When the Antidepressants Run Out, by Dr. S.V.

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Worldwide, Prozac is the most prescribed antidepressant.  It is also prescribed for obsessive-compulsive disorder (OCD) and co-morbid anxiety. By inhibiting serotonin re-uptake, more serotonin is available at the synapse, which is anti-depressant.  There are many SSRIs prescribed for depression: Prozac, Zoloft, Paxil,  Celexa, Lexapro, etc.  There are antidepressant medications which target serotonin and other neurotransmitters, such as norepinephrine (Effexor), but they lie outside the scope of this article.

When raw ingredient availability is interrupted these medications will become abruptly unavailable.  There are recent examples of this phenomenon in the United States:  in 2003 tetanus toxoid became very scarce for some months due to a “pharmaco-political” issue, private clinics and urgent care centers ran out of tetanus toxoid for a period of some months, and it was available only in hospital emergency rooms.   In 2004 Ciprofloxacin became temporarily unavailable from any source for largely unknown reasons.  It is used for many common infections and it was nowhere to be found.

Current conditions will evolve to produce critical shortages in vital medications as is happening now in Greece:  "Pharmaceutical companies are no longer interested in selling to Greece where hospitals and pharmacies are in debt," said Kostas Lourantos, head of the pharmacies' association in the Attica region that includes the capital Athens.   Rampant inflation is making lifesaving drugs unaffordable even if available.  This is especially true for cancer drugs, antibiotics, antidepressants, and insulin (emphasis mine).

Abrupt cessation of SSRI’s creates both prompt and delayed withdrawal symptoms.  This is well recognized and variously called “SSRI withdrawal syndrome,” “SSRI cessation syndrome,” “Discontinuation syndrome,” etc.  Neurologically, phenomena called “paraesthesias” occur, feeling like  “electric shocks” in the head. Other symptoms include: sweating, nausea, insomnia, tremor, confusion, nightmares, and vertigo agitation, anxiety, akathesia, panic attacks, irritability, hostility, aggressiveness, worsening of mood, dysphoria (unhappiness), crying spells, mood instability, hyperactivity, depersonalization, decreased concentration, slowed thinking, confusion, and memory/concentration difficulties.

The current standards of medical practice advise a slow, gradual, well controlled withdrawal of SSRI’s in cases where discontinuation is advisable.  In the event of drug shortages and hyperinflation, discontinuations will be abrupt, and acute withdrawal syndromes will be frequent.

As with other TEOTWAWKI survival strategies, those who take SSRI anti-depressants must plan for their unavailability.  In general, naturally occurring substances and adjunct therapies are not enough by themselves to treat depression completely, although there is much disagreement on this issue. Naturally occurring substances often do not produce the pronounced pharmacological effects like manufactured medications do.  For this reason, when SSRI’s are available, one must  not discontinue the SSRI’s in favor of taking “natural” substances whose anti-depressant effects may not be as pronounced. One could endanger one’s health, have recurrent depression which resists treatment, become suicidal, etc. (“Available” is a relative term: congress just passed a bill to prohibit and destroy any medications bought online from foreign pharmacies, thereby eliminating access to affordable pharmaceuticals for those on a budget).

However, in this informational article, we discuss the situation where the American economy, society and infrastructure are collapsing and SSRI’s are no longer available.  In that case, it will be necessary to substitute available substances and strategies to replace the SSRI’s and continue to treat depression.  If the U.S. ends up like Greece, one may have to seek and use natural substances, plants, foods to treat depression.

Serotonin is involved in mood, appetite, sleep and impulse control. Serotonin taken orally cannot easily cross the blood brain barrier. However, serotonin levels can be increased by ingesting a precursor amino acid: tryptophan. L-tryptophan is an essential amino acid necessary for the production of serotonin. Some people find that boosting their L-tryptophan levels helps alleviate the symptoms of depression or insomnia. The figure below shows l-tryptophan converting into 5-HTP, which then readily converts into serotonin. Once serotonin is made, the pineal gland is able to convert it at night into melatonin, the sleep-inducing hormone.
L-Tryptophan --> 5-Hydroxytryptophan 5-HTP --> Serotonin --> N-Acetyl-serotonin --> Melatonin

Either tryptophan or 5-hydroxy-trytophan are good natural options since they convert into serotonin after going into the brain.  If supplemental tryptophan and 5-HTP are available, they can be stockpiled.  But, supplements too are manufactured and may become unavailable.

L-tryptophan dietary supplements were available for use in the 1980s.  Consumers were using tryptophan for sleep and as an antidepressant. It was available without a prescription until 1989 when the FDA prohibited its over-the-counter sale because a manufacturer in Japan shipped a contaminated batch to the U.S. causing a serious illness called eosinophilia myalgia syndrome (EMS) in about 1,000 individuals. Around 1995, tryptophan gradually became available by prescription through compounding pharmacies, and since the year 2000 it slowly and cautiously resurfaced on the over-the-counter market through a few vitamin companies.

