Depression is a feeling of intense sadness; it may follow a recent loss or other sad event. After anxiety, depression is the most common psychiatric diagnosis. An estimated 10 percent of the people who see their doctors for what they think is a physical problem are actually experiencing depression, which typically begins in one's 20s, 30s, or 40s. An episode typically lasts 6 to 9 months, but in 20 percent of cases it lasts for 2 years or more. Episodes generally tend to recur several times over a lifetime. Some people also have anxiety associated with it. Craving for sweet rewards is increased by depression in both animals and humans. 
   There are many herbs and nutrients that have been tested in relation to depression treatment. Unfortunately, most doctors are not as familiar with these natural depression treatment options as they should be. I hope this information will offer hope to those who are depressed, and also serve as a way for physicians to learn more about these alternative treatments.

There are several supplements, herbs, and vitamins as alternatives to depression medication treatment - natural herbal remedy cures
Exercise, a proper and healthy diet, relaxation techniques, and yoga can help fight depression. These approaches influence may aspects of brain and body chemistry. Some people think that depression can be pinpointed to one chemical imbalance, such as serotonin and hence a medication that raises levels can be curative. There are numerous factors in the body and brain, numerous chemicals, hormones, and other substances, including the connection and communication between brain cells and parts of the brain, that influence mood and wellbeing.
   Diet has a significant effect on mood. Unhealthy diets promote inflammatory chemicals in the body that can negatively impact brain cell and neurotransmitter function. Change to a low inflammation diet that reduces inflammatory prostaglandins and leukotrienes. Reduce your intake of trans fats.
   If you have moderate or severe depression, or are currently taking pharmaceutical medications, discuss with your doctor before adding any supplements or switching to them. If you have suicidal thoughts you must visit your doctor. These natural supplements are meant for those with mild to moderate depression. Some of them are quite powerful and may interact with medications.
   If you would like to improve mental focus, mood, and concentration, consider Mind Power Rx. If you have low mood due to low libido, consider Passion Rx.
   Here is a list of nutrients and herbs. Use them one at a time for a week or two rather than mixing them so you know how each one works by itself. After you have a good understanding how each one makes you feel, you can combine them in lower dosages.

5-HTP sometimes starts working within hours. 5-HTP converts into serotonin, an important brain chemical involved in mood, appetite, and impulse control. 5HTP suits those whose depression is associated with anxiety, restlessness, or racing thoughts. A disadvantage is that it reduces sex drive.
Tryptophan is back on the market. It works by converting to 5-HTP which then converts into serotonin. It has similar properties to 5-HTP and some people prefer tryptophan while others prefer 5HTP. It is difficult to predict which one will work better without first trying them separately for a week or two.
SAM-e is a powerful nutrient that starts working within hours. It could, in some people, be considered a natural cure for depression. A SAM-e supplement can be purchased online. SAM-e can raise levels of several brain chemicals including norepinephrine, dopamine and others. A study found it was helpful even in depressed patients who did not respond well to Prozac and other SSRIs. It is best suited in those whose depression is associated with low energy and low motivation. High dosages can cause restlessness and anxiety. For those whose depression is associated with anxiety, 5-HTP is a better option. There is a risk for overstimulation with SAM-e use, hence dosage should be kept low and it is is a good idea to take a day or two off when one notices overstimulation. SAM-e is not advised for those who have manic depression (bipolar disease).
St. John's wort is an herb used for depression and usually takes a few days to work. I suggest you take frequent breaks from the use of this natural antidepressant and substitute other dietary supplements that elevate mood. Prolonged use of St. John's wort and concurrent exposure to sunlight may cause harm to the retina and perhaps increase the risk for cataract formation.
Acetyl l-carnitine can lift mood and enhance mental activity. It is found in Mind Power Rx. This nutrient starts working within hours and provides mental clarity and stamina.
B vitamins, including pantothenic acid, have a mild but pleasant influence on mood and should be considered as depression vitamins. Supplementing with folic acid could be helpful for certain mood disorders. People with low blood levels of B vitamins have an increased risk of depression. Older adults with relatively low intakes of vitamins B6 and B12 may have a higher risk of developing depression than those who get more of the nutrients. Use a product that has all of them in good proportions.
Vitamin D supplementation may be helpful in easing depressive symptoms during the winter months. Older people with low blood levels of vitamin D and high blood levels of parathyroid hormone are more likely to suffer from low mood. You may consider supplementing with 400 to 2000 units of cholecalciferol each day.
Fish oils have mood balancing properties and are a mild natural remedy for depression. They can be combined with other supplements, or even pharmaceutical depression medications. Flaxseed oil is an alternative in those who are vegetarian or vegan.
CoQ10 helps enhance physical energy and it would be reasonable to consider supplementing with 30 to 50 mg a day.
CDP-choline helps in some people, and it works quite quickly to cause alertness and mental clarity.
NADH can be used occasionally, but not daily.
DHEA in low dosages could be of benefit in older individuals who are hormone deficient, but use hormone replacement in low amounts and for short periods of time.
Pregnenolone may be taken in low dosages in older individuals who are hormone deficient, but only temporarily.
Cordyceps is a mushroom extract that may be of benefit in some users.
Maca is an herb from South America that can increase energy levels. Rhodiola can also improve energy levels.
Muiria puama takes two or three days to work. It it also used as an aphrodisiac and may be appropriate to those who have mild depression associated with low libido.

