Over-the-Counter Antidepressants

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When to Use Over-the-Counter Antidepressants

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When you are suffering from more severe depression and need reliable relief from symptoms, prescription antidepressants are your best option. However, if you have mild to moderate depression without suicidal thoughts and urges, certain over-the-counter preparations may be worth a try.

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St. John's Wort

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St. John's wort has a long history of usage, going back to ancient times. In the modern world, it has become a popular depression remedy as well, backed by increasing support in the medical literature.

Its reported side effects are uncommon and rare, including dry mouth, dizziness, constipation, gastrointestinal symptoms and confusion.  I can also interact with certain other medications. Experts also recommend the usage of sunscreen with this herb due to the potential for creating sun sensitivity.

Dosages used in studies have been quite variable and are dependent upon the formulation of the herb or its extracts. You should follow the package directions for your particular brand of product.

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Omega-3 Fatty Acids

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Omega-3 fatty acids are very important for health; but, since our bodies can't make them, they must be obtained from the foods that we eat. Unfortunately, we tend to not eat enough of these in order to maintain a proper balance in our bodies, which is believed to contribute to depression and other health issues.

While omega-3 fatty acid supplements, generally derived from fish oil, are considered to be quite safe, some people may experience stomach upset and fishy burps with higher doses. In addition, doctors warn that they may increase the effects of blood-thinning medications.

No particular dosage is recommended at this time for depression, although a generally recommended starting dose is around 0.5 to 2 g daily. The FDA recommends not going over 3 g per day without your doctor's permission due to a potentially increased risk for bleeding. For those who opt to eat fish rather than take a supplement, the American Heart Association recommends two servings of fish per week for general health, which could be taken as good minimum consumption level.

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5-HTP

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5-HTP, or 5-hydroxytryptophan, is an amino acid that our body makes from a dietary amino acid called l-tryptophan.  Since it can be made into serotonin, a neurotransmitter that is believed to be involved in mood-regulation, it is thought that it can be supplemented in pill form in order to help depression.

While better-quality studies are needed to firmly establish its effectiveness as an antidepressant, there is some evidence for it helping in depression. In addition, it is generally  safe and well-tolerated, although side effects can occur and there are concerns that it could lead to a dangerous build up of high serotonin levels if it is used in conjunction with other medicines that impact serotonin.

Doses of around 200-300 mg per day seems to be fairly well-tolerated.

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SAMe

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SAMe (S-adenosylmethionine) is produced in our bodies from the essential amino acid methionine and the energy-producing compound adenosine triphosphate (ATP).  It can also be taken as a dietary supplement. 

SAMe plays a role in methylation, a process involved in the regulation of neurotransmitters like serotonin so it could possibly play a role in depression.

Studies indicate that it may relieve depression as well as an older type of antidepressants called tricyclic antidepressants. So far it has not been compared to the more popular SSRI antidepressants.

No serious side effects have been reported.

In clinical trials involving its use in treating depression, doses have ranged between 800-1,600 mg.  Follow the package directions or consult with your physician for an appropriate dose for you.

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Rhodiola Rosea

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Although not much English-language research is currently available on Rhodiola rosea, it has been studied extensively in Russia and Scandanavia as an herbal antidepressant and stress-reliever. In addition, it has long been used by herbalists as an adaptogen, meaning that it is thought to be able to help people better cope with the effects of stress. While American and European research is still in its early stages, this herb does appear to have some action as an antidepressant and it has a good safety record.

Commonly used doses range from 200 to 600 mg/day.  In studies, 340 to 680 mg of of an R. rosea extract known as SHR-5 have been tested for up to 12 weeks of usage.

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Vitamins and Minerals

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A wide variety of vitamins and minerals have been investigated for their potential role in depression. Some of the nutritional treatments which have been researched include vitamin B12, chromium and inositol. It is not possible within the scope of this article to give full details about all of the nutritional factors involved in depression. More detailed information is available at the links. In general, however, an adequate, well-balanced diet will provide all of the vitamins and minerals needed by the individual for good health and emotional balance. Alternatively, vitamin and mineral supplements may be used. Please see your doctor if you have particular concerns about a vitamin or mineral deficiency.

Sources:

Iovieno, Nadia, Elizabeth D. Dalton, Maurizio Fava and David Michoulon. "Second-tier natural antidepressants: Review and critique." Journal of Affective Disorders. 130 (2011): 343-357.

Michoulon, David, MD, Phd. "Update and Critique of Natural Remedies as Antidepressant Treatments." Obstetrics & Gynecology Clinics of North America 36 (2009): 789-807.

"Rhodiola Rosea."  Drugs.com.  Wolters Kluwer Health.  Published:  2009.  Accessed:  June 27, 2015.

The Natural Standard Research Collaboration.  "Drug and Supplements:  SAMe."  Mayo Clinic.  Mayo Foundation for Medical Education and Research.  Last updated:  November 1, 2013.  Accessed:  June 27, 2015.

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