DEPRESSION, ANXIETY AND A.D.D.: NATURAL ALTERNATIVES TO PROZAC, VALIUM & RITALIN
by: DeMarco, Carolyn, M.D.
Dr. Carolyn DeMarco is a consultant in holistic medicine from British Columbia who specializes in women's health issues and alternative medicine. She is a well-known author and journalist, and her latest book, Doctor DeMarco Answers Your Questions and an innovative CD-ROM have recently been released.
I DEPRESSION AND ALTERNATIVES TO PROZAC
TYPES There are many different types of depression. Depression which is cyclical where there are manic and depressive episodes is called bipolar depression. In unipolar depression, the common type of depression, there is just depression without the manic state. It is just the down state, and it can be mild, moderate or severe. It is characterized by changes in appetite and weight, disturbed sleep, fatigue, loss of energy, difficulty concentrating, feelings of worthlessness and suicidal thoughts or attempts. Reactive depression may be brought on by an identifiable event like the death of a parent, or loss of a job, but this is not true depression. Dysthymia means "bad mood" and refers to mild to moderate depression. There is also seasonal affective disorder, which many people in Canada are subject to.
Many factors affect depression including diet, excess sugar, sugar substitutes, coffee, alcohol and junk food, which can all create mental state abnormalities.
Depression can be a very serious illness and drugs can be a godsend for people with severe depression, especially those who are suicidal and unable to function in any way. There is a place for psychiatric drugs. I would never deny that. However, they are very much subject to overuse. There is less necessity for tranquilizers because there are excellent effective natural remedies.
ST. JOHN'S WORT However, there is a great role, in depression, for St. John's wort (Hypericum perforatum). I have endorsed one specific kind of St. John's wort because I have had a very good experience with it, and that is Flora's St. John's wort which comes from Greece and it is completely wild. They pick it on the hills, put it in vats of extra-virgin olive oil, let it sit in the sun for 1,000 hours, then take that oil and put it into capsules. It is not a so-called standardized extract, but I have found that it always works well in doses of three or four capsules from two to four times a day, depending on the severity of the depression. All herbs are better taken without food, because they will have an increased effect. Don't take it with food unless you are having a lot of nausea. Take it between meals if you can. So take one dose at bedtime, one first thing in the morning and then just place your other doses sometime during the day.
Michael Murray surveyed all the St. John's wort in the U.S. and found out there was much more being sold than there was actually plant material available. So, there are a lot of very weak or ineffective St. John's wort products. So we will have to investigate that. At the very least, if you don't want to try the Flora, try a St. John's wort that is standardized to contain .3% hypericin. There are many good ones out there. Natural Factors and many other companies make some good standardized extracts of St. John's wort. So we still use that 0.3% hypericin as a marker for quality.
It grows everywhere in the countryside of Ontario and is also very common in B.C. It is actually considered a noxious weed because it grows so well. St. John's wort has a balsam-like smell. It has yellow flowers and there are little dots on the leaves which contain hypericin, one of the active ingredients. Nobody knew exactly how St. John's wort worked in the beginning; they thought the action was due to the hypericin. Now they have found that St. John's wort affects almost every neurotransmitter in the brain. It affects serotonin, dopamine, GABA and norepine-phrine. Some of you may know about the drug Effexor (used for depression) which targets two receptors: norepinephrine and serotonin. The new trend in antidepressants is to target specific neuroreceptors in the brain. However, St. John's wort actually acts on all the receptors. So it has a complex action, much more complex than they thought at the beginning. There are ten active ingredients of which hypericin is only one. And that is why I still feel there is a place for whole plant extracts. Otherwise the hypericin is a good marker of quality control. And usually St. John's wort is standardized to contain .3% hypericin.
