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James McNabb, M.D., C.N.

Depression and Nutrition
(Part II)

Multivitamins and Specific Nutrients

Importance of B Vitamins

I feel it is necessary to take a multivitamin with the correct amounts of B vitamins, as B vitamins can play a significant role in the support of depression. Several of the B vitamins play powerful roles in neural functioning. As individual vitamins, pyridoxine (B₆) is important in the formation of serotonin, B₁₂ in the formation of acetylcholine, and folate in the production of dopamine, norepinephrine and epinephrine. These are all neurotransmitters important in the functioning of the brain.

In addition to their direct effects, B vitamins reduce homocysteine, a harmful substance known to induce depression in addition to its well-known propensity of causing cardiovascular disease. Thus it is critical for us to take a B vitamin formula in the treatment of depression.

Vitamin C deficiency is also associated with depression.

The multivitamin I recommend for depression is the Perfect Multi Focus. It contains the basic multivitamin formula contained in the Perfect Multi, but has ten additional ingredients that are known to support brain and memory. As a caution, I would not recommend taking over 10 mg of riboflavin (vitamin B2), as amounts higher than this can contribute to cataract formation. You are safe with the Perfect Multi formulas.

Specific nutrients

SAMe

While SAMe should not be used in manic depressive patients, SAMe is quite effective in mild to moderate depression. It is used in the dosage range of 400 to 1600 mg daily. There are no side effects in this dosage range. It can begin working in as little as 1-2 weeks, which is much faster that many conventional antidepressants.

SAMe has been studied as a single nutrient for depression and has been found to be as effective as the older (tricyclic) antidepressants. In one study combining SAMe and the patient’s antidepressant, 43% of patients became asymptomatic.  Studies comparing it to the newer SSRI type drugs have not been performed.

Alpert et.al, added SAMe to major depressive disorder patients currently taking SSRIs. but who were resistant to treatment. They found a response rate of 50% and a remission rate of 43% by adding SAMe. This is powerful news indeed.

Of all the nutrients reviewed in this article, I would have to say that SAMe is the best supported by current research. It is even more amazing when you think that SAMe has only been available in this country since 1999.

Fish Oil

There seems to be lots of evidence that omega 3 oils have a great deal to do with depression. Numerous studies have shown that omega 3 oils are lower in depressed patients than in normal individuals. A very interesting French study showed that volunteers who took 7.2 G fish oil daily had lower adrenal hormones. The lower our stress hormones, the happier we are. I recommend 1 tsp of fish oil daily for everyone. For those battling depression, I would take that amount twice or three times a day.

Folic Acid

Deficiency of folic acid is one of the more common nutrient deficiencies. Studies have shown that 1/3 of depressed patients have low levels of folic acid. I recommend 2 mg daily.

Inositol

Inositol is one of those ubiquitous substances that is present in virtually every cell in our body. Its highest concentration, however is in the brain and heart. It is required for the manufacture of acetylcholine and serotonin, both critical neurotransmitters. There is a huge safety margin in taking inositol. It can be taken up to 6 g three times a day for severe problems. I recommend starting at 2 g daily, and increasing the dose gradually every 3 to 4 days, until beneficial results can be seen. 

Vitamin D3

Vitamin D3 is perhaps the most underrated vitamin I can think of. People tend to think of vitamin D as necessary for making strong bones, which indeed it is. However, there is much more to vitamin D. There is now strong evidence that this vitamin is a potent cancer fighter. There is also much evidence that it also reduces autoimmune diseases such as Multiple Sclerosis. Its ability to dispel the blues is why I recommend it here.

Veith et.al. studied patients treated with 4000 IU daily of vitamin D and showed that vitamin D was not only safe (it did not elevate Calcium to worrisome levels), but patients had improved scores on wellbeing.

Fifteen minutes of full body sunshine will allow your skin to manufacture 10,000 IU of vitamin D. Being a fat soluble vitamin, vitamin D can be stored for a period of time, up to 12 weeks, but not long enough to last for a whole northern winter. The current RDI for vitamin D is 200 IU daily. This amount seems rather paltry in view of our body’s production of 10,000 IU in one session of sunshine. My recommendation is for 2000-4000 IU vitamin D daily for those who do not get sun for whatever reason, be it winter, northern latitudes, or fair, easily damaged skin. Your psyche will be the happier for it. Best of all, get in a bathing suit and expose your skin to 15 minutes of sun. This is not enough to cause sunburn. Vary your exposure depending upon the season, time of day and your skin coloration.

Melatonin

Melatonin is recommended here for those over 40 who do not make their own melatonin like they did while younger. Our production drops steadily during our lifetime. It is recommended primarily for its ability to produce lasting sleep. Please get the timed-released variety that lasts the entire night. Remember that the type of sleep disturbance associated with depression is the terminal sleep type. I recommend starting with 3 mg timed-release melatonin and adjusting the dosage weekly, either more or less depending on your results. While it is a hormone, it is one your body makes naturally while you are young. I therefore think that it is not something you should avoid taking because you are afraid of taking hormones.

Herbs

St. John’s Wort

A recent, very well publicized study concluded that St. John’s Wort was ineffective for severe depression, with the conclusion that it should not be used. There have been, however, many studies that have shown it to be quite effective for mild to moderate depression, which is far more common. In Germany, where St. John’s Wort is classified as a drug, there are 20 million patients taking prescriptions for this herb. This would hardly be the case for an ineffective substance. The dosage is 300 mg up to three times a day.

Energy levels

CoQ10 and Carnitine (and acetyl-L-carnitine)

One of the major complaints of depressed patients is their lack of energy. There are two nutrients that will do more for energy production than any I can think of, those two being CoQ10 and carnitine. It is the acetyl-L-carnitine form of carnitine that crosses the blood-brain barrier and enters the brain. Both of these nutrients help the mitochondria of the cells to burn fuel, thus increasing our energy levels. If you are listless and want more energy, I recommend 100 mg of CoQ10 and 100 mg of acetyl-L-carnitine daily (Carnitine-Synergy). Unfortunately, these two nutrients, CoQ10 and carnitine, are among the most expensive on the market.

Hormones

Testosterone

As men age, the production of testosterone drops rather dramatically throughout life.  Clinical laboratories use a sliding scale for measuring testosterone depending upon age, with the normal range decreasing with each decade of life. Testosterone is not just a sex hormone. There are receptors for this hormone throughout the body, especially in the brain. Testosterone has a lot to do with men’s self-esteem and drive, totally apart from the sexual aspect of it. For elderly men, it might be worth measuring testosterone levels and restoring them to more youthful levels. This alone could be a cause of depression in elderly men, and easily treated with a testosterone skin cream.

Conclusion

I want to emphasize the difference between nutrients and pharmaceuticals, especially in treating depression. Pharmaceuticals that treat the brain are quite powerful and often have significant side effects. Great care must be taken when changing medications and dosages, as abrupt changes can make the condition worse. These changes should only be made in close collaboration with the psychiatrist, and never on your own.

While medication work like arrows or spears going directly to the problem (hopefully), nutrients work quite differently. Nutrients are more like instruments in a symphony, each one contributing to overall effect. Like a symphony orchestra, you need all of the various instruments to make the most pleasing sound.

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