Dr. Nicole Sundene, NMD
“What is the best natural treatment for depression?”
Samantha G Scottsdale, AZ
I am very passionate about helping people with depression as a Naturopathic Doctor.
Throughout my lifelong battle with severe depression, natural medicines and alternative therapies are really the only things to help me make significant progress as I share in my story "Why I Became a Naturopathic Doctor." Be sure to also read my blog "Seasonal Depression: Natural Remedies" as I discuss the importance of "Vitamin L" or Light Therapy for mood and lifestyle factors that should always be in place for depressed women.
I personally use a lot of curcumin every day to help my depression. Today we will discuss my other nine favorite natural treatments for depression. Check out my blog all about why I love curcumin and the 17 research studies for pain and depression: "#1 Pain Doctor's Remedy." The reason I love to use curcumin for my mood is it also helps my pain as a Lupus patient. The anti-viral, immune-boosting, anti-cancer and anti-aging properties are my favorite "side effects" of my favorite natural antidepressant.
I am frank about my depression because I see it as a disease just like any other disease, and I don’t see any reason to be ashamed of it.
Nor do I want women to be ashamed of it, especially when it is often imbalanced female hormones to blame. I simply hope I can shed some light on depression for silent sufferers, and inspire them to get help, especially if they don’t respond well to traditional antidepressants. Some patients, such as myself feel no improvement with using an antidepressant because the problem is not low neurotransmitters.
Antidepressants will not help in these cases. I was not receiving any benefits from the dozens of meds I have tried, instead, I just got side effects of weight gain, headaches, and stomachache. After gaining weight on antidepressants I was even more frustrated and hopeless feeling as I shared in my story about “Why I Became a Naturopathic Doctor.”
Alternative medicines, herbal medicines, nutritional therapies, diet, and lifestyle are wonderful complementary approaches to addressing depression over the long haul.
Women with depression may have a hormonal cause if they are experiencing monthly swings in their depression during their PMS window or days 21-25 of their menstrual cycle. Women can keep a period tracker app to watch for this pattern as PMDD-Premenstrual Dysphoric Disorder is a severe depression that occurs monthly for women in their reproductive years. When women suddenly become depressed in their 40's and 50's this also can be from dramatic hormone swings that occur with perimenopause and menopause. Hormones should always be of suspicion when women have depression or anxiety especially when it occurs without situational triggers. If you are struggling with a divorce or death of a loved one that is much different than just random depression that occurs out of nowhere. Depression without triggers indicates a physical imbalance such as with hormones, vitamins, minerals, nutrition, or neurotransmitters.
Specialty testing such as Neurotransmitter Testing and Food Sensitivity Testing can also be game-changers in helping pinpoint the specific treatment the patient needs. With Neurotransmitter testing, I was able to discover that I am low in serotonin and GABA. My body does not make these important chemicals that make people feel happy and calm. Knowing this I was able to target the right amino acids, vitamins and herbs to boost the low levels and finally my mood improved! For instance, 5-HTP helps boost low serotonin production and Passionflower helps to support my low GABA levels that cause insomnia as I discussed in my "Herbal Remedies for Anxiety" blog.
Please do keep in mind when I am discussing depression am doing so generally and you will need to work with your Naturopathic Doctor or BOOK WITH ME to receive optimal natural care. You should ALWAYS work with a professional when treating your depression because the consequences of sub-optimally treated depression can be life-threatening.
Please do not choose to discontinue your natural medicines without the advice of your physician, psychiatrist, or Naturopathic Doctor overseeing your care. Depression is complicated to sort out. Please do not try to do it alone. Someone needs to be documenting your mood fluctuations as well as when you start and stop specific therapies.
Before we get started let’s just be perfectly frank about what natural medicines and herbs will and will not do. Herbs work well for mild, moderate, and situational depression, however they will not likely be solely effective for SEVERE depression. Herbs are a great alternative for people that do not like the side effects of their antidepressant, or that feel they no longer need to be on a treatment as strong as a prescription antidepressant. Herbs are helpful for transitioning all the way off medications and can be used for a period of time after an antidepressant is discontinued to help stabilize the mood. Natural remedies may be helpful for women suffering from pre-menstrual, menopausal, or post-partum depression, however if you are pregnant or breast feeding you should never take any natural remedies aside from vitamins (at standard prenatal doses) unless advised by your physician.
