A honking horn in traffic. A tapping foot in a long line. Another beer. A closed door. Everywhere we look, there are signs of an epidemic of bad moods and bad behavior—we are a nation suffering a 32% incidence of anxiety, depression and drug problems (1). This sobering statistic causes us to look at our witty anecdotes of daily encounters with “crazy” people and wonder what’s really happening with true concern. The prevalence of this rampant emotional instability is the result of many factors: genetics, nutrition, chemical imbalances in the body and brain, poor stress management, environmental dynamics and so on. The answers to these problems can be complex and difficult to face.

Although traditional prescriptions can be the life-saving answer for some, these medications are often overprescribed and have been known to cause side-effects so severe, it becomes questionable whether the pros outweigh the cons.

Many drugs prescribed for anxiety and depression can worsen mood instability, or leave the patient with an overall emotionally numb feeling. Other more serious physical conditions have been reported. For example, a recent study has shown that the group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may increase the chances of upper gastrointestinal tract bleeding, especially in those with peptic ulcers or those who are elderly (2).
Many natural therapies offer a more gentle alternative to mood recovery, some even addressing the cause of the mood disorder, rather than just tampering with or suppressing the symptoms.

Herbal Answers

• St. John’s wort is a perennial plant containing hypericin, a substance thought to be the natural chemical compound responsible for the healing and mood stabilizing effects of the plant. Double-blind and randomized trials published in European Archives of Psychiatry and Clinical Neuroscience involving over 1,200 patients showed that St. John’s wort extract has a “meaningful beneficial effect during acute treatment of patients suffering from mild depression and leads to a substantial increase in the probability of remission.” At the end of acute treatment lasting six weeks, 57% of the patients treated with 600 mg/day, 33% of the 900 mg/day group and 62% of the 1,200 mg/day group were in remission, compared to 25% in the placebo group (3).
   
•  Yi-gan san (YGS) is an herbal mix that was developed in 1555 as a remedy for restlessness and agitation in children. One of the ingredients, Angelicae radix, is thought to be particularly effective because of its effects on gamma-aminobutyric (GABA) acid and serotonin receptors. Emerging research shows that this natural serotonin modulator may be a safe way to treat many psychological, mood and behavior problems, including borderline personality disorder (BPD), a condition characterized by severe moodiness, impulsivity and unstable relationships. A recent study showed that YGS “significantly improved the symptoms [of BPD], without significant side effects” (4). Japanese geriatricians have also used this traditional regimen for behavioral and psychological symptoms of dementia in the elderly.
   
• Kava is a plant native to the islands of the South Pacific, of which ceremonial drinks have traditionally been made for centuries to increase sociability and enhance a sense of well-being. The active components in kava, kavalactones, are said to have numerous beneficial effects including relieving anxiety. Unlike prescription anxiety medications that often cause drowsiness and decreased attention span, kava is said to cause a tranquil, relaxed state that has yielded improved performance on mental function in several studies (5). When taken in larger amounts, kava will have immediate effects, but when taken in smaller doses daily, it has been shown to significantly improve anxiety symptoms within a week with no adverse reactions (5). According to a recent study published in American Family Physician, for those with mild to moderate anxiety “who are not using alcohol or taking other medications metabolized by the liver, kava appears to be acceptable for short-term use” (6).

Lighten Up
Light therapy can be an effective treatment for Seasonal Affective Disorder (SAD), a deficiency of serotonin and an excess of melatonin caused by lack of sunlight that is common during the cold, dark winter months. Symptoms include sadness, overeating, craving carbohydrates, anxiety, fatigue and headaches. In addition to herbal and nutritional therapies, light therapy is an effective and natural way to combat the wintertime blues. Patients can be treated with light therapy by exposing themselves to more sunlight if possible, or by sitting in front of a specially designed light box consisting of 2,500-10,000 lux fluorescent bulbs with a diffusing screen for anywhere from 15 minutes to several hours. Our internal clock, “which controls daily rhythms such as temperature, hormone secretion and sleep patterns, is light sensitive. When little light is taken in through the eyes, the production of melatonin increases, signaling the body to sleep. Internal processes slow down. When ambient light increases, production of melatonin slows down or ceases, and the body becomes alert” (7). Without adequate sunlight, the body is also at risk for vitamin D deficiency which can lead to a slew of other problems including improper calcium absorption, imbalanced hormones and immunity problems.
A dose of bright light every day may also be the answer for those suffering from non-seasonal major depression or bipolar disorder. A recent study, published in the medical journal Bipolar Disorders, found “six out of nine patients had some degree of benefit from bright light therapy, once the time of day and duration of treatment had been adjusted to individual responses (8).