After reading about natural treatments for depression, I am a bit confused as to which is most effective and which one to begin with: SAM-e, St. John's Wort, 5-HTP and L-tryptophan.
    It is difficult to know which supplement will work best in someone without actually trying it for a week or two. If you have a tendency for anxiety then 5-HTP and tryptophan are good options. If your depression is associated with low energy and motivation, SAM-e is a good choice. Each person responds differently. Some may be very deficient in serotonin and benefit from 5-HTP, while others may benefit from SAM-e. There's really no good blood test that can tell who will respond to what. Only by trial and error can one know for certain which one, or a combination in lower dosages, is the best choice.

Do these natural supplements interact with prescription antidepressant meds? What if someone is already on an SSRI?
   The combination of herbs and supplements with prescription meds has not been tested so it is difficult to predict their interactions. Under the guidance of a physician one could reduce the dosage of the antidepressant drug while gradually starting the natural mood lifting pills in low dosages.

What daily dosage of fish oil do you generally prescribe for depression?
    I don't have a standard amount. I evaluate the whole patient, including their diet and lifestyle patterns. I don't use fish oils by themselves, but depending on the person I will use fish oils in combination with 5-HTP, St. John's wort, or SAM-e, or Mind Power Rx, etc. As a general guideline, though, I will use three to five fish oil softgels but this varies.

I was reading where you said to take Sam-e for depression if you have low energy and low motivation and to take 5HTP for anxiety. Well I have all 3. I also have insomnia. I also have a lot of stress and feelings of being overwhelmed. I am just trying GABA for that so could I take the 3 together. Thank you for your website and the information you share. I am 50 years old and have struggled since high school if not before that. I took antidepressants for 15 years without much relief. Please help.
    In order to provide a helpful and accurate answer, I would have to examine you and review your full medical history. A good option is to try one supplement at a time starting in small amounts and building up the dose over several days until benefits occur or side effects negate the benefits. That is one of the best ways to find out whether a particular natural product will help you. With time two supplements can be combined as long as you have a good understanding on how each one works for you separately.

I have had a number of tests done, and been told I suffer from stress, depression, and anxiety. I am only 33 and decided to opt out on a prescription anti depressant. I started working out four days a week, taking vitamins, but I still have this sensation similar to just stepping off an elevator. Ever day I go through this symptom, along with being really tired, sometimes shaky. Which I think continues feelings of depression, because these little problems do not seem to go away. I just bought and took my first dose of Sam-e today, and felt so much better! I am just wanting to know how long I should take it. Thanks for a very informational website
   We're glad SAM-e is helping. We cannot give individual advice partly because each person is unique in their response. However, as a rule, it is best to use SAM-e in as little a dose as possible.

Does alpha lipoic acid help with depression?
   Not in a major or noticeable way, at least in the short term. Perhaps it may have a subtle effect in some people.

Is there a definitive "cure"? Meaning, is depression one of those things that, even if well-controlled with diet and exercise and herbs and nutrients, stress control, and overall healthy lifestyle, it will always "be a part of you" for the rest of your life, once you have had it? Will there always be the chance of a relapse throughout a person's life?
   Depression is caused by a number of factors that include a genetic predisposition, anatomical or neuronal changes in the brain, poor diet, social factors, personal belief system, neurotransmitters in the brain, lack of exercise, sleep disturbances, stressful work situations, etc. Some of these factors are reversible and hence presenting an opportunity for a cure, but some other factors may not be reversible and hence depression may continue at some level or another for a lifetime. In most cases it can be improved with the right approach or combination of methods.

