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Depression: Could St. John’s Wort & Diet Help?

I worked as a clinical dietitian at a hospital near Cleveland, Ohio. I enjoyed my job. Every day was never the same. I had the pleasure of meeting new people which gave me the opportunity to heal through nutrition. I enjoyed teaching patients on eating right with diabetes, calculating tube feedings in the ICU, or recommending the right foods and supplements for wound healing. I was a healer. I wanted to extend healing through nutrition to other units of the hospital, so, I developed a nutrition education program with the inpatient adult psychiatric units at the hospital. The patients were admitted due to many manifestations of different psychiatric diseases (with forms of depression being the most prevalent). Common questions the psychiatric patients would ask me were: “what foods can I eat to help me feel happier?”; “what can I take to help with my depression?”; , “Can you just give me a list of foods so the doctors can let me go home?” And, “I’m already on depression medication. It just makes me feel sleepy, what can I eat to make me feel better?” To be honest with you, I did not have any dry-cut, black and white answers for them. The reality is that there are so many other factors besides diet that affect mood and state of mind. I had to do my own personal research on depression and the role nutrition played. Today, I would like to share what I learned. Maybe it could help you or someone you love suffering from depression.

Depression 101: Quick Facts from the World Health Organization 

  • Depression isn’t just about being sad or weak minded. It is a real illness. It affects people in different ways with different signs and symptoms varying from person to person.
  • 350 million people WORLDWIDE suffer from depression
  • More women are affected by depression than men.
  • At worst, depression can lead to suicide. Over 800,000 people die due to suicide every year.
  • Suicide is the second leading cause of death in 15-29 year olds
  • Bipolar disorder is a form of depression
  • Barriers to effective treatment for depression are: lack of trained healthcare workers, inaccurate assessment, misdiagnosis, and social stigma

St. John’s Wort: The Pros and Cons

The effectiveness of taking St. John’s Wort for depression was a common question I was asked at the hospital. St. John’s Wort is not a magic fix-all plant or pill. However, it could help. Here’s why: Orally, St. John’s Wort is used mainly for depression, but has been taken to help with other mood disturbances, attention deficit-hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), and seasonal affective disorder (SAD). There is an overwhelming amount of studies supporting the effectiveness of St. John’s Wort when taken for depression. St. John’s Wort extracts are more effective than placebo, likely as effective as some serotonin reuptake inhibitors (SSRIs) (1,2), including fluoxetine, (Prozac) (3,4), sertraline (Zoloft) (5), and paroxetine (Paxil) (6) prescriptions for treating depression. Taking St. John’s Wort extracts improves mood, decreases insomnia related to mild to severe major depression (7-22). According to the clinical guidelines from the American College of Physicians-American Society of Internal Medicine suggest that St. John’s Wort can be considered an option along with conventional anti depressions for short-term treatment of mild depression (23). However the since St. John’s Wort causes many drug interactions, it may not be an appropriate choice for those who are taking other conventional drugs. Always check with your healthcare provider before taking any dietary supplements.

Foods and Nutrition Considerations

Unfortunately there is no specific diet validated to help with depression. The bottom line is that a wholesome, healthy, nutrient dense diet with exercise can be an integral part in the treatment of depression.

Tryptophan 

When I was attending a convention about plant based nutrition this year, the foods we choose to eat has an impact on our brains.  Serotonin is a neurotransmitter that relays messages from one area of the brain to another. When the amount of serotonin is low in the body, it can cause depression or changes in mood. Scientifically speaking, serotonin is made from an amino acid called, tryptophan. There are no foods containing serotonin, but there are plenty that contain tryptophan. Good sources of tryptophan include: lean meats, salmon, eggs, legumes, seeds, nuts, soy, and cheese.

Vitamin D

Many individuals in the United States do not get the amount of Vitamin D they need whether it’s due to lack of Vitamin D in the diet, little exposure to sunshine. Getting the right amount of Vitamin D to avoid deficiency could improve mental well being (24). Good sources of Vitamin D are: cow’s milk, boxed breakfast cereals, fortified orange juice, yogurt, and fortified margarine.

Selenium

Studies have linked Selenium diets and depression. Selenium is an antioxidant and trace mineral needed in small amounts to keep the body functioning correctly. These foods are a good source of selenium:  Brazilian nuts, seafood, legumes, lean pork, beef, chicken, and turkey, low fat dairy products, and whole grains.

Omega-3 Fatty Acids

We already know the omega fatty acids are associated with heart health. A newer study suggests omega-3 fatty acids were shown to be more effective than placebo for depression in both adults and children in small controlled studies and in an open study of bipolar depression. Sources of omega-3 fatty acids include salmon, anchovy, mackerel, tuna, flaxseed, walnuts, and canola oil.

Exercise

Exercise is the most underrated anti-depressant. Get up and get moving! Even walking is exercise! Remember to consult with your health care provide first before starting new diet plans, dietary supplements, and exercise program.