Unless you are actually deficient in a vitamin, mineral, or amino acid that is causing your depression, natural treatments will not likely “cure” your depression, as they have similar mechanisms as medications, and most medications typically only work while you are taking them. Be sure, however, that you are not iron deficient if you are depressed, as a public health study saw a correlation between iron deficiency anemia and depression in young women. Herbs and natural medicines are more gentle than drugs and will thus take longer to work in your system. You therefore have to be PATIENT when working with naturopathic medicines. Most therapies will take at least two weeks to notice an effect. Natural medicines also require the same diligence as daily drugs and should be taken at the same time of day religiously for optimal effect.
Addressing the root cause of your depression with therapy is fundamental to any treatment plan, whether prescription or alternative. If counseling “did not work," please find a new counselor with a different approach or technique. There are so many helpful techniques out there, don’t give up on therapy, give up on the therapist if after three months you do not notice notable improvement. Ask your insurance if they cover an EMDR therapist. I see EMDR helping provide mental health patients the tools they need to cope rather than just talking about the problem.
1. St. John’s wort- Pictured above, the bright yellow flowers of the St. John’s wort plant are full of an oily red substance called hypericin. If you have St. John’s Wort growing nearby you can see the little red spots in the plant (hence the perforations in the name Hypericum perfoliatum), now roll the flowers between your fingers to release the red oils and see the medicine first hand! The red oily hypericin is the active constituent of Hypericum perfoliatum. This herb has been highly studied in many double blind research trials and shown to have significant effects similar to prescription anti-depressants. St. John’s Wort has also been shown to have a lower risk of side effects than conventional antidepressants.
THIS HERB SHOULD NOT BE COMBINED WITH OTHER MEDICATIONS! The reason for this, is that it activates the liver’s cytochrome p450 detoxification pathway and will metabolize drugs at a faster rate, thus moving them out of your system before they likely can have their therapeutic effect. This is why we don’t combine St. John’s wort and birth control pills. I find it interesting that St. John’s Wort works so well for depression and is also such a great detoxifying agent. According to Chinese Medicine most depressed people have “sluggish livers” and thus the liver/bowel meridians are typically treated. St. John’s wort should NOT be used with prescription antidepressants as it has a weak MAOI and SSRI effect similar to the standard activity of anti-depressants and thus may cause adverse effects. Standard dose of St. John’s Wort for those not on any other medications, is 300 mg THREE times daily of the 0.3% standardized extract is what was used in a research study demonstrating efficacy.
2. Schisandra- “Chinese Prozac” is the perfect herb for depressed people that are stressed out and need to lose weight as Schisandra aids fat burning. The berries of Schisandra chinensis improve mood, break up anxiety, support the adrenal glands through their “adrenal adaptogen” properties, enhance libido, and aid the liver’s detoxification.
I would say if you are a stressed out stay at home mom with a low libido and feeling frazzled as an exhausted Mom, then this herb is most likely created just for you! Standard capsule dose is two 500mg capsules taken twice daily. Take in the morning and at lunch. Because of the adaptogen properties, do not take this herb in the evening as we want it to support the adrenal glands when they are the most active. Adrenal gland support is imperative for people “running on empty” and under chronic stress, as the adrenal glands create the “fight or flight” response in the form of cortisol and catecholamines that eventually become burnt out and dysfunctional from chronic stress.
3. Passionflower- I have yet to meet a depressed person that does not have some degree of anxiety, so I am including this gentle nervine relaxant herb on my list so that if you are depressed because you are anxious, you can use Passiflora incarnata to help calm down a bit. From my observations anxiety typically feeds depression forward.
Watch your depression patterns, and if you tend to get REALLY stressed out, and then just crash and burn in to a depressive state, an herb like passionflower might help you more than an anti-depressant herb, or both can also simply be used. Implementing stress management tools like breathing, meditation and yoga is also important for mood. A research study found Passionflower extract at 45 drops daily (tincture) was shown to be as effective as oxazepam (similar to valium).
4. B-vitamins- Now I never prescribe B-vitamins alone without prescribing the WHOLE family. If you have attended dozens of mental health continuing ed lectures after a while you realize that it is all about B vitamins for mental health. There is also no point in prescribing them alone as they rely on each other to work. The family works synergistically together on the Kreb’s cycle to produce energy in the form of ATP as well as serves as very important coenzymes for a ton of other important biochemical pathways. B-12, methylcobalmin (cyanocobalmin is synthetic garbage), for instance is needed for the production of the myelin conductive sheath that insulates the neurons of our nervous system, adequate B-12 is thus critical to a healthy nervous system. B-6, pyridoxine, is imperative for women suffering from PMS, and folic acid has research supporting it’s ability to improve the efficacy of fluoxetine (prozac) in a clinical trial. Folic acid comes from “foliage” so be sure to eat your green leafies too! All depressed people need green vegetables. Be sure you are taking 800mcg of folic acid in the natural form methylfolate in your supplement.