Tryptophan side effects, caution, safety, toxicity

A common tryptophan side effect from high dose use is drowsiness.  Therefore, it should be taken in the evening and not while driving or operating heavy machinery. Dry mouth is a less common side effect. Other less common l-tryptophan side effects include nausea, dizziness, and loss of appetite.  A beneficial l-tryptophan side effect is drowsiness since that is the desired effect of many users who take this supplement for sleep. Confusion or disorientation is rare.  L-tryptophan occurs naturally in food and there is no danger of EMS from eating foods which contain tryptophan.  Poultry and some vegetables supply tryptophan (remember turkey sandwich bedtime snack helps you sleep?). So, the approach should include adequate intake of tryptophan containing foods

  • Meats – turkey, red meat, fish, shellfish, poultry, pork chops.
  • Dairy - Milk, egg whites and cheese are all good source of tryptophan
  • Soy products, nuts and seeds are high in tryptophan. Fruits and vegetables containing tryptophan are bananas, spinach and beans.
  • Pumpkin seeds are a natural source of L-tryptophan, with a tryptophan content of 0.576 grams per 100 grams of dried pumpkin seeds. Roasted pumpkin seeds, with or without added salt, have a slightly lower tryptophan content

Description 5-hydroxy-tryptophan (5-HTP) is an amino acid that is the immediate precursor of serotonin.  It is produced in the body and is used to make the neurotransmitter serotonin. Although taking 5-HTP in supplement form may boost the body's serotonin levels, some experts feel there is not enough evidence to determine the safety of 5-HTP. There is general agreement that 5-HTP should not be combined with other pharmacologic anti-depressants.

Efficacy Since 95% of depressed individuals also have one or more anxiety symptoms, anxiety will be mentioned often as accompanying depression.  One RCT (retrospective controlled trial, the “sine qua non” for many doctors) examined 5-HTP for anxiety disorders. A total of 45 patients with agoraphobia, panic attacks, generalized anxiety disorder, panic disorder, or obsessive–compulsive disorder, were randomized to clomipramine (a tricyclic antidepressant), 5-HTP or placebo for 8 weeks.  Patients treated with 5-HTP showed a reduction in anxiety which was similar to that of clomipramine. Five out of 15 treated with 5-HTP improved more than 50%, compared with only one out of 15 on placebo.

Safety Issues:
A study by Kahn, et.al. showed an initial and transient worsening of anxiety symptoms in those treated with 5-HTP before improvement.  Overdosing on 5-HTP can cause: fever, nausea, dizziness, confusion, hallucinations, and restlessness; severe cases can result in fever and death. These symptoms can progress very quickly and can prove to be fatal within 24 hours of the first symptom. 
Those on other serotonin-targeting chemicals such as SSRI’s, tryptophan, SAM-e, or St. John's wort should not take 5-HTP supplements. 5-HTP should not be taken with anti-depression or anti-anxiety medication because this can cause serotonin levels to increase to a dangerous level, causing “Serotonin Syndrome.” Supplements of 5-HTP can also raise blood pressure and increase heart rate, so it is not recommended for those with high blood pressure unless approved by their physician. Pregnant and nursing women should also avoid 5-HTP, as well as anyone with cardiovascular disease or who is at risk for cardiovascular disease. The increased blood pressure brought on by 5-HTP may also increase tumor growth rate: those with carcinoid tumors should avoid 5-HTP.

Conclusion 5-HTP shows promise for anxiety disorders which often accompany depression. Many physicians feel insufficient research has been done to recommend 5-HTP (Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459).
Because of its chemical/biochemical relationship to L-Tryptophan, 5-HTP has been under scrutiny by consumers, industry, academia and government for its safety. However,  extensive analyses of several sources of 5-HTP have shown no toxic contaminants similar to those associated with L-Tryptophan. References: “Safety of 5-hydroxy-L-tryptophan,” Toxicol Lett. 2004;  Expert Rev Pharmaco- economics Outcomes Res. 2009;9(5):445-459).

B Vitamins  

Vitamin B6 is involved in the metabolism of tryptophan to serotonin. Vitamin B-12 and other B vitamins play a role in producing brain chemicals that affect mood and other brain functions. Low levels of B-12 and other B vitamins such as vitamin B-6 and folate may be linked to depression and can result from eating a poor diet or not being able to absorb the vitamins consumed. Older adults, vegetarians and people with digestive disorders such as celiac disease or Crohn's disease may have trouble getting enough B-12. Sometimes a vitamin B-12 deficiency occurs for unknown reasons.
The best way to make sure one is getting enough B-12 and other vitamins is to eat a healthy diet including sources of essential nutrients. Vitamin B-12 is found in animal products such as fish, meat, poultry, eggs and milk. Fortified breakfast cereals also are a good source of B-12 and other B vitamins.

| Taking a daily supplement that includes vitamin B-12 may help the body get the nutrients it needs, especially if one is older than 50 and/or a vegetarian. However, B-12 and other vitamin supplements can interact with some medications, especially in high doses and one should consult with a doctor before taking a vitamin supplement.
The precise role of B vitamins in depression not clear.  In the case of a vitamin deficiency, taking a supplement may help. But no supplement can replace proven depression treatments such as antidepressants and psychological counseling (see below for more on B vitamins).

