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.