Vitamin D for Depression

I typically place depressed patients on a starting dose of 2000 IU’s of vitamin D, check their calcium and vitamin D levels and then decide if the dose should go up or down from there. I have seen great response to vitamin D especially in those that are low. Most people that live in the northern lattitudes like Seattle will be low on vitamin D.

Out of the hundreds of patients I have checked, I have only found one person in Seattle that had a normal vitamin D level. Repleting deficiency is imperative, as this vitamin that is now considered a “pro-hormone” may have more of a role in the physiology of the body than we are currently aware. Overdosing on vitamin D can result in a life threatening case of hypercalcemia as vitamin D and calcium absorption are interrelated.

Do NOT take more than 1000 IU of vitamin D without being monitored by your doctor. Although the active form of vitamin D in the body is 1, 25 cholecalciferol the best test for vitamin D levels is 25-D-OH, ask your doctor to do a basic metabolic panel and check your vitamin D, pre-treatment, a month out, 3 months out and so forth. If you are deficient in vitamin D and start a 2000 IU daily dose it will take about 1 week to raise your vitamin D levels 1 point.

So if your level is 16 and you need to get to 60, it will take about 44 weeks to get you back to the normal range. You are better off doing this gradually in my opinion as we do not want to cause atherosclerosis (hardening of the arteries) by hypercalcemia from taking large doses of vitamin D at once. Other naturopaths may be willing to dose you up really high, but I am completely against it, until we have more research supporting the safety of this fat soluble vitamin that stores in the body. Be sure to use vitamin D3 (cholecalciferol) in an emulsion form, because vitamin D2 is just crap, and not worth your time taking.

SAMe and Depression

S-adenosyl-Methionine (SAMe)- A natural amino acid anti-depressant that is part of the homocysteine metabolism pathway and serves the role of “methylating” neurotransmitters. As
A very great natural anti-depressant is SAMe. This should NOT be used by those with bi-polar as it has been shown to cause manic outbreaks.

How does SAMe work?

SAMe converts to S-adenosyl-homocysteine it donates “methyl” groups (CH3) to the nervous system so that it can effectively produce neurotransmitters such as serotonin, dopamine, and catecholamines that make us feel GOOD and HAPPY. This natural anti-depressant is also a great detoxifying agent for the body as it activates phase II detoxification pathways in the body.

SAMe for Detox

If you are recovering from alcoholism or drug abuse this may be the better choice of natural anti-depressants, however it should not be used by those that suffer from bipolar because of it’s ability to increase catecholamines and may trigger a manic episode. I would stick with St. John’s wort or 5-HTP for those susceptible to manic or hypomanic episodes. Do NOT combine with prescription drugs. Typical dose of SAMe is 50 mg once to twice daily. Always take SAMe with magnesium for optimal methylation of neurotransmitters, and a multi-vitamin as the B-vitamins folic acid, B-6, and B-12 are necessary for preventing homocysteinemia, a potential consequence of consuming elevated levels of SAMe. Homocysteine is correlated with cardiovascular damage and B-vitamins will ensure it’s conversion to an inert substance.

A natural amino acid anti-depressant that is part of the homocysteine metabolism pathway and serves the role of “methylating” neurotransmitters. As SAMe converts to S-adenosyl-homocysteine it donates “methyl” groups (CH3) to the nervous system so that it can effectively produce neurotransmitters such as serotonin, dopamine, and catecholamines that make us feel GOOD and HAPPY. This natural anti-depressant is also a great detoxifying agent for the body as it activates phase II detoxification pathways in the body.

If you are recovering from alcoholism or drug abuse this may be the better choice of natural anti-depressants, however it should not be used by those that suffer from bipolar because of it’s ability to increase catecholamines and may trigger a manic episode. I would stick with St. John’s wort or 5-HTP for those susceptible to manic or hypomanic episodes. Do NOT combine with prescription drugs. Typical dose of SAMe is 50 mg once to twice daily. Always take SAMe with magnesium for optimal methylation of neurotransmitters, and a multi-vitamin as the B-vitamins folic acid, B-6, and B-12 are necessary for preventing homocysteinemia, a potential consequence of consuming elevated levels of SAMe. Homocysteine is correlated with cardiovascular damage and B-vitamins will ensure it’s conversion to an inert substance.

5-HTP and Depression

Now most studies have been done on tryptophan, but because of past contamination issues it is tough to get your hands on tryptophan except through diet. 5-Hydroxy Tryptophan is just the new and improved tryptophan, and is a better therapeutic agent in my opinion because it is a biochemical step ahead of tryptophan in the production of serotonin, passing the “rate limiting step” that tryptophan fails to do. This means that 5-HTP can only feed forward in to serotonin and not go backwards in to something else.

With that being said this medicine can be a bit expensive, but is certainly worth a try! Do NOT combine this natural anti-depressant with prescription anti-depressants. I typically prescribe about 250 mg of 5-HTP on an empty stomach once or twice daily. This is pretty mega considering that most capsules start at 50mg, but the 200mg to 300mg range is what appears to work best.

