Q: I often feel sad and depressed, but I’m wary of drugs. What do you recommend? –Susan Kramer, 57, Orefield, PA
A: You’re right to be wary of drugs. There is accumulating evidence that even in severe depression, the SSRIs, such as Prozac, work no better than placebos. And there may be significant toxic effects.
Some studies suggest that men who take them may be at increased risk of heart attacks and strokes, and women may have an increased risk of developing breast and ovarian cancers. There was even a study in the Archives of General Psychiatry suggesting that the children of women who take these drugs in the first trimester of pregnancy have a modestly increased risk of autism. These are preliminary findings, but they’re worrisome.
There is also disturbing evidence that these drugs can actually prolong depression. They artificially boost mood-enhancing serotonin, which in turn prompts the brain to make less of this feel-good chemical and to reduce the number of receptors for it. The result is that it becomes harder for you to function without the pills, so they create their own need. Of course, medication is appropriate for very severe cases of depression, but not for more than a year.
So what should you do instead? The best evidence is for aerobic activity. The intervention that’s most studied is walking, but whatever form of activity you choose, the point is to do it every day. Exercise probably works in many ways-for example, by increasing endorphins and other neurotransmitters that are involved in mood. Interestingly, there’s some research showing that moderate exercise is more effective than intense exercise. We don’t know why.
There’s also a very clear correlation between mood and levels of omega-3 fatty acids in your tissues.
The country with the lowest incidence of depression worldwide is Iceland, which is surprising given how cold and dark it is there for much of the year, but the people there eat a lot of fish that are rich in omega-3s. (Icelanders have the highest tissue levels of omega-3s of any people in the world.) Omega-3s are good for both prevention and treatment of depression. In addition, St. John’s wort can help with mild to moderate cases of depression, but bear in mind that it can take 4 to 6 weeks to have an effect. SAM-e, a chemical found naturally in the body, works much faster-sometimes in a day or two-and is very useful.
I think the contributing factor that’s been most eroded in my lifetime is social connectedness.
My parents lived through the Great Depression and World War II, and by all accounts, mental health was better then than it is today. Even now, depression is unknown in the few hunter-gatherer societies that still exist. Why is that? The people interact face-to-face every day, rather than virtually. They maintain tribal connections. They’re not living on information overload. And their lifestyle as a whole is healthier: They are not disconnected from nature; physical activity is part of their daily routine; and they’re eating whole, real food rather than processed.
Obviously, we’re not going to revert to a tribal society. But we can apply some of these lessons to our own lives. My tips? Get out into nature. There’s a whole area of psychology that deals with the benefits of this. Do some deep breathing exercises, which can also have a very positive effect on mood, especially depression and anxiety. Try to connect more with your friends and family-and even companion animals. In particular, cultivate friendships with people who are positive and optimistic. Finally, practice gratitude. The body of research on this is very impressive. The easiest way to do that is to keep a gratitude journal, where every night before bed, you write down a few things that you’re grateful for. Studies show that people who do this for a week can have a positive lift in mood that lasts for months.
Rather than taking drugs, first try these supplements, which have a proven track record:
Dosage: 2 to 3 g of EPA and DHA from fish oil a day. Make sure the brand is “molecularly distilled,” so it’s free of contaminants. And read the label carefully to ensure that the 2 to 3 g you’re getting are not just total fish oil, which contains many fatty acids, but actual EPA and DHA.
St. John’s Wort
Dosage: 300 mg three times a day of capsules standardized to 0.3% hypericin, one of the main active compounds in the herb. Also look for hyperforin. But St. John’s wort interacts with many drugs, including alprazolam, birth control pills, and cyclosporine, so check with your doctor.
Dosage: 400 to 1,600 mg a day, taken on an empty stomach. Look for enteric-coated tablets, which can survive stomach acid. Don’t take SAM-e late in the day, because it can have stimulant effects. And because it can worsen manic symptoms, don’t take it if you have bipolar disorder.
Dr. Andrew Weil
Andrew Weil, MD, is founder and director of the Arizona Center for Integrative Medicine and clinical professor of medicine at the University of Arizona. For more information, go to DrWeil.com.