STUDIES St. John's wort became accepted in the medical profession when a study was published in The British Medical Journal in August, 1996 which reviewed all the highest quality trials on St. John's wort. The authors concluded that St. John's wort was a very effective treatment for mild to moderate depression. They were careful to investigate all the trials and choose only the best-designed and highest quality. So they were very stringent. Of the 37 studies reviewed, only 23 were accepted. A total of 1,757 patients with mild to moderate depression were surveyed, and St. John's wort was found to be significantly superior to a placebo or a dummy pill. It was also determined that St. John's wort effects were equal to a series of standard antidepressant drugs such as imipramine and amitriptyline, but there were far less side effects. It really was very good news. The studies used products in which the hypericin was standardized to .3%. In three other studies, St. John's wort was compared to standard antidepressants. Basically, they found that the reduction in depression was 63% for St. John's wort and 58% for standard antidepressants.
The medical community is very cautious, and they suggest that longer-term studies of St. John's wort are required. Recently, a widely published long-term study performed by the makers of Zoloft comparing St. John's wort with standard antidepressants was inconclusive because the St. John's wort used in the study was not properly standardized.
SAFETY You may have seen information in the news lately about the safety of St. John's wort, because if you are an AIDS patient, St. John's wort will actually increase the excretion of drugs through the liver, and you may have to change your dosage. So it is not considered appropriate to take with AIDS drugs. But basically, it has a very wide safety margin. In one study, they monitored over 3,000 patients (and by the way, most drug studies don't monitor such a large number). Over 600 private general practitioners participated in this study, and they found that 80% of individuals with mild to moderate depression showed an improvement. Side effects were rare and mild. So the experience of general practitioners using St. John's wort was that it was both safe and effective.
SIDE EFFECTS The documented side effects of St. John's wort are very low, 2.43% overall. The main side effects are nausea, stomach upset, and occasional allergic reactions. The remaining side effects were almost negligible: .4% fatigue and a few incidents of anxiety. There has been some discussion about photosensitivity with St. John's wort, but it is not a major problem. If you want to improve your tanning, it will help, but fair skinned, blue-eyed people should be somewhat cautious; they tend to occasionally experience an allergic reaction. If you know anything about drug profiles (e.g. Prozac), the side effects and contra-indications go on for about four to five pages, and this is true of almost every antidepressant. These are very powerful drugs. Prozac has a lot of side effects and one of them is complete sexual dysfunction. The average Prozac prescription is given after an interview of about three to five minutes, so a lot of Prozac is given out without an adequate history of the patient.
If you are taking Prozac for any of the milder problems such as mild to moderate depression, moderately severe PMS, menopause, or other ailments for which Prozac is now being prescribed, you shouldn't go suddenly off your drugs. If you are on the SSRIs (Prozac, Paxil or Zoloft) or tricyclic antidepressants like Elavil (amitriptyline) or Tofranil (imipramine), you must gradually reduce them over four weeks until the St. John's wort starts to kick in. Some antidepressants like Paxil have a serious rebound so that you will feel seriously worse when you go off them suddenly, and you can have a severe crash. Even missing a dose of Paxil can result in a severe emotional crash. Ideally, you should only go off your drugs under a doctor's supervision. As you gradually decrease your anti-depressants, add one St. John's wort the first week, two the second week, three the third, and then the fourth week you are off. The book by psychiatrist Hyla Cass called St. John's Wort: A Common Sense Guide to Understanding and Using St. John's Wort (Avery, 1998) provides a practical guide to using St. John's wort including how to make the switch from drug treatments.
SEVERE DEPRESSION Study: Currently, the general consensus of the medical community is that you cannot use St. John's wort for severe depression. However, in a study of severely depressed patients, high doses of St. John's wort produced equivalent results to the standard antidepressants. This was a randomized controlled multi-center test, which means they had divided two groups into two parts: one group received a high dose (kind of a double dosage) of St. John's wort, the other received a high dose antidepressant which was Elavil. This was only one study and it hasn't been widely published, but it is very interesting because the results showed that both treatment regimens were equally effective, except that there were almost no side effects, of course, in the St. John's wort group. There were more side effects with the exceptionally high doses, but compared to the antidepressant group in which 41% (four out of every ten patients) had dry mouth, stomach upset, sweating, constipation - only 23% of the St. John's wort group had side effects and these were a lot milder.
