Depression Protocol

A host of vitamins and minerals help maintain normal brain function. A deficiency of any one of them can lead to depression and other mental disorders. The following are some you may want to consider.

Folic Acid
Folic acid is a member of the B family of vitamins. Low levels have been linked to depression and bipolar disorder in a number of studies. Insufficient folic acid is one of the most common nutritional deficiencies, and one third of depressed adults are low in this vitamin (Alpert et al. 1997). Other nervous system disorders associated with folic acid deficiency include dementia, schizophrenia-like syndromes, insomnia, irritability, forgetfulness, organic psychosis, peripheral neuropathy, myelopathy, and restless legs syndrome (Young et al. 1989).

Many studies have examined folic acid's ability to fight depression, including one in which 36 patients with either endogenous depression or schizophrenia had low levels of folic acid: 13 of them were given standard treatment plus folic acid, while the remaining 26, acting as the control group, received only the standard treatment. Results were that 92% of the folic acid group made a full recovery, compared with only 70% of the control group. Folic acid was especially helpful to those with endogenous depression. Those who received the vitamin spent only 23.3 days in the hospital, while those in the control group averaged 32.9 days (Young et al. 1989, 1993; Carney 1995; Kelly 1998).

Studies have also linked low folic acids levels with poor response to antidepressants. So does folic acid supplementation enhance antidepressant efficacy? According to a British study, the answer is yes (Coppen et al. 2000). Researchers took 127 depressed patients and gave half of them 20 mg of fluoxetine (Prozac) plus 500 micrograms of folic acid or fluoxetine plus a placebo. In women, the addition of folic acid significantly improved the antidepressant action of fluoxetine and reduced the side effects related to this medicine. Why did men not reap similar benefits? They seem to require higher doses. The 500-mcg dose significantly increased blood levels of this vitamin, more so in women than in men. In women, but not men, the vitamin supplement reduced levels of homocysteine, an amino acid damaging to arterial linings and nerves (Coppen et al. 2000).

The effectiveness of supplementation may be due to the fact that people with folic acid deficiency have decreased synthesis of serotonin and dopamine. It has been reported that people with folic acid deficiencies do not respond to Prozac as well as people who have sufficient levels. Folic acid deficiency alone can cause severe depression, as can vitamin B12 deficiency.

Note: The usual methods of measuring these two vitamins in people is not very accurate. Additionally, because they work together, it is sometimes hard to tell which vitamin is deficient.)

The RDA for folic acid is 400 mcg a day. If you are depressed, you may want to take 800 mcg a day. You also may want to eat green leafy vegetables (especially spinach and kale), whole wheat bread, wheat germ, bananas, and other foods containing this member of the B family of vitamins.

Caution: Folic acid supplementation can mask a vitamin B12 deficiency resulting in nerve damage. For this reason, it's best to take a balanced B-vitamin complex that includes at least 300 mcg of vitamin B12. Some drugs (e.g., methotrexate) work by blocking the activation of folic acid. If you are taking such medication, do not supplement with folic acid without consulting your physician.

Vitamin B12
Vitamin B12 (also called cobalamin) is needed by the body only in very small quantities. A major deficiency causes a serious disease called pernicious anemia. Lesser deficiencies, which are common among the elderly, can produce depression, confusion, and other symptoms. B12 may help to fight depression by inhibiting monoamine oxidase (MAO), an enzyme that metabolizes some of the neurotransmitters that help to elevate mood. In that sense, B12 works like the monoamine oxidase inhibitors (MAOI), drugs prescribed for depression. Because the vitamin is not as strong as these drugs, it lacks their side effects.

Although B12 deficiency is not as common as folic acid deficiency, it can contribute to depression, particularly in the elderly. We know that perhaps 20% of senior citizens have difficulty absorbing B12 from their intestines which means that they can have a deficiency even if there is plenty of the vitamin in their food. The resultant B12 deficiency may be one reason depression is more common among the elderly. Fortunately, the treatment is simple, inexpensive, and safe.

You will find this vitamin in beef liver, chicken liver, clams, oysters, and sardines, with smaller amounts in eggs, many fish, and cheeses. Vegetarians who eat no foods coming from animals should scrutinize their diets and consider taking supplements to make sure they are getting enough of this vitamin. For the treatment of depression, 500 mcg of sublingual B12 (methylcobalamin) twice a day is recommended.

