor)
Benzodiazapines (Xanax, Klonopin, Ativan)
SSRIs (Prozac, Zoloft, Paxil, Luvox, Effexor)
From: Gorman, Jack M., MD. The New Psychiatry. N.Y.: St. Martin's Press, 1996.
The shift toward drug therapy has not been without controversy. The benzodiazapines, including Valium and Librium, were widely prescribed in the 1970s for anxiety and insomnia, and were often abused. They are still in use, and sometimes prescribed for depression in concert with other drugs. They are not intended for long-term use, since they are addictive, associated with numerous side effects, and cause abnormal sleep patterns. Side effects can be severe in combination with alcohol.
Benzodiazapines can cause a morning "hangover" effect, and side effects can include memory impairment, nervousness, confusion, irritability, and even increased depression. Stopping the drug after continued use can cause dangerous withdrawal symptoms, including anxiety, irritability, panic sensations, insomnia, seizures, and paranoia. Many health care professionals make the common mistake of treating anxiety exclusively with benzodiazapines. They do quench anxiety in the short term, but ultimately can worsen the problem.
If Valium was the miracle tranquilizer of the 1970s, Prozac became the star antidepressant of the 1990s. Launched in 1987, it has become the most widely prescribed (and most profitable) psychiatric drug, with over one million prescriptions written for Prozac each month. Prozac is one of the new category of antidepressants called "selective serotonin re-uptake inhibitors," or SSRIs. It is prescribed for a breathtaking range of disorders from anxiety to depression to obsessive-compulsive disorder. Initially, the media touted Prozac as a major breakthrough in treatment of depression. Psychiatrist Peter Kramer's enthusiastic book Listening to Prozac climbed to the New York Times best-seller list. Dr. Kramer touted Prozac as a "personality pill" that could help a normal person develop a more "socially rewarding personality."
As with Valium, a more careful assessment is being made of this drug. While Prozac is sometimes remarkably effective in alleviating depression and anxiety, it is also associated with many side effects. According to clinical trials published in the International Journal of Psychopharmacology, 21% of patients taking Prozac experience nausea, 20% headache, 15% anxiety and nervousness, 14% insomnia, 12% diarrhea, 9.5% dry mouth, 9% loss of appetite, 8% sweating and tremor, and 3% rash. Sexual side effects are common with Prozac, including delayed ejaculation in men and inability to achieve orgasm in women. These are frequently cited by patients as reasons for discontinuing medication.
Controversy has raged over whether Prozac has the ability to prompt suicide or violent behavior. A few celebrated criminal cases invoking the "Prozac defense" have cast doubt on the safety of Prozac, although admittedly Prozac users may be inherently predisposed to mental instabilities and impulsivity. Concern has been raised, too, over the long-term effects of Prozac use. Study data is scant but one researcher, L.J. Brandee, has detected increased tumor growth in animals given Prozac at doses comparable to those given to humans.
In the final analysis, I must say that I'm disturbed to see physicians freely prescribing dangerous drugs with known side effects to treat anxiety and depression, when there are safe natural alternatives.
Alternative Approaches to Quelling Anxiety and Relieving Depression
There are some natural alternatives to medical psychoactive drugs that could be used with benefit by people who may be suffering from either clinically-diagnosed disorders or subclinical "shadow syndromes." Let's look at two primary alternatives: natural pharmacology, and nutritional support.
Nutritional and Natural Pharmacology
For centuries, traditional healers and shamans in cultures around the world have known of the psychoactive properties of certain plants and herbs. Herbs such as St. John's Wort, valerian, chamomile, and hops have been prescribed for anxiety in Europe. We are now adding new botanical herbal remedies such as kava from the Pacific islands. Further, medical researchers are finding that some natural nutrients have pharmacological effects when given in large doses. This is not the same as using nutrients for supplementing the diet, or preventing deficiency, but as an alternative to medical pharmacology. Nutritional pharmacology employs substances that are part of the body's own natural pathway. One natural nutrient, Inositol, has shown promise in treating depression, panic disorder, and OCD, without risk of side effects.