SEASONAL AFFECTIVE DISORDER (SAD) You can also use St. John's wort for seasonal affective disorder. Many people suffer from seasonal affective disorder in the winter when the light diminishes, and crave food, eat a lot, sleep a lot and become depressed. That is seasonal affective disorder in a nutshell. St. John's wort works like a dream. Four capsules of St. John's wort at night is very effective in preventing that decline in mood. There are studies showing that the results of St. John's wort for seasonal affective disorder are comparable to Prozac. There is no problem with long-term usage. For SAD, of course, you don't have to take it in the summer. It is very, very safe.
LABOUR AND CHILDBIRTH We also use a tincture of St. John's wort during labour to lessen the pains of contraction, and for uterine contractions after labour, there is nothing like St. John's wort tincture. Midwives have always used it. Historically, they didn't use it for depression. Maybe they didn't have the amount of depression we have now.
HERBAL TINTURES AND OILS You can also make your own St. John's wort in an alcoholic tincture and it is very easy to make. You won't know exactly how to adjust the dosage, but you can use it for mild depression. To extract the active ingredients you need alcohol. You just grind it up with vodka or brandy or some other alcohol, let it sit for about eight weeks and then strain and discard the herb. It is very simple. You are making a herbal tincture. St. John's wort also makes a lovely oil. You put the flowers and the plants in olive oil, which will then turn red, and it is very good for joint aches and pains. In homeopathy, we use it for nerve injuries and head and spine trauma.
ATTENTION DEFICIT DISORDER St. John's wort can also be very helpful for children with ADD and ADHD. It is very safe to use. It helps calm them down.
THYROID SUPPLEMENTS There are several natural products that can augment an antidepressant. The thyroid supplements T3 and T4 have been used for treatment-resistant depression.
TRYPTOPHAN Another thing that you can use is tryptophan, which is an amino acid, one of the building blocks of protein. I am a big fan of tryptophan. Tryptophan is very good for insomnia and you usually use 2000 mg. at night. It is a great sleep aid; it is totally natural and has no side effects. It is also good for the sleep disorders of chronic fatigue syndrome, grief and menopause. In Canada, it is only available by prescription because a batch of Japanese genetically-engineered tryptophan caused serious health problems and it was taken off the market in the US.
5-HTP (5-hydroxy-tryptophan) can be used instead of tryptophan. 5-HTP is available without a prescription in health food stores. But where you would use 1000 mg of tryptophan, you need only 100 mg of 5-HTP. and that is the ratio, ten to one.
COGNITIVE THERAPY This is an inexpensive therapy which has a very good track record. Studies have demonstrated that it not only relieves depression, but it has a much lower relapse rate than any drug, or even herb, because it deals with some of the root causes of depression. Over two dozen controlled studies have demonstrated that by the end of 12 to 20 weeks there is a 70% reduction in depression. So this is a really great therapy. It is hard to find a cognitive practitioner, but you can do it yourself. Some of the books that instruct you how to do it yourself are, Feeling Good Again, The New Mood Therapy, and Feeling Good Again Handbook by David Burns, psychiatrist. It is based on the premise that all thoughts are created by beliefs, attitudes and interpretations. Since your thought interpretations cause your emotional reaction, you can change your original thoughts. Depressed thoughts are dominated by pervasive negativity, thoughts like, "nothing ever goes right in my life; bad things always happen to me; life isn't fair." Other thought patterns that can lead to depression are: "I should be perfect; other people should be perfect; life should always be smooth," things like that.