Reference: Skarupski KA. “Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time,” American Journal of Clinical Nutrition. 2010;92:330. Mayo Clinic, Daniel K. Hall-Flavin, M.D.

Ginkgo Biloba

Extracts of the leaves of the Ginkgo biloba tree are used therapeutically. EGb 761® is a Ginkgo biloba extract registered in a number of countries for the treatment of dementia disorders. According to mayoclinic.com, studies show possible benefits of using ginkgo for depression in elderly patients. Investigation is ongoing.

The mechanism of action in improving depression and anxiety is not precisely known. Ginkgo may inhibit serotonin reuptake at serotonin receptor sites.  According to the University of Maryland Medical Center, clinical studies suggest that ginkgo provides improvement in the areas of cognition, daily living, social behaviors and feelings of depression in the elderly. Persons with depression may need to take ginkgo consistently for 12 weeks before seeing benefits; others have reported positive effects as soon as two to three weeks after starting ginko.

The Mayo Clinic information on ginko suggests dosages between 80 and 240 mg taken daily by mouth in two to three divided doses.  A dosage of 3 to 6 mL of 40 mg per mL extract may be taken in three divided doses, or the herb is available as a tea. These dosages are for adults over the age of 18 years; there have been no clinical studies of ginkgo use in children. The recommended dosage is 80 mg twice a day, once in the morning and again after lunch.

Precautions: The University of Maryland Medical Center cautions when adding ginkgo to a current depression regimen and should be done under the care of a physician. Ginkgo should be taken with caution when combined with selective serotonin reuptake inhibitors (SSRI) or other MAO inhibitors (anti-depressants), because of possible negative side effects. In addition, ginko has anti-coagulant properties and should not be combined with warfarin (Coumadin) to avoid bleeding.  Bleeding is also a consideration in the very elderly.

Reference: Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459;  Mayo Clinic “Ginko Evidence;” National Institutes of Mental Health “Depression.”

Kava

Kava is a plant native to the South Pacific.  The root is used for medicine. Kava affects the brain and other parts of the central nervous system. The kava-lactones in kava are believed to be responsible for its sedative effects.

There are substantial safety concerns about kava. Many cases of liver damage and even some deaths have been traced to kava use. As a result, kava has been banned from the market in Switzerland, Germany, and Canada, and several other countries are considering similar action.  The National Institutes of Health firmly recommends against using Kava at this time, citing the histories of deaths, and serious interactions with other medications and herbs.

Passionflower (Passiflora incarnata)
 Passionflower is a plant native to the Americas used as a folk remedy for anxiety and insomnia, and can be used to treat anxiety symptoms that may occur with an agitated depression, or generalized anxiety disorder with depression.  The therapeutic mechanism is not understood, but may be related to activation of benzodiazepine receptors.

Passion Flower and anxiety

Roots and leaves of the passion flower species, Maypop, were used by Native Americans and later by the American colonists. The leaves were used fresh or dried out to make a tea that was useful in treating epilepsy, “hysteria” and insomnia. A tincture even proved to be analgesic.  The roots and leaves contain most of the active  compounds:  flavonoids, maltol, cyanogenic glycosides, harman indole alkaloids, etc. A double-blind randomized trial compared the efficacy of passion flower extract with oxazepam ( a benzodiazepine in the same family as Valium®) in the treatment of generalized anxiety disorder. The study was performed on patients diagnosed with anxiety:  18 people received passion flower extract 45 drops/day (plus placebo group receiving sham drops), and 18 people received 30 mg/day (plus placebo group receiving placebo tablets) for a 4-week trial. Passion flower extract and oxazepam were effective in the treatment of generalized anxiety disorder, which can often accompany depression. More problems relating to impaired job performance were associated with oxazepam. The results suggest that passion flower extract is an effective herb for the management of generalized anxiety disorder, with low incidence of impairment of job performance. 

Safety Issues
 A case has been reported in which self-administration led to severe nausea, vomiting, drowsiness, prolonged QTc (a dangerous cardiac electrical effect seen on EKG)  and episodes of nonsustained ventricular tachycardia (which can progress to fatality).

Conclusion
Anecdotal and traditional historical use of passion flower suggest it is helpful for treatment of anxiety, from whatever cause. There is a lack of well controlled scientific studies for the medical community to reach a consensus.

Passion flower should not be relied on to treat panic disorder or other severe anxiety disorders.  Very often, several conditions will co-exist, e.g. depression, anxiety and obsessive compulsive disorder. Along with an anti-depressant there may be a need for an anti-anxiety agent .However, note that the use of anti-anxiety medications and/or herbal supplements/substances may worsen depression.  Exercise caution using passion flower use for anxiety in the setting of concomitant depression. Reference: Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459; Rehwald A, Meier B, Sticher O. “Qualitative and quantitative reversed-phase high-performance liquid chromatography of flavonoids in Passiflora incarnata L.”, Pharm Acta Helv . 1994;69:153-158.

