peter bongiorno
Source: peter bongiorno

Most psychiatrists are very wary about giving a patient supplements (sometimes referred to as “nutraceuticals”) with antidepressants for fear of negative interaction. In my books,  I discuss both the ample research as well as my clinical experience that suggests how not only are some nutraceuticals safe to take with antidepressant medications, but they are actually very helpful too.

Now, before we dive into this further, I do recommend if you are thinking of adding a supplement to your antidepressant regimen, talk to your prescribing doctor first, for it is important a practitioner knowledgeable of both medications and supplements is monitoring your care properly. While generally gentler and safer, just because a supplement is natural, it does always not mean it is the best choice. 

Ok, having said that, I wanted to talk about a new study on this exciting subject: authors from the University of Melbourne in Australia and Massachusetts General Hospital reviewed many studies that broached the use of nutraceuticals with antidepressant medications.  Initially, they reviewed about 5500 studies, and looked for the most stringent studies.  Out of these, 40 studies were chosen. In these studies, the authors believed they found the most stringent and well-designed ones, and whose results were representative of good science (1).

Then, Which Nutraceuticals Are Best with Antidepressants?

Out of the studies closely reviewed, about 70% found benefit using a natural supplement along with medication. The medications used were mostly selective serotonin uptake inhibitors (the “SSRI’s” – these are Prozac, Paxil, Lexapro, and others). The supplements that looked like they helped the most were:

  • S-adenosylmethionine (SAMe):  considered a prescription medication in many countries, it is thought that SAMe supports all the neurotransmitters, including dopamine. (2)  Interestingly, many of the positive studies for SAMe were not even considered for they were written in Italian. It’s likely that these positive studies would have shown even greater benefit
  • omega fats: are known to be a fantastic support to the nervous system, and also helps lower inflammation in the body. Both of these are helpful to keep mood.
  • methylfolate: is a natural version of folate that has had a number of studies showing benefit for mood. Methylfolate is found in high amounts in green leafy vegetables.
  • vitamin D: is the “sunshine” vitamin and is considered neurosteroid. It has a long history of positive results for both anxiety and depression.

This analysis also identified single studies that were encouraging for creatine. Creatine is well known for its support as a muscle building supplement, it seems to have a beneficial effect on brain function by increasing the production of the energy Also, this research also found some positive results for zinc, folic acid, vitamin C and tryptophan, while other studies suggested no special beneficial effect for these. 

Were There Side Effects Using Any of These?

No major side effects or drug interactions were noted in this analysis. Nevertheless, there can be some interactions or side effects with anything, including natural supplements, which is why it is good to check in with a naturopathic doctor or other practitioner who is well-trained in drug/nutrient/herb interactions. For instance, SAMe and creatine may not be appropriate for people with bipolar disorder. While healthy for the majority of the people who take it, vitamin D can build up to toxic levels if overdosed - where it can cause cardiovascular problems. And, caution is needed when considering omega three fats when a patient is taking ‘blood thinning’ drugs. Some past work suggested omega fats as a factor in prostate cancer, but that work seems to be inaccurate.

Overall Steps to Heal Depression

One of the drawbacks of this study is that it didn’t really look at individual patients and their needs, and as a result, may have skipped over individual supplementation that may be useful for particular patients. For example, I discuss in my books about the studies supporting the use of saffron for depression. The authors of this study did not review saffron, but it is clear to me from my experience that this culinary spice can be invaluable for patients who have both mood issues that accompany long standing digestive issue concerns.

Also, this study doesn’t take into account the fact that there are many lifestyle factors that affect whether a person and how severe, a person gets depressed. While genetics may predispose someone to depression, there are a number of effective lifestyle factors over which we have control.  These include sleep, exercise, healthy whole foods and an anti-inflammatory diet, psychotherapy, stress reduction work (like meditation or yoga), and the right supplements. If someone is stressed, and not getting enough sleep, this could be a reason their B vitamins and folate are depleted. Adding folate may help, but did not really address the reason they were depleted to begin with.

In my practice, I find most nutraceuticals and herbs don’t always work by themselves, but when used in a plan that includes diet and lifestyle changes, they can help attain powerful results.

Finally, when it comes to supplementation, I strongly recommend starting with a base of supplementation support. When we eat food, usually there is an array of vitamins, antioxidants, minerals, fats and flora (the good germs that live in our digestive tract). One way to get these is by taking a regular regimen of what I call the “3 U Need” .  While this study reviewed omega three fats and found significant benefit, it did not mention the strong studies regarding the overall affect of a multiple vitamin and a probiotic has on healthy mood. As a general rule, I recommend each patient first take a good quality multiple, fish oil and probiotic, then consider mood supportive nutrients like SAMe or methylfolate as needed.

Natural Conclusion

In conclusion, it is exciting to me that modern medicine is starting to take a look at safe, non-toxic ways to support the body to heal. This study is a in good step forward in acknowledging what naturopathic doctors and other healers have known for a long time - that nature heals.

about the author: Peter Bongiorno, ND, LAc. is President of the New York Association of Naturopathic Physicians. Dr. Bongiorno trained at Bastyr University, and researched at Yale and the National Institutes of Health before medical school. In 2010, Dr. Bongiorno authored Healing Depression: Integrated Naturopathic and Conventional Treatments, the first comprehensive textbook designed to teach physicians how to use the science and art of natural medicine to heal depression. The public book, How Come They’re Happy and I’m Not? The Complete Natural Guide to Healing Depression for Good (Red Wheel) followed. In 2015, he authored the practitioner-guide Holistic Therapies for Anxiety and Depression (WW Norton). His newest book for the  public is, Put Anxiety Behind You: The Complete Drug-Free Program.  

Visit drpeterbongiorno.comInnerSourceHealth.com and join him on twitter @drbongiorno for updates on naturopathic mental health.

References:

1 - Sarris J, Murphy J, Mischoulon D, Papakostas GI, Fava M, Berk M, Ng CH. Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses. Am J Psychiatry. 2016 Jun 1;173(6):575-87

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