Natural Rx for depression

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Nearly 19 million Americans suffer from depression. EAch year we spend $20 billion on treatment. And yet for mild to moderate cases, help may be as simple as a trip to your fridge or herb garden.

In his gripping memoir, Darkness Visible (Random House, 1990), novelist William Styron called depression "the despair beyond despair." Author Susan Sontag named the dark state of mind "melancholy minus its charms." And philosopher Eric Hoffer, in The Passionate State of Mind (Buccaneer Books, 1997), explained the heaviness of the feeling in this way: "The world leans on us. When we sag, the whole world seems to droop."

In less poetic terms, depression is, simply, the pits. Instead of tasting the sweet fruits of life, you're stuck with its hard, inedible stones. If you've been there, you know how it feels, and many of us have been there--or perhaps one day will go. One in four women and one in 10 men can expect to experience some sort of depressive episode during their lifetime. Nearly 19 million Americans suffer from it right now.

Depression is something way beyond the blues: It's an illness of your brain chemistry that can rob you of sleep, appetite, energy, concentration, pleasure and, most frighteningly, hope. A situational depression is a normal response to a painful event such as divorce, but when the symptoms become unrelenting and linger beyond a month or so, you're considered clinically depressed.

Although its causes are still being unraveled, depression clearly involves an insufficient level of one or both of the crucial neurotransmitters (cell-to-cell brain messengers), serotonin and norepinephrine, which help us sleep and maintain a feeling of well-being. Sometimes depression arrives without an easily identified precipitation, but most times it's triggered by a disturbing life event involving loss. Various theories also connect depression to nutritional imbalances, drug withdrawal, environmental factors and other illnesses, such as hypothyroidism.

Thankfully, though, it can be treated. In the words of Styron, whose own depression nearly drove him to suicide, "Men and women who have recovered from the disease...bear witness to what is probably its only saving grace: it is conquerable." Unfortunately, too many physicians and too many depressed people believe there's only one way to conquer this insidious disease. "As soon as a patient says the word depression, some doctors reach for their prescription pad," says James Gordon, M.D., clinical professor of psychiatry at Georgetown Medical School and author of the best-selling Manifesto for c New Medicine (Addison-Wesley, 1996). "They aren't looking at the psychological issues. Depression is first of all a human experience and needs to be treated that way."

And yet, pharmaceutical antidepressant medications--most notably the serotonin reuptake inhibitors (SSRIs) Prozac, Zoloft and Paxil--are among the most popular medications in the country, ranking 2, 5 and 9 respectively on the top 10 prescription list. As the Lilly company brags in its recent ads, "Prozac has been prescribed for more than 17 million Americans."

These drugs, along with some even newer ones, have definitely helped people with certain types and severities of depression. But at the same time, they may have become too easily prescribed by general doctors (rather than more-qualified psychiatrists), too easily taken by quick-fix seekers and too easily assumed to be the only cure not just for a serious depression but simply for bad moods. And though considered safe, they are not without side effects, including the frequently noted loss of libido or capacity for orgasm. A backlash has begun, as depressed people seek a more holistic, less strictly pharmaceutical road to recovery and a growing cadre of caregivers map out alternative treatment plans for those with mild to moderate depression.

Depression is serious business; it requires careful psychological and physical evaluation, and treatment should be regularly monitored. Patients should also engage in some form of psychotherapy to help heal the root causes that may have triggered the depression. Cognitive therapy, in which you learn to reformulate self-defeating thought patterns, can be especially helpful in preventing relapses.

But there can be a bright side to this ordeal. "I've noticed that people often come to a new understanding and perspective after depression," says Jonathan Zuess, M.D., a holistic physician in Phoenix, Ariz., and author of The Natural Prozac Program: How to Use St. John's Wort, the Antidepressant Herb (Three Rivers Press, 1997) and the forthcoming The Wisdom of Depression (Three Rivers Press). "If it's treated holistically and if the process is respected, you can get life-transforming results."

