A Naturopathic Doctor's Approach to Depression

In this guest post, Dr. Jordan Robertson BHSc. ND discusses natural treatments for depression.  

One of the reasons I enjoy treating depression is that it highlights some of the fundamental differences between conventional medical care and alternative care with a Naturopathic Doctor. Depression and depressed symptoms can occur in patients for many reasons, but conventional care has focused on the use of one or two types of drugs to treat it.  

Conversely, Naturopathic care focuses on why you have depression. You may not have an imbalance in serotonin (the neurotransmitter associated with depression) but may be struggling with low vitamin D, B vitamins, essential fatty acids, or require more of these nutrients than others to feel better.  Through my research at McMaster University and my clinical experience, I have spent considerable time collecting the best evidence for the treatment of depression with natural medicine.  

The natural product with the most evidence behind its use in depression is Omega-3 fatty acids from fish oil. In repeated research trials, fish oil has been shown to improve virtually every psychiatric disorder in adults and children alike. With depression, it is essential to choose a highly weighted EPA formula. DHA, another Omega-3 you will see in your oil, can worsen symptoms of depression in some patients, and may contribute to aggression in young patients with concurrent ADHD. High quality 6.5:1 ratio fish oil will ensure you achieve the highest dose of EPA possible. Patients who are not responding to traditional drug therapy may have greater benefit from adding 1g per day of fish oil. One of my published research articles looks at the use of phosphatidylserine (PS), a natural phospholipid, in elderly patients with depression. At a modest dose of 200 mg/day, PS showed improvement in elderly depression better than placebo, and comparable to drug therapy. PS may be useful in younger patients with depression, although most of the evidence has focused on older patients.  

Amino acids are the building blocks of neurotransmitters – the molecules responsible for mood in the brain. Amino acids such as L-tyrosine, threonine, 5-HTP and glycine all promote better mood by supplying the nutritional building blocks of serotonin, dopamine and GABA. Amino acids in combination can be effective at addressing mild to moderate depression, helping patients who are not responding to their medication or help patients who are looking to discontinue their medication as bridge therapy.  

Herbs such as Saint John’s Wort, Passionflower, and Valerian have all been shown to be effective for mild to moderate depression. I like using herbs because they can be chosen specifically for each patient based on the root of their depression. There are herbs that treat depression in menopause or PMS, or depression with concurrent symptoms of anxiety or insomnia. A well-tailored herbal prescription can work wonders in patients, especially if they have had little success with drug therapy. Pascoe’s Neurapas is an herbal formula with company-sponsored evidence for its effect in mild to moderate depression. This formula may help patients wean off their current drug therapy, with an individualized titration schedule.  

Deficiencies in nutrients such as vitamin D, B12, and Folate can also produce symptoms of depression. Vitamin D testing is recommended for all patients experiencing low mood, to accurately dose supplemental vitamin D. Most patients need far beyond the 1000 IU currently recommended to correct for deficiency. B12 and Folate are involved in brain and nerve health, and should also be tested. Patients with low vitamin status can easily be treated with dietary changes and supplements.   The limitations of standard care (SSRI drugs or other similar drug classes) include a poor response rate, side effects, and even an increased risk of stroke, and possibly death. 

Discontinuing antidepressant therapy is also challenging, and requires a long, supervised, titration process to avoid side effects and rebound depression. These are all important factors to consider before starting drug therapy, or while using long term drug therapy. The scientific literature to-date is in support of using natural medicine for mild to moderate depression. The effect of antidepressants for patients with mild to moderate depression is no better than placebo, making this population the ideal candidate for natural medicine. Patients with severe depression can also benefit with co-treatment.  

Addressing the reasons why you are struggling is your best chance at overcoming your symptoms. Depression can be treated with natural medicine and should be combined with other therapies such cognitive behavioral therapy and acupuncture to achieve the best results. Drug therapy is not for every case of depression, but all patients can benefit from incorporating naturopathic medicine into their health program.  

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References  

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Maggioni M, Picotti GB, Bondiolotti GP, Panerai A, Cenacchi T, Nobile P,Brambilla F. Effects of phosphatidylserine therapy in geriatric patients with depressive disorders. Acta Psychiatr Scand. 1990 Mar;81(3):265-70.  

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