You Are What You Eat (and Supplement)
Nutrition is an overlooked aspect of proper mood support that is very closely tied with our need for adequate intake of vitamins and minerals based on a simple principle: If we eat bad food, we won’t feel good. Reliance on fast food and bad nutritional habits are probably a large part of what has caused many to be deficient in vitamins and minerals and, therefore, the cause of a lot of physical and emotional instability. Our moods and thoughts are based on the chemistry of our bodies and brains, which are, of course, a result of what we put in our bodies. Jack Challem, author of The Food-Mood Solution writes, “All of our neurotransmitters are influenced by what we eat. They depend on vitamins, minerals, protein, healthy fats, and a small amount of high-quality carbohydrates” (9).

Vitamin and mineral deficiencies can often lead to drastic alteration of the entire body’s chemistry, leading to many physical, mental and emotional troubles. For example, magnesium deficiency can produce symptoms of anxiety or depression, including muscle weakness, fatigue, insomnia, apathy, poor memory, confusion, anger, nervousness and rapid pulse (1). Serotonin, the “feel good” brain chemical, depends on magnesium for its production and function, while magnesium supports our adrenal glands, which are overworked by stress.

B vitamins have also been noted for their positive effects on mood. According to a recent study, “Inositol, part of the vitamin B complex (B8) and an intracellular messenger, has evidence suggesting superiority to placebo and even comparability with the SSRI fluvoxamine” and “appears to have a positive effect on patients with panic disorder” (6).
Recently, in studies of omega-3 fatty acids for the treatment of borderline personality disorder, the treatment seemed to be as effective as commercial mood stabilizers, and better compliance was achieved owing to the low side-effect burden and lack of stigma (4).

Work It Out
Exercise can be an extremely effective treatment for depression, with the only potential side effect being sore muscles. This seems like a small price to pay for the increased self-esteem, health, sociability and natural release of endorphins and regulation of neurotransmitters that come as a result of regular exercise.

A study published in Psychosomatic Medicine involving 202 depressed adults showed that those who went through group-based exercise did as well as those treated with an antidepressant drug, with 45% no longer meeting the criteria for major depression. For a group that exercised at home alone, 40% went into remission. The author of the study states, “There is certainly growing evidence that exercise may be a viable alternative to medication, at least among patients who are receptive to exercise as a potential treatment for their depression” (10). For safety reasons, exercise routines should always approved by a doctor.

The Forgotten Few
Although we see certainly see problems with mood every day, there are specific populations that have been neglected in terms of addressing problems with depression and mood support: children and the elderly. These groups, often overshadowed, are usually made less of a priority because symptoms can be more difficult to detect and denial commonly leads to these serious problems being ignored.

This isn’t child’s play. Some estimates calculate that as many as one in thirty-three children and one in eight adolescents suffer from depression (11), but depression in children has only recently being looked at as a serious problem. If a child is predisposed to depression or displays depressive symptoms at a young age, the child’s chances of developing serious depression, anxiety or even suicidal thoughts in their teen years or early adulthood are extremely high because of the natural stresses associated with these age groups.

Children may manifest depression symptoms in ways that may not blatantly indicate a depressive disorder, such as feigning illness, overdependence and attachment, and/or aggressive behavior. Among parents of children with serious difficulties 49% reported that medications were prescribed for their child (12). Although prescription medication may be an appropriate treatment for some children, many parents are rightly concerned about the side-effects (which can included higher risk of suicide) and quick-fix implications of such harsh chemical treatments. Nutrition and exercise might be the most natural and effective ways for a child’s mood to be regulated. Carolyn Dean, in The Magnesium Miracle, recommends, “Instead of reaching for Ritalin or Prozac for kids, consider whether they’re getting enough magnesium first” (1). Other useful recommendations include supplementing with omega-3 fish oils, B-complex vitamins and avoiding sugary and processed foods (9). Of course, if additional help seems necessary, never hesitate to seek professional care to discover the best treatment for a child.