HERBS
IF PROZAC was the king of antidepressants for the past decade, St. John's wort may wear that crown into the new millennium. The extract from the common flowering weed known scientifically as Hypericum perforatum is already the most popular antidepressant in Germany, where a number of studies have shown it has an effect similar to tricyclic antidepressant medications but with fewer side effects. It's now becoming quite popular in the United States as well.

Take the case of Barbara, 46, a Los Angeles administrator. She began taking St. John's wort to treat severe PMS depression and irritability, as well as a mildly depressed feeling the rest of the time. "I didn't want anything to do with Prozac or anything like that," she says. After a few weeks, she noticed a distinct mood improvement. "I can handle things better; I don't get stuck in a place and dwell on it horribly," she says. "It just lifted the black cloud that seemed to weigh me down."

Next June, the National Institutes of Health is undertaking the first U.S. clinical trial of hypericin (the active ingredient in St. John's wort), but many medical practitioners in this country are already convinced. "It's really a superior treatment for people with mild to moderate depression," says Zuess. "I think the drug companies are going to have a run for their money."

St. John's wort seems to have a serotonin-boosting effect comparable to the SSRIs'. Unlike them, however, it doesn't reduce the sex drive, although there is concern about photosensitivity as a possible side effect among some users (especially the fair-skinned). The optimal safe and effective dosage, as determined in clinical tests, is 300 milligrams (mg.) of hypericum extract (containing 0.3 percent hypericin) 3 times a day. It should not be taken in conjunction with any other antidepressant medications and is not recommended for bipolar disorder (manic depression).

While St. John's wort gets all the press, there are other herbal options for depression according to Lise Alschuler, N.D., chair of the Botanical Medicine Department at Bastyr University, in Bothell, Wash. She recommends kava kava for anxious depression, as it can help people sleep, and ginkgo biloba for those with memory loss and dulled mental functions. Steven Foster; author of Herbs for Your Health (Interweave Press, 1996), adds that black cohosh is a rising star, having shown promise as an antidepressant by increasing energy, calming nerves and encouraging sleep.

NUTRITION
THE OLD CLICHE, YOU are what you eat, may never be more true than when you're blue. "For some people with depression, their moods are definitely affected by the foods they eat," says Alschuler. "They may not be eating enough"--a common symptom of depression--"and therefore aren't feeding their brains, or they may metabolize certain foods in ways that adversely affect their brain chemistry." A depressed person may overeat and/or crave sugar and carbohydrates, which only exacerbates the depression. Those two eating patterns can be related to whether your depression is caused more by a deficiency in serotonin or norepinephrine (the former causing a more agitated depression, the latter a more lethargic one).

Naturopaths believe in treating the cause, rather than just the symptoms, of depression. "Everyone's depression is unique to who they are, so it's important to individually formulate the treatment," says Alschuler. However, some general dietary rules apply to almost all depressions.

Alcohol is a definite no-no. Because it's an overall central nervous system sedative, it actually maintains depression, rather than elevating your mood. It also can increase the level of cortisol, which helps modulate sugar levels in the body causing hypoglycemic (low blood sugar) reactions.

Caffeine is more controversial. Some studies have shown it can elevate mood in depressed people, while others show it aggravates the condition.

Too much sugar can trigger depression because the chemicals that the body releases to modulate sugar levels (cortisol and insulin) can result in a decreased level of the mood-soothing brain chemical serotonin. Caffeine and sugar together can be a double downer.

According to Jay Lombard, M.D., and Carl Germano, R.D., writing in their book The Brain Wellness Plan (Kensington Books, 1997), the optimum eating style for most depressed people is a higher-protein, lower-carbohydrate, low-fat diet eaten in small, frequent meals to keep blood sugar at a steady level. Like Alschuler, they recommend certain nutritional supplements. Vitamin C, for one, enables the body to turn the chemical dopamine into norepinephrine (a key brain chemical that's at a low ebb during depression). Vitamins B6, B12 B12and folic acid also are usually deficient in depressive patients. The authors also suggest adding a tablespoon of flaxseed oil (containing omega-3 fatty acids, which help improve neurotransmitter function) to your daily diet.

