Prozac Nation

By Bonnie Jenkins, Advanced Natural Medicine

A couple of weeks ago, I had lunch with a friend who has been out of work for the past few months. It’s no surprise that her extended unemployment is taking its toll. As our salads arrived, she half-heartedly joked, “Maybe I should forget about getting a job and just get some Prozac.”

Even though Prozac has become the butt of numerous jokes, it’s no laughing matter. Prescriptions for antidepressants, are at an all time high. In fact, over the past eight years, the use of antidepressants has increased five-fold. What’s even more outrageous is that the FDA recently approved Prozac for the treatment of depression in children age seven to 17.

The FDA based its decision on two studies that showed that Prozac was more effective than placebo in battling pediatric depression. The problem is, both studies also showed that the normal rate of growth was slowed in the children taking the drug. Kids aren’t the only ones to suffer the ill effects of antidepressants. Adults are just as vulnerable to the side effects of Selective Serotonin Re-Uptake Inhibitors (SSRIs) like Prozac, Zoloft, Paxil.

Instant Karma

SSRIs work by desensitizing the receptors that absorb serotonin, the brain’s natural antidepressant chemical, leading to a sense of well-being. Touted as a way to develop a more “socially rewarding personality,” psychiatrists and physicians alike are doling out SSRIs like candy for everything from post-partum depression to seasonal affective disorder (SAD) and even everyday maladies like shyness and perfectionism.

But, while these mood-enhancing drugs may offer happiness in a pill, numerous studies confirm that their use can come with a hefty price. Common to all antidepressants are sexual side effects that include impotence and reduced desire. Other side effects can include drowsiness, headaches, heart irregularities, blurred vision, confusion, nightmares, insomnia, hallucinations, anxiety, tremors and an elevation in blood pressure. But what I find truly frightening is the impact these drugs have when patients stop taking them. The most common symptoms when stopping SSRIs are dizziness and light-headedness with sensory problems such as numbness and electric shock-like reactions. More serious reactions can include memory loss, tremors, abnormal heart rhythm, flu-like symptoms and visual hallucinations. Paxil users are at particular risk of serious side effects, according to a British study conducted a few years ago. In the study, 87 patients receiving maintenance therapy with either Prozac, Zoloft, Celexa or Paxil had their treatment interrupted for four to seven days using a double-blind placebo. Following interruption of treatment, the Paxil group experienced significantly more cognitive failure, poorer quality of sleep and an increase in depressive symptoms.

A Healthier Prescription

People suffering from mild to moderate depression may want to “just say no” to synthetic antidepressants in favor of a more holistic approach. Often called “Nature’s Prozac,” St. John’s wort is the superstar of herbal antidepressants for treating mild to moderate depression. St. John’s worttargets depression by inhibiting the breakdown of several neurotransmitters, including serotonin. One recent double-blind German study tested 126 patients taking St. John’s Wort with 114 taking Prozac and found both groups achieved similar improvement. Yet side effects for those taking the herb were only 8 percent compared to 23 percent for those patients taking Prozac. St. John’s wort is well-tolerated by most people. But if you are taking oral contraceptives, certain anti-retrovirals, seizure medications and calcium channel blockers, you should know that taking high doses may speed up the rate liver enzymes process your medication.

S-Adenosyl-Methionine, better known as SAMe, is another natural antidepressant that received a flurry of media attention a few years back. SAMe is a naturally occurring compound made from the amino acid methionine.  Necessary for the manufacture of brain chemicals such as serotonin and dopamine, SAMe increases the binding of neurotransmitters to receptors and improves the fluidity of brain cell membranes. A recent animal study by the University of Modena and Reggio Emilia in Italy showed that SAMe reversed depression-like symptoms in rats without any  side effects. The same effect can be found in people. An open, multicenter study of 195 patients at Massachusetts General Hospital in Boston found that depressive symptoms improved within just two weeks when 400 mg. of SAMe were taken. And again, without any apparent side effects.