Vitamin B6
Vitamin B6 (also known as pyridoxine) is needed for conversion of the amino acid tryptophan to serotonin. While serious deficiencies of B6 are not common, minor deficiencies are and they can cause depression, convulsions, and other problems. Alcoholics are more likely to be lacking this vitamin as are those who have heart disease, liver disease, diarrhea, or other illnesses or injuries. Women who are pregnant, lactating, or taking oral contraceptives may also be at risk for B6 deficiency.

Levels of this vitamin are often low in people with depression, particularly women taking oral contraceptives, because the synthetic hormones antagonize B6. For this reason, B6 supplements may be particularly helpful for women who develop depression as a result of taking oral contraceptives.

Vitamin B6 has also been shown to ease the emotional difficulties associated with premenstrual syndrome and as part of the treatment for depression in postmenopausal women. Furthermore, a study by Bell et al. (1992) (Department of Psychiatry at the Harvard Medical School) found that when 14 elderly patients with depression took 10 mg each of vitamins B1, B2, and B6, this B combination augmented the efficacy of tricyclic antidepressant treatment. Start out with 50 mg of supplemental B6 in divided doses or take it as part of a good B-complex supplement. Eat plenty of food rich in this vitamin such as brewer's yeast, sunflower seeds, soybeans, walnuts, lentils, lima beans, hazelnuts, brown rice, avocados, and many other foods.

Vitamin B1
Vitamin B1 (also know as thiamin) was the first of the B family of vitamins to be discovered. A severe lack of this vitamin leads to beriberi which causes confusion, high blood pressure, problems with the heart, and other symptoms. A more subtle deficiency leads to depression and fatigue, as well as constipation and numbness or a "pins-and-needles" sensation in the legs. Taking B1 supplements, or in some cases simply eating lots of foods rich in this vitamin, has resolved side effects of antidepressant medication, such as dry mouth, insomnia, and stomach upset--inexpensively and with no side effects. Begin with 100 mg a day of vitamin B1 or look for a B-complex that contains at least 100 mg of this vitamin. Eat plenty of foods containing B1, including kale, spinach, turnip greens, green peas, lettuce, cabbage, and many other vegetables.

Vitamin B3
Vitamin B3 (also known as niacin or niacinamide) helps to "beat the blues." The body needs B3 to convert the amino acid tryptophan into serotonin, a neurotransmitter that plays an important role in keeping us happy. Not enough B3 means not enough serotonin, with resultant depression and anxiety. Prozac and the other SSRIs work by increasing brain levels of this neurotransmitter.

The vitamin B3 story began in the early part of the 20th century, when an old disease called pellagra made a resurgence in the southern United States. Pellagra causes the "4Ds:" diarrhea, dermatitis, dementia, and death. The rapid rise in the number of pellagra cases was caused by refined corn meal.

You see, many Southerners lived on the "3M Diet," which consisted of meat (mostly fatback), molasses, and meal (cornmeal), but improvements in food refining and railroad transportation led to many Southerners dropping "whole" corn meal in favor of the refined version. Unfortunately, the outer husk of the corn is discarded in the refining process, along with vitamin B3.

Without sufficient B3, the body cannot convert tryptophan into serotonin, leading to deterioration in mood. The treatment is raising B3 intake. When the U.S. government ordered that certain vitamins be added back into refined flour and other foods, the pellagra problem receded.

In 1950, physician Abram Hoffer followed up on the B3/pellagra connection by treating schizophrenia patients with a nutritional program featuring B3. Many of the patients improved immediately and were still doing fine when rechecked 15 years later. These were not pellagra patients. Instead, they were suffering from "vitamin dependency," a condition in which they need larger amounts of a vitamin or vitamins than do the rest of us. No studies have investigated the benefits of this B-vitamin in treating depression.

Caution: Because high-dose niacin can be toxic to the liver, it is not a good idea to take this vitamin alone unless a physician monitors your liver function. Niacin can also impair glucose tolerance which means diabetics also need a physician's supervision when supplementing with this vitamin. A more minor annoyance is the skin flushing that can occur, particularly with the initial dose.

The safest plan (and one that does not require a physician's blessing) is to take a balanced B-complex that contains 50 mg of niacin and also eat niacin-rich foods such as torula or brewer's yeast, brown rice, whole wheat, seeds, nuts, peanuts, and other legumes.

Vitamin B2
Vitamin B2 (also known as riboflavin) has been linked to mood. In 1973, researchers discovered that if normal, healthy men were given diets nearly devoid of this vitamin, they would soon score higher ratings on tests designed to detect depression. Take 50 mg of B2 or a B-complex tablet each day. Because it is also a good idea to eat foods containing this vitamin, add asparagus, broccoli, spinach, almonds, wheat germ, millet, and whole wheat bread to your diet.

