Sunday, November 19, 2006

Easing Depression Without a Prescription

(HealthDay News) -- A brisk run, a friendly game of chess, a soothing massage: All these pursuits can help ease mild depression, experts say.

"These are all things that are certainly worth trying and are generally healthy, anyway," said Dr. Nadia Marsh, an expert in treating depression and chief of the division of geriatrics at Cabrini Medical Center, in New York City.

Marsh stressed, however, that alternative or complementary therapies probably won't do much to ease really serious depression.

"For any form of mild depression, all of these things can help when added together," she said. "But, even then, it's not a form of treatment in and of itself."

Each year millions of Americans are diagnosed with depression, and many turn to their doctors for either professional psychotherapy or an antidepressant medication -- usually widely used selective serotonin reuptake inhibitors (SSRIs) such as Prozac or Zoloft.

But increasingly, people are also looking for non-pharmacologic relief of illness, including depression. Unfortunately, according to Marsh, the evidence to support the effectiveness of alternative therapies against the disease isn't strong.

"The studies for non-pharmacologic interventions have not been great," she said. "There are relatively few randomized controlled trials, and the ones that have been done are plagued by problems such as too-short follow-up or small sample size."

Still, some research has been encouraging. One study released about five years ago found that exercise could be a major weapon against depression.

"Exercise, at least when performed in a group setting, seems to be at least as effective as standard antidepressant medications in reducing symptoms in patients with major depression," said researcher James Blumenthal, a professor of medical psychology at Duke University.

His team's study found that 10 months of regular, moderate exercise reduced depressive symptoms at a rate equal to that of Zoloft.

Another study, this time by researchers at the University of Texas Southwestern Medical Center at Dallas, found that 30-minute workouts done three to five times a week could cut depressive symptoms in half in young adults.

Even less vigorous activities, such as T'ai chi or yoga, may help lower blood pressure and ease stress, Marsh said. "People who exercise also tend to feel that they have more control over their life," she added. That's important, since a persistent feeling of helplessness is a hallmark of depression.

According to Marsh, the science is much less clear when it comes to the effectiveness of supplements and herbal medicines. For example, there's little good data to support the use of either folate or the B vitamins in warding off the blues, she said.

Perhaps the most talked-about herbal therapy for depression is St. John's wort, but "the evidence that it can help moderate-to-severe depression is very poor," Marsh said. "Even for mild depression, it's unclear what the correct dose should be -- the studies have been all over the map."

Marsh also warned that both St. John's wort and prescription SSRIs get metabolized through the liver. "They both affect the liver, and it affects the metabolism of the antidepressant," she said.

"A lot of people combine antidepressants and alternative medicines -- we see that all the time," Marsh said. It's a dangerous mix, however, because adding St. John's wort to an antidepressant might boost the risk for side effects. The herbal can also trigger photosensitivity in users, causing their skin to quickly turn "beet-red" if they go out in the sun, she said.

"It shouldn't be given during chemotherapy, either, that can be very dangerous," Marsh added.
The bottom line, according to Marsh, is to always let your doctor know what over-the-counter medications -- herbal or otherwise -- you might be taking.

Finally, non-pharmacologic interventions such as massage therapy, acupuncture or aromatherapy are great at easing short-term stress, "but the real issue, when it comes to depression, is what is the effect over the long term?" Marsh said. Right now, nobody really knows, she said.

One thing the science does show, however, is that contact with others -- friends, family, clubs and group activities -- can boost mood and help ease depression.

"If you're socially isolated, especially, just reaching out can help," Marsh said. "It can have a huge impact on how people see themselves and help them to 're-orient.'"

Marsh stressed that most of the interventions listed above certainly won't hurt, and taken together, probably will help boost mood.

"They'll certainly improve your physical well-being and transiently, at least, your mental well-being, too," she said.

More information
Find out more about depression at the U.S. National Institute of Mental Health.

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