Depression is a feeling of intense sadness; it may follow a recent loss or other sad event but is out of proportion to that event and persists beyond an appropriate length of time. After anxiety, depression is the most common psychiatric disorder. An estimated 10 percent of the people who see their doctors for what they think is a physical problem are actually experiencing depression. Depression typically begins in one's 20s, 30s, or 40s. An episode of depression typically lasts for 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. 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, and many of these supplements are believed to have a role to play in treating depression. Unfortunately, most doctors are not as familiar with these natural depression treatment options as they should be. I hope the information I have provided here, and plan to update regularly, will offer some hope to those who are depressed, and also serve as a way for physicians to learn more about these alternative treatments for depression.

There are several supplements, herbs, and vitamins used as depression medication and natural herbal remedy
Exercise, proper diet, relaxation techniques, and yoga can help fight depression. If you have moderate or severe depression, or are currently taking pharmaceutical medicines for depression, discuss with your doctor before adding any supplements or changing to them. If you suicidal thoughts you must visit your doctor. These natural supplements are meant for those with mild to moderate depression.
   Some of these supplements used for depression help can be quite powerful and may interact with medicines. Diet has a significant effect on mood. unhealthy diets that promote a great deal of inflammatory chemicals in the body can negatively impact brain cell and neurotransmitter function. I suggest you switch to a low inflammation diet that reduces certain inflammatory prostaglandins and leukotrienes. For suggestions regarding a healthy diet.
   If you would like to improve mental focus, mood, and concentration, consider Mind Power Rx. If eating too much food is dampening your mood, Diet Rx, an herbal appetite suppressant could help you eat less. If you have low mood due to low libido, consider Passion Rx. See below after this list. Here is a list of nutrients and herbs for depression. Use them one a time for a week or two rather than mixing them so you know how each one works for you.

5-HTP may sometimes start working within hours. 5-HTP converts into serotonin, and important brain chemical involved in mood, appetite, and impulse control. 5-HTP suits those whose depression is associated with anxiety, restlessness, or racing thoughts. A disadvantage of 5-HTP is that it reduces sexual drive.
SAM-e a powerful nutrient that starts working within hours and could be, in some people, be considered a natural cure for depression. A recent study found SAM-e was helpful even in depressed patients who did not respond well to Prozac and other SSRIs. Sam-e supplement is best suited for those whose depression is associated with low energy, low motivation, and no 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 would be good to take a day or two off when one notices overstimulation. SAM-e is not advised for manic depression.
St. John's wort is an herb used for depression, usually takes a few days to work.
Acetyl-l-carnitine can lift mood and enhance mental activity. It is found in Mind Power Rx.
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.
Fish Oils have mood balancing properties and are a mild natural remedy for depression. Their effect is mild but fish oils can be combined with other supplements, or even pharmaceutical depression medications.. Many people looking for alternatives to pharmaceutical medicines search using these keywords:
CoQ10 helps with energy
Tryptophan is back on the market, it works by converting to 5-HTP which converts into serotonin.
CDP-choline helps in some people
NADH to be used occasionally, not daily. See NADH for more information.
DHEA in low doses in older individuals who are hormone deficient, and only temporarily.
Pregnenolone in low doses in older individuals who are hormone deficient, and only temporarily.
Cordyceps is a mushroom extract
Maca is an herb from South America
Muiria Puama takes two or three days. It it also used as an aphrodisiac and may be appropriate to those who have mild depression and low libido.
Vitamin D and depression - Older people with low blood levels of vitamin D and high blood levels of parathyroid hormone are more likely to suffer from depression.

Mind Power Rx for better mood, concentration, and focus
Formulated by Ray Sahelian, M.D.
Mind Power Rx 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.

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.
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.

Suggested use: Take 1 capsule in the morning a few minutes before breakfast or with breakfast. If needed, another capsule can be taken before  lunch. If you find Mind Power Rx to be too potent, take it with a meal. If you don't notice the effects as much as you like, take it on an empty stomach.

Subscribe to a FREE Supplement Research Update newsletter. Twice a month you will receive an email with a review of several studies on various supplements and natural medicine topics, including depression treatment with herbs, by Ray Sahelian, M.D.

Email from Mind Power Rx user:
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 MP rx) as I suffer from depression. However, your product seems to have made the most difference for me. Must be the synergistic effect! I am only taking 2 in the morning and noticed a difference on the 3rd day and it seems each day just gets a little better.

PASSION Rx
Highly Effective Sex-Boosting Product with mood lifting properties
Passion Rx is perfect for Men and Women who have a low libido, low energy, and low mood,  and also for those who wish to enhance a normal sex life to new heights of Passion. Passion Rx should not be taken the same day as an antidepressant medicine.

