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Anxiety and Depression - What Might Help Besides Meds?

  [ 89 votes ]   [ 1 Comment ]
By Dr. Richard Podell, MD, MPH • • July 16, 2009

Anxiety and Depression - What Might Help Besides Meds?

Adding natural alternative treatments for depression, natural anxiety treatments, and stress management techniques can make a big difference in your life… Why are natural depression treatments, stress management techniques, and anxiety treatments likely to be more effective than just standard therapies alone?

An integrative medicine approach adds to standard therapies the often over-looked elements of natural healing - including nutrition, herbal, and mind-body therapies. These add holistic support for the body’s natural healing systems, which help resist and overcome a broad range of both physical and mental health problems, including but not limited to depression, anxiety, and stress.

Mind and Body Do Not Function Separately
The unstated assumption of most conventional strategies is that mind and body function separately: Each organ of the body is largely on its own. However, current science shows that just the opposite is true.

The multiple systems of mind and body communicate and interact with each other in a complex holistic web of biochemical, hormonal, and metabolic relationships. Even such distant organs as the brain, thyroid gland, adrenal gland, immune system, gut, and liver interact, and in important ways function effectively as one.

Our ‘functional medicine’ approach views all systems of the mind and body as part of one large, interactive web. This implies that any obstacle to healing that affects one part of the system feeds through and harms all others. Any improvement we can make in any part is also likely to feed through this web and improve your well-being as a whole.

Supporting the Body’s Biochemical and Metabolic Pathways
Many alternative treatments for depression act by strengthening the same biochemical pathways that medicines use to treat depression. For example, St. John’s Wort acts in part by increasing the activity of brain neurotransmitters such as serotonin and norepinephrine.

Other natural depression treatments work on metabolic pathways that standard medicines don’t seem to use. These include the one carbon methylation* pathways, omega-3 fatty acids [from fish oil, flax seed oil, algae, for example], and intracellular signaling messengers such as inositol [part of the vitamin B complex, sometimes called "brain food"].

Other natural depression treatments include diet, restorative sleep, the correct level of exercise, and mind-body stress management techniques. All can play a vital supportive role.

Many - probably most - alternative treatments for depression can be used safely and supportively along with standard medicines. However, other natural depression treatments should not usually be combined with Prozac™ or with other anti-depressants because of potential adverse interactions. For example, the amino acid 5-hydroxy tryptophan, and St. John’s Wort, both raise the brain level of serotonin, as does Prozac.™ This might often be of benefit, but rarely, too much serotonin can cause harm - the “hyper-serotonin syndrome,” which causes agitation, fever, confusion, and other symptoms, and which can be fatal.

* * * *


Alternative treatments for depression rely on the fact that depression, at heart, is a biochemical illness. Whether the main triggers are physical or emotional, these triggers then induce a broad range of neurochemical changes that, in turn, lead to the feelings of depression and to the physical and psychological disruptions that being depressed then causes.

Once one thinks about the biochemistry, it should not be surprising that alternative treatments for depression often play an important role. Almost every biochemical in our body is either directly derived from a biochemical found in food, or else is the product of the body’s processing of such foodstuff.

Especially important are the co-factors or small molecules that help our metabolic enzymes assume their proper shape, so that enzymes can make our metabolic pathways do their work. In almost every case these enzyme enabling co-factors are vitamins and minerals such as B vitamins, magnesium, and selenium.

Following are lists of selected natural treatments for depression that have good scientific support for a beneficial role in treating depression.

Alternative Treatments for Depression - Nutrients
These nutrients and their presumed mechanisms of action include:
Inositol - Intracellular second mechanism [“messenger” within nerve cells]
S-adenosyl methionine (SAMe) - Improves methylation pathways (see later section on Brain Biochemistry.)
Fish Oil - Omega-3 essential fatty acid
Tyrosine - Amino acid body uses to make norepinephrine and dopamine
Eliminate wheat gluten - May apply if blood antibody test is abnormal
Anti-hypoglycemia style diet - Mood stabilizing effect
Folic Acid - Improves methylation pathways*
Vitamin B-12 - Improves methylation pathways
Tryptophan - Amino acid. Body uses to make serotonin
L-Carnitine - Improves mitochondrial energy metabolism
Thiamine (Vitamin B1)- May help energy pathways
“Allergy” elimination diet - May be helpful for some.

