Opinion — 14 September 2012

A look at some lifestyle and over-the-counter medications used in the treatment of depression.

Using the same measures, rates of depression have been calculated as 5–10 times higher today than they were in 1950.

The reasons for this are not clear, but the implications are interesting. For example, depression and obesity are often comorbidities. Understandably depression can arise from being overweight. But alternatively, morbid depression can arise from over-eating, which can lead to being overweight.

Many of the prescribed medications used for depression are problematic in this case because they can cause weight gain (at least some do in some people and others cause weight loss in others). Hence, in some cases a natural non-pharmaceutical product with fewer side effects could be preferable.

At the recent Australasian College of Nutritional & Environmental Medicine conference in Melbourne, several experts examined the possibilities of this with some known remedies and products.


Despite one recent negative UK study, there is considerable evidence that a regular exercise program has a dampening effect on mild to moderate depression and may also have some value as an adjunct to drug treatment in severe depression.

Animal work has shown that inactivity can lead to neural atrophy in a part of the brain (hippocampus) associated with feelings of wellbeing.

The reinstitution of an exercise program can result in neurogenesis of these connections. The process is identical to that caused by some recent antidepressant drugs.


S-adenosylmethionine is part of the dopamine, or ‘feel good’ cycle in the brain. As such, it’s a natural substance, which can be depleted in depression.

Supplements, at the dosage of about 800mg per day, have been shown in meta-analyses to be as effective as the modern generation of antidepressants, at least in non-severe cases of depression. They appear to have few side effects.

St John’s Wort

St John’s wort is a herb that has been used in depression for centuries with different levels of effectiveness. Much of this might depend on the plant being used.

If taken with traditional antidepressants, the potentially serious clinical condition of serotonin toxicity can occur. Hence, it is important that the treating health professional is made aware of all medications the patient is taking.

Fish oil

Fish oil could be perceived as the 21st century’s natural wonder treatment. Not only has it been shown to have a positive effect on depression (at least in non-severe cases), but it can have positive effects in those with established heart disease. It can also aid arthritic problems.

It appears that one type of fatty acid in fish oil (EPA or n3) is more effective at doing this singly than the other prominent type (DHA or n6). But it may well be that it’s the combination in some form that does the trick. In any case, a good 3–6g of total fish oil is necessary to deliver an appropriate dose.

The fact that fish oil is given to old animals at the zoo to help their arthritis suggests the effect may be real rather than just placebo.

But in any case, what’s wrong with placebo? A recent stinging article on depression in The Skeptic magazine suggests, after considering several lines of research, that placebos usually work as well as all the modern drugs used for mild depression, provided people think they are going to work.

No treatment, they suggest, is often as good as any, as it forces a form of critical thinking about the problem, which can be curativein itself.

Professor Garry Egger Director, Centre for Health Promotion and Research, Sydney; Professor of lifestyle medicine and applied health promotion, Southern Cross University, Lismore, NSW.

As first appeared in The Medical Observer


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