CHINESE MEDICINE
WHEN A CHINESE medicine practitioner talks about heart, kidney and lung, forget your Western notions. They're not referring to anatomical organs per se but to a network of functions. "They're responsible for a to-do list in the body," explains Harriet Bienfield, L.Ac., a licensed acupuncturist and coauthor (with Efrem Korngold, L.Ac., O.M.D.) of Between Heaven and Earth: A Guide to Chinese Medicine (Ballantyne, 1991).

In Oriental medicine, depression is related to the heart network, which propels blood through the body and protects a person's inner spirit, or shen. "Shen is the integrative, animating quality we think of as mind or intelligence," says Bienfield, who operates the San Francisco clinic Chinese Medicine Works along with Kornfeld. "We measure shen by the luster of the skin and eyes. When someone's depressed, the eyes lose their shine. One could say that shen is being depressed, or is loosened or separated from the body."

In Chinese medicine, all the body systems interrelate, and the two primary treatments--acupuncture and herbs--harmonize and rebalance them. "They work on the same things by different routes," says Bienfield. "Ideally, you do them together."

From that perspective, depression isn't "as simple as taking St. John's wort," says Bienfield, though she and Korngold do prescribe that herb, along with 2 3 others, including gardenia bud (zhi zi), white peony root (bai shao yao) and white chrysanthemum flower (bai ju hua)--in a special formulation. "I think herbs are helpful for everyone," says Bienfield, "but whether they're helpful enough depends on why you're depressed. If you've had something really hard happen, you may just have to live through the effects of it, and nothing in a bottle is going to be enough."

AYURVEDA
ACCORDING TO THIS ancient Indian medical philosophy (which translates into "science of life"), brought to fame by best-selling author Deepak Chopra, people are believed to be characterized by one of three types of life forces, or doshas: vata, pitta or kapha. A vata is typically wiry, quick and nervous; a pitta is of medium build, smart and a Type-A personality; and a kapha is heavier, relaxed and slow, but possessing great strength and endurance. Depression is different for each dosha too: Vata depression is connected with fear and anxiety; pitta with fear of failure, losing control, or making mistakes; and kapha with fatigue and weight gain.

Ayurvedic practitioners treat depression, then, by attempting to rectify the imbalances in the doshas. They rely on a variety of techniques, from massage and herbs to color- and aromatherapy and yoga. "The root cause of depression is the pressure we put on ourselves," explains Sandra McLanahan, M.D., of the Integral Health Center in Buckingham, Va.

Breathing is a fundamental tool in relieving depression. "When you're stressed, you breathe fast and shallow," says McLanahan. But if you make yourself breathe slowly and deeply, you can actually alter your [brain chemistry] and release tension." More specifically, she says, depressed kapha types should eat more raw and spicy foods, drink spiced tea, get lots of exercise and deep massages and wear red or bright purple. Pitta types need milder foods, mint tea, deep relaxation and blue clothing. And vatas should eat soothing foods like root vegetables, drink chamomile tea, get Swedish massages and wear green or navy blue. She also recommends special Ayurvedic massage for all three types, done with hot herbed oils and buttermilk dropped on the "third eye," located between the brows.

HOMEOPATHY
FOUNDED 200 years ago by the German doctor Samuel Hahnemann, homeopathy is based on the principles that like cures like; that the smaller the dose of a remedy, the higher the potency; and that a prescription should be based on the total picture of a person's physical and emotional health. There are more than 2,000 homeopathic remedies, derived from natural substances, such as flower buds and minerals (read labels, not all are vegetarian), and then successively diluted and "potentized" by shaking. Skeptics say that there's nothing of the remedy left in the highest potency remedies; homeopaths claim that their energy to cure is stronger than ever.

"Once the remedy has delivered its medicine, your immune system kicks into action and begins to heal itself," says Toronto-based homeopath Susanne Engel. "The remedy is like a gentle nudge to get the ball rolling. In homeopathy, less is more. "

The homeopath's "bible," the Materia Medica guide, lists 400 different remedies for depression (homeopaths usually prescribe one remedy at a time, although sometimes they suggest combinations). You can select your own remedies at a homeopathic pharmacy, based on your particular symptoms and personal characteristics, but an experienced homeopath will certainly offer more specific guidance. In any case, these remedies cannot hurt you, as they have virtually no side effects.

