By Ellen Vora, M.D.
We live in a culture that is conditioned to think If you don't feel well, reach for a pill. In general, I buck against this mentality. I believe it's possible to fundamentally heal from depression, anxiety, ADHD, and even bipolar disorder using other strategies—strategies that require a lot more than just taking a pill or two a day.
I my years as a holistic psychiatrist, I've learned that true healing comes from comprehensive, effortful diet and lifestyle changes, like shifting toward a real food diet, getting to bed early enough that you get a full night of sleep, moving your body, engaging with your IRL community, limiting your social media use, connecting with nature, drinking water, getting exposure to sunlight and fresh air, and escaping the trap of perpetual busyness by doing less. No pill, whether a synthetic prescription drug or natural supplement, takes the place of these changes.
That being said, there are certain supplements that can support the process of healing from depression. If you're trying to take a more holistic approach to managing your depression, and you want to use diet and lifestyle rather than pharmaceuticals, here are my go-to supplements to augment this process. Just make sure to always consult your doctor before making any changes to your treatment regimen or medications.
Curcumin, which is the active compound in turmeric (the spice that gives curry its characteristic golden color), is a powerful anti-inflammatory. Given that inflammation is at the root of so many modern cases of depression, this is a go-to effective treatment to improve your mood while helping your body get healthier. The best way to get the benefit of turmeric is to cook with it. Make a curry, and be sure to combine turmeric with black pepper for a synergistic benefit, or prep a turmeric paste and use that to make golden milk. If you don't think you'll be able to consume it consistently, then take curcumin in pill form. Curcumin is safe and effective, and you might see side benefits like improved joint pain or less digestive discomfort.
Rhodiola is an adaptogenic herb that supports your body in dealing with stress, which is at the root of so much depression. It has additional benefits by helping with adrenal fatigue, focus, and attention. While Rhodiola is very effective, it's not safe for everyone. I don't recommend Rhodiola for my patients on the bipolar spectrum, and it's not recommended during pregnancy or lactation. Rhodiola can also have interactions with certain medications like ACE inhibitors and some diabetes medications, so it's important to clear this one with your doctor.
SAM-e is not safe in all scenarios, but when it's indicated, it can be a huge help. Some people with depression have what's called a methylation defect at the root of their depression. SAM-e helps compensate for this defect and can have a tremendous impact on mood. I recommend starting at a dose of 400 milligrams daily and increasing by 400 milligrams every week. A good final dose is 1,200 to 2,400 milligrams daily. It's best to take it on an empty stomach along with a B complex. Some people get activated by SAM-e, which means it's not the right fit in those cases and it should be discontinued. It's not safe for folks on the bipolar spectrum, and it can't be taken in conjunction with some psychiatric medications, such as MAO-I's. It's definitely best to clear this one with your doctor before initiating it.
Probiotics are a very helpful augmentation in the treatment of depression. It's becoming increasingly apparent that a compromised gut flora is at the root of gut inflammation, systemic inflammation, and compromised neurotransmitter production, all of which contribute to depression. If you've ever taken antibiotics or are drinking chlorinated municipal tap water, it's probably worth your while to rebuild your gut flora. The first way to do this is by consuming fermented foods (e.g., sauerkraut, sauerkraut juice, beet kvass, kimchi, miso paste, natto) along with starchy vegetables (e.g., sweet potatoes, plantains). The second way to repopulate your gut is by taking the right probiotic.
5. Cod Liver Oil
There's decent evidence that omega-3 fatty acids (aka fish oil) can support brain health and improve mood. And sadly, many people are walking around with omega-3 deficiency. Signs of deficiency include things like brittle nails, dry hair or hair loss, slow wound healing, excessive thirst, and even those red bumps on the backs of your upper arms. Another good sign of omega-3 deficiency is if your diet consists of processed foods, fried foods, and other foods that are lacking in essential nutrients. If you do take cod liver oil, it's worth monitoring vitamin D levels, since cod liver oil contains vitamins A, D, E, and K in addition to the omega-3 fatty acids.