NEGATIVITY If you analyze the thoughts of a depressed person, it seems to be the interpretation that causes the problem. For instance, if a car runs over your foot, an appropriate response would be, "This is terrible, and I will be more careful in the future". An inappropriate interpretation would be: "This type of thing always happens to me; nothing ever goes right." In other words, generalizing from the specific to the general. When you look at your depressed thoughts, they are a repetitive cycle that go over and over in your head, and they can be summarized as Louise Hay says by three phrases: "My body doesn't work; my life doesn't work; my relationships don't work." I think that covers everything. "Something is not working and it never works for me." You can't be positive all the time; but you don't want to dwell in this negativity and live there. When you catch yourself repeating the same negative thought to yourself over and over again in a repetitive manner, this causes depression. By the way, almost everybody's tapes are similar, although you may think that you are the only one who has them. So these books teach you how to reprogram your thinking. They are based on excellent studies and they are teaching general practitioners how to do it. But you can do it yourself. That is the great thing. It is very cheap.
GINGKO BILOBA has a natural antidepressant effect, and is a great memory herb. It is very good for treatment-resistant depression. If you are not having good results with your antidepressant, you can add the gingko and it will augment the results. Over forty double-blind studies showed that it increases circulation to the brain. So it is very useful for stroke and for stabilization of Alzheimer's disease. It doesn't reverse Alzeimer's, but it improves the circulation; it improves the memory. It is a fantastic herb and has a frequent antidepressant effect.
You can increase the dose; even tripling or quadrupling the dosage has been done because there are no side effects. However, its full effect can take up to 12 weeks to develop. The gingko biloba leaf extract should be standardized to at least 24% gingko flavone glycosides. You have to look very carefully on the package and see if you can find this. Sisu, Genestra, Gaia, St. Francis Herb and Thorne are high quality brands. Genestra and Thorne are not always easy to find because they are professional brands (try Supplements Plus stores). Shawla Herbs are very good too.
Gingko biloba is very well researched. In over 44 studies involving 9,772 patients, there were virtually no side effects. Twenty-one subjects had some stomach upset, seven had headache, and six had dizziness. You will never see a drug with a profile like that. Another study of elderly patients (aged 51 to 78) who had depression unresponsive to any drug found that when gingko biloba was added, they had a 50% decrease in their depression score, a dramatic response. The placebo group had a 10 % decrease.
AROMATHERAPY is wonderful for depression because it goes right to the limbic system. Lavender is a great antidepressant, but it has to be a high quality lavender. I do prefer the Young Living Oils because I know the quality has been certified. There are other high quality oils from France; they aren't the only high quality oils, but you won't pay anything less that $25 for a good bottle of lavender. It should be certified. Most of the lavender in the stores is low quality. If you paid $5 or $10 for a bottle of lavender you are getting something that is synthetic or has chemicals added to it, and it can actually burn your skin. You can apply good lavender to your skin; you can breathe it. We use a number of oils. Clary sage is another oil that has a hormonal balancing effect and it also is a natural euphoric. It is a very nice oil also. And there are blends in Young Living like Peace and Calming which are very good. They have a lovely combination called Joy which is very uplifting. Aromatherapy is actually very complex and there are a lot of studies which demonstrate its effectiveness.
II ANXIETY AND ALTERNATIVES TO VALIUM
KAVA KAVA Kava kava is a wonderful herb from the South Seas and is harvested when it grows to six to eight feet in height. It acts on various parts of the brain, and it may even have an anti-convulsive effect. It could be an anti-epileptic as well, though that hasn't been proven. Again, these herbs don't just act on one part of the brain; they have multiple actions. Kava kava has wonderful qualities. It induces tranquility, sociability and a deep restful sleep with no side effects. What could be more pleasant? This is the perfect baby boomer herb with all the great sociable effects, no side effects and no addiction. It is excellent. And although the studies haven't been too extensive, it compares to Valium in its effect. The active ingredients are kava lactones. The label should specify that the kava lactones are between 30 and 70%.