... OR TAKE A HIKE
NO MATTER WHAT path you choose to fight depression--Western psychiatry, Eastern medicine, herbalism or homeopathy--you also can take advice and comfort from other treatment plans (as long as you don't mix antidepressant herbs and prescription medicines). Here are some other suggestions for mood-boosting action:

Exercise is a well-documented way to lift your spirits. Aim for a 30-minute workout at least three times a week; every day if possible. Even walking is good.

Get out in the sun! Hormonal balance is profoundly affected by sunlight, says Woodstock, N.Y., herbalist Susun Weed.

Aromatherapy can alter brain chemistry right through your nose. Lavender, for example, induces restfulness. Try floral oils, such as rose, jasmine, neroli, melissa and ylang ylang, and citrus oils, such as grapefruit, lime, mandarin and bergamot. Pick scents that appeal to you. You can inhale scents directly from a bottle, add oils to a bath, or use them (diluted) for a massage.

Bach Flower Remedies, developed by British homeopath Edward Bach in the 1930s, are said to relieve mild depressive symptoms. Extracted from flower essences, they supposedly retune the body's cells to the correct vibrational frequency. Common recommendations include the all-purpose Rescue Remedy, Mustard (for gloom and despair), Wild Rose (for those who have become apathetic)and Walnut (for difficulty adjusting to change).

Bodywork can help you work out the kinks of your depression, so to speak. Massage, chiropractic, Rolfing and Hellerwork are just a few ways to improve your attitude through your muscles.

Do yoga and meditation. Yoga poses improve blood circulation, which might raise you up above the lethargy of depression. Meditation and deep breathing help calm agitated depressions and help you sleep--a crucial component of your healing. Biofeedback is another calming technique that can train you to control your own physiological responses.

Music can be wonderful therapy for depression. Slow and relaxing music might bring calm and foster sleep. Or, choose music that you can sing or dance to!

"Imitate joy," says Weed. "Stand tall, smile with your whole face, and breathe deeply. You will either actually start feeling happier or make your rage/grief more visible and more easily accessed."

Commune with nature. Pick your favorite landscape--ocean, desert or mountains--and feel its energy raise your spirits.

Visit an art museum or attend a classical music concert. Great art has a healing effect.

Surround yourself with favorite things and favorite people. Do more of what you like and less of what you don't like.

James Gordon, M.D., adds a final dimension to this holistic approach to treating depression. "The Hippocratic Oath says, `First, do no harm.' And these therapies are far less likely to do harm [than prescription medicine]. Because depression is accompanied by feelings of helplessness, the very act of doing the therapies improves your self-esteem. Ultimately, it's not a good idea to look to any pill--Western, Eastern or whatever--as an answer. You should look to your life. To depend on any `fix' fosters a sense of dependency and doesn't give you the opportunity to explore what may be missing in your life and what you need to change."

Could It Be the Winter Blues?
IF THE DIMINISHING sunlight has sent your mood into a nosedive for yet another winter, ask yourself some questions. Every year, from October to April, do you....

Experience mild to moderate depression?

Feel tired all the time or have difficulties falling or staying asleep?

Have little or no energy all day?

Crave sugar and carbohydrates?

Lose interest in activities you normally enjoy (including sex)?

Have trouble concentrating or remembering things?

Feel irritable, out-of-it, unproductive?

If you answered yes to three or more questions, you may have Seasonal Affective Disorder (SAD), otherwise known as the winter blues. And you're hardly alone. Some 35 million Americans suffer from SAD. The good news is, studies show that light therapy (spending 20 minutes a day in front of a specially designed light-emanating box) can radically reduce or eradicate symptoms. (Though no one is completely sure, researchers believe the disorder is linked to decreased levels of serotonin or melatonin.) If you suspect you have SAD, talk with your medical practitioner.

PHOTO (COLOR): St. John's wort

PHOTO (COLOR): Exercise

PHOTO (COLOR): Acupuncture

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BY MICHELE KORT

Michele Kort is a Los Angeles--based writer who specializes in health and fitness.

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