Mind Power Rx for better mood, concentration, and focus
Formulated by by Ray Sahelian, M.D.
This natural brain booster is formulated by Dr. Sahelian, bestselling author of Mind Boosters to provide steady mental sharpness and focus all day, along with mood and memory support.

Mind Power Rx supplement Facts: Carnosine as antioxidant, Choline for acetylcholine production, DMAE methyl donor, Trimethylglycine (TMG) methyl donor, Tyrosine amino acid, Vinpocetine for oxygen enhancement in brain tissue. Plus: Cyanocobalamin 30 mcg. Cyanocobalamin is similar to Methylcobalamin, and Pantothenic acid 30 mg.


Plus a proprietary blend of: Ginkgo Biloba leaf extract, Mucuna Pruriens extract, Ashwagandha extract, Bacopa monniera extract, Gotu kola extract, Reishi extract, Ginseng extract, Fo-ti extract, and Rhodiola extract.

I notice that you cite this product to enhance mood. Would that include mild to moderate depression? Is this product good for these symptoms or is one better off with going directly to 5-htp or St. Johns?
    In most cases 5-HTP, SAM-e and St. Johns wort work better, but in other people Mind Power Rx may be more helpful, it is difficult to predict in any one individual which would be most effective.

Just wanted to let you know how delighted I am with Mind Power Rx. The biggest change I have noticed is in my mood. I feel much more positive and more myself. I have tried (and still take) many supplements to improve my mood (some of which are in this formula) as I suffer from depression. However, your product seems to have made a difference for me. Must be the synergistic effect! I am taking it in the morning and noticed a difference on the 3rd day and it seems each day just gets a little better.

Causes
Depression has many causes, and all aren't fully understood. A number of factors may make a person more likely to experience depression, such as a heredity, side effects of certain medications, an introverted personality, poor self image, and emotionally upsetting events, particularly those involving a loss. It may also arise or worsen without any apparent or significant life stress. Another cause is having a mother who has experienced depression. This can double a child's chances of becoming depressed.
   Women are twice as likely as men to experience depression, though the causes aren't entirely clear. Psychological studies show that women tend to respond to adversity by withdrawing into themselves and blaming themselves. In contrast, men tend to deny adversity and throw themselves into activities. Of biologic factors, hormones are the ones most involved. Changes in hormone levels, which can create mood changes shortly before menstruation (premenstrual tension) and after childbirth (postpartum depression), might play some role in women. Similar hormonal changes may occur with the use of oral contraceptives in women. Abnormal thyroid function, which is fairly common in women, may also be a cause.

Depression that follows a traumatic event, such as the death of a loved one, is called situational depression. Some people become temporarily depressed in reaction to certain holidays (holiday blues) or meaningful anniversaries, such as the anniversary of a loved one's death. Depression without an apparent precipitating event is called endogenous depression.

Sedatives and sleeping pills prescribed to ease anxiety and sleep problems increase the risk of suicide among the elderly. Antidepressants, antipsychotics, sedatives and hypnotics make it more likely an older person will commit suicide. some drugs somehow trigger aggressive or impulsive behavior or provide the means for people to take an overdose.

A lack of sunshine may cloud memory or cognitive function in some people. There is a well-known association between sunlight exposure and mood, the clearest example being seasonal affective disorder (SAD) -- a form of depression in which symptoms shift with the seasons, usually arising in the late fall and winter and improving in sunnier months. Winter depression is called seasonal affective disorder or SAD. Just a few minutes of exercise a day in the great outdoors can improve mental health which should encourage more people to spend time in parks and gardens.  Environmental Science & Technology, 2010. Low dose melatonin given in late afternoon may be of benefit.

Association between depressive symptoms and serum concentrations of homocysteine in men: a population study
American Journal of Clinical Nutrition, Vol. 80
The objective was to study the association between depression and serum concentrations of total homocysteine. A cross-sectional study of a sample of 924 men aged 46–64 y was conducted as a part of the Kuopio Ischaemic Heart Disease Risk Factor Study. Those who had a history of psychiatric disorder (6%) were excluded. Those in the upper tertile for serum homocysteine had a more than twofold higher risk of being depressed than did those in the lowest tertile for serum homocysteine. The results remained significant after adjustment for the month of study, history of ischemic heart disease, smoking habits, alcohol consumption, marital status, education, and socioeconomic status in adulthood. High serum concentrations of homocysteine may be associated with depression in middle-aged men.