One study, which compared kava kava to oxazepam (a cousin of Valium) found that they both reduced anxiety equivalently, but there were no side effects with the kava kava. And as you know, Valium (diazepam), oxazepam and that whole family of drugs are addictive, as well as having drowsiness as the main side effect. In another study a group of subjects taking kava kava was compared to a group who took a placebo (a dummy pill). After four weeks the kava kava had produced an improved sense of well being, a marked reduction in anxiety and no side effects.
In one well-designed study, it is described as the perfect herb for menopause because it reduced menopausal symptoms like anxiety and depression, as well as reducing hot flashes and other menopausal symptoms.
Kava kava is an excellent herb, but it must be of good quality. Seventy percent kava lactones is ideal, but you will find that not many brands have that concentration. You take 100 mg. of the kava kava standardized to 70% kava lactones. Natural Factors and many other companies have standardized extracts, but some of them are only 30%. If the active ingredients are only 30%, then you would have to double the dosage. There are a number of excellent companies like Thorne and Seroyal, which have very high quality supplements. Gaia is very good. Genestra is excellent. But some companies' products are totally useless. There is a lot of crappy kava kava which is not standardized and may only contain 10% kava lactones. You will not notice much effect with that, and people will think it is not effective.
VALERIAN You can try valerian. I don't find valerian is strong enough for a lot of the anxiety that we are facing today, even in combination with other herbs.
MELATONIN There is no doubt that we are not getting enough rest and one of the things you can do to help your anxiety is to sleep in a room that is completely dark with no light coming in at all. That is very, very important for proper regeneration. So blacken out your windows and make sure there is no light coming in your room at night. That will increase your secretion of melatonin. By the way, melatonin is very helpful for sleep and for people who are working shift work. Melatonin is a very useful supplement in doses of one to three mg one hour before bedtime, and it is very, very safe.
Many tranquilizers are so addictive that you must decrease them very slowly over a one to two month period. You would never do it suddenly. If you don't, you won't go off the drugs successfully. And at the same time increase your herbs and increase your nutritional supplements.
III ATTENTION DEFICIT DISORDER AND ALTERNATIVES TO RITALIN
As you know, Ritalin is over-prescribed, and ADD is over diagnosed. The National Institutes of Health are actually conducting an investigation on the over-prescription of Ritalin. Sometimes it is prescribed to keep a child sedated and in line, and a very creative and bright child can be well sedated with Ritalin often without adequate testing. There was one area in B.C. where 10% of the children were being given Ritalin. That is a lot of kids, and there is no evidence that it actually improves long-term school performance.
If a teacher recommends it, and the parents don't want to give it to the child, the child can be removed from school. Dr. Peter Breggin, a psychiatrist who wrote Talking Back to Ritalin states that the diagnostic criteria focus on behaviours which parents find frustrating and disruptive, and conflicts between children and adults are redefined as diseases or disorders within the children. He believes that Ritalin suppresses creative, spontaneous and autonomous activity in children making them more docile and obedient, and more willing to comply with boring tasks in the classroom.
There are children who have severe ADD who cannot survive in the school system, but so many more can easily be helped through natural alternatives. First of all the proper diagnosis must be secured. Secondly, natural alternatives must always be tried first and drugs only as a last resort, not the first approach to ADD.
ALLERGIES Frequently, diet is absolutely crucial. It is important to anyone with any kind of mental disorder. Children should go off all sugar immediately and should be examined for food allergies. Studies have found certain food allergies common to children with ADD. Sugar is number one. Common allergens are sugar, wheat, dairy, food additives, egg, corn and citrus. You can use the elimination diet to find out what your kids are allergic to. The first day, you must take them off all food except rice and chicken, then daily you add back foods one at a time and watch for the allergic reaction. Kids can also be allergic to dust, pollen, moulds, animal dander and chemicals.