 

Depression_ It's Worldwide-4

 

References:

  1. Linde, K., Berner, M. M., and Kriston, L. St John’s wort for major depression. Cochrane.Database.Syst.Rev. 2008;(4):CD000448.
  2. Rahimi, R., Nikfar, S., and Abdollahi, M. Efficacy and tolerability of Hypericum perforatum in major depressive disorder in comparison with selective serotonin reuptake inhibitors: a meta-analysis. Prog.Neuropsychopharmacol.Biol.Psychiatry 2-1-2009;33(1):118-127.
  3. Harrer G, Schmidt U, Kuhn U, Biller A. Comparison of equivalence between the St. John’s wort extract LoHyp-57 and fluoxetine. Arzneimittelforschung 1999;49:289-96.
  4. Schrader E. Equivalence of St. John’s wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mild-moderate depression. Int Clin Psychopharmacol 2000;15:61-8.
  5. Brenner R, Azbel V, Madhusoodanan S, et al. Comparison of an extract of Hypericum (LI 160) and sertraline in the treatment of depression: A double-blind, randomized pilot study. Clin Ther 2000;22:411-9.
  6. Szegedi A, Kohnen R, Dienel A, Kieser M. Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John’s wort): randomised controlled double blind non-inferiority trial versus paroxetine. BMJ 2005;330:503.
  7. Vorbach EU, Arnoldt KH, Hubner WD. Efficacy and tolerability of St. John’s wort extract LI 160 versus imipramine in patients with severe depressive episodes according to ICD- 10. Pharmacopsychiatry 1997;30:81-5.
  8. Wheatley D. LI 160, an extract of St. John’s wort, versus amitriptyline in mildly to moderately depressed outpatients – a controlled 6-week clinical trial. Pharmacopsychiatry 1997;30:77-80.
  9. Volz HP. Controlled clinical trials of hypericum extracts in depressed patients – an overview. Pharmacopsychiatry 1997;30 Suppl 2:72-6.
  10. Hubner WD, Lande S, Podzuweit H. Hypericum treatment of mild depressions with somatic symptoms. J Geriatr Psychiatry Neurol 1994;7 Suppl 1:S12-4.
  11. Kim HL, Streltzer J, Goebert D. St. John’s wort for depression: A meta analysis of well-defined clinical trials. J Nerv Ment Dis 1999;187:532-9.
  12. Linde K, Ramirez G, Mulrow CD, et al. St. John’s wort for depression: an overview and meta-analysis of randomized clinical trials. BMJ 1996;313:253-8.
  13. Harrer G, Schmidt U, Kuhn U, Biller A. Comparison of equivalence between the St. John’s wort extract LoHyp-57 and fluoxetine. Arzneimittelforschung 1999;49:289-96.
  14. Philipp M, Kohnen R, Hiller KO. Hypericum extract versus imipramine or placebo in patients with moderate depression: randomized multicentre study of treatment for eight weeks. BMJ 1999;319:1534-9.
  15. Gaster B, Holroyd J. St John’s wort for depression. Arch Intern Med 2000;160:152-6.
  16. Schrader E. Equivalence of St. John’s wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mild-moderate depression. Int Clin Psychopharmacol 2000;15:61-8.
  17. Linde K, Mulrow CD. St. John’s wort for depression. Cochrane Database Syst Rev 2000;(2):CD000448.
  18. Brenner R, Azbel V, Madhusoodanan S, et al. Comparison of an extract of Hypericum (LI 160) and sertraline in the treatment of depression: A double-blind, randomized pilot study. Clin Ther 2000;22:411-9.
  19. Williams JW, Mulrow CD, Chiquette E, et al. A systematic review of newer pharmacotherapies for depression in adults: Evidence report summary. Ann Intern Med 2000;132:743-56.
  20. Kasper S, Dienel A. Cluster analysis of symptoms during antidepressant treatment with Hypericum extract in mildly to moderately depressed out-patients. A meta-analysis of data from three randomized, placebo-controlled trials. Psychopharmacology (Berl) 2002;164:301-8.
  21. Szegedi A, Kohnen R, Dienel A, Kieser M. Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John’s wort): randomised controlled double blind non-inferiority trial versus paroxetine. BMJ 2005;330:503.
  22. Linde K, Mulrow CD, Berner M, Egger M. St John’s Wort for depression. Cochrane Database Syst Rev 2005;(3):CD000448.
  23. Snow V, Lascher S, Mottur-Pilson C. Pharmacologic treatment of acute major depression and dysthymia. Ann Intern Med 2000;132:738-42.
  24. Penckofer S, Kouba J, Byrn M, Ferrans CE. Vitamin D and depression: where is all the sunshine? Issues Ment Health Nurs. 2010 Jun;31(6): 385-393.

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