Treating depression with supplements and complementary therapies

Photo Cred: Ashley Batz/Unsplash

By Avery St. Onge, Avery St. Onge

As the world continues to face a mental health crisis due in large part to the novel coronavirus (COVID-19) pandemic, many integrative and functional medicine practitioners have turned to supplements and complementary therapies to help address the root cause of their patients’ depression.

Since the beginning of the COVID-19 pandemic, depression rates have skyrocketed, not just in the United States, but globally. In 2020, there was a 28 percent increase in major depressive disorder cases worldwide, according to the World Health Organization. In the U.S. alone, 40 percent of adults reported issues with mental health or substance abuse in 2020, according to a study by the Centers for Disease Control and Prevention (CDC).

Unpacking depression

Depression is a broad term and can present itself in several different ways. Peter Bongiorno, ND, LAc, founder of InnerSource health clinic with two locations in New York, said he treats three general categories of depression. The first is known as major depressive disorder, where patients have extremely low moods, low motivation, a lack of hope, and may have thoughts of suicide. The next, he explained, is more of a low-grade depression known as dysthymia, where people experience low moods but are still functional. Finally, Bongiorno said he often sees patients who have been diagnosed with depression, but really, their problems are rooted in anxiety which causes them to feel overwhelmed and unmotivated.

“What I’ve learned is that depression is a symptom of a number of different factors that are going on psychologically and synergizing to become this condition we’re calling ‘depression,’” said Bongiorno.

Bongiorno described depression as “multifactorial.” He said addressing the root causes requires a detailed patient history. At Bongiorno’s practice, a patient’s first appointment often lasts an hour and a half, during which he gathers in-depth details about the patient’s concerns that help him determine what lab tests to run. After he’s identified the patient’s psychological and physiological issues, Bongiorno determines a treatment plan.

Within the past few years, Andrew Wong, MD, IFMCP, founder of Capital Integrative Health, a primary care, functional medicine, and medical acupuncture clinic in Bethesda, Md., has seen more patients coming in with depression as their main health concern.

Wong explained that his clinic is often a patient’s first stop on their mental health journey. Treating them, he said, involves first identifying the root cause of their depression by applying a whole-person, holistic approach.

From a functional medicine perspective, depression is inflammation in the brain, Wong explained. When the brain is inflamed, neurotransmitter production is reduced, decreasing levels of serotonin and dopamine, two key contributors to a happy mood. However, the brain is not the only place where neurotransmitters are produced, said Wong. Much of the body’s dopamine and serotonin is made in the gut. As a result, inflammation in both the gut and the brain need to be addressed when treating depression.

According to Araceli Benavides, CNS, IFMCP, functional medicine nutritionist at Capital Integrative Health, although the causes of depression vary person to person, generally the underlying reasons that patients experience depression fall under five categories: gut health; nutrient deficiencies; under methylation; toxic overload; and situational.

Addressing gut health is crucial, said Benavides. It not only helps produce more serotonin and dopamine by lowering inflammation, but it also improves cell membrane absorption, allowing vitamins and supplements to work. This process involves treating overgrowth of bacteria in the gut and making sure the gut lining is healthy.

Identifying the root cause and developing a plan of action

When determining the underlying factors of a patient’s depression, Wong and his medical team run multiple lab tests. To get an idea of problems surrounding hormones and nutrients, Wong does extensive blood work including a comprehensive metabolic panel and a lipid panel. To measure gut health, he tests the patient’s stool. In addition, if a patient expresses concern about their toxic exposure, Wong will conduct a toxin test which looks at heavy metal exposure, mold, and environmental toxins. Finally, to identify what’s disrupting a patient’s biochemistry and their neurotransmitters, Wong will run a quantitative electroencephalography (EEG).

Depending on the lab results, Wong and his team will use supplements to replenish any nutrients that are deficient and work to reduce inflammation. Wong shared three main supplements that have shown significant improvements in patient depression in his experience: vitamin D; omega-3; and curcumin.

He said patients struggling with mood often have low levels of vitamin D. Providing supplemental vitamin D can help fix a deficiency as well as reduce inflammation. Omega-3 fatty acid supplements help restore the balance between omega-6 and omega-3 which effect neurotransmitter production, Wong explained. He also recommends curcumin and turmeric to help reduce brain inflammation, potentially decreasing feelings of depression and brain fog. Benavides also said when addressing nutrient deficiencies, vitamin B12 and folate can help manage mood.

To find out if a patient’s depression is due to under methylation, which can lead to a lack of dopamine, Bongiorno said he will perform a genetic test. Depending on the test results, Bongiorno will prescribe nutrients like zinc, copper, and iron to help breakdown histamines. Also, vitamins like B12, B6, and folate are often used to address under methylation, according to Benavides.

When a patient’s test results show high levels of toxins, Benavides said it’s helpful to undergo a detox. However, she added, the gut must be healthy for a detox to work properly and be successful.

For patients whose anxiety is a strong component of their depression, Bongiorno said supplements like nutritional lithium and linden flower can help alleviate anxiousness. He also said supplements like St. John’s wort and saffron can be as effective as a SSRI, although he cautioned that St. Johns wort can have negative effects when mixed with certain medications.

Supplements can be extremely helpful for depression, however, Wong said diet and lifestyle changes are essential to improve symptoms of depression. Addressing food sensitives and prescribing an anti-inflammatory diet as well as adequate exercise and emotional counseling are key to treating depression, Wong explained.

“I always say supplements are supplemental and you of course need a healthy diet and lifestyle,” said Wong.

Bongiorno also suggested that bringing in other modalities like acupuncture, massage therapy, reiki, craniosacral, and vagal nerve stimulation are effective in reducing negative emotions. He said meditation is also a powerful tool to reduce depression, but it involves work from the patient who might not always be ready for that kind of effort.

“I like to bring in modalities that input good energy without the patient having to do much. Modalities like acupuncture are great because all they have to do is lie on a table and the work is done to them,” said Bongiorno.

There are always underlying factors that must be addressed to treat depression, specifically in the long term, explained Bongiorno. Just like medications alone generally do not cure depression, using supplements as a monotherapy is not going to be as effective as a combination of several therapies that work together to provide optimal results.

“Functional medicine and naturopathic medicine practitioners have so many wonderful tools at our disposal,” Bongiorno said. “As practitioners, it’s up to us to look into all of the factors of depression and say ‘okay it’s going to be different for each person. It’s going to take some time but that’s what they’re here for.’”