Choline
Choline is a member of the B family of vitamins that is converted by the body into the neurotransmitter acetylcholine which plays an important role in learning and memory. Choline is more effective when taken with vitamin B5 which helps convert choline to the neurotransmitter acetylcholine. Some depressed people get worse when they take choline, however. You may find that 2000 mg a day, taken in divided doses, is a good starting point. Also eat plenty of choline-containing foods, including eggs, brewer's yeast, soybeans, green peas, and peanuts.

Inositol
An unofficial member of the B vitamin family, inositol is present in all tissues with highest levels in the brain and heart. It functions closely with choline and is also a component of cell membranes. Proper action of several neurotransmitters, including serotonin and acetylcholine, requires inositol.

In 1995, Levine conducted two preliminary studies that found inositol benefited people with depression (Levine et al. 1995a, 1995b). In 1997, he investigated the effects of inositol supplementation in patients with various neuropsychiatric problems, including depression. For 4 weeks, 28 depressed patients took 12 grams a day of inositol. At the end of the study, people experienced significant improvement compared to placebo treatment. No side effects or changes in laboratory tests were noted (Levine 1997).

To match the large amount of inositol used in this study, it is more convenient to take powdered inositol dissolved into liquids than capsules. Scott Shannon, M.D., President of the American Holistic Medical Association and an integrative psychiatrist practicing in Fort Collins, Colorado, finds that as little as 1000 mg twice daily is often effective.

Vitamin D
Vitamin D is considered both a vitamin and a hormone because our bodies, given exposure of the skin to sunlight, can produce it. During the winter, there is less sunlight and we also tend to spend less time outdoors. At this time or year, we are most vulnerable to becoming low in vitamin D. Winter is also the time when vulnerable people develop seasonal affective disorder or "winter blues." One treatment for this disorder involves the use of "light boxes" to articifically increase exposure to light. One theory is that this works by stimulating, via the eye's retina, the brain's pineal gland. It may also promote vitamin D production.

A study by Lansdowne et al. (1998) supports the vitamin D theory. During the Australian winter, researchers gave 44 healthy students either 400 IU, 800 IU, or no vitamin D3 for 5 days. Both dosages of vitamin D3 significantly enhanced mood. Because vitamin D is a fat-soluble vitamin, it can accumulate in tissues and become toxic. Vitamin D3 can safely be taken in daily doses up to 1400 IU.

Vitamin C
Vitamin C (also known as ascorbic acid) acts as an antioxidant and helps to maintain the immune system, manufacture collagen, guard against cancer and heart disease, reduce the risk of cataracts, and otherwise encourages health. Deficiency of vitamin C can lead to depression and mental confusion, among other problems. In fact, depression is the first clinical symptom detected when humans are deliberately deprived of vitamin C for purposes of study.

One study found that vitamin C intake was lower among depressed women who attempted suicide than among those who did not. And when researchers compared the amount of vitamin C in the blood of 885 psychiatric patients and 110 healthy controls, the psychiatric patients were found to have significantly lower levels. No studies, however, have examined the effects of supplementation (Schorah et al. 1983).

If you wish to supplement your diet with vitamin C, a 1000-mg capsule is a good place to start. This vitamin also is found in red chili peppers, guavas, parsley, green and sweet red peppers, broccoli, strawberries, oranges, mangoes, cantaloupe, and many other foods.

Potassium
Potassium is a mineral that helps to keep the heart beating regularly and has also been linked to depression. Mood upsets, fatigue, and weakness, all symptoms of depression, have been associated with low levels of the mineral. These problems can occur if there is not enough of the mineral inside the cells, even if there is enough potassium in the body fluids (outside the cells). Lower levels of potassium in the brain have been found in suicide victims. Replenishing potassium stores helps to reverse the fatigue and muscle weakness that may be associated with depression--or may be present on its own.

Unless potassium levels are dangerously low, it is probably best to get more of the mineral by increasing your intake of foods high in potassium, such as bananas, nonfat milk, oranges, and fresh peas. Enjoying four to five servings of fresh vegetables and fruit a day is usually enough to ensure that you are getting enough of this mineral.

Caution: Although many depressed people benefit from natural treatments, none of the above therapies may be effective in patients who have serious clinical depression or manic depression. Such patients may require FDA-approved antidepressant drugs and/or lithium. Anyone who has clinical depression of any type should be under the care of a physician.

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These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure, or prevent any disease