Alternative medicine includes medical practices and products that are outside the ambit of standard Western medical concepts and practice. Most of these treatments are readily available and commonly used because many people prefer these treatments to standard treatment. I plan to discuss commonly used supplements to antidepressant or mood stabilizing treatment.
The four most commonly used supplements are:
- Omega-3 fatty acids
- St. John's wort
- SAMe (S-adenosyl-L-methionine)
St. John's Wort (Hypericum perforatum extract) has been used extensively in Europe and has been exhaustively studied both as a stand alone antidepressant as well as an add on to conventional antidepressants. Probably the best studies were placebo-controlled with a large n. Those did not show St. John's wort separating from placebo. It also acts as an inducer of Cytochrome P450 3A4 isoenzyme system and thus has an impact on other concomitantly used medications especially oral contraceptives, hormone replacement therapy, retrovirals and more. In addition, there is evidence suggesting that sunlight promotes cataract formation. Therefore, anyone taking St. John's wort should not use light treatment for depression. I therefore do not recommend its use because of lack of efficacy in moderate to severe depressions and because of its many interactions.
SAMe (S-adenosyl-L-methionine) has been studied and has been found to be effective as an antidepressant but the studies are not generally considered to be definitive because of small n, unstable preparations and most comparisons against older antidepressants. Theoretically this should work because as a donor of methyl groups, it should increase the supply of the neurotransmitters dopamine, serotonin, and norepinephrine. Most side effects are gastrointestinal but anxiety and insomnia have been reported. This was tried in the office in the past without mixed results. A new study in the August 2010 issue of the American Journal of Psychiatry by Papakostas and colleagues report on its adjunctive use in the treatment of 73 patients with major depression. They found that response was more likely with adjunctive SAMe than placebo and remission was more likely as well. I think we will try it again as a adjunct.
Folate and related compounds have been demonstrated to be effective as adjuvant in the treatment of major depression. There are some polymorphisms in about 15% of the population which impair the methylation process and in those individuals methylfolate is the more effective agent.