By Jeanie Lerche Davis
Reviewed By Cynthia Haines
In fact, some are concerned. People who rely on alternatives too much -- who don't get treatment that is proven to be effective -- can slip into a more serious clinical depression or anxiety disorder before they realize it.
"There's highly suggestive evidence that some alternatives, especially SAM-e and omega-3 fatty acids, can help, but it's not conclusive," says Andrew F. Leuchter, MD, vice-chair of psychiatry at the UCLA Neuropsychiatric Institute.
"When someone needs treatment, we have to look at what really works," he tells WebMD. "The real danger is that somebody with serious illness could forgo getting an effective treatment for months, even years."
Why are people turning to alternatives? For some, it's the side effects from antidepressants. Others simply don't want to take antidepressants -- they prefer a more "natural" approach. Still others don't think their antidepressants have worked well enough in treating their clinical depression or anxiety disorders.
Ronald Glick, MD, medical director of the Center for Complementary Medicine at the University of Pittsburgh Medical Center-Shadyside, has seen plenty of patients searching for alternatives for their mood disorders.
"Medications and psychotherapy are still the mainstays when it comes to treating depression and anxiety," says Glick, who is also professor of psychiatry at the University of Pittsburgh School of Medicine. "But alternative therapies can help. It depends on what you expect from them."
The Top Contenders
This may be the most-studied herb -- with more than 30 studies so far -- and some show it to be effective for treatment of mild forms of depression, says Glick. In fact, the University of Pittsburgh is participating in a study of the herb. "It looks quite promising," he says.
Despite the promise, the story of St. John's wort illustrates some important points, says Leuchter.
"There is data suggesting an effect -- a number of studies in Europe showed that it worked for major clinical depression," he tells WebMD. "But when double-blind, placebo-controlled 'gold-standard' studies were done, we found that it was not effective for major depression. That shows the peril of looking at small studies that are not well controlled to establish that something works."
Also, the FDA has issued a warning on St. John's wort, saying it dangerously interferes with a long list of prescription drugs. Too many people don't recognize that herbs affect the body physiologically just like prescription drugs do, Leuchter says.
It's short for S-adenosylmethionine, a molecule that naturally occurs in the cells of plants and animals -- and it's not an herb. As we age, our bodies produce less SAM-e, so replacing it with a supplement can theoretically treat clinical depression.
"In my mind, SAM-e is really promising," says Glick. "In some studies, it has held up as well as an antidepressant in treatment of major clinical depression. It's a compound in the body, involved in a number of pathways, including the neurotransmitters serotonin and norepinephrine. And it doesn't cause side effects for most people."
Glick's cautionary note: "Most people don't realize these products are medicines and that there are certain precautions. You don't want to take them with another antidepressant. You can get all kinds of side effects by getting too much serotonin. Also, SAM-e can be outrageously expensive, so that limits accessibility for most people."
Leuchter also likes SAM-e but stresses that the data are "suggestive, not conclusive."
It's not fishy, it's likely fact: Growing evidence shows that caviar, salmon, mackerel, and sardines can chase away clinical depression. These coldwater fish -- as well as walnuts and flaxseed -- have high amounts of omega-3 fatty acids.
"This is another natural substance that plays a part in the functioning of every cell of the body," Glick explains. "It reduces the risk of heart disease, stroke, and Alzheimer's disease, and it seems to have a preventive effect on manic depression -- but also is beneficial for clinical depression."
In parts of the world where fatty fish are a dietary mainstay, there is less depression, he notes. One small study showed that people with manic depression who took omega-3-rich fish oil capsules every day had fewer episodes of manic-depression than those who took a placebo.
Again, omega-3 is not intended to replace other medications, but it can help in treating clinical depression. There's no downside to eating an omega-3-rich diet, experts say.
"We feel it's really key that someone experiencing clinical depression, anxiety disorders, fatigue, or insomnia get hooked up with a mind-body technique," he tells WebMD. "It can help with mood, concentration, and energy."
Indeed, studies of meditation -- an ancient spiritual tradition -- show that daily meditation can have long-lasting positive effects on heart rate and other physiological processes, reports Herbert Benson, MD, president of the Mind/Body Institute at Beth Israel Deaconess Medical Center in Boston.
Yoga, tai chi, Lamaze breathing, and repetitive prayer (like a rosary) can do the same thing, says Benson. Any condition that is caused or exacerbated by stress can be relieved by these means -- and that includes clinical depression and anxiety disorders. Relaxation is the key, however it is achieved, he says.
Biofeedback -- which involves "training" the mind to control heart rate and other biophysical responses -- can also provide relief, says Glick. "The person learns to focus on their heart rate, on relaxation, on their emotions -- and learns to make heart rate less chaotic. We've found it can have direct benefit for people with clinical depression and anxiety disorders."
We've heard it before: Regular exercise can beat the blues. But research suggests it helps with all levels of depression, even the most severe. Exercise may also help keep depression from coming back.
We're talking about aerobic exercise -- getting your heart pumping, getting winded, and doing it for at least 20 minutes three times week, says Glick.
One study showed that people who kept exercising after they recovered from depression had a lower risk of relapse compared with those who took antidepressant medication but did not exercise, reports James A. Blumenthal, PhD, a professor of medical psychology at Duke University Medical Center.
Leuchter agrees: Exercise helps clinical depression and anxiety disorders. "I recommend that patients do exercise, be active. It helps with recovery. But I would not recommend it as a sole treatment."
Chinese Traditional Medicine
Acupuncture and "integrative medicine" approaches are the least studied, says Glick. Some studies have found that acupuncture can have "a very good effect" on depression. Glick has applied for a federal grant to study acupuncture and depression. "We're interested in looking at specific acupuncture points that have shown the most dramatic effect in depression," he tells WebMD.
When patients don't seem to benefit from other depression treatments, Glick looks more holistically at their problem -- the integrative approach.
"What roles do diet, lifestyle, even toxins stored in your body play in depression and other mood disorders?" Glick tells WebMD. "We look at the gut, how it absorbs nutrients. If it's not absorbing adequately, why is that -- is it toxicity or an intestinal overgrowth?" Integrative approaches also involve looking at the hormonal system -- the thyroid, the adrenal glands, etc., he adds.
Tried and True
Nothing will replace the time-tested approach -- antidepressants and psychotherapy, Leuchter says. "The point is, there are probably many pathways to symptom improvement, but if you're really looking for a cure to depression, try what works."
If one antidepressant does not help enough, talk to your doctor about trying others. Numerous antidepressants are now available, each with positives and negatives, to help both clinical depression and anxiety disorders, psychiatrists say.
Published Aug. 22, 2003. Updated Dec. 9, 2004.
SOURCES: Andrew F. Leuchter, MD, vice-chair of psychiatry, UCLA Neuropsychiatric Institute. Ronald Glick, MD, medical director, Center for Complementary Medicine, University of Pittsburgh Medical Center-Shadyside. WebMD Medical Reference from Healthwise: "St. John's Wort For Treating Depression." WebMD Medical News: "St. John's Wort Interferes With Lifesaving Drugs." WebMD Medical Reference from Healthwise: "Sam-e for depression." WebMD Medical News: "Can Caviar Cure Depression?" WebMD Medical News: "The Mysterious 'Medication' of Meditation." WebMD Medical News: "Exercise Beats the Blues -- and Keeps Going."