B-vitamins are dirt cheap and can be like water on a wilting plant for a depressed person. A good quality multivitamin is typically what I prescribe to my depressed patients for B-vitamins. A multivitamin is a great insurance policy that nutritional deficiency is not contributing to depression. B-vitamins and standard multivitamin doses are most likely safe to take with antidepressants and most medications.
5. Calcium/Magnesium- Also dirt cheap are a simple quick fix for reducing the stress, muscle tension, and insomnia associated with depression. Most people on the Standard American Diet (SAD) are deficient in magnesium, and some are likely deficient in calcium. A 500mg calcium citrate with a 250 mg magnesium an hour before bed will help replete this likely deficiency while improving quality of sleep at night. Cal/mag is most likely safe to combine with most prescription medications, but always check with your doctor before starting anything new!
Magnesium helps SAMe donate methyl groups to form neurotransmitters, and is also needed for muscle relaxation as well as over 400 enzymatic processes in our body including detoxification pathways and is also beneficial for constipation, muscle cramping, torticollis, acute angina after myocardial infarction, stroke, asthma, kidney stone prevention, dysmenorrhea, premenstrual syndrome, acute gastrointestinal spasms or cramping, eclampisa, heart disease especially cardiomyopathy, diabetes mellitus, nocturnal muscle cramping, mitral valve prolapse, toxemia of pregnancy, fibromyalgia, migraine headaches, lead toxicity, and fatigue.
Calcium is of course necessary for bone and muscle health, optimal functioning of our nervous system and is shown in the research to benefit hypercholesterolemia, hypertension, blood clotting, periodontal disease, insomnia, smooth and skeletal muscle relaxation, anxiety, hyperactivity, lead toxicity, prevention of calcium oxalate stones, prevention of colon cancer, and leg cramps.
6. Omega 3 Fatty acids- although fish oil is likely more efficacious than flax oil, I would experiment with the oil that works best for you. You can read my article on “Fish oil vs Flax oil”. A concentrate of 9.6 grams per day was shown to be effective compared to a placebo in a small pilot trial. Patients in the study were not taken off their current medications. This is one natural therapy you can safely add as an adjunctive to most treatment plans unless you are taking blood thinning medications. I typically prescribe one tablespoon of Carlson lemon flavored cod liver right before a meal, and yes you can take it in capsules if the thought of drinking fish oil makes you gag. Ask your doctor if you can be on 3000mg of Omega-3 fish oil concentrate per day. That is generally what I start my patients on although the research study used three times that amount!
7. 5-HTP- Now most studies have been done on tryptophan, but because of past contamination issues it is tough to get your hands on tryptophan except through diet. 5-Hydroxy Tryptophan is just the new and improved tryptophan, and is a better therapeutic agent in my opinion because it is a biochemical step ahead of tryptophan in the production of serotonin, passing the “rate limiting step” that tryptophan fails to do. This means that 5-HTP can only feed forward in to serotonin and not go backwards in to something else.
With that being said this medicine can be a bit expensive, but is certainly worth a try! Do NOT combine this natural anti-depressant with prescription anti-depressants. I typically prescribe about 100-200 mg of 5-HTP on an empty stomach once or twice daily. This is pretty mega considering that most capsules start at 50mg-100mg. Start with taking this at bedtime to optimize sleep and serotonin.
5-HTP is also beneficial for insomnia, pain syndromes, schizophrenia, anorexia and bulimia, PMS, and migraine headaches. Excess tryptophan in the body is converted to serotonin (makes us happy) and melatonin (makes us sleepy). So if you have depression with insomnia 5-HTP should work well for you and low serotonin is the likely cause of your symptoms. Although it is possible to have hormone imbalance such as in menopause and perimenopause cause insomnia and mood disturbance.
8. S-adenosyl-Methionine (SAMe)- A natural amino acid antidepressant that is part of the homocysteine metabolism pathway and serves the role of “methylating” neurotransmitters. As SAMe converts to S-adenosyl-homocysteine it donates “methyl” groups (CH3) to the nervous system so that it can effectively produce neurotransmitters such as serotonin, dopamine, and catecholamines that make us feel GOOD and HAPPY. This natural antidepressant is also a great detoxifying agent for the body as it activates phase II detoxification pathways in the body.
If you are recovering from alcoholism or drug abuse this may be the better choice of natural antidepressants, however it should not be used by those that suffer from bipolar because of it’s ability to increase catecholamines and may trigger a manic episode. I would stick with St. John’s wort or 5-HTP for those susceptible to manic or hypomanic episodes. Do NOT combine with prescription drugs. Typical dose of SAMe is 50 mg once to twice daily. Always take SAMe with magnesium for optimal methylation of neurotransmitters, and a multivitamin as the B-vitamins folic acid, B-6, and B-12 are necessary for preventing homocysteinemia, a potential consequence of consuming elevated levels of SAMe. Homocysteine is correlated with cardiovascular damage, and B-vitamins will ensure it’s conversion to an inert substance.