Senior symptoms. An estimated 2 million older adults may have a depressive illness, which is the second highest prevalence of depression across the age range (13). Mood disorders in the elderly can begin developing as early as retirement, as many have trouble coping with their new lifestyle and finding meaning in their lives outside of the workplace. In addition, the elderly are at high risk for depression because they are more likely to have experienced illness, death of loved ones, impaired function and loss of independence. Due to the stigma associated with depression in previous generations, many older people will not admit to the signs and symptoms of depression, for fear that they will be seen as weak (14). Further complicating the issue, depression can also be a sign of serious medical problems, such as Alzheimer’s disease and dementia, as many become deeply saddened and frustrated by these brain disorders.

Younger generations often assume that depressive behavior is a “normal” part of elderly behavior, and that the “cranky” old person is only a charming vignette of the aging process, which unfortunately leads to numerous undiagnosed and undertreated cases. Untreated depression is the primary cause of suicide in the elderly (11).

Many depressive symptoms are associated with risk factors for diabetes such as physical inactivity or excess calorie intake, leading to increased BMI or disturbed sleep patterns. The highest prevalence of diabetes in the population is among those 65 years and older, and nearly 39% of diabetes cases in older adults were diagnosed after the age of 65 years. A study including 4681 participants who were 65 years and older, found “older adults who reported higher depressive symptoms were more likely to develop diabetes than their counterparts (14).”

In regard to sleep patterns, insomnia can be a common cause and symptom of depression in the elderly. “Persistent insomnia may perpetuate depression in elderly patients receiving standard care by primary care providers,” according to study findings reported in the journal Sleep (15). In such cases, more gentle supplements such as melatonin or kava could be useful in regulating healthy sleep patterns to prevent or reduce symptoms of depression. Other gentle and effective supplements include St. John’s wort, fish oils, magnesium, a high-potency multivitamin or B-complex, ginkgo and ginseng (9).

References
1. C. Dean, The Magnesium Miracle (Ballantine Books, New York, NY, 2007).
2. W. Dunham, “Antidepressants tied to gastrointestinal bleeding.” Reuters, July 2008
3. S. Kasper, et al., “Efficacy of St. John’s wort extract WS 5570 in acute treatment of mild depression.” European Arch. of Psychiatry and Clinical Neuroscience 258 (1), 59-63, Feb. 2008.
4. T. Miyaoka, et al., “Yi-gan san for the treatment of borderline personality disorder: an open-label study.” Progress in Neuro-Psychopharmacology and Biological Psychiatry, 32 (1), 150-154, Jan. 2008.
5. E. Mindell, All About Kava (Avery Publishing Group,Garden City Park, NY, 1998).
6. S. Saeed, et al., “Herbal and Dietary Supplements for Treatment of Anxiety Disorders.” American Family Physician, 76 (4), Aug. 2007.
7. L. Knittel, User’s Guide to Natural Remedies for Depression (Basic Health Publications, North Bergen, NJ, 2003).
8. “Light Therapy May Help Women with Bipolar Disorder,” www.reuters.com
9. J. Challem, The Food-Mood Solution (John Wiley & Sons, Inc., Hoboken, NJ, 2007).
10. A. Norton, “Exercise on par with drugs for aiding depression.” Reuters Health, Sept. 2007.
11. L. Vukovic, User’s Guide to St. John’s Wort (Basic Health Publications, North Bergen, NJ, 2003).
12. www.childstats.gov
13. www.nlm.nih.gov
14. M. Carnethon, et al., “Longitudinal Association Between Depressive Symptoms and Incident Type 2 Diabetes.” Arch. of Int. Med. 167 (8), 802-7, April 2007.
15. K. Gale, “Insomnia prolongs depression in the elderly.” Reuters, April 2008.

Published in WholeFoods Magazine, Sept. 2008