In the 1960's, Carl Pfeiffer, a pioneering physician and researcher at the Princeton Bio-Brain Institute, was treating patients with mental disorders when he made a curious observation. He noticed that patients who took Inositol supplements displayed BBG images of brain waves that looked like the brain waves of patients who took Librium, a potent tranquilizer.
More recently, researchers found that Myo-Inositol occurs in reduced levels in the brains of those suffering from depression. This spurred Dr. Joseph Levine, Dr. Yoram Berak, Dr. Mirtha Gonzalves and others at two major mental health centers in Israel to engage in pioneering research in to the benefits of Inositol. Their research, published in the American Journal of Psychiatry, showed that treatment with Inositol could actually cause improvement in symptoms of depression. In Levine's study, 12 grams daily were given to patients suffering from treatment-resistant depression. By the fourth week, patients experienced significant improvement in mood, insomnia, anxiety, agitation, and hopelessness.
Following up on these promising results, Dr. Levine, along with Dr. Jonathan Benjamin, Dr. Mendel Fux and others, prepared another study to investigate possible beneficial effects of Inositol in treating panic disorder and obsessive-compulsive disorder. They found that 12 grams daily of Inositol reduced the incidence and severity of panic attacks. Doctors Fux, Levin, Alex, Aviv, and R.H. Belmaker continued these investigations at the Ben Gurion University of the Negev, Israel, and found that 18 grams daily of Inositol brought about measurable improvement in the symptoms of obsessive-compulsive disorder. These studies were also published by the American Journal of Psychiatry.
Interestingly, Inositol seems to affect the same paths of brain chemistry as Prozac and Zoloft, but without the side effects of those drugs. In the controlled Israeli studies of more than 100 patients, no significant side effects were noted. Inositol has been used safely in Europe for years as a remedy for anxiety and depression.
Inositol is a natural food component found in fresh fruits and vegetables, beans, grains, nuts and meat. White people generally consume a gram a day in a normal diet, the doses needed to have a pharmacological effect are much higher -- from 12 to 18 grams. It would be tough to derive enough Inositol from the diet to affect anxiety or depression.
It can sometimes even be difficult to obtain sufficient quantities of Inositol from health suppliers. The "Stress B" tablets generally contain only about 50 mg of Inositol. This is nutritionally supportive but inadequate to achieve the anti-anxiety or anti-depressive effect. There are Inositol tablets available in 500 milligram dosages, but it would take 30 tablets to reach the daily dose for treating anxiety. And, while Inositol powder is more manageable it may be difficult to find. There's also the issue of taking a measurable, accurate dose.
While Inositol is probably the first choice in the treatment of anxiety and depression, there are other natural psychoactive compounds that have traditionally been used to relieve symptoms.
Kava (Piper methystieum) has been shown to be useful in dampening the symptoms of anxiety without the risk of reducing alertness or of addiction. Studies have shown that kava-kava can be as effective as Valium-type drugs in reducing anxiety. Dosage:100-200 milligrams of the standardized preparation of kava lactones per day.
Valerian (heliotroge), calms the central nervous system, relaxes smooth muscle tissue, and is effective for insomnia, with no morning after-effects. Valerian should only be used on occasional basis, or for acute conditions, since prolonged used can cause side effects of melancholia or hysteria, or in rare cases, hallucination. Dosage: The effective dose can vary widely -- 2-10 ml tincture of Valerian may be effective.
St. John's Wort (Hypericum perforatum) Products using hypericin, the active ingredient in St. John's Wort, account for more than 50% of the anti-depressant market in Germany. In a landmark study, researchers from Germany and the United States reported that in thousands of patients with mild to moderately severe depressive disorders, hypericum was just as effective as standard antidepressants. But without the side effects.
Other alternative remedies (and brands) include Kavatrol (Naicol), a standard potency kava extract; St. John's Wort (Enzymatic Therapy, PhytoPharmica), a standardized .3% hypericin source, and Valerian (Solgar Laboratories), a standardized extract containing .8% valerenic acid plus raw valerian root powder. These are generally available in health food stores and nutritional catalogs.