After years of research, Ray Sahelian, M.D., whose new book is Natural Sex Boosters, has formulated a product that has a powerful effect on sex drive, passion, desire, and performance, along with better erections and orgasms/climaxes. "Passion Rx is an amazing product," he says, adding "It REALLY works. My patients love it!"
        Passion Rx has a combination of several sex-enhancing herbs, mixed in the right combination, extract potencies, and dosages to provide all day sexual enhancement.

The potent herbal extracts in Passion Rx include ashwagandha, catuaba, cnidium, coleus forskohlii, damiana, horny goat weed, maca, muira puama, mucuna pruriens, rhodiola, suma, tribulus terrestris, tongkat ali, Passion Rx has a version with yohimbe.

Causes of Depression
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. Depression may also arise or worsen without any apparent or significant life stress. Another cause of depression is having a mother who has experienced depression. This can double a child's chances of becoming depressed. Winter depression could occur due to decreased daytime hours. This is called seasonal affective disorder or SAD.
   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 who have experienced depression. Abnormal thyroid function, which is fairly common in women, may also be a cause of depression.

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 depression, anxiety and sleep problems increase the risk of suicide among the elderly. Antidepressants, antipsychotics, sedatives and hypnotics make it more likely an older person would commit suicide. Drugs somehow trigger aggressive or impulsive behavior or provide the means for people to take an overdose.

Cytokines, inflammation, fish oils, and depression
Depressive symptoms, omega-6:omega-3 fatty acids, and inflammation in older adults.
Psychosom Med. 2007 Apr;69(3):217-24. Epub 2007 Mar 30. Kiecolt-Glaser JK, Belury MA, Porter K, Beversdorf DQ, Lemeshow S, Glaser R. Department of Psychiatry, Ohio State University College of Medicine, 1670 Upham Drive, Columbus, OH 43210, USA.
Dietary intake of polyunsaturated fatty acid (PUFA) 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. Researchers took blood samples from 43 older adults and tested for PUFAs, tumor necrosis factor (TNF)-alpha, and interleukin (IL)-6. Depressive symptoms and n-6:n-3 ratios worked together to enhance proinflammatory cytokines. Higher n-6:n-3 ratios were associated with progressively elevated TNF-alpha and IL-6 levels as depressive symptoms increased. Six individuals who met the criteria for major depressive disorder had higher n-6:n-3 ratios and TNF-alpha, IL-6, and sIL-6r levels than those who did not meet the criteria. Diets with high n-6:n-3 PUFA ratios may enhance the risk for both depression and inflammatory diseases.

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.

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.

Depression may also occur with, or be caused by, a number of physical diseases or disorders. Physical disorders may cause a depression directly (such as when thyroid disease affects hormone levels, which can induce depression) or indirectly (such as when rheumatoid arthritis causes pain and disability, which can lead to depression). Various prescription drugs, most notably drugs used to treat high blood pressure, can cause depression. A number of psychiatric conditions can predispose a person to depression, 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 to fight depression, the SSRIs such as Prozac, Paxil, Zoloft, and others, are often 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 after analyzing data primarily from unpublished studies. 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 medication.

Symptoms of Depression
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 of depression which is a thought of suicide. The worst sign of depression is suicide or suicide attempt.

Winter Depression
The findings from a new study lend further support to the "circadian phase-shift hypothesis" as the basis for winter depression, also known as seasonal affective disorder (SAD). According to the phase-shift hypothesis, the authors explain, SAD is caused, at least in part, from a mismatch between circadian rhythms related to the sleep/wake cycle and rhythms more closely associated with the body's own "circadian pacemaker." For most patients with SAD, depression occurs in winter because of the late sunrise, "causing their circadian rhythms to delay with respect to clock time and with respect to the sleep/wake cycle." r. Alfred J. Lewy, from Oregon Health and Science University in Portland, tested the hypothesis by giving low-dose melatonin or placebo to 68 patients with SAD. If the phase-shift hypothesis were correct, giving melatonin in the afternoon to the typical SAD patient would cause a shift in their wake cycle to earlier in the day, resulting in an improved mood. By contrast, giving melatonin or placebo in the morning would not be expected to improve mood. The authors found that a low dose of melatonin could be given safely to the subjects and did not cause sleepiness. As anticipated, in typical SAD patients, treatment with melatonin in the afternoon worked best at alleviating their depression. Conversely, in the smaller group of patients with phase-advanced disease (possibly triggered by the earlier winter dusk), treatment in the morning appeared to be optimal. Proceedings of the National Academy of Sciences, April 24th early edition, 2006.

