Treatment Of Depression

Depression ranks as one of the most widespread mental health problems in the world. Besides causing significant morbidity and mortality (through suicide), depression also contributes to or is associated with several other serious problems. Depression may contribute to atherosclerosis, perhaps by impairing glucose tolerance, and depression has been repeatedly linked to depressed immune function. In fact, over half of people with chronic or severe illnesses may suffer from depression. Depression can strike at any age, but depression in the elderly is a particularly significant problem. The surgeon general of the United States recently noted that suicide rates increase with age and that nearly 5 million of the 32 million Americans over 65 suffer from some form of depression. Natural medicine offers many options for helping cope despite the enormity of the problem of depression at any age.

Today, allopathic antidepressant drugs are all too often prescribed and dispensed without a second thought as a treatment for depression. The decision to institute or maintain patients on these drugs should be made much more cautiously. The profitable new antidepressant drugs (selective serotonin-reuptake inhibitors [SSRIs] and atypical agents) have not been shown to be more effective than older drugs, and have not been shown to be more effective than psychotherapy or cognitive behavioral therapy. Newer drugs may not even have fewer adverse effects than some older agents, and reports about unforeseen negative consequences of these drugs, such as upper-gastrointestinal bleeding (increasedby concomitant non-steroidal anti-inflammatory drug use), are emerging.

Antidepressant drugs have strong placebo effects, and placebo itself is very effective for people with depression. Depression also resolves on its own in up to 50% of people affected. It has also recently become clear that negative trials on these drugs have been actively suppressed by the drug companies, and when they are included in meta-analyses, antidepressants are in fact no more effective than placebo. Furthermore, it has been alleged that some drug makers hid evidence that some antidepressants actually increase the risk of suicide, at least in teenagers and children. According to a review of trials by independent researchers and clinicians in the United Kingdom, trial results of antidepressants in children have exaggerated the benefits of the drugs that the investigators rate as having “doubtful clinical significance,” adverse effects have been downplayed, and that these drugs cannot be recommended for childhood depression.

Therefore, in mild cases it is critical to support the mind-body as opposed to ruthlessly suppressing any sign of depression. Ultimately, antidepressants should be reserved for more serious cases of depression that do not respond to safer natural treatments, and even in those cases the practitioner should continue to look for and treat the cause of the depression.

From a holistic perspective, treating depression is not about substituting St. John’s Wort for an allopathic antidepressant medication. Instead, therapies should be chosen that will strengthen the individual so as to eliminate the core cause of the depression while using botanicals to palliate symptoms (in this case, elevating mood). Here we focus on botanicals for treating the causes and symptoms of depression, but it is critical to remember that diet and lifestyle issues must be addressed to effectively help people with this condition. Also, we focus primarily on major depression rather than helping patients cope with temporary and normal feelings of sadness or despondency in response to life’s trials and tribulations.

Bitters, The Gut, And Depression

Essential Fatty Acids, Oxidation, And Depression

Cerebrovascular Insufficiency And Depression

Overlooked Herbs

Herbal Stimulants

Volatile Oils For Depression

A number of volatile oils have been recommended for people with depression. There are varying opinions about which oils are useful, although there is near agreement on a handful of oils. The volatile oil of Jasminum officinale (jasmine) is claimed by one author to be among the longest used for depression in Asia, and this author also suggests the use of volatile oils of Matricaria recutita (German chamomile), Rosmarinus officinalis (rosemary), and Rosa spp. (rose). Chamomile is also mentioned in a classic work by the French aromatherapist, Jean Valnet, MD, as being particularly indicated for depression. He further mentions borneol (extracted from Dryobalanops camphora or Borneol camphor), lavender, and thyme as useful antidepressants. He suggests 2-5 drops of volatile oil two to three times per day of lavender and thyme as internal doses, but does not give doses for chamomile and borneol. This text does not discuss molecular mechanisms of action for any of the oils, only reporting traditional actions.

Lavandula officinalis (lavender) is perhaps one of the most widely known psychoactive volatile oils. Lavender oil aerosolized in the air was reported to be more effective than pharmaceutical drugs for relieving insomnia in one study. No studies were located on the effect of lavender oil on people with depression but there is a preliminary randomized, controlled study of lavender tincture in mild to moderate depression. It was far less effective than the drug imipramine but greatly enhanced the antidepressive effect of the drug when the two were combined. As mentioned in chapter 5 on anxiety, lavender aromatherapy reduced agitation in elderly patients with dementia. This suggests that lavender might be best indicated in people with agitated depression.

More research on the efficacy of volatile oils in people with depression is needed but, in the meantime, they should not be overlooked as potentially very valuable therapies, in particular considering that inhaled volatile oils pass through the olfactory nerve directly to the cerebrum.

Low-Dose Herbs For Depression

Combining Herbs And Antidepressants

General Approach To People With Depression

Obviously there are many potential routes to helping people with depression, some better documented than others. In holistic medicine, it is always critical to attempt to find the underlying cause of the disorder as well as palliate symptoms. Nervine herbs to rebalance or normalize mood are almost always indicated, as well as some degree of gastrointestinal balancing because people in Western society so commonly have disordered digestion (which then affects the rest of their mind-bodies). Counseling and mind-body work is also usually very important.

Table A Basic Depression Formula Template

Herb Dose Form Amount in Formula Function
Stachys betonica (wood betony) herb Fresh or dry plant tincture 35% Nervine, tonic
Hypericum perforatum

(St. John’s wort) flowering top

Fresh plant tincture 35% Symptom palliation
Rosmarinus officinalis (rosemary) leaf* Fresh plant tincture 15% Nervine, anti-atherosclerotic, antioxidant, circulatory stimulant
Rosmarinus officinalis (rosemary) volatile oil Volatile oil 3-5 drops Antidepressant, nervine
Achillea millefolium (yarrow) flowering top Fresh plant tincture 10% Bitter digestive tonic
Peganum harmala (Syrian rue) seed Dry plant tincture 5% Symptom palliation, stimulant
Zingiber officinale (ginger) rhizome Fresh or dry plant tincture 1% Synergizer, mildly stimulating, circulatory stimulant, digestive tonic
Ignatia amara (St. Ignatius bean) seed Dry plant tincture 1 drop Synergizer

*Use ginkgo standardized extract capsules along with this formula in anyone where cerebrovascular insufficiency is a suspected contributor to depression. Dose: 5 ml three times per day.

Except in mild cases of depression, some degree of symptom control is also indicated to improve quality of life and avoid the real possibility of suicide. There are numerous natural products that can be used for this purpose. The best supported and most generally applicable is St. John’s wort. For severe cases, pharmaceutical intervention is obviously necessary, but this does not mean that other treatments should be dropped.

Table A Basic Depression Formula Template proposes a basic formula that can be used as a base for prescribing an individualized combination for people with depression. This is not intended as a simple recipe or magic bullet that will help everyone, but as a learning tool to help pull together a complex set of information for practitioners. This formula, individualized to meet the patient’s needs, along with appropriate dietary, lifestyle, mind-body, and nutritional supplement work, can provide an important base for helping people heal themselves of depression.