St. John's Wort
St John's wort is a flowering plant used as a traditional remedy for sadness, worry, nervousness, and insomnia. The most common modern-day use of St. John's wort is the treatment of depression. Today, the results of over 20 clinical trials suggest that St. John's wort works better than a placebo and is as effective as antidepressants for mild to moderate depression, with fewer side effects.

Numerous studies report St. John's wort to be equally effective as tricyclic antidepressant drugs in the short-term treatment of mild-to-moderate depression (1-3 months). It is not clear if St. John's wort is as effective as selective serotonin reuptake inhibitor (SSRI) antidepressants such as sertraline (Zoloft®). In Germany, St. John’s Wort is indicated for clinical use in mild to moderate depression, nervous disturbances, fear, somatoform disturbances, anxiety and insomnia. Some 66 million annual doses of this plant are consumed in Germany and three million prescriptions are given to patients. In Germany use of hypericum extract is supported by many clinical studies and doctors’ prescriptions, and is extensively listed in the German Commission E Monographs (you can purchase the German Commission E Monograph on Amazon).*

Scientific evidence supports the effectiveness of St. John's wort in mild-to-moderate depression. It may also be helpful in treatment of Seasonal Affective Disorder (S.A.D.) The efficacy of St John’s wort in severe major depression is unclear and it should not be used to treat severe depression. St. John's wort may take 4 to 6 weeks to produce full effects.

Therapeutic Mechanism

Evidence suggests serotonergic, dopaminergic and GABA-ergic activity, but the exact mechanism is not known.  St. John's Wort is available from herbalists, health food stores, drug stores and online in the form of capsules, tablets, liquid extracts, or brewed as a tea.  St. John’s wort is easy to grow, and although it is an annual, it readily reseeds itself coming back year after year.
The daily dose of St. John’s Wort for capsules standardized at 0.3% hypericin, is 300mg, 3 times per day. For non-commercial preparation, the flowering and leafy parts of hypericum plant should be obtained from dried above ground part of the plant just before or after the flowering period. The lower part of stem has lower concentration and fewer active ingredients. For tea one would place 2 teaspoons of herb in 1 cup of boiling water, and take 3 times per day.

Safety issues

Side effects may include dizziness, dry mouth, indigestion, and fatigue. St. John's wort increases photosensitivity. Also, recent disturbing information from the University of Alabama suggests that St. John’s wort is related to development of cataracts and macular degeneration. Apparently, the hypericin in St John’s wort reacts with ultraviolet light producing free radicals which can damage the lens and/or retina.  These are serious and irreversible side effects of using St. John’s wort, and anyone beginning therapy with this herb must weigh these risks of its use against the benefits of its use. It is not known if polarized UV protection with sunglasses can prevent these complications or not.One must take frequent breaks from the use of this natural antidepressant and substitute other dietary supplements that elevate mood. Reference: “St John's Wort (Hypericum perforatum),”, Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459.

Overall, St John's wort causes fewer side effects compared with the use of antidepressants. However, it may have clinically dangerous interactions with a range of prescribed medications, including anticancer agents, anti-HIV agents, anti-inflammatory agents, antimicrobial agents, cardiovascular drugs, CNS agents, hypoglycemic agents (oral diabetes medication), immune suppressants , oral contraceptives, proton pump inhibitors (for stomach acid), asthma medications and statins (for lipids) . St. John's wort is not recommended for pregnant or nursing women, children, or people with bipolar disorder, liver or kidney disease.  St. John’s Wort can cancel out the effects of oral contraceptives, making one more likely to become pregnant. People using this or any other medication/herbal remedies should consult their healthcare providers prior to starting therapy.  Reference:  Mayo Clinic St. John's wort (Hypericum perforatum L.)  Natural Standard Patient Monograph, 2012.

Omega-3 fatty acids
Omega-3 fatty acids are a type of good fat needed for normal brain function. Our bodies can't make omega-3s on their own, so we must obtain them through our diet. Studies have linked depression with low dietary intake of omega-3 fatty acids. In countries with higher fish consumption, such as Japan and Taiwan, the depression rate is 10 times lower than in North America. Postpartum depression is also less common.  Studies strongly suggest that omega-3's together with antidepressants may be more effective than antidepressants alone.
Cold water fish such as salmon, sardines, and anchovies are the richest food source of omega-3 fatty acids. But instead of eating more fish which contain mercury, PCBs, and other chemicals, fish oil capsules are a “cleaner” source of omega-3 fatty acids. Many companies filter their fish oil so that these chemicals are removed.
Fish oil capsules are sold in health food stores, drug stores, and online.  When comparing brands, the key active components for depression are EPA (eicosapentaenoic acid)  and DHA  (docosahexaenoic acid). Fish oil capsules may interact with blood-thinning drugs such as warfarin and aspirin. Side effects may include indigestion (To prevent the “fishy aftertaste” one may take the fish oil just before meals). Fish oil should not be taken 2 weeks before or after surgery to avoid bleeding. 
Controlled studies have examined omega-3 fatty acids and placebo in depression. One clinical study found that four months of treatment with 9.6 g of omega-3 fatty acids (6.2 g EPA/3.4 g DHA) showed a highly significant effect in treating depression (p < 0.001). In another trial, the addition of 2 g of pure EPA to standard antidepressant medication enhanced the effectiveness of that medication vs. medication and placebo. These particular patients had treatment-resistant depression, and EPA had a beneficial effect on insomnia, depressed mood, and feelings of guilt and worthlessness.