Cytokines, inflammation, fish oils, and depression
Depressive symptoms, omega-6:omega-3 fatty acids, and inflammation in older adults.
Psychosom Med. 2007. Kiecolt-Glaser JK, Belury MA, Porter K, Beversdorf DQ, Lemeshow S. Department of Psychiatry, Ohio State University College of Medicine, Columbus, OH, USA.
Dietary intake of polyunsaturated fatty acids (PUFAs) influences inflammation. Depression and stress promote cytokine production that lead to inflammation. Dietary intakes of omega-3 (n-3) and omega-6 (n-6) PUFAs also influence inflammation. High intakes of omega-6 fatty acids enhance cytokine production whereas omega-3 fatty acids reduce inflammation.

Research suggests foods rich in omega-3, like fish and eggs, can prevent depression and promote learning. A study of 14,500 pregnant women by Dr Joseph Hibbeln from the US National Institutes of Health found those who ate fish throughout their pregnancy were less likely to suffer from depression.

Depression in teenage girls
Girls who discuss their problems extensively with friends appear be at an increased risk of developing depression and anxiety symptoms. One explanation is that such "co-rumination" causes some girls to focus on fleeting problems like boy trouble and party snubs, leading to persistent feelings of sadness, hopelessness or worry. Developmental Psychology, July 2007.

During pregnancy
I would like to know what supplement can I take for depression while pregnant? I currently take a prescribed medication. It is not safe to stay on this while pregnant. Can you suggest something natural that I can use while pregnant for the treatment of depression?
   We have not seen much research regarding the use of natural supplements in women who are pregnant, hence it is up to your doctor to read this page and decide if any of the supplements are appropriate for you, weighing the benefits versus potential risks.

Clinical depression is associated with physical changes in the brain.
There is decreased blood flow in the brain's emotional centers, abnormal metabolism, shrinking of certain brain regions, and changes in neurons and dendrites. Therefore, it is unrealistic to tell someone with depression to "just snap out of it." Depression is as much of a physical illness as diabetes and heart disease.

It may also occur with, or be caused by, a number of physical diseases or disorders. Physical disorders may cause depression directly (such as when thyroid disease affects hormone levels) or indirectly (such as when rheumatoid arthritis causes pain and disability). Various prescription drugs, most notably drugs used to treat high blood pressure, can cause depression. A number of psychiatric conditions can predispose a person, including certain anxiety disorders, alcoholism and other substance abuse disorders, schizophrenia, and the early phase of dementia.

Clinical depression treatment - medicines and medications
The most commonly used pharmaceutical agents, the SSRIs such as Prozac, Paxil, Zoloft, and others, may be effective in fighting depression but have a high rate of side effects including headache, loss of sex drive and sensation, nausea, insomnia, and upper gastrointestinal bleeding. People taking popular Prozac-type antidepressants may be twice as likely to attempt suicide than those on placebo and the risks are particularly high early in treatment.
   Adults taking the antidepressant Paxil (also known as Seroxat or paroxetine) should be monitored closely because the drug may increase the risk of suicide attempts, Norwegian investigators conclude. The drug-maker, GlaxoSmithKline Plc, however, calls the results "flawed and misleading."
   Can there be cases where antidepressants must be administered in treating certain forms of depression, where natural supplements won't do the job? Yes. and there are cases where a natural supplement works better than a prescription antidepressant. It is difficult to predict which option would work better. Much depends on the person who is being treated whether they have a stronger belief or trust in prescription drugs or natural supplements.
   Regular exercise improves depression symptoms in people who've failed to get better with antidepressant medications.

Depressed individuals who fail to respond to initial treatment with an antidepressant or psychotherapy may do better if they are switched to the alternative treatment. Therefore, for chronically depressed patients, switching to psychotherapy after a medication fails to alleviate depression and, conversely, switching to medication when psychotherapy fails to relieve the mood disorder.

A study of nearly 2,800 British adults and children bolsters the evidence that patients with depression are prone to suicidal impulses when they are first put on antidepressants. The risk of suicidal behavior is similar among new users of Paxil (paroxetine), Prozac (fluoxetine), Elavil (amitriptyline), and Dosulepin (dothiepin). The SSRIs used to treat depression include Paxil, Prozac, and Zoloft (sertraline) among others. Elavil and Dosulepin, by contrast, belong to an older drug group called tricyclic antidepressants.

Does bupropion work for depression?
In some people bupropion is helpful.

I am on 20 mg of Prozac once at nite, and 0.5 mg of Klonopin for panic attacks. I am concerned about long term effects, and also being on meds has taken away my sexual desire and orgasms. I am determined to find a way to balance my neurotransmitters and get back that zip in the bedroom, I will be discussing matters with the doc regarding the info in your article.

