Mind over Mood

References

Spending on prescription drugs to treat depression, anxiety, schizophrenia and other mental health conditions climbed from $7.9 billion in 1997 to $20 billion in 2004 (a 150-percent increase), according to the Agency for Healthcare Research and Quality (AHRQ). These monetary values elucidate society’s growing need for “mood support”—as an estimated 26.2 percent of Americans age 18 and over (one in four adults) suffer from a diagnosable mental disorder (in a given year).¹

Depression involves the body, mood and thoughts—affecting the way a person eats and sleeps, feels about oneself, and thinks about things. By the year 2020 depression is projected to reach second place in the ranking of Disability Adjusted Life Years (DALYs), the sum of years of productive life lost due to disability.

Women are also more likely than men to suffer mood disorders, including depression and anxiety. In a given year, almost 10 percent of the U.S. population suffers a depressive disorder, with nearly twice as many woman afflicted as men, according to the Society for Women’s Health Research.

On the bright side, there are several natural options to help ward off the blues or keep them at bay; in fact, major players in the anti-blues band are critical omega-3 polyunsaturated fatty acids (PUFAs). Studies have linked low consumption rates of n-3 food sources and high prevalence rates of major depression, bipolar disorder and suicide. ² And recent studies have demonstrated an inverse relationship between fish consumption and the prevalence of major depression.³

Research published in the British Journal of Psychiatry showed lower plasma levels of essential fatty acids (EFAs), combined with low cholesterol concentrations, were associated with self-harm, high-risk pathological behavior, as well as impulsivity and affect.⁴ In an accompanying study assessing the efficacy of omega-3 EFAs in improving psychological well-being in patients with recurrent self- harm, 49 patients were randomized to receive 1.2 g/d of eicosapentaenoic acid (EPA) and 0.9 grams of docosahexaenoic acid (DHA) (as EPAX 5500TG capsules, from EPAX, with 305 mg EPA and 227 mg DHA) or placebo.⁵ At 12 weeks, the omega-3 EFA group had significantly greater improvements in scores for depression, suicidal thoughts and daily stress; surrogate markers of suicidal behavior were substantially reduced and improvements in well-being were observed. Scores for impulsivity, aggression and hostility did not differ.

Omega-3 fatty acids were also assessed in a double blind dose-ranging trial with women suffering from postpartum depression (PPD), which may be linked to hormonal changes in the brain during pregnancy and after childbirth. A combination of omega-3 EPA and DHA fatty acids (from EPAX) in 0.5 g/d, 1.4 g/d or 2.8 g/d doses was randomly assigned to 16 women in one recent trial.⁶ Among all three doses, patients with PPD improved substantially during the trial. Scores on depression measures were statistically significant; and decreased by approximately 50 percent.

DHA may be particularly important in stabilizing mood, as it is present in the synaptic membranes, helping release neurotransmitters that influence mood, sleep and pain awareness.⁷ In a recent paper discussing clinical studies conducted in the area of depression and the possible mechanism of action behind omega-3 EFAs, Chinese researchers stated: “It is clear from the literature that DHA is involved in a variety of processes in neural cells and that its role is far more complex than simply influencing cell membrane properties.⁸”

Omega-3s were also one of the effective therapies for depression cited in a review published in the Journal of the American Medical Women’s Association.⁹ Other treatments they addressed were folate and Hypericum perforatum (St. John’s wort). Researchers noted positive results for folate’s ability to a ugment standard antidepressant treatment, even in women who were not deficient. Other researchers have found plasma folate concentrations are associated with depressive symptoms in older women, though not in men, despite folic acid fortification.¹⁰ Folate deficiency may also play a role in the etiology of depression, possibly linked to hyperhomocysteinemia.¹¹ Studies have shown individuals with the lowest levels of homocysteine had the fewest depressive symptoms, while those with the lowest levels of folic acid had increased depressive symptoms.¹²

St. John’s wort has demonstrated efficacy in randomized controlled trials; however, its safety in pregnancy has not been established, and the herb has multiple drug interactions due to its effect on the cytochrome P450 (CYP) 3A pathway.¹³ German researchers did find a proprietary preparation of St. John’s wort (as WS 5572 or Perika®, from Nature’s Way) is at least as effective as paroxetine in the acute treatment of moderate to severe depression.