9. Vitamin D- I typically place depressed patients on a starting dose of 2000 IU’s of vitamin D, check their calcium and vitamin D levels and then decide if the dose should go up or down from there. I have seen great responses to vitamin D especially in those that are low. Most people that live in the northern latitudes like Seattle will be low on vitamin D. Out of the hundreds of patients I have checked, I have only found one person in Seattle that had a normal vitamin D level. Repleting deficiency is imperative, as this vitamin that is now considered a “pro-hormone” may have more of a role in the physiology of the body than we are currently aware. Overdosing on vitamin D can result in a life threatening case of hypercalcemia as vitamin D and calcium absorption are interrelated.
Do NOT take more than 1000 IU of vitamin D without being monitored by your doctor. Although the active form of vitamin D in the body is 1, 25 cholecalciferol the best test for vitamin D levels is 25-D-OH, ask your doctor to do a basic metabolic panel and check your vitamin D, pre-treatment, a month out, 3 months out and so forth. If you are deficient in vitamin D and start a 2000 IU daily dose it will take about 1 week to raise your vitamin D levels 1 point.
So if your level is 16 and you need to get to 60, it will take about 44 weeks to get you back to the normal range. You are better off doing this gradually in my opinion as we do not want to cause atherosclerosis (hardening of the arteries) by hypercalcemia from taking large doses of vitamin D at once. Other naturopaths may be willing to dose you up really high, but I am completely against it, until we have more research supporting the safety of this fat soluble vitamin that stores in the body. Be sure to use vitamin D3 (cholecalciferol) in an emulsion form, because vitamin D2 is just crap, and not worth your time taking.
So that is a long list of natural medicines! Should you take these all at once?
So where to start?
If you are currently on anti-depressants, you need to work with a Naturopathic Doctor such as myself to safely implement natural meds that won't interfere with your antidepressant. I generally start by adding only vitamins, minerals, omega 3’s, exercise, and "Vitamin L" to see if your mood can be boosted enough to consider titrating off of them, work on implementing my Depression Diet gradually. NEVER ever ever… discontinue your prescription medicines without following the advice of the doctor that prescribed them. I have seen patients permanently damaged from doing this with their antidepressants and it is possible with Naturopathic medicine to reverse that reaction but it is a lot of work and we can save everyone the headache by tapering gradually down from all antidepressants. Last week I saw a new patient exactly for this reason and it was 2 years since she stopped her Effexor yet still is shaking, dizzy and has ringing in her ears and severe anxiety from the sudden withdrawal.
My blogs are designed to educate patients on how Naturopathy works so they know up front if they can do it. Check out my blog on "How to Be Successful with Naturopathy," to ensure you will be my next success story.
I typically start a depressed patient that is not on any anti-depressants on either St. John’s Wort, 5-HTP, OR SAMe in conjunction with a multivitamin, vitamin D, omega 3’s, and cal/mag. If stress and anxiety is a problem, I then add in schisandra or passion flower. Following my Depression Diet guidelines to ensure adequate amino acids in the nervous system to make neurotransmitters and adequate Omenga-3's to ensure your nervous system is functioning optimally is critical to maintaining mood without medication. Please also work with a counselor for your mood, counseling is imperative to a successful mind/body/spirit approach to the management of depression. Try the St. John’s wort, 5-HTP, or SAMe at least a month if not three before swapping out for a new treatment. Most research studies I read have a minimum of 8 weeks before improvement. While I do see patients improving before then it is important you have realistic expectations of herbal medicine for mood.
Be cautious when using combinations of herbs, amino acids and antidepressants as “Serotonin Syndrome” can occur and is dangerous. This results in too much serotonin causing anxiety, high blood pressure, profuse sweating, irritability, and agitation may occur.
Thank you for your Women's Health and Herbal Medicine questions. Please send them to me on a postcard as I love to get something in the mail that is not a bill. If your question cannot fit on a postcard then you need to treat yourself to a Naturopathic visit with me. Simply pop over to my SCHEDULE page to get set up. I love helping women with their depression, anxiety, ADHD, PTSD, and mental health!
Dr. Nicole Sundene, NMD
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum Depression, Chronic Fatigue, Holistic Psychiatry, Depression, Anxiety, Chronic Pain, Autoimmunity, Food Sensitivities, Digestion, Dermatology, Acne, Psoriasis, Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!