Symptoms and signs
The symptoms of depression include: persistent sad, anxious, or "empty" mood; feelings of hopelessness and pessimism; feelings of guilt, worthlessness and helplessness; loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex; decreased energy, fatigue; difficulty concentrating, remembering, making decisions; insomnia, early-morning awakening, or oversleeping; loss of appetite and/or weight loss, or overeating and weight gain; persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain; and, if the depression gets worse, some people experience the most severe symptom or sign of depression which is a thought of suicide or a suicide attempt.
   Physical symptoms (such as headache, back pain, stomach problems, joint or muscle pains, and dizziness) are nearly as common in depression as emotional symptoms and are the predominant complaint patients present with in the primary care setting.

Internet use and mood effect
People who spend a lot of time surfing the internet are more likely to show signs of depression but it is not clear whether the internet causes it or whether depressed people are drawn to it in an excessive manner.

emails
I came across your website during a google search and have found it extremely interesting and informative. I have come to the conclusion that I am suffering from mild depression which seems to have been ongoing for many, many months. I have read and researched as much as I can on depression in order to be able to improve my situation through a natural route rather than visit my doctor and have her prescribe pharmaceutical drugs. To be honest I'm terrified of becoming addicted to them and their side effects. I live a very hectic, demanding lifestyle that is based around my work. Living and working in central London is like being in the fast lane of the rat race - unfortunately we can't get out for another two years due to my husbands military posting. I have tried to take 5HTP in the evenings approx 30 mins before bed but unfortunately it wiped me out the next day and I was unable to shake off the dopey feeling for most of the day which became significantly worse over a short period of time. I'm now considering taking St John's Wort. I am currently taking Trinordial (birth control) but will soon be coming off that as we are hoping to start a family in the near future once I'm well on the road to recovery. I'm aware that St John's Wort has been reported as making the pill ineffective, but we're not worried about that at the moment. Basically my questions are, based on the information above, how much St John's Wort should I take, when should I take it and for how long? Also, would I have added benefit by taking 5HTP again and concurrently with St John's Wort, this time with a specified dosage - and at what time of the day? Or better still, please can you advise me which supplements I could take to improve my mental well being.
   Thank you for your email but we are not in a position to offer individual advice. In general terms, dosage makes a significant difference on the effectiveness of a supplement or medicine whether for depression or any medical condition. If the 5-HTP was too strong, then you could consider using a third or half a capsule. It is possible to use St. John's wort in the morning and 5-HTP in the evening, but no one can know which dosage will work and the best way is to start with tiny amounts and over time see how these small amounts influence your mood and depression and base you dosage on your response. It is also possible that you may start with low doses, increase the dose after a few days but then need to decrease again bases on response and side effects.

I was fortunate to discover your website at the same time that I'm preparing to withdraw from SSRI / SNRI medications in favour of a non-prescription medication strategy. It's with this in mind that I'm writing for your valued opinion on withdrawal strategies which you have found in your experience to work best. I am a 32-year old generally very healthy male from Australia with have a history of depression/anxiety (diagnosed by a consultant psychiatrist as a predominantly endogenous condition) and Irritable Bowel Syndrome which were treated with Zoloft beginning in 2003 until 2009. Following discontinuation of Zoloft I experienced a relapse which did not respond to further treatment with Zoloft and was subsequently switched to Lexapro. Results were good for approximately one month after which a further relapse occurred and an augmentation strategy with the addition of Mirtazapine was trialled. Results have been mixed in terms of mood stabilisation but good in regulating sleep and colon motility. I have recently been diagnosed as having a mild yeast overgrowth and ingested mold following my suspicions that my condition was somehow attributable to food intolerances. I am currently on 20mg Lexapro and 30mg Mirtazapine. I would like to discontinue this partially effective therapy and trial SAM-e, and/or 5-HTP. What kind of discontinuation strategy concurrent with the introduction of SAM-e and/or 5-HTP would you generally recommended? Any advice you could proffer would be greatly appreciated.
    I am not able to provide specific suggestions, but as a general rule it is best to learn how each supplement works by itself and to use low dosages when combining with medications, and to lower the medication dosages gradually. Each person will respond differently, therefore it is not easy to give simple advice that applies to everyone.

I am a psychiatrist from Stanford University. While doing my training, I was disappointed with the side effects of many psychiatric drugs. I have found that the natural supplements which you discuss on you website and in you books are amazing, with great efficacy and few side effects.