Another supplement which can help lift you out of the doldrums is 5-Hydroxytryptophan, or 5-HTP, the intermediate metabolite of L-tryptophan and a precursor to serotonin. Since we don’t get significant amounts of 5-HTP from our diets, supplementing with 300 mg. per day can reduce anxiety and sleeplessness while boosting our sense of well-being. A recent review of 5-HTP by researchers at the Lawrence Berkeley National Laboratory in California found strong evidence that this serotonin precursor can help ease mild to moderate depression. But a word of caution: 5-HTP should never be combined with St. John’s wort or SAMe since doing so can significantly increase the supplements effectiveness.

The elderly are at a particularly increased risk of depression. There’s some evidence, however, that ginko biloba (Ginko biloba L.) can help seniors increase the number of serotonin receptor sites in the brain. One study of older rats showed a 33% increase in the number of serotonin receptor sites after ginko supplementation. How does that translate to humans?  A comparative study of 16 patients taking either a standard antidepressant drug or ginko found that, unlike the patients taking the antidepressant, those taking the herb experienced a significant improvement in sleep quality and cognitive ability after only eight weeks.

Get a Whiff of This

If you suffer from severe depression and are taking a tricyclic antidepressant like Imipramine, you may be able to cut down on the amount needed to ease symptoms. A new study in Progress in Neuro-Psychopharmacology and Biological Psychiatry suggests that taking a moderate amount of lavender may help reduce the amount of tricyclic antidepressants needed to treat depression, leading to fewer side effects.

In the study, 45 adults, age 18 to 54, who had been diagnosed with depression were assigned to one of three groups. Each day the groups received either 60 drops of lavender tincture plus a placebo tablet, 60 drops of a placebo tincture plus 100 mg. of imipramine or 60 drops of the lavender tincture and 100 mg. of imipramine for four weeks. Scores from the Hamilton Rating Scale for Depression (HAM-D), a questionnaire used to evaluate the severity of depression, were evaluated initially and then weekly after the start of treatment. Each of the three treatment groups showed a significant decrease in HAM-D scores at the conclusion of the study, compared with initial measurements. However, the group taking the combination of imipramine and lavender had a significantly greater reduction in HAM-D scores and the antidepressant effect occurred more rapidly, compared with those taking imipramine or lavender alone. Lavender has long been used by herbalists as a treatment for anxiety, nervous exhaustion, and depression. However, this is the first scientific study to document its effectiveness as an adjuvant to prescription medication for the treatment of depression.

One Last Thing . . .

Along with using herbs and supplements to treat mild to moderate depression, what you eat can also help move you into a happier state of being. While sugar, caffeine and alcohol can contribute to depression, Elson M. Haas, M.D., director of the Preventative Medical Center of Marin in San Rafael, California, says that a well-balanced diet, rich in whole grains, fruits and vegetables can help relieve symptoms. Of particular importance are the omega-3 fatty acids found in fish and fish oil. Magnesium and the B vitamins have also been shown to relieve the symptoms of depression. For example, vitamin B-6 and complex carbohydrates can increase serotonin levels. And foods rich in vitamin B-12 and folic acid aid in the synthesis of naturally-occurring SAMe.

If you or someone you love suffers from mild to moderate depression and is being encouraged to use Prozac, Paxil or any other synthetic antidepressant, I urge you to consider these natural interventions before filling your prescription. You may just find that the gentle help they provide makes all the difference.  

References:

Akhondzadeh S, et al. “Comparison of Lavandula angustifolia Mill. Tincture and imipramine in the treatment of mild to moderate depression: a double-blind, randomized trial.” Progress in Neuropsychopharmacology and Biological Psychiatry. 2003; 27:123-127.

Hemmeter U, et al. “Polysomnographic effects of adjuvant ginko biloba therapy in patients with major depression medicated with trimipramine.” Pharmacopsychiatry. 2001; 34:50-59.

Hindmarch I, et al. “Abrupt and brief discontinuation of antidepressant treatment: effects on cognitive function and psychomotor performance. International Clinical Psychopharmacology. 2000; 15:305-318.

Meyers, S. “Use of neurotransmitter precursors for treatment of depression.” Alternative Medicine Review. 2000; 5:64-71.