Over the past one hundred years, Americans have experienced a radical change in diet, from fresh, unprocessed foods to highly processed food products that have been largely stripped of vitamins and loaded with sugar and salt. While we don't often see full-fledged vitamin deficiencies, we've created a world in which foods are not supplying the basic nutritional components our bodies need. On top of this, people consume quantities of caffeine, alcohol, and simple sugars that can strip nutrients from the body. Not everyone has the same amounts of nutrients, but it's safe to say that many Americans are suffering borderline and subclinical deficiencies. Not surprisingly, these include deficiencies of key nutrients that are linked to the health and balance of the nervous system.
The B complex vitamins are especially important in warding off anxiety and depression. Among other things, they can reduce high levels of lactic acid in the blood that are associated with anxiety and panic attack. (Infusing lactic acid into the blood can directly induce the panic response in experimental volunteers.) Alcohol, caffeine and sugar all contribute to higher lactic acid levels, and the B vitamins niacin (niacinamide) and thiamine can help reduce them.
Vitamin B1 (Thiamine)is an essential B vitamin related to nervous system balance. Studies have shown that thiamine deprivation can induce such symptoms as fearfulness, depression, agitation, emotional instability, and psychosomatic complaints. Recommended as a dietary supplement:: 75-100 mg/day.
Vitamin B 3 (Niacin or Niacinamide) has been shown in experimental animal studies to have an anti-conflict, anti-aggressive, muscle relaxant and hypnotic action, with effects similar to those of the benzodiazapine tranquili-hypnotic action, with effects similar to those of the benzodiazapine tranquilizers. It has been used in large doses to treat symptoms of schizophrenia. This must be done under a physician's supervision because mega-doses can affect liver function.
Recommended supplemental dosage: 50-100 mg 3 times daily.
Vitamin B6 (pyridoxine) can favor the production of higher levels of the neurotransmitter serotonin in the brain, which are linked to relaxation and sedation. (Prozac and Prozac-like drugs are prescribed to achieve the same effect.) It has been used in the treatment of such neural disorders as carpal tunnel syndrome and hyperventilation syndrome.
Recommended supplemental dosage: 75-100 mg/day.
Inositol, discussed above, is considered on of the essential B vitamins, even when not used pharmacologically.
Recommended supplemental dosage: 3-6 grams/day.
Magnesium is probably the most significant non-B complex nutrient for nervous system balance. Magnesium deficiencies are associated with migraine headaches and are common in people with epilepsy and mitral valve prolapse. Magnesium plays an important role in maintaining breathing patterns and managing reflex muscle tension. Magnesium deficiency increases the level of circulating adrenal hormones that can contribute to panic attack, predispose to hearth arrhythmias, and contributes to disregulation of the immune system and the autonomic nervous system. People with hyperventilation syndrome often have magnesium deficiencies.
Recommended supplemental dosage: magnesium oxide or magnesium citrate, 50-200 mg 2-3 times/day. Diarrhea is a possible side effect.
Magnesium and the B vitamins are derived from animal protein or complex carbohydrates in the diet, so eating refined flours and sugars, or an ultra-low-fat diet, can induce deficiencies.
Excess sugar in the diet depletes B vitamins, especially thiamine. Alcohol depletes both magnesium and thiamine.
Natural Antidepressants and Anti-Anxiety Remedies
Inositol Plus' (Advanced Nutritional Products) is an exciting new alternative treatment based on cutting edge research into the benefits of Inositol for treating anxiety and depression. This is a completely new therapeutic approach, which provides Inositol therapy in a nutritional pharmacological dose, plus nutritional supplements vitamins B3 (niacinamide), B6 (pyridoxine), and magnesium. Inositol Plus' supplies pre-measured effervescent packets of 4 grams of powdered inositol that can easily be dissolved in water for three times daily use. Until recently, this was not a practical recommendation, since taking four grams of Inositol would require consuming scores of capsules or Inositol powder in unmeasured dosages. Inositol Plus' has been developed by Advanced Nutritional Products (1-888-436-7200).
Other alternative remedies (and brands) include Kavatrol (Natrol), a standard potency kava extract, St. John's Wort (Enzymatic Therapy, PhytoPharmica), a standardized 0.3% hypericin source; and Valerian (Solgar Laboratories), a standardized extract containing .8% valeric acid plus raw valerian root powder. These are generally available in health food stores and nutritional catalogs.
By Ronald Hoffman