Dr. Doris Rapp is a pediatrician who filmed children before and after ingesting sugar. Beforehand, children who had been behaving very well, after being given a dose of sugar, started attacking their mothers, actually hitting their mothers and their handwriting deteriorated completely. It is a very dramatic video. She wrote a book called, Is This Your Child? which describes common allergic reactions of children. They may have circles under their eyes, and I have seen young children about a year old with a severe reactions to certain foods just arch their head back and scream. These allergic reactions are sometimes almost immediate and sometimes delayed.
NUTRITIONAL DEFICIENCIES Children also have multiple nutritional deficiencies. It is shocking what kids are eating. They are eating a lot of fried food and sugar and very little real nutrition. Sugar is constantly being pushed on these kids. Of course, now we have MacDonalds in the schools and it is a nightmare. And often the parents are reluctant to get them off the junk food because you have to go through at least a week or two of terrible trauma as you wean them off all the junk food and sugar. But it is more than worth it.
NUTRITIONAL TESTING There is a wonderful pharmacy in Ottawa called Nutri-Chem Pharmacy who do detailed nutritional testing with children. They work with Down's Syndrome children, but they can test any child for nutritional deficiencies. Then they will formulate vitamins in a liquid specific to that child's deficiency. They are very good, and can be reached at 1-888-384-7855 or www.nutrichem.com.
NUTRITIONAL SUPPLEMENTS Hyperactive children are commonly deficient in zinc, iron and B-vitamins. Studies show that zinc supplementation improves memory, thinking and I.Q. Super green drinks like Greens Plus, Barley Plus, blue green algae or spirulina provide trace minerals that are very important for children. I highly recommend them for ADD. All the green drinks are very useful.
Children also need omega-3 fatty acids, flaxseed oil or fish oil for learning. They cannot learn without it. Gingko biloba can be used with ADD and calcium and magnesium are very important for ADD children because magnesium has a calming effect. I am using St. John's wort with ADD kids and it is also very helpful.
We can also use herbs like valerian, passionflower and lemon balm. These are calming herbs; they are very, very mild and can be also used for sleeping.
TOXIC METALS Accumulation of lead, cadmium and other heavy metals can also cause ADD in some children.
AROMATHERAPY is wonderful for ADD. Dr. Freedman has been studying children and found that breathing in lavender, orange or citrus oils can actually change the brainwaves and calm the children down. Nick Begich mentioned that you can teach children to change their brainwaves by using biofeedback. This is a relatively new technology for ADD. They look at their waves on the screen and they change them to a calmer brainwave. Brain Gym is another thing, an extract which unites the right and the left brain.
A wonderful doctor in Vancouver, Gabor Mate, MD, feels that ADD is a symptom of our speeded up age and overstimulation (e.g. television images which change every few seconds). He has written a book called Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder (for more info see www.scatteredminds.com). He feels that ADD may result from early childhood parental and environmental issues that "morph into a biochemical one". There is an excellent book called Ritalin Free Kids by Judith and Robert Ullman who treated 400 ADHD kids with homeopathy. The other book that I really like is called Natural Treatments for ADD and Hyperactivity by naturopathic doctor, Skye Weintraub.
"People who advocate medication as the first way to make children behave, without exploring their life situation and real needs might as well treat unhappiness with cocaine!" (Psychiatrist Dr. Felix Yarochevsky & psychotherapist David Schatzky in Globe & Mail editorial). A lot of these children have very complex family situations and we should at least consider that there are other factors going on before we just sedate them as fast as possible.
Also refer to Michael Lyon's book, Healing the Hyperactive Brain and his website www.pureliving.com. Dr. Lyon advocates the gingko product AD-FX and Memory-FX by Herb Tech. Also see his article on ADD on the Consumer Health website www.consumerhealth.org.
* * *
Dr. DeMarco's new book Dr. DeMarco Answers Your Questions contains special sections outlining alternative treatments for schizophrenia, depression, anxiety and A.D.D. Her book is available at Consumer Health for $19.95 plus GST. Her CD-ROM contains the contents of both her books. Dr. DeMarco's website is www.demarcomd.com