SAM-e

SAM-e, pronounced "sammy", is short for S-adenosyl-L-methionine, a chemical found naturally in the human body and believed to increase levels of neurotransmitters serotonin and dopamine. Several studies have found SAM-e is more effective in treating depression than placebo. A study found it was helpful even in depressed patients who did not respond well to Prozac and other SSRIs.  SAM-e works best for  depression associated with low energy and low motivation. High doses can cause restlessness and anxiety. For depression 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 a good idea to take a day or two off when one notices overstimulation. Side effects can include nausea and constipation.  SAM-e is not advised for those who have manic depression (bipolar disease).  If a patient has been diagnosed with any type of manic or anxiety disorder, use with extreme caution only under a physician's monitoring. Severe manic episodes can occur with the use of SAM-e.
In North America, SAM-e is available as an over-the-counter supplement in health food stores, drug stores, and online. It should be enteric-coated for maximum absorption.  

Acetyl L
-carnitine

Acetyl L-carnitine can lift mood and enhance mental activity. This nutrient can begin working within hours, providing lifted mood, mental clarity and stamina. However, acetyl-L-carnitine must be avoided by breast cancer patients as it may induce or exacerbate a chemotherapy induced peripheral neuropathy. Reference: 2012 Annual Meeting of the American Society of Clinical Oncology,.Duloxetine Useful in Chemo Neuropathy, But Avoid ALC”, Zosia Chustecka.

Diet

Reduce intake of sweets
Sweets temporarily make one feel good as blood sugar levels soar, but may worsen mood later on when they plummet.

Avoid caffeine and alcohol

Caffeine and alcohol both dampen mood. Alcohol temporarily relaxes  and caffeine boosts energy, but the effects of both are short-lived. Both can worsen mood swings, anxiety, depression, and insomnia.  Conversely, caffeine withdrawal can also cause depression.

B Vitamins

It is unknown whether  B-vitamin deficiency is the cause or the result of depression. Given that the chemical reasons for depression are largely unknown, it is difficult for scientists to pinpoint any association, says the NIMH. However, it is known that a B-vitamin deficiency strongly correlates with depression. Patients with high levels of vitamin B12 respond better to antidepressant treatment of depression. B vitamins seem to play an important role in relieving depression by alleviating the anxiety and restlessness that often accompanies this illness.  Dietary vitamin B12 can help fight anemia which can also cause depressed moods.

 

Folic Acid
Folic acid (or “folate”) is a B vitamin often deficient in people who are depressed.  Folate is found in green leafy vegetables, other vegetables, fruit, beans, and fortified grains. It is one of the most common vitamin deficiencies because of poor diet. Chronic conditions and various medications such as aspirin and contraceptive pills can also lead to deficiency. Besides food, folic acid is also available as a supplement or as part of a B-complex vitamin.
Researchers at Harvard University have found that depressed people with low folate levels don't respond as well to antidepressants, and taking folic acid in supplement form can improve the effectiveness of antidepressants.

Vitamin B6
 
Vitamin B6 is needed to produce the mood-enhancing neurotransmitters serotonin and dopamine. Although deficiency of vitamin B6 is rare, a borderline deficiency may occur in people taking oral contraceptives, hormone replacement therapy, and drugs for tuberculosis.   B6 may help with the depression of the pre-menstrual syndrome.
B vitamins, including pantothenic acid (B5), have a mild but discernable influence on mood.  Low blood levels of B vitamins  increase the 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. A B complex supplement containing all the B vitamins is advisable.  Reference:National Institutes of Mental Health: “Depression.”

Magnesium

Most people do not get enough magnesium in their diets. Good sources of magnesium are legumes, nuts, whole grains and green vegetables. Like vitamin B6, magnesium is needed for serotonin production. Stress depletes magnesium. According to review published in "Medical Hypotheses" in 2006 and 2010, magnesium deficiency is a major cause of depression. Magnesium supplementation may thus function as an effective treatment for depression. A 2008 clinical trial referenced in the review showed that magnesium was as effective as a tricyclic antidepressant in treating depression in diabetics. Additionally, case histories indicate rapid recovery from major depression using a magnesium dosage of 125 to 310 mg with each meal and at bedtime. It is important to note, however, that these experimental dosages for depression treatment are higher than those considered safe by health authorities, and one should not attempt to self-treat depression by taking such high doses of magnesium.

Risks
Magnesium doses of less than 350 mg/day are considered safe for most adults. However, taking large doses may cause magnesium levels to build up in the body, resulting in serious side effects such as low blood pressure, confusion, irregular heartbeat, coma and death. Taking magnesium supplements is very dangerous if one has kidney problems or kidney failure because magnesium can only be excreted by the kidneys. Magnesium may also cause moderate drug interactions with the following types of medications: antibiotics, bisphosphonates, calcium channel blockers, muscle relaxants and diuretics. Magnesium supplements may interact with other dietary supplements including calcium, boron, vitamin D, malic acid and zinc.

