Over-the-counter herbs or supplements have become popular alternatives to antidepressant medications for the treatment of depression.

For some people, non-prescription herbs and supplements appear to be just as effective in relieving symptoms of mild to moderate depression as antidepressant medications.

*A person with severe depression should be under the care of a physician.

Are Herbs Safer Than Prescription Drugs?

Many people believe that "natural" products such as herbs are safer than prescription medications. Herbs are not safer because they are "natural." Herbs that are effective often act in the same way as drugs. They may have side effects and may interact with other medications. "Natural" products should be treated like any prescription medication.

Whether from natural sources or from the lab, substances that cross the brain barrier and alter brain function, e.g. augment or block the effects of naturally occurring neurotransmitters in the brain, are psychoactive drugs. The effects of psychoactive drugs on mood and behavior can be subtle or dramatic.

Psychoactive drugs include commonly consumed substances such as caffeine (found in coffee, tea, cola, and chocolate), nicotine, and alcohol; medications such as analgesics and antidepressants; and street drugs such as marijuana, ecstasy (MDMA), and crystal methamphetamine.

However, the term "psychoactive" is usually reserved for drugs that cause immediate and dramatic changes in mood (especially euphoria) and behavior. Antidepressants are more often referred to as 'mood regulators' because they take several days to weeks to have any effect on mood and only help restore a 'normal' mood. They do not cause a 'high'.

In the US, dietary supplements are regulated in the same way that food is regulated. (Through the Food and Drug Administration). The contents are not checked. There may be more or less of the active ingredient than claimed on the label. There may be some contamination. Be sure to buy from a reputable company.

*Some people prefer to take herbs such as St. John's Wort or other 'natural' remedies over prescription medication because no prescription is needed and they prefer to treat themselves. This may be dangerous if the depression is severe and prevents a person from receiving proper treatment.

Herbs and Supplements to Treat Depression:

5-HTP
St. John's Wort
SAMe

5-HTP: (5-Hydroxytryptophan)

The body turns the amino acid tryptophan into 5-HTP. The body uses 5-HTP to make serotonin. Tryptophan is found in many foods. 5-HTP itself is not found in any significant amount in foods. The supplement is derived from the seeds of Griffonia simplicifolia - an African plant. 5-HTP is more easily absorbed than tryptophan, which is an amino acid that must compete with other amino acids for absorption.

The dosage of 5-HTP used for depression in studies has been 300 mg per day (100 mg three times per day). Many manufacturers of 5-HTP recommend 100 mg per day only. The effects of long-term use of 5-HTP are not known.

Safety Issues:

5-HTP is considered by many to be a 'replacement' for tryptophan supplements, which have been banned by the FDA since 1989.

The FDA did not rule out that L-tryptophan itself could have been a contributing factor to the EMS outbreak. Though it doesn't seem likely that pure tryptophan could be harmful, it appears the FDA is not willing to take any chances. Even though tryptophan is an essential amino acid and is in fact added to baby formula, taking tryptophan or any nutrient in very high dosages may cause it to act like a drug - with possible side effects. The FDA also has some similar concerns regarding 5-HTP. Both dietary supplements and prescription medications carry some risk of side effects.

Pharmaceutical-grade L-tryptophan is available as a prescription medication. It also has become available over the counter and online in the U.S. Whether or not it is "legal" is unclear. Click here for more info on pharmaceutical-grade tryptophan.

'PEAK X' in 5-HTP? Because tryptophan supplements were manufactured using bacteria, and 5-HTP supplements are not, 5-HTP is not believed to pose the same risk of contamination as tryptophan supplements. However, in 1998 some 5HTP products were found to have very small amounts of the same substance (Peak X) believed to have caused the tryptophan catastrophe. Some companies claim that they now test their 5-HTP supplements for 'Peak X' and other contaminants.

*Never combine any antidepressant (prescription or supplement) with 5-HTP unless under the supervision of a physician.

Since 5-HTP raises serotonin, it should not be taken in conjunction with antidepressants that also increase serotonin levels. It may result in dangerously high levels of serotonin (serotonin syndrome). St. John's Wort and SAMe (popular supplements taken for depression) are also believed to increase serotonin levels and using 5-HTP together with either of these supplements may also be risky.

