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Nutritional Supplements and VitaminsThis list is updated on a regular basis so please check back frequently. For those who are interested in the topic and are concerned about the fact that there are no regulations to ensure that these products are safe and that they contain the ingredients they claim to contain, we strongly recommend visiting this website: ConsumerLab.com, provides independent test results and information to help consumers and healthcare professionals evaluate health, wellness, and nutrition products. It publishes results of its tests online at www.consumerlab.com, including listings of brands that have passed testing. Products that pass CL's testing are eligible to bear the CL Seal of Approval. CL addresses a growing need of consumers and healthcare professionals for better information to guide the selection of health, wellness, and nutrition products. A recent report in the Journal of the American Medical Association by Saper and colleagues highlights the concern about safety in Ayurvedic medicines. It found that 25% of Ayurvedic supplements purchased at random contained potentially toxic levels of heavy metals (such as lead, mercury, etcetera). SupplementsSupplements are drugs that are found in nature (note: supplements don't have to be any more "natural" in terms of how they are made than prescription drugs). Because they are found in nature they are not, in the United States, subject to review and approval by the Food and Drug Administration. Also, because they are found in nature, they tend to be safer than prescription drugs (although that is not necessarily always true). We believe in the value of supplements a great deal, but they are certainly not the right answer for everyone. What we have tried to do is summarize the available information on the supplements that have the most importance for those with mood disorders.
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Fish Oil
Since then there have been several more studies and the results are mixed. In October of 2002 in an article in the most prestigious journal in psychiatry (the Archives of General Psychiatry) Peet and Horrobin from Swallownest Court Hospital, in Sheffield, England found that treatment with ethyl-eicosapentaenoate (one of the principle omega-3 fatty acids in fish oil) at a dosage of 1 g/d was effective in treating depression in patients who remained depressed despite adequate standard therapy. Zanarini and Frankenberg from McLean Hospital (also affiliated with Harvard) found that the same dose (1 gram/day) of ethyl-eicosapentaenoate was effective in treating borderline personality disorder (a condition associated with depression and rapid shifts in mood). Then in May of 2003 Lauren Marengell and colleagues from Baylor College of Medicine in Houston found that 2 grams per day of docosahexaenoic acid (DHA) (the other major omega-3 fatty acid in fish oil) was not effective in treating depression. Our own experience with fish oil is also mixed, it seems to have helped patients with unstable or cycling mood disorders achieve more stability, but it is not dramatically helpful. On the other hand, it has no side effects other than a very slight fishy "taste" that reminds you that you took it for a few minutes. And there is pretty good evidence that it may be good for preventing blood vessel disease that can cause strokes, memory loss, and heart disease. The only way to get substantial amounts of those omega-3s is from fish or fish-oil supplements. The least expensive way to get fish-oil supplements is most likely from a membership club, like Kirkland Signature Natural Fish Oil at Costco or Member's Mark Omega 3 Fish Oil at Sam's Club. Some other quality brands** are: Spring Valley Natural Fish Oil Concentrate, Walgreen's Fish Oil Concentrate, Vitasmart Naturals Fish Oil Concentrate (Kmart), Natrol Omega-3, GNC Fish Body Oils. Consumer Reports magazine reviewed fish-oil supplements in their July 2003 edition. Saint John's WortSee the information at our Saint John's wort page SAM-eS-adenosylmethionine, or SAM-e for short, is one of the few nutritional supplements that has reasonable clinical research to support its safety and effectiveness. Although SAM-e is used for many purposes, we are particularly interested in it as a compound that may have antidepressant properties. A recent article summarizing the literature on SAM-e had this to say: "SAMe is a methyl donor and is involved in the synthesis of various neurotransmitters in the brain. Derived from the amino acid L-methionine, SAMe has been postulated to have antidepressant properties. A small number of clinical trials with injected or oral SAMe have shown that, at doses of 200-1600 mg/d, SAMe is superior to placebo and is as effective as tricyclic antidepressants in alleviating depression, although some individuals may require higher doses. SAMe may have a faster onset of action than do conventional antidepressants and may potentiate the effect of tricyclic antidepressants. SAMe may also protect against the deleterious effects of Alzheimer disease. SAMe is well tolerated and relatively free of adverse effects, although some cases of mania have been reported in bipolar patients. Overall, SAMe appears to be safe and effective in the treatment of depression, but more research is needed to determine optimal doses."