According to the National Institutes of Health, the best and safest way to get extra magnesium is to eat a variety of whole grains, legumes, and dark, leafy vegetables. Certain types of fish and nuts also provide magnesium. According to the NIH, a 3-oz. serving of cooked halibut provides 90 mg of magnesium, or 20 percent of the Daily Value for magnesium set by the U.S. Food and Drug Administration. Other foods that are especially high in magnesium, each providing 20 percent of the DV, include a 1-oz. serving of dry roasted almonds, cashews, or mixed nuts; a 1/2-cup serving of cooked soybeans; and 1/2 cup of cooked spinach. Baked potatoes, peanut butter, fortified oatmeal, yogurt, and brown, long-grained rice are some other common foods that are good dietary sources of magnesium and it would be wise to stockpile these foods if one suffers from depression.

Caffeine Reduction
Caffeine is a CNS stimulant that can be found in coffee, tea, cola and chocolate.  It is thought that caffeine can induce anxiety by binding to adenosine receptors and blocking the anxiolytic effects of adenosine. Caffeine intoxication presents with similar symptoms to anxiety (e.g., restlessness and nervousness) and some anxiety disorders may be caffeine-induced. For these reasons, reducing or abstaining from caffeine could be helpful for those with anxiety disorders accompanying depression.
Symptoms of rapid caffeine withdrawal include headache, fatigue, decreased energy/activeness, decreased alertness, drowsiness, decreased contentedness, depressed mood, difficulty concentrating, irritability and foggy/not clearheaded. These symptoms may last for 2–9 days.  Even for those without depression, caffeine withdrawal will be an unpleasant exercise for many when coffee/tea/chocolate become unavailable. Reference: Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459.

Exercise

Regular exercise is one of the most effective and inexpensive ways to improve mood.  Exercise, particularly aerobic exercise, releases mood-elevating chemicals in the brain and decreases stress hormones, though the precise mechanism is unknown. Preliminary evidence suggests downregulation of 5-HT2C receptors or GABAA receptors, enhancement of slow-wave sleep, enhancement of perceived coping ability, and change in focus from ruminations and worries
One of the best options to combat depression is taking a brisk walk outside each morning for at least 30 minutes five days a week. Non-aerobic weight training has also been shown to improve depression.  What's important is that one chooses something either enjoyable or practical in a TEOTWAWKI environment.

Safety Issues
There is a risk of injury when exercising for those who are overweight, have a chronic health condition, or have not exercised regularly for a long time. There is no way to predict who will benefit from exercise to improve depression, and if there are no contraindications to exercise, the approach should be tried.  References: Journal of Clinical Psychiatry; Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459

Light Therapy  
Getting enough sunlight has been shown to be effective for seasonal mood changes that happen in the darker winter months.  Recent studies indicate that bright light also helps depression that is not seasonal:  Three weeks of daily, bright light therapy improved depression symptoms compared with placebo. Three weeks after treatment, symptoms continued to improve in the light treated group, but there was no improvement in the placebo group. Reference: Evid Based Ment Health. The British Psychological Society and the Royal College of Psychiatrists, 2011;14(3)
Exposure to light in the morning helps the body's sleep/wake cycle work properly. Production of serotonin is activated in the morning upon exposure to light. During the winter when there is less sunlight, serotonin levels can drop, causing one to feel tired and prone to seasonal affective disorder (SAD).
The simplest way to increase one’s exposure to light is to walk outdoors in the morning. It is recommended to wear sunscreen.  Another option is to use special lights that simulate natural daylight. Studies have found they are effective.

Suitable lights can be found online. There are different types available, from light boxes to visors. Look for lights with a minimum of 3,000 lux (used for about 45 minutes a day), though many experts suggest 10,000 lux ( used for 30 minutes a day).

Vitamin D 

Recently, several studies show correlation between low vitamin D (vit D) and depressive symptoms. Although the medical community is reluctant to say that very low vit D levels cause depression, in reality, physicians are testing everyone for vitamin D deficiency, especially if they are depressed, and recommending enthusiastic replacement of the deficient vitamin.   There are widespread anecdotal reports of vit D replacement dramatically improving depressive symptoms.  Many have suggested that Vitamin D associated improvement in symptoms mirrors the improvement in depressive symptoms with sun exposure.  However, it is unlikely to be the only reason sunlight exposure helps depression.   Keep in mind that normal exposure to sunlight for 15 or more minutes can produce transient blood vitamin D levels of 20,000 IU or more, which is quite high, and seems to suggest a direct link.  With these recent findings in mind, the recommended daily dose of vitamin D for adults has gone from 400 IU to 2000 IU per day.  In a very deficient person (<10ng/ml), there is an accepted regimen for more robust replacement of 50,000 IU a week for 4 weeks, then daily dosing of around 2000 IU a day.  Some physicians have a bit different regimen of 7,000 to 8,000 IU of vit D a day for 3-4 weeks, then resumption of recommended daily doses. 