6. Vitamin D
When I do blood work, I find that nearly all of my patients are vitamin D deficient. Vitamin D deficiency contributes to a host of hormonal and inflammatory imbalances in the body, thereby contributing to depression. There's some controversy around what the correct vitamin D levels are, but one thing I feel fairly confident about is that a vitamin D level in the 20s or lower is too low. I'm generally a naturalist, and I prefer my patients get their vitamin D the old-fashioned way, from sun exposure. But in many parts of the country during the winter, sun exposure is on backorder. In those cases, I recommend a good liquid vitamin D3 with K2 supplement. Most people do well taking around 2,000 to 5,000 IU daily, with periodic monitoring of vitamin D levels by your primary care provider.
7. Methylated B Vitamins (methylated folate and methylated B12)
As I mentioned when we were discussing SAM-e, some people have a methylation defect that contributes to depression. You can find out if you have this by having your MTHFR gene tested or by doing 23andMe and linking your results to a methylation analysis (an integrative or functional medical doctor can help you with this). If you have a methylation defect, a good-quality B complex containing methylated B vitamins such as 5-MTHF and methylcobalamin is essential to proper neurotransmitter function and good mood.
For some, it's even necessary to get your B12 as a monthly shot. Ask your doctor to test your B12 levels, and consider getting intramuscular B12 shots if you're very low. If you find that a methylated B complex makes you feel activated, that can mean we're barking up the right tree, but sometimes it can be too much too fast—some people need to build up their methylated B vitamin stores gradually. If this is you, it's worth working closely with a knowledgeable practitioner to find the right balance.
8. Hemp Oil
Let me add my voice to the chorus singing the praises of hemp oil. This is good medicine. The hemp plant seems to have co-evolved with humans to be a source of healing. Its anti-inflammatory and relaxing properties can be immensely helpful for depression. I instruct my patients to find a good-quality liquid tincture of high-CBD hemp oil and start with a dose of around 15 milligrams, increasing from there until they experience the benefit. It can take a few weeks of regular use to experience the full benefit. Research suggests that hemp oil is very safe, but it can cause sleepiness so it's still worth observing your body to make sure you're tolerating it well.
9. St. John's Wort
I'd be remiss if I didn't bring up St. John's wort (SJW) in a conversation about supplements for depression—it's kind of the original supplement for depression. The good news is that it's very effective (with evidence to support that it's just as effective as some antidepressants and often better tolerated). My only hesitation around SJW is that I think it should be by prescription rather than over-the-counter. It can have dangerous interactions with other medications (such as MAO-I antidepressants), and it can make birth control less effective. I'll typically have someone start at 450 milligrams twice a day for a month, then increase to 900 milligrams twice a day. With such a potent supplement, I would recommend working with an integrative practitioner to make sure you're using SJW safely.
10. Lithium Orotate
At full doses, lithium is a very powerful and effective treatment for bipolar disorder. At microdoses like 5 to 20 milligrams, lithium can be a gentle mineral that helps balance brain chemistry and improve mood. I don't recommend it cavalierly—I don't recommend it during pregnancy or lactation, and it's worth being in care with an integrative practitioner, paying extra attention to staying properly hydrated and following creatinine, TSH, and lithium blood levels. But if properly managed, this can be a useful strategy for depression treatment. I generally recommend starting at around 5 milligrams and slowly titrating up to a final dose of about 15 to 20 milligrams, taken at bedtime.
Like Rhodiola, ashwagandha is also an adaptogenic herb that supports the body's ability to cope with stress, which is so often at the root of depression. I recommend taking 225 to 500 milligrams twice a day for three to six months and then giving your body a break from it. It should soothe depression and anxiety, and it can even help you feel less overwhelmed by the stressors of life.
Depression is a way your body communicates that something is not right. Perhaps you're lacking community, perhaps you're chronically sleep-deprived, or perhaps your diet is inflammatory and lacking in nutrients. Depression tells us something is out of balance, and it's a call to action to identify the issue and address it at the root. This requires diet and lifestyle modifications and getting brutally honest with ourselves about how we're spending our time. Are we doing things that bring joy, fulfillment, and meaning to our lives?
A supplement will never be the silver bullet that addresses these fundamental causes of depression, but there are several supplements that are safe, well-tolerated, and helpful in the process of healing depression. I hope this list can give you some options to pursue on your path toward reclaiming your health and well-being.
M.Om., Dipl. Acu (NCCAOM) L.Ac.
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