Depression Treatment Research Update
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 with depression present with in the primary care setting.

GlaxoSmithKline Plc is alerting physicians about a study suggesting the company's antidepressant Paxil may be linked more often to birth defects than similar drugs.

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, the present results provide a strong basis for switching to psychotherapy after a medication fails to alleviate depression and, conversely, for switching to medication when psychotherapy fails to relieve depression.

A U.S. government medical reviewer told an advisory panel in Sept, 2004, that new findings confirmed his conclusion months ago that certain antidepressants increase the chances of suicidal behavior among children and teens. Dr. Andrew Mosholder was prevented from giving his analysis to the panel at a public meeting in February because his supervisors thought the information he relied on was unclear.

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 are used to treat depression and include Paxil, Prozac, and Zoloft (sertraline) among others. Elavil and Dosulepin, by contrast, belong to an older drug group called tricyclic antidepressants.

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.

Close female friends help women through depression -- Nearly all women say they get depressed, stressed or anxious at some point in their lives, and most turn to their female friends for support during these and other tough times.

Association between depressive symptoms and serum concentrations of homocysteine in men: a population study
American Journal of Clinical Nutrition, Vol. 80, No. 6, 1574-1578, December 2004
Results of studies of the association between blood concentrations of homocysteine and depression in general populations and among psychiatric patients are inconsistent. Objective: The objective was to study the association between depression and serum concentrations of total homocysteine. Design: 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 (6.0%) were excluded. Depressive symptoms were assessed with the 18-item Human Population Laboratory Depression Scale. Those who scored 5 at baseline or at the 4-y follow-up were considered to have a tendency toward depression. Results: The participants were ranked according to their blood homocysteine concentration and divided into tertiles. 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. Conclusion: High serum concentrations of homocysteine may be associated with depression in middle-aged men.

Anxiety and depression are often associated.

Depression emails
Q. For depression, should one try 5HTP or SAM-e?
A. 5-HTP converts into serotonin while SAM-e can raise levels of several brain chemicals including norepinephrine, dopamine and others. 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.

Q. Is there a definitive "cure" for depression? 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? Will a depressed person always have that predisposition even if the depression is controlled?
     A. 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, exercise, sleep, work situations, etc. Some of these factors are reversible and hence depression can be cured, some other factors may not be reversible and hence depression may continue at some level or another for a lifetime. In most cases depression can be improved with the right approach or combination of methods.

Q. Hello, I live in Visalia California. I have been experiencing a number of strange things over the past few months. 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 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 shakey. 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. If you can help me that would be wonderful. Thanks for listening, and for a very informational website
     A. We're glad SAM-e is helping your depression. 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.

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

Q. I am not sure what to try. I am 50 years old. I have tried premarin, and felt severe depression, sam-e puts me in a manic state. I am very , very sensitive to medications...i try child doses. i have ptsd..still have my periods..but lab tests show menopausal. it is worse, my mood with depression after my period. do i try 5 htp, etc. i feel confused and low self worth. help.
     A. There are many supplements that may help with depression, and it is impossible to tell which will work in a particular person unless it's tried. Discuss with your doctor and always start with a portion of a capsule or tablet, even if it is a quarter of the regular dose. Sam-e can induce a manic state, but unlikely at a quarter of a 200 mg pill. So, trial and error is a good approach using low dosage.

Q. I came across your website during a google search and have found it extremely interesting and informative. However I need your help and advice. 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.
     A. 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.

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

Q. 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. I need some help. Can you suggest something that I can use while pregnant for the treatment of depression?
   A. 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 on the natural treatment of depression and decide if any of the supplements are appropriate for you, weighing the benefits versus potential risks.

I usually I am a very upbeat kind of person. I am a realtor and have been majorily affected by the economy. This has been going on for nearly 2 years. I am starting to feel the stress and strain of all this. I am 63 and have never been on any medication. Blood pressure has always been very good. I am wondering what supplements might be good for me now. My moods are not very good right now. Can you suggest some supplements?
   Perhaps the suggestions on this page can help you in consultation with your doctor.

Vagus Nerve Stimulation for Depression
May 2006 - Cyberonics Inc.'s online advertisement for its device to treat depression is misleading and makes exaggerated claims about how well it works. The ad, which is running on WebMD Health Corp.'s WebMD Web site, makes at least 10 false claims about its vagus nerve stimulation (VNS) device violating U.S. regulations, Public Citizen's Health Research group said in a letter to the Food and Drug Administration.