*If you are taking any other medication (prescription or over-the-counter), consult your doctor before taking 5-HTP.

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St. John's Wort:

The herb St. John's Wort appears to be as effective as prescription antidepressants for some people in alleviating mild depression (backed up by many studies). St. John’s Wort has been used for centuries in Europe for the treatment of depression, where it is now a prescription medication. In the US it is sold as a dietary supplement.

*St. John's Wort often must be taken for four weeks to obtain full effects.

Like any antidepressant medication, St. John’s Wort does not work for everyone, but it certainly is as worth trying as any antidepressant for those with mild depression. Many people have to try two or more medications before they find one that works and St. John's Wort seems to work with the same efficiency and frequency as other antidepressant drugs for mild to moderate depression. It is not believed to be effective for severe cases of depression.

St. John's Wort does have a lower side-effect profile than many prescription medications. Possible side effects include nausea, diarrhea, dry mouth, dizziness, and fatigue. It may cause sun-sensitivity and/or a rash (though usually mild). Many people don’t have any noticeable side effects.

*St. John's Wort may interfere with other medications and should be taken under the supervision of a physician.

Do not take St. John's Wort in combination with prescription antidepressants unless advised to do so by a physician. It is believed St. John's Wort may increase serotonin levels and if taken with another medication that increases serotonin levels, dangerously high levels of serotonin may result (serotonin syndrome). For the same reason, it may be dangerous to use St. John’s Wort with 5-HTP or SAMe, supplements that may also raise serotonin levels. St. John's Wort can also interfere with several other medications (including cancer drugs).

*If you are taking any other medication, consult your doctor before taking St. John's Wort.

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SAMe (S-Adenosylmethionine):

SAMe has many functions in the body. As a supplement, SAMe is most commonly used to treat depression or osteoarthritis. It is not known how SAMe works in improving depression in some people but it may increase the production of neurotransmitters involved in mood such as serotonin, dopamine. For this reason, SAMe should not be taken with other antidepressant medications (unless under the supervision of a physician).

The body manufactures SAMe; it is not found in foods. It is made from methionine (an essential amino acid) and ATP (adenosine triphosphate). Inadequate amounts of methionine in the diet can result in decreased SAMe levels. However, deficiencies of methionine are uncommon. Methionine is found in high protein foods. Vitamin B12, B6, and folate help the body manufacture SAMe.

There is evidence that low levels of SAMe in the bloodstream correlate with an increased risk of depression. However, taking SAMe in pill form may not significantly raise SAMe levels in the bloodstream. SAMe supplements are difficult for the body to absorb. The digestive enzymes in the stomach degrade SAMe. Most SAMe supplements are enteric coated, to prevent the supplement from degrading before it makes it through the digestive tract. Still, how much is absorbed may be negligible.

Studies on the effects of SAME on depression are limited and believed to be inadequate. Most studies that showed SAMe to be effective for depression used parental forms (injections) of SAMe. Only a handful of studies – all small - used an oral form of SAMe. More research is needed to determine whether it is safe for long-term use.

In Europe, SAMe has been available by prescription for many years. In the US it is sold as a dietary supplement (with a recommended dosage or 400 mg per day). The oral dosage of SAMe for depression used in studies has been 1600 mg per day. Taking 1600 mg per day costs about $250 – $ 300 per month. If SAMe does work, it works fairly quickly, generally within one to two weeks. There are generally less side effects than with prescription antidepressant medications.

Possible side effects of SAMe: Dry mouth, nausea, diarrhea, headache, anxiety, restlessness, and insomnia. The most common side effect is upset stomach. If this occurs, reduce the dosage and build up gradually.

*SAMe should not be taken with antidepressant medications unless recommended by a physician.

*SAMe does not work for everyone (like any antidepressant medication).

*Folate, vitamin B12, and B6 increase the body’s production of SAMe and may be as effective in raising SAMe levels in the bloodstream than hard-to-absorb SAMe supplements and are much more affordable. Taking a B complex supplement is recommended.

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