Ashwagandha (Withania somnifera)

Withania somnifera is a plant that has been used for centuries in India to treat a variety of ailments, including stress,anxiety, and depression. Ashwagandha is easy to grow as a shrub and the roots are the main part of the plant used for therapeutic purposes.  The therapeutic mechanism is thought to involve its beneficial effects on GABA neurotransmission.
A review of one double-blind, placebo-controlled study of Withania somnifera in 39 patients with anxiety disorders found Withania superior to placebo after 6 weeks, and it caused no more adverse effects than placebo.

A study done in 1991 at the Department of Pharmacology, University of Texas Health Science Center indicated that extracts of ashwagandha had GABA-like activity. This may account for this herb’s anti-anxiety effects.
  A 2000 study with rodents showed it to have anti-anxiety and anti-depression effects.
Extensive studies in animals indicate that it is nontoxic in a wide range of reasonable doses. Anecdotal reports suggest that Withania somnifera may potentiate the effects of barbiturates causing sedation. Large doses have been shown to cause gastrointestinal upset and may possess abortifacient properties, so it should not be taken during pregnancy. Reference: Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459.

Rhodiola

Rhodiola rosea is a succulent herb which grows in the Arctic regions of eastern Siberia. It is a popular plant in traditional medical systems in Eastern Europe and Asia. Russians have drunk rhodiola tea for centuries as an energy booster. The root has a reputation for stimulating the nervous system, fighting depression, enhancing work performance, decreasing fatigue, and reducing high altitude sickness. This herb has been categorized as an adaptogen by researchers due to its ability to increase resistance to a variety of chemical, biological, and physical stressors. The adaptogenic activities have been attributed  to its ability to influence levels and activity of monoamines and opioid peptides such as beta-endorphins.
The botanical Rhodiola rosea, has been studied in the U.S.  for anti-depressive efficacy using 340mg versus 680 mg versus placebo for 6 weeks in mild-to-moderate depression. A significant reduction in depression inthe Rhodiola groups was found, but no improvement with placebo. 
Reference: Expert Rev Neurother. “Complementary and Alternative Medicine Therapies in Mood Disorders”,Aleeze S Moss; Daniel A Monti; Andrew B Newberg, 2011;11(7):1049-1056.

Another study found that overall depression, together with insomnia, emotional instability and somatization improved significantly following medication with Rhodiola while the placebo group did not show such improvements. No serious side-effects were reported in any of the groups. Reference: Nord J Psychiatry, “Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression,” Darbinyan V, Aslanyan G, Amroyan E, Gabrielyan E, Malmström C, Panossian A., 2007;61(5):343-8.                                                             

Safety Issues
Due to its energy boosting properties, too high a rhodiola rosea dose can cause side effects including restlessness, irritability, and insomnia. A possible adverse reaction on high doses is increased heart rate while very high doses could produce heart palpitations or development of atrial fibrillation. It is also possible that high doses could increase blood pressure.  Reference:  “Experimental analysis of therapeutic properties of Rhodiola rosea and its possible application in medicine”, Medicina, 2004.

Dosage

Rhodiola extracts are standardized to their content of salidroside. A typical dosage of 170 to 185 mg daily supplies 4.5 mg of salidroside.
If growing your own Rhodiola, order the seeds online and plant according to package directions. It is hardy down below zero. Dry the herb without affecting potency by hanging it in bunches in a dry, shady location. Make Rhodiola tea by pouring 1 cup of hot or boiling water over 1 teaspoon of dried Rhodiola, steep for five to 10 minutes, strain and drink once per day.
References: Darbinyan V, Kteyan A, Panossian A, et al. “Rhodiola rosea in stress induced fatigue—a double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty”, Phytomedicine. 2000;7:365-371; Shevtsov VA, Zholus BI, Shervarly VI, et al. “A randomized trial of two different doses of a SHR-5 Rhodiolarosea extract versus placebo and control of capacity for mental work”, Phytomedicine. 2003;10:95-105; Spasov AA, Wikman GK, Mandrikov VB, et al. “A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen”; Phytomedicine. 2000;7:85-89;  Fintelmann V, Gruenwald J., “Efficacy and tolerability of a rhodiola rosea extract in adults with physical and cognitive deficiencies,” Adv Ther. 2007;24:929-939;  Darbinyan V, Aslanyan G, Amroyan E, Gabrielyan E, Malmström C, Panossian A., “Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression,” Nord J Psychiatry. 2007;61(5):343-348.

Holy Basil 

Holy basil, also known as tulsi or Ocimum sanctum, is a small, branched shrub that has been used in ancient Ayurvedic medicine to treat a variety of ailments. The strongly aromatic leaves contain tannins, flavonoids and essential oils responsible for its biological activity. Holy basil supplements are available as tablets, capsules, liquid extracts and tea, and the dosage depends on the age and condition of the patient.

According to a study published in the September 2008 issue of the "Nepal Medical College Journal," 500 mg of holy basil capsules taken two times a day after meals  significantly lowered the intensity of generalized anxiety disorder. Some studies have  indicated that holy basil extracts have the ability to attenuate depression and anxiety in laboratory animals. Managing anxiety and depression may, in turn, help treat insomnia. Reference: Nepal Medical College Journal; “Controlled Programmed Trial of Ocimum sanctum Leaf on Generalized Anxiety Disorders”, D. Bhattacharyya et al., September 2008.

