Health Check: five supplements that may

help with depression

September 2, 2014 | by Jerome Sarris

Photo credit: While there’s evidence for the efficacy of some supplements as potential
treatments for depression, there’s none for others, and some have been found to be
ineffective. Михал Орела/Flickr, CC BY-SA

Over two-thirds of Australians are thought to use complementary medicines ranging

from vitamin and mineral supplements to herbal to aromatherapy and homeopathic
products. Mental health concerns are one of the reasons why people use supplements,
but are they really useful?

While there’s evidence for the efficacy of some supplements as potential treatments for
depression, there’s none for others, and some have been found to be ineffective. But
effectiveness is not the only concern – the quality and cost of unregulated products can
also be problematic.

And then there’s the issue of discerning between bone fide evidence from double-blind
randomised controlled trials and slick company marketing campaigns.

Of the supplements that have been studied for improving general mood or treating
clinical depression, omega-3 fatty acids, St John’s wort, S-adenosyl-methionine
(SAMe), N-acetyl cysteine (NAC) and zinc are the most researched and commonly
used.

Omega-3 fatty acids

There are three types of omega-3 fatty involved in human physiology. They are
important for normal metabolism.

Epidemiological studies show that low dietary intake of omega-3 oils from fish may be
related to increased risk of depressive symptoms. A review of dozens of clinical trials
on major depression that assessed the efficacy of these fatty acids alone or in
combination with antidepressants, supported their use in depression.

And a meta-analysis combining the results of five similar studies found a significant
effect in favour of omega-3 fatty acids for reducing bipolar depression.

SAMe

S-adenosyl-methionine (SAMe) is a naturally occurring compound found in almost

every tissue and fluid in the body that’s involved in processes, such as producing and
breaking down brain chemicals including serotonin, melatonin, and dopamine.

Double-blind studies show injected and oral preparations (between 800 milligrams to
1600 milligrams) of SAMe are as effective as antidepressants, and tend to produce
relatively fewer adverse effects. SAMe also improves the response to antidepressant
medication.

It’s a little expensive but SAMe appears well tolerated with only mild adverse effects
such as headaches, restlessness, insomnia and gastrointestinal upsets.

St John’s wort

St John’s wort (Hypericum perforatum) is a flowering plant that has a long history of
medicinal use. It’s been studied for treating depression in over 40 clinical trials of
varying methodological quality.

A 2008 Cochrane review of 29 trials involving 5,489 patients analysed comparisons of

St John’s wort with placebo or dummy pills and with antidepressants. It showed people
were significantly more likely to respond to St John’s wort than to placebo. In the same
analysis, St John’s wort had an equivalent effect to antidepressants.

Because of the risk of drug interactions, people taking other medicines should only use
St John’s wort with low amounts of the plant chemical hyperforin, which has effects on
drug levels in the body (see an appropriate health professional for advice on this).

The supplement should not be taken with antidepressants as it can cause serotonin
syndrome, a potentially fatal nervous system event.

NAC
N-acetyl cysteine (NAC) is an amino acid with strong antioxidant properties that has a
history of use in the management of paracetamol overdose. It’s been found to
significantly reduce depression in bipolar disorder.

In a 24-week placebo-controlled trial of 75 people with bipolar disorder, one gram of

NAC twice a day significantly reduced depression. The supplement appears to have no
significant adverse reactions but is currently only available from compounding
pharmacies or from overseas.

Zinc

Zinc is a mineral found in some food, and there’s emerging evidence that it improves
depressed mood.

A 2012 review of randomised controlled trials found two 12-week trials, with sample
sizes of 60 and 20 people, showed zinc as an adjunct to antidepressants significantly
lowered depression.

Zinc can be safely prescribed in doses up to 30 milligrams a day, although it should

have amino acid another aid to improve absorption. While zinc is a fairly safe
supplement, it may cause nausea on an empty stomach.

A cautionary note

This is a very basic overview of the evidence for these five supplements, and people
considering their use should get health professional advice before starting to take them.

The studies mentioned here tend to support that “add-on” prescription of a range of
nutrients, such as omega-3 fatty acids, SAMe, folic acid, N-acetyl cysteine and zinc,
with various medicines, such as antidepressants, have a beneficial effect in improving
treatment beyond that of placebo. But again, be sure to seek medical advice before
combining any supplements with medications.

Clinical trials have demonstrated little or no effect for valerian in insomnia, St John’s
wort in anxiety disorders or attention deficit hyperactivity disorder, n-acetyl cysteine or
docosahexaenoic acid (DHA) fatty acids for unipolar depression, and omega-3 for
bipolar mania, among others.

The majority of Australians, especially women, already take a range of nutrient and
herbal-based supplements for a number of mental health problems. But, consumers
should be mindful of the evidence for their effectiveness and differences between the
quality and standardisation of supplements, as well as potential drug interactions.

Click here for information on participating in a clinical trial, running in Brisbane and
Melbourne, assessing the use of nutraceuticals for people who are depressed.

Dr Sarris is involved in academic research of natural products in the treatment of

psychiatric disorders. This publication is not supported by any direct funding and no
potential financial benefit is expected as a result of this publication. Dr Sarris has
received honoraria, research support, royalties, or consultancy or travel grant funding
from Integria Health, Blackmores, Bioceuticals, South Pacific Elixers, Pepsico,
HealthEd, Soho-Flordis, Pfizer, Elsevier, the Society for Medicinal Plant and Natural
Product Research, CR Roper Fellowship, an the National Health and Medical Research
Council.

This article was originally published on The Conversation. Read the original article.