Our own experience is that SAMe is not entirely free of one side effect that can be of significant concern for those with bipolar (or manic depressive) disorder: It can definitely induce mania. Good sources of SAMe include: GNC, Natrol, Nature Made, Puritan's Pride, Twinlab and the Vitamin Shoppe. It is often recommended that one start at 200 mg a day and then increase gradually to around 800 mg a day. SAMe should be taken in divided doses (at least 2 times a day and preferably 3 times a day) and improvement can be seen in a few days to 3-4 weeks. Buyer be ware! In its most recent review of these products, Consumer Lab found that almost half of all formulations were unacceptable. For one product the amount was below detectable. MelatoninMelatonin is a hormone made by your body's pineal (pih-knee-uhl) gland. When the sun goes down, and darkness comes, the pineal gland "goes to work." As melatonin production rises, you begin to feel less alert. Body temperature starts to fall as well. Levels are so low during the day that scientists often have difficulty detecting melatonin then. Few studies have been done on melatonin's safety, side effects, interactions with drugs, and long-term effects. (Unlike products recognized as "drugs, melatonin does not require extensive testing in animals and people before being sold in the U.S.). How much to take, when to take it, and melatonin's effectiveness for many groups of people are also unknown. One review summarizes what we know about this compound: Our experience is that melatonin is an agent that is not a particularly effective sedative (in other words it doesn't help that much putting you to sleep), however it can help to re-establish normal circadian (night/day) biorhythms. An alternative approach, that has no side effects at all involves calculating when to expose yourself to light use a jet lag body clock. Those of you who are interested in trying this agent are in luck because the quality of melatonin supplements available is generally pretty good. Natrol, Twinlab, Puritan's Pride and Walgreen's are among the companies with good products. ValerianIn its review of Valerian Consumer Labs noted that the quality of data supporting Valerian as either a medication effective for insomnia, or a medication useful for daytime anxiety, was relatively poor. Studies were not that well designed, and some found that it was helpful, others did not. Also of concern was the fact that the quality of valerian products was poor. One product was actually contaminated with lead, and four products did not have much valerian in them. Brands that would be worth trying include: Puritan's Pride and Vitamin World. PassionflowerPassionflower has been proposed as a treatment for anxiety. However, there is only weak supporting scientific evidence that passionflower works for these purposes. Preliminary double-blind, comparative trials suggest that passionflower might be helpful for anxiety and chemical dependency. Passionflower contains some components that act like monoamine oxidase inhibitors, which suggests that the herb may interact with some medications, such as antidepressants. Passionflower has not been tested by Consumer Labs so we cannot suggest any brands. The proper dosage of passionflower is 1 cup 3 times daily of a tea made by steeping 1 teaspoon of dried leaves for 10 to 15 minutes. Passionflower tinctures and powdered extracts should be taken according to the label instructions. VitaminsFolic AcidStudies find that one quarter to one half of those people with depression have a deficiency of folic acid (or folate). Also, depression is the most common symptom of folate deficiency. Limited evidence from a recent Cochrane review suggested that the addition of folate to conventional antidepressant therapy is beneficial. Two studies compared treatment with folate to placebo in the context of continued use of other psychotropic medication. Of these, one used 500 μg folic acid (Coppen and Bailey, 2000) and, the other, 15 mg methyltetrahydrofolate (Godfrey et al., 1990). On the other hand a handful of studies have found that taking 1 mg a day of folic acid definitely did not reduce the risk of a recurrence of cancer, and may have slightly increased the risk. At this point we still feel that the potential benefits of 500 mcg a day of folate supplementation in those at high risk of deficiency, patients with depression, outweighs these potential negative effects. MultivitaminsConsumerLabs tested multivitamins in January 2007. Their review can be found at ConsumerLabs.com.* Surprisingly, 12 of the Multivitamins failed the tests. Not surprisingly, among those that passed was the Kirkland Signature Multivitamin distributed by Costco. Another one that passed were two products from Vitamin World. Minerals:Just as vitamins can be lacking in the diets of those with depression, so to can essential minerals. CalciumAccording to the National Institutes of Health, the Recommended Dietary Allowance (RDA) for calcium is 1,200 to 1,500 mg. Men age 25 and older, and women age 25 to 50 require 1,000 mg per day. Since less calcium is absorbed as one ages, women older than 50 require closer to 1,500 mg per day. A series of studies done at Purdue University suggest that low calcium intake may actually be linked to a higher risk of obesity. In these studies, daily calcium intake of 1300 mg was associated with 4-5 pounds less weight than intakes of less than 700 mg a day. Although the study found that calcium from non-fat dairy products was most helpful, some individuals may still find that a calcium supplement is a necessary addition to a healthy diet. A recent review of calcium supplements pointed to the extraordinary hype around "coral calcium" and identified two of these very expensive products as "unacceptable," one because of the presence of lead and one because the product didn't dissolve properly, and therefore couldn't be absorbed. Examples of acceptable products included:
*This web link is provided as a courtesy. Gateway Psychiatric Services receives no reimbursement from these companies.
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©2002 - 2007 Gateway Psychiatric Services All Rights
Reserved.
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Ever
since May of 1999, and the first publication of a study by Andy Stoll from
Brigham and Women's Hospital at Harvard Medical School, there has been a great
deal of interest in the value of omega-3 fatty acids in the prevention and
treatment of mood disorders.* The study compared 9.6 grams per day of omega-3
fatty acids from fish oil with olive oil (as a placebo) and found that, on
nearly every measure, bipolar patients did better on the fish oil supplement.