Depression is an emotional disorder that can range from mild (depressive reaction) to severe (major depression). It is the most common psychological problem in this country, affecting nearly 20 million people. It can be caused by a particular event, it can be a side effect of medication, or it can be due to hormonal changes. A dysfunction or deficiency of neurotransmitters (chemicals that help the brain’s cells communicate with each other)-doctors call it a chemical imbalance-also can cause depression. Depression can worsen cancer, asthma, diabetes, and heart disease, and it can even decrease bone density. At some time in life, we all feel depressed. But if your depression is prolonged, interferes with life’s activities, or is present without any particular precipitating event, you have a health problem that needs medical attention and treatment.

Common Symptoms

If you have five or more of the following nine symptoms, you could have depression:

• Poor appetite accompanied by weight loss, or increased appetite accompanied by weight gain
• Insomnia or hypersomnia (too much sleep)
• Physical inactivity or hyperactivity
• Loss of interest or pleasure in your usual activities
• Fatigue
• Feelings of worthlessness
• Self-reproach or inappropriate guilt
• Diminished mental skills
• Recurrent thoughts of death or suicide

What You Need to Know

Because depression can be caused by numerous drugs (antihistamines, antihypertensives, anti-inflammatory agents, birth-control pills, steroids, and tranquilizers/sedatives) and environmental toxins (heavy metals, pesticides, herbicides, solvents), it is important to be fully evaluated physically to rule out these other causes. If you are depressed for no specific reason and are taking any medications, check the Physician’s Desk Reference (PDR) to see whether depression is a side effect of your medication. Other causes of depression include alcohol, which is a brain depressant, and smoking, which increases your body’s cortisol levels (elevated cortisol levels can contribute to depression)- If you have depression, drinking alcohol and smoking will make it worse.

General Recommendations

Diet: I recommend eating more fruits and vegetables; they contain B vitamins and folate, both of which can fight depression. Omega-3 fatty acids found in cold-water fish (salmon, mackerel, tuna, sardines, trout, halibut, cod) can also boost your mood.

Exercise: helps depression by improving blood flow to the brain, elevating mood, and relieving stress. All types of exercise are good. Aerobic is the best-it can actually relieve depression substantially faster than medications. Exercise at least three days a week for 30 minutes.

Meditation: is quite helpful in depression, especially if you also have stress and/or anxiety. Meditation promotes self-examination, problem solving, and spiritual support. It also decreases your body’s output of cortisol, a chemical that negatively affects your mood.

Qigong: is also a very helpful treatment for depression. It stimulates the production of neurotransmitters in the brain, improves blood flow, and increases energy.

Your Herbal Healing Action Plan for Depression

• If your depression is severe, start with Steps 1 and 6.
• I recommend that you continue antidepressant therapy, whether conventional or natural, for four to six months after you are no longer depressed, to reduce the like­lihood that your depression will return.
• Often, the most effective approach is to use more than one method.

Step 1: Undergo Interactive Imagery or Other Psychotherapy

Psychotherapy is the most important conventional step to identify and address the emotional basis of your depression. I recommend interactive imagery, if available, as the best psychotherapeutic approach to depression, because it works more quickly than most other approaches, and it adds the benefits of relaxation and meditation. It’s a mind-body method in which you mentally interact with images that represent your emotions-so it’s a powerful way to uncover and deal with subconscious psychological issues of which you may not be aware. If interactive imagery is not available in your area, then I recommend cognitive therapy and interpersonal therapy.

Psychotherapy is just as effective as drugs for treating depression, but you may need several months or more before you notice improvement. I recommend psychotherapy as the first step, however, because to get long-term benefit, you must uncover and treat the underlying reasons for your depression. While you’re in psychotherapy, you can use the following steps for short-term control of your depression.

Step 2: Take St. John’s Wort, Gingko Biloba, and/or Omega-3 Supplements

Natural antidepressants can be as effective as conventional drugs, but without their side effects. My first choice is St. John’s wort (300mg containing 0.3 percent hypericin, three times a day), an effective herbal antidepressant for mild to moderate depression that works by re-balancing brain neurotransmitters. It takes from one to three weeks to be effective and is particularly helpful if you are under the age of 50.

If you are over 50, gingko biloba (160mg to 240mg containing 24 percent tlavongly­cosides per day) may be an effective antidepressant for you. Gingko works by increasing blood and oxygen flow to the brain, but it may take four to eight weeks to be effective. In addition, I recommend taking fish oil (4 grams daily, primarily containing EPA), or flaxseed oil (1 tablespoon to 2 tablespoons daily), which can be effective even in major depression that hasn’t responded to conventional medications. It may take three weeks to notice improvement from these omega- 3 fatty acid supplements.

Caution: Do not take St. John’s wort with conventional prescription antidepres. sants, especially SSRls, because these substances all increase serotonin levels. In combination, these substances can make your serotonin levels too high, which can cause a complication called serotonin syndrome. Symptoms of serotonin syndrome include confusion, itching, fast heartbeat, elevated blood pressure, muscle stiffness, restlessness,shaking, nausea, or sweating. If you are taking conventional antidepressants and want to change to St. John’s wort, you should wean yourself off the conventional drugs first (slowly decrease the amount you take over at least two weeks), and then start St. John’s wort. Do this only under a doctor’s supervision.

Step 3: Take Appropriate Chinese Herbal Remedies

If natural antidepressants don’t help you, or give you only partial relief, there are several excellent Chinese herbal antidepressant formulas. Because these formulas contain a variety of herbs (some even contain St. John’s wort), they are often able to treat forgetfulness, phobias, anxiety, and nervous exhaustion along with depression. Gui Pi Wan and An Shen Bu Xin Dan are common formulas. Consult a practitioner qualified in Chinese herbal medicine to determine which Chinese herbal formulas are the best for your particular syndromes. You should notice improvement within three weeks.

Step 4: Undergo Acupuncture

If the Chinese herbs alone do not help your depression, I recommend acupuncture in conjunction with them. Acupuncture is thought to rebalance the brain neurotransmitters that are deficient in depression. Principal points are usually found on the back, chest, legs, and arms. Ear acupuncture is also effective; there actually are two specific antidepressant points and a “tranquilizer” point in the ear. Always seek evaluation and treatment from a practitioner certified in acupuncture. You should notice improvement within six treatments, but you might need additional sessions for maximum benefits.

Step 5: Take 5-HTP

The supplement 5-HTP is converted to tryptophan, a precursor to serotonin, a brain neurotransmitter that is found to be deficient in many people with depression. 5-HTP can increase the levels of serotonin in your brain, thus reducing depressive symptoms. It is equal in effectiveness to most conventional antidepressants, with few side effects. Use it if the above steps are not effective. As with St. John’s wort, however, do not take 5-HTP with conventional antidepressants, because of the risk of serotonin syndrome. Take 100mg to 200mg three times daily. You should observe benefits in two to four weeks.

Warning: Be sure to use only products that are “peak X-free.” Peak X is a contaminant that can cause significant side effects and even death.

Step 6: Take a Prescription Antidepressant

Conventional antidepressants are useful and popular. In fact, 3 of the top 10 medications used in the U.S. are antidepressants. Unfortunately, these drugs can have many more side effects than the natural antidepressants, often making you feel emotionally “flat” or like a “zombie,” so I recommend that you try the previous steps first. However, prescription antidepressants like cymbalta are very effective and sometimes are the best treatment, especially for severe depression.

They include several different classes of drugs:

• Serotonin reuptake inhibitors, or SSRls (Prozac, Zoloft, Paxil, Celexa, Effexor, Luvox)
• Phenylpiperizine (Serzone)
• Trazodone (Desyrel)
• Tricyclics (Elavil, Pamelor, Sinequan, Anafranil)
• Bupropion (Wellbutrin, Zyban)
• MAO inhibitors (Pamate, Marplan, Nardil)

Within each of these classes of antidepressants, the drugs are generally equivalent to each other in effectiveness. However, you still may respond differently to different drugs (both in benefits and side effects), whether they are in the same or a different class. So you may have to try several before finding the one that is best for you.

For most antidepressants, it takes 2 to 3 weeks to see benefits. If you have severe depression and your doctor prescribes tricyclics, he can also prescribe thyroid supplement (triiodothyronine or T3) for a short period of time to speed up the response to the tricyclics. We don’t know whether or not T3 will accelerate the response to other antidepressants.

One major side effect of SSRIs is decrease in libido (sexual interest), both in men ana women. To reverse or reduce this side effect, take gingko biloba, 60mg to 120mg per day.

Warning: Stop taking St. John’s wort or 5,HTP before beginning conventional antidepressants, due to the possibility of serotonin syndrome (see Step 2 for description). Do not abruptly stop taking any antidepressant-you run the risk of a wide range of unpleasant side effects. Instead, gradually take less of the drug (over several weeks), especially if your antidepressant is short-acting (such as Paxil and Luvox). Always consult your doctor before stopping your antidepressant.

Step 7 : Take SAMe

SAMe (400mg daily for mild depression, 800mg to 1,600mg for moderate-to-severe depression), imported from Germany, can be an effective antidepressant. It affects several brain neurotransmitters and phospholipids that are essential for brain function. It also boosts antioxidants and protects DNA. I recommend SAMe if the previous steps are not effective or have intolerable side effects. SAMe can also improve the effectiveness of antidepressants, so you can take it along with them if the others are only partially effective.

Because SAMe starts working in half the time needed for tricyclics and does not cause the weight gain or sexual dysfunction that can be problems with other antidepressants. you may prefer to try it before Step 5. However, no studies have compared SAMe to SSRIs for effectiveness, the top-quality products are expensive, and many SAMe products contain sub therapeutic amounts or are poor quality. That’s why I made it Step 7. As with most antidepressants, SAMe may take three weeks to have a beneficial effect.

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