Another player in the anti-blues brigade is Apocynum venetum (as Posinol™, from Soft Gel Technologies). Positive trends have been observed in Apocynum venetum’s effect on depression as an alternative to St. John’s wort.¹⁴ In a small pilot trial, researchers observed positive trends for depression rating scales and blood neurotransmitters in patients taking Posinol compared to placebo; it was deemed generally safe, with few side effects. Significant differences in mood scores were especially noted between four and eight weeks of use.

Lemon balm extract

(as Cyracos®, from Berkem) may be another botanical mood booster, as an unpublished double blind, placebo-controlled clinical study out of France demonstrated its efficacy in reducing anxiety, anxiety-associated symptoms and insomnia.¹⁵ Thirty patients showing symptoms of anxiety and suffering from sleep disturbances were given 600 mg/d of Cyracos for 15 consecutive days. The researchers focused on 19 emotional parameters including signs of anxiety, agitation and nervous tension, and their associated symptoms, emotional instability, mental confusion and insomnia. The study results revealed a significant decrease of stress after only 15 days of taking lemon balm—including a 49-percent reduction in the state of anxiety, a 72-percent reduction of anxiety associated symptoms and a 39- percent decrease of insomnia.

As spending on prescription drugs to treat mental health disorders rises, manufacturers can play an important lead with natural players for “mood support”. Whether one is musically inclined or not, the blues can heard when the mind is not at its best, and the right ingredients can help consumers start whistling down the road to better emotional health.

References

1. Kessler RC, Chiu WT, et al “Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R)” Archives of General Psychiatry 62,6:617-27, 2005. www.nimh.nih.gov

2. Hallahan B. et al “Essential fatty acids and mental health” Journal of Psychiatry 186:275-277, 2005. http://ajp.psychiatryonline.org/

3. Mcnamara, Mairead et al “Lipids and essential fatty acids in patients presenting with self-harm” Br J Psychiatry. DOI:10.1192/bjp.bp.105.019562

4. Garland M et al. “Lipids and essential fatty acids in patients presenting self harm” British Journal of Psychiatry 190:112-117, 2007. DOI: 10.1192/bjp.bp.105.019562

5. Brian Hallahan, “Omega-3 fatty acid supplementation in patients with recurrent self-harm” Br J Psychiatry DOI: 10.1192/bjp.bp.106.022707

6. Freeman MP, Hibbeln JR, Wiesner KL, Brumbach BH, Watchman M, Gelenberg AJ. Randomized dose-raging pilot trial of Omega-3 fatty acids for postpartum depression” Acta Psychiatr Scand 1-5, 2005. http://www.blackwellpublishing.com/journal.asp?ref=0001-690x

7. Thibodeau G., Patton K. Structure and Function of the Body, 12th Edition, 2004.

8. Sinclair AJ, Begg D et al. “Omega 3 fatty acids and the brain: review of studies in depression” Asia Pac J Clin Nutr. 16,1:391-7, 2007. http://www.blackwell-synergy.com/?cookieSet=1

9.Freeman et al “Selected Integrative Medicine Treatments for Depression: Considerations for Women” Journal Of The American Medical Women’s Association http://www.jamwa.org/index.cfm?objectid=2AB8990E-D567-0B25-5B387AE8ABC49E37

10. Abou-Saleh MT, Coppen A. “Folic acid and the treatment of depression.” J Psychosom Res. 61,3:285-7, 2006. http://linkinghub.elsevier.com/retrieve/pii/S0022-3999(06)00318-7

11. Park H, Kim YJ et al. “The risk of folate and vitamin B(12) deficiencies associated with hyperhomocysteinemia among pregnant women” Am J Perinatol.21,8:469-75, 2004. DOI:10.1055/s-2004-835964

12. Dimopoulos N, Piperi C, “Correlation of folate, vitamin B(12) and homocysteine plasma levels with depression in an elderly Greek population” Clin Biochem. ePub ahead of print Jan. 26, 2007. doi:10.1016/j.clinbiochem.2007.01.007 

13. Obach, RS”Inhibition of human cytochrome P450 enzymes by constituents of St. John's Wort, an herbal preparation used in the treatment of depression” J Pharmacol Exp Ther. 294,1:88-95, 2000. http://jpet.aspetjournals.org/cgi/content/full/294/1/88

14. D.C. Crowley, M.D. & Pratibha Chaturvedi, Ph.D. “Effect of Posinol™on Symptoms of Depression in Individuals with Mild Depression” May, 2006. www.soft-gel.com.

15. Lemon balm extract (as Cyracos®, from Berkem, www.berkem.com) demonstrated efficacy in reducing anxiety, anxiety-associated symptoms and insomnia in an unpublished, double blind, placebo-controlled clinical study.