Holy Basil can be direct-seeded in the spring after the last frost with germination rates at temperatures between 65-70 F.  Cover with a thin layer of soil as seeds require light for germination.  Holy Basil will grow to a height of approximately 20" and produce green and red leaves and delicate purple flower bracts from mid summer on.  Ocimum teniflorum is the variety used for medicinal purposes, and all the cultivars are in the mint family, and related to sweet basil.

Though holy basil is still being examined for potential risks and side effects, some negative side effects have been reported. According to the University of Michigan Health System, use of holy basil has been linked to fertility problems. No drug interactions are known as of yet.

Ketogenic diet

A ketogenic diet results from restriction of carbohydrate intake, and often calories, relying on fat metabolism to produce ketones to meet metabolic needs. Ketones can be produced by using “MCT’s” (medium chain triglycerides, from e.g. coconut oil) for up to 50% of fat intake. Under these circumstances, the body produces ketone bodies from fat (your own fat, ingested fat and MCT’s) which the brain and body can use for fuel. A ketogenic diet reduces seizure frequency, and medical doctors have observed it to benefit depression.  The ketogenic state changes the metabolism of the amino acid glutamate to be preferentially made into GABA, an inhibitory neurotransmitter, associated with calm and relaxation.  Physicians widely note that excessive carbohydrates and low fat intake correlate strongly with depression.  This could result from several mechanisms: excessive glucose directly causing depression, the hyperinsulinemia response to excessive carbohydrates may cause depression, insulin resistance could cause depression, obesity, and diabetes, lack of dietary fat could lead to depression, and the lack of vitamin D could cause or exacerbate depression.

Although there have been no rigorous studies to statistically demonstrate that ketogenesis benefits depression, the observation is so widespread and consistent that it is more than anecdotal, and impossible to deny.  In the TEOTWAWKI scenario we are considering, much like present day Greece, medications including antidepressants can and will become scarce or nonexistent.  Millions of people will suddenly withdraw from anti-depressants causing crises of depression and suicide rarely seen nowadays.  The time for collapse may be near, and one must gather available information including anecdotal and historical experience to prepare to treat depression without medications if the situation arises.

Medications represent top tier, sophisticated manufactured goods which will be among the first to disappear as the infrastructure collapses.  Recent history is rife with examples of this phenomenon.  In the “stable” pre-collapse society we live in now, many physicians demand rigorous, repetitive, consistently reproducible data to decide that a particular therapy may be helpful.  We will not have money, time or personnel to employ this process on non-medication forms of therapy if the SHTF very soon, as we believe it will. 

A smart survivalist who either has depression or family members with depression will examine this information and do the obvious: stockpile fish oils, St. John’s Wort seeds, canned salmon,sardines, anchovies, coconut oil, a bright light source (e.g. LED, get them online while you still can), SAM-e and/or other supplements and adaptogens, consider growing other adaptogens and acquire their seeds, consider growing chamomile/lemon balm/skullcap/valerian to use for anxiety, stockpile vitamin D, B vitamins, multivitamins, and start preparing physically for the increased physical activity. I guarantee in Greece today, people with depression desperately wish they had done these things. Because when the Prozac runs out, a stockpile of non-medication treatment modalities may prevent a miserable reversion to immobile depression, and will literally be worth more than gold for trade value.  ?

This article is not intended to offer professional medical advice. It is written for informational purposes only.  It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL CONDITION OR EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition or treatment. Any other use of this information if at the reader’s risk, and the author will not be held responsible for the outcome.

This information does not apply to manic depression, or bipolar affective disorder. Although all of the afore mentioned help depressive symptoms, you should neither self - diagnose nor use herbal or nutritional remedies to self-treat your symptoms. Consult your doctor or a qualified medical professional if you think you may be suffering from depression. Depression can become worse if not properly treated and may result in suicide/death.

* Germany's Commission E is the scientific committee of Federal Department of Health. This committee is active since 1978 and it has a panel of multidisciplinary experts in the field of medicine, pharmacology, botanist, toxicologists and others.

This panel came out with 312 monographs of clinically supported herbal use with 286 individual herbs and herbal formulations. The main criteria of this panel is that the herb should be absolutely proven to be safe and and should show reasonable efficacy. These monographs represent the most comprehensive and supported information about herbs In 1978 the German government established an expert committee, the Commission E, to evaluate the safety and efficacy of over 300 herbs and herb combinations sold in Germany. The results were published as official monographs that give the approved uses, contraindications, side effects, dosage, drug interactions and other therapeutic information essential for the responsible use of herbs and phyto-medicines. For the first time, the complete set of all Commission E monographs has been complied, translated into English and edited for use by physicians, pharmacists, health professionals, researchers, regulatory agencies, consumers and the herb industry.

You can purchase a copy of the The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines on Amazon.  A pre-owned copy is fine and much less expensive.

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This page contains a single entry by Jim Rawles published on September 1, 2012 12:11 AM.

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