5-HTP is also beneficial for insomnia, pain syndromes, schizophrenia, anorexia and bulimia, PMS, and migraine headaches. Excess tryptophan in the body is converted to serotonin (makes us happy) and melatonin (makes us sleepy). So if you have depression with insomnia this should work well for you.

Snacks for Depression

The recipe for success with depression is to pair light proteins such as vegetable proteins, turkey, nuts, or white cheeses with a high fiber friend such as a fruit, vegetable, or a whole grain choice.

These foods also are typically rich in calcium and magnesium, minerals that serve to relax the nervous system and alleviate muscle tension.

Think of cottage cheese as your "drug of choice" for boosting these amino acids. Be sure to always combine light proteins with high fiber foods to stabilize your blood sugar as I have discussed in the The Low Glycemic Index Diet.

Some simple snack ideas:

• Cottage cheese and fruit.
• A string cheese and a few whole grain crackers.
• A small serving of salmon and brown rice.
• A bowl of oatmeal with almonds.
• Yogurt, fruit, and wheat germ.
• Granola and yogurt.
• Peanut butter on whole grain toast.
• One egg and a piece of whole grain toast.
• A fruit smoothie with protein powder.
• A small bowl of high fiber cereal and milk.
• A handful of raw cashews, peanuts, or other nuts.
• Half an avocado and whole grain chips.
• Half a turkey sandwich on whole grain bread.
• 3 tablespoons of hummus and veggies or a few whole grain chips.
• 2 tablespoons of cashew butter and celery decorated with raisins.
• Rice cakes and cashew or peanut butter.
• Almonds and apple slices.
• 3-6 tablespoons of freshly ground flax seeds mixed with applesauce or yogurt.

Resource: http://KitchenTableMedicine.com

Recommended Reading: Sleep, Stress, The Low Glycemic Index Diet, Hypoglycemia, Fiber, Amino Acids and Mood Disorders, Anxiety

Omega 3 Fatty Acids for Depression

Fish oil is likely more efficacious than flax oil, I would experiment with the oil that works best for you. You can read my article on “Fish oil vs Flax oil”.

A concentrate of 9.6 grams per day was shown to be effective compared to a placebo in a small pilot trial. Patients on the study were not taken off their current medications. This is one natural therapy you can safely add as an adjunctive to most treatment plans unless you are taking blood thinning medications.

I typically prescribe one tablespoon of Carlson lemon flavored cod liver right before a meal, and yes you can take it in capsules if the thought of drinking fish oil makes you gag.

Calcium and Magnesiusm for Depression

Calcium/Magnesium- Also dirt cheap are a simple quick fix for reducing the stress, muscle tension, and insomnia associated with depression. Most people on the Standard American Diet (SAD) are deficient in magnesium, and some are likely deficient in calcium. A 500mg calcium citrate with a 250 mg magnesium an hour before bed will help replete this likely deficiency while improving quality of sleep at night. Cal/mag is most likely safe to combine with most prescription medications, but always check with your doctor before starting anything new!

Magnesium helps SAMe donate methyl groups to form neurotransmitters, and is also needed for muscle relaxation as well as over 400 enzymatic processes in our body including detoxification pathways and is also beneficial for constipation, muscle cramping, torticollis, acute angina after myocardial infarction, stroke, asthma, kidney stone prevention, dysmenorrhea, premenstrual syndrome, acute gastrointestinal spasms or cramping, eclampisa, heart disease especially cardiomyopathy, diabetes mellitus, nocturnal muscle cramping, mitral valve prolapse, toxemia of pregnancy, fibromyalgia, migraine headaches, lead toxicity, and fatigue.

Calcium is of course necessary for bone and muscle health, optimal functioning of our nervous system and is shown in the research to benefit hypercholesterolemia, hypertension, blood clotting, periodontal disease, insomnia, smooth and skeletal muscle relaxation, anxiety, hyperactivity, lead toxicity, prevention of calcium oxalate stones, prevention of colon cancer, and leg cramps.

B-Vitamins and Depression

Now I never prescribe B-vitamins alone without prescribing the WHOLE family. The family works synergistically together on the Kreb’s cycle to produce energy in the form of ATP as well as serves as very important coenzymes for a ton of other important biochemical pathways.

B-12, cyanocobalmin, for instance is needed for the production of the myelin conductive sheath that insulates the neurons of our nervous system, adequate B-12 is thus critical to a healthy nervous system. B-6, pyridoxine, is imperative for women suffering from PMS, and folic acid has research supporting it’s ability to improve the efficacy of fluoxetine (prozac) in a clinical trial.

Folic acid comes from “foliage” so be sure to eat your green leafies too! All depressed people need green vegetables. Be sure you are taking 800mcg of folic acid in your supplement.

B-vitamins are dirt cheap and can be like water on a wilting plant for a depressed person. A good quality multi-vitamin is typically what I prescribe to my depressed patients for B-vitamins. A multi-vitamin is a great insurance policy that nutritional deficiency is not contributing to depression. B-vitamins and standard multi-vitamin doses are most likely safe to take with anti-depressants and most medications.