Alternative Treatments for Depression - Herbs & Hormones
These substances and their presumed mechanisms of action include:
St. John’s Wort - Serotonin and norepinephrine reuptake inhibitor
Estrogen - Often helps in perimenopause; usually does not help during menopause
Testosterone - Possibly helpful for both men and women
Thyroid, especially T3 form - Double blind studies show improvement even if thyroid blood tests are normal [See Dr. Podell’s article on “Low Thyroid, Hypothyrodism and Natural Therapies: Should we treat with Cytomel or Armour Thyroid Even when Thyroid Blood Tests are Normal?”]
DHEA - Adrenal gland hormone.

Other Natural Depression Treatments
If you are vulnerable to depression due to biochemical, psychological, medicine side-effects, or other factors, this vulnerability will tend to increase if you also have suboptimal function of one or more of your body’s functional physiological symptoms.

For example, we will want to repair any nutritional deficiencies and metabolic imbalances we can identify, whether or not that particular nutrient or metabolic pathway has been specifically studied as a treatment for depression. Another natural treatment is exercise conditioning. Appropriately paced, many studies show benefit.

* * * *


Anxiety, feeling tense or nervous, is not the same thing as depression, although they often occur together. Many but not all of the alternative treatments for depression also improve anxiety, but others do not. The following natural anxiety treatments have some scientific studies supporting their use:
Valerian root
Kava herb
Rhodiola herb
Appropriate exercise (not too much, not too little)
Hypoglycemia diet
"Food allergy" elimination diet
Candida yeast overgrowth theory (speculative)

* * * *


The body’s ability to withstand stress improves with the mastery of a few basic stress management relaxation techniques that calm and regularize the body’s natural rhythms.

Relaxation Skills
For example, most people with chronic stress or anxiety fall into a pattern of shallow, relatively rapid chest breathing. For the most part we don’t even realize when we do this, since the pattern is fairly subtle. However, even at modest levels, this breathing habit tends to make people feel tense. In contrast, even a few minutes of slow, deep diaphragmatic breathing can usually be counted on to have calming effects.

We offer a broad selection of physiologically based stress management techniques and treatments. Behavioral medicine relaxation skills can quickly calm the mind and body once a stress reaction has occurred - or better yet prevent it. Brief training in diaphragmatic breathing, visual imagery, muscle relaxation, and other methods often has great rewards.

For preventing and reversing crises, we are especially impressed with a technique that employs the natural biorhythms of the heart to trigger the “relaxation response” within just about one minute. Most stress management techniques can be learned in just one or two training sessions.

Cognitive-Behavioral Treatment Counseling (CBT)
CBT is another highly effective practical stress management technique than can be learned very quickly. It often does wonders. CBT is very different from standard psychotherapies, emphasizing practical skills for handling stresses and not over-reacting.

Most people who are ill tend to fall into frustration’s mental traps - making mountains out of molehills; seeing the glass half-empty; feeling helpless and losing hope. Fortunately, once we realize how this happens, we can master simple “mental tricks” that put our thoughts and feelings into a more constructive mode.

CBT stress management techniques are not a substitute for standard psychotherapy. Its techniques are different. However, CBT stress management techniques can make standard therapy more effective. Indeed even people who don’t require therapy, but are struggling to cope with an illness, often find benefit from even a few sessions of training in CBT stress management techniques.

- Richard N. Podell, MD, MPH


To Learn More: On his website (, Dr. Podell outlines a “System-by-System Protocol for Assessing and Addressing Issues that Influence Anxiety, Depression, and Vulnerability to Stress.” These systems range from “metabolism of essential fats and oils,” “building brain neurochemicals one carbon atom at a time,” “improving mitochondrial energy for the brain,” and “sleep medicine” to dealing with “amino acid imbalances” and “hormone imbalances.” For each system, Dr. Podell summarizes the recent research, possible tests & recommendations, and cautions. To review these possibilities, click here.

* Methylation is a biochemical process that involves passing a methyl group (CH3, or three hydrogen atoms bonded to one carbon atom) from one molecule to another. It is an "on-off" switch that activates more than 100 processes in the body, including production of neurotransmitters such as serotonin and dopamine. It is known to decline as we age. SAMe (S-adenosyl-L-methionine) - found in virtually every cell of the body - acts as a co-factor in methylation, or as a “methyl donor” to neurotransmitters, lipids, and proteins believed to be involved in depression. The body synthesizes SAMe from the amino acid methionine, but is also available as a dietary supplement.

Note: This information has not been evaluated by the FDA. It is reproduced here with kind permission of Dr. Podell, and is for general information purposes only. It is not meant to prevent, diagnose, treat, or cure any condition, illness, condition, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

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Article Comments Post a Comment

Dr Podell- thanks for the info
Posted by: bigmama2
Aug 4, 2009
good info on depression! I know someone who see dr podell. he is a good dr. i am thankful that there are some good drs who help cfs/fibro patients. they are hard to find.
Reply Reply
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