When it comes to improving mood, most of us
will do anything, including taking boatloads of pills. One of the challenges I face as a naturopathic
doctor is choosing which supplements to prescribe my patients; in the realm of natural medicine
we have what seems like an infinite amount of options. I can prescribe herbs for regulating the stress
response, calming inflammation, or Zen-ing out the brain. I can prescribe amino acids, like 5HTP, which
help regulate chemicals in the brain. I can recommend the hottest new products,
like collagen, or a greens powder, or the newest Superfood. There are also a host of nutrients that the
brain and body need for optimal functioning. I try to keep my list of supplement recommendations
to a maximum of 5, letting diet and lifestyle do the rest of the heavy-lifting. This means that I work in layers. When I see a new patient, I start by prescribing
nutrients that fill in nutritional gaps. Perhaps my patients are showing signs of deficiency,
based on their health histories, diet diaries or blood results; Or perhaps they just need
a bit more nutrient support in the face of physical, mental, emotional and environmental
stressors. After they start to notice improvement, we
might move on to clearing more layers using herbs or therapies, like acupuncture or Mindfulness-Based
Cognitive Therapy. Naturopathic medicine does not believe in
one-size-fits all treatment plans. If I see two patients with depression on the
same day, both may receive entirely different plans. I base my recommendations on the person and
her unique biography and biology, not the condition. However, because I try to keep my supplement
suggestions to a minimum, when I work with patients with depression, I find these 5 nutrients
continue to appear on my list. 1. Fish Oil
While most anti-depressant therapies target the brain, we know that depression isn’t
simply a brain disorder. Depression is a complex condition impacted
by our genes, physical health, social and physical environments, early childhood traumas,
current stressors, nutrients status, and many other factors. Our minds and bodies are connected and therefore
depression is as much a product of the health of our bodies and our environments, as it
is of our brains. Mounting evidence shows that inflammation
in the body plays a major role in depression. Since the 90’s, scientist have found inflammatory
cytokines (immune system molecules that cause inflammation), like IL-6 and TNF-a, elevated
in depressed individuals. When pro-inflammatory substances, like lipopolysaccharide
(LPS) or interferon-a, traditionally used to treat hepatitis C, are injected into healthy
individuals they cause symptoms of depression like lack of motivation and pleasure, and
feelