Health Focus: Depression
Rather than stay on medications, Emily Thompson considers an alternative path to prevent recurring depression

By Radha Marcum

Emily Thompson
Status: 26, single, no children
Profession: Prenursing student and barista at a coffee shop
Issue: Wants to stop taking antidepressant drugs Emily Thompson's days are demanding, full of prenursing schoolwork and endless shots of espresso to be made. With her energetic approach to these responsibilities, you'd never guess that Thompson has suffered from depression. Yet during her teens, she was so depressed, she dropped out of college.

Since Thompson first experienced depressive episodes, her doctors have prescribed antidepressants for her, but she doesn't want to stay on them forever. "At one point, the medications may have saved my life," she says. "But now I'm no longer depressed. I'm in one of the most stable, successful periods of my life—going to school full-time and supporting myself without my parents' help—and I feel my emotions and creativity are blunted by [the medications]." Composing music was once Thompson's passion, she recalls, but her creative juices have dried up while she's been on antidepressants.

As Thompson knows, it's not always as simple as just "quitting" the medication. The underlying causes of depression can be complex and elusive, and prescription antidepressants can be effective in controlling symptoms. Some physicians, such as Barbara Geller, MD, professor of psychiatry at the Washington University School of Medicine in St. Louis, are reluctant to give Thompson the green light to withdraw from medication. Other doctors and health experts, such as Alicia Gonzalez, ND, of Bastyr University and nutritional consultant Kathleen Emmer, of Petaluma, California, might recommend that Thompson, who has been on antidepressants for the past eight years, consider gradual withdrawal, citing evidence suggesting that people should use most antidepressants only for short periods of time. They also suggest numerous alternatives to medication that appear to be effective in treating depression.

Before embarking on nondrug treatment, Gonzalez would first rule out hypothyroidism, hypoglycemia, and food sensitivities as causes of or contributors to Thompson's depression. Hypothyroidism and hypoglycemia can be detected with blood tests; food sensitivities are trickier to measure and would require Thompson to go on an allergy elimination diet, which she would begin by eating only foods that are unlikely to be allergenic. After a three-week elimination period, Thompson would gradually reintroduce and observe the effects of common allergenic foods, such as wheat, soy, corn, dairy products, and eggs. "Food sensitivities can cause severe depression for some people," Gonzalez says, "especially sensitivities to wheat." Caucasians, she explains, are particularly prone to this problem with wheat because wheat is a relatively recent addition to their diets and has moved west from the Middle East in the past several thousand years.

Eating For Balance
Most experts agree that a balanced, nutrient-rich diet is one of the best foundations for sound mental health. Eating well, Gonzalez emphasizes, provides vital nutrients necessary for brain neurotransmitters. Thompson admits that she doesn't always have the best eating habits, often snagging a bagel at work and then not eating again until late at night, and that she would like to consume healthier cuisine, knowing it could have a positive effect on her mental health.

Gonzalez urges Thompson to eliminate all processed and prepackaged foods from her diet, which Thompson has relied on because of her busy schedule, and replace them with organic foods, which provide more mental-health-supporting nutrients and contain fewer pesticides and hormones, which can overburden the liver and eventually cause sluggishness and depression. Emmer concurs, urging Thompson to eat five or more servings of vegetables and fruits daily (preferably organic), to limit refined sugar and salt intake, and to eliminate partially hydrogenated oils and replace them with olive and flaxseed oil. By doing this, Thompson will naturally increase her intake of vitamin B6, selenium, and folic acid. Vitamin B6 supports normal brain function. Selenium aids in healthy thyroid function, which researchers cite as important to mental health, and folic acid helps maintain healthy levels of neurotransmitters in the brain, including the neurotransmitter serotonin, a hormone that affects mood.

Emmer encourages Thompson not to overeat or binge eat pastas, bread, rice, or potato products and to switch from refined carbohydrates (including white flour) to complex carbohydrates, such as brown rice and whole-grain breads and pastas, which contain more fiber and additional nutrients. Thompson should also limit foods high in saturated fats, such as some meats, dairy products, and fried foods, which "may lead to sluggishness, slow thinking, and fatigue and interfere with blood flow, resulting in poor circulation, especially to the brain," says Emmer.

Thompson loves soda, a habit Emmer recommends Thompson break, especially diet soda. "The artificial sweetener aspartame can block the formation of serotonin and can cause headaches, insomnia, and depression in individuals who may be serotonin-deprived." In general, says Emmer, it's a good idea to avoid caffeine and sugar and consider replacing soda with "mineral-rich herbal teas, juice from freshly squeezed fruits and vegetables, spring or filtered water, and antioxidant-rich green tea."

Thompson might also consider taking selected supplements, particularly during her transition from medication. Gonzalez recommends a good B-complex supplement to support the nervous system, as well as an omega-3 fatty-acid supplement, such as cod-liver or flaxseed oil, for optimum cell health. Nerve cells benefit particularly from omega-3 fatty acids, which are found in the cells' outer, protective membranes and which facilitate the uptake of serotonin, helping cells transmit signals. Gonzalez also recommends the herb ginkgo (Ginkgo biloba) to increase circulation to the brain. Milk thistle (Silybum marianum) supports the liver, which processes and discards toxins, including those that may come from her current medications. Although St. John's wort (Hypericum perforatum) is a popular supplement for depression, Gonzalez would recommend the herb for Thompson only if depression symptoms returned after she withdrew from medication. "I wouldn't want to simply replace a synthetic drug with a 'green' drug—unless it were necessary," she explains.

Lifting Mood With Exercise
Regular exercise can be crucial in improving and maintaining mental health. People with depression, like those without it, "may feel best when they exercise regularly," says Geller. Adds Gonzalez, "Exercise increases endorphins, which make us feel good." Endorphins are the body's natural sedatives, and even moderate amounts of exercise increase these mood-boosting, pain-relieving hormones. "Both cardiovascular exercises, such as walking or swimming, and toning-focused exercises, such as yoga and tai chi, relieve mental stress," says Emmer. Exercise also detoxifies the body by pumping toxins out of the lymphatic system, she explains, and helps deliver nutrients to the brain through increased circulation.

"I don't have a whole lot of time to exercise," Thompson admits, "but I know I could benefit from it." Gonzalez recommends Thompson consider a team sport. It can be a good motivator when others count on you to participate, she says, and the interaction with others is beneficial for people who suffer from depression, who tend to isolate themselves. Gonzalez also highly recommends yoga, particularly types that combine physical postures with meditation. The physical postures help relax the body and increase blood circulation, and numerous studies have shown that meditation has positive effects on mental health. "Meditation calms," says Gonzalez, "and yet it also stimulates and clarifies thinking."

Snooze Lessons
Getting adequate sleep, meaning at least seven to eight hours a night, is also high on all three experts' to-do lists. "I have trouble sleeping," Thompson says, "and so I take an antidepressant that has a sedative effect." But Gonzalez encourages her to consider natural alternatives instead. To promote sleep, Thompson should go to bed relaxed, says Gonzalez. She recommends drinking herbal tea (which actually isn't tea, and contains no caffeine) as a bedtime ritual—a simple act that helps you slow down and relax. Teas that contain relaxing herbs, such as German chamomile (Matricaria recutita), kava (Piper methysticum), passion flower (Passiflora incarnata), and valerian (Valeriana officinalis), are most helpful. She also suggests taking a hot bath with lavender (Lavandula spp) essential oil, meditating, or doing gentle exercise to help calm your mind and body before bed.

Gonzalez also points out the importance of supporting the body's production of melatonin, the hormone that regulates the body's sleep patterns and that the body naturally produces when it's dark. Turning off or dimming the lights and turning off the TV and the computer can help stimulate your body's melatonin production. On nights when insomnia is particularly troubling, Thompson might consider taking a melatonin supplement.

Thompson is eager to try many of these options but is also understandably nervous about the transition. "Take the reins of your health and find medical doctors and other health professionals who will work with you," suggests Emmer, "and seek out supportive relationships." With the right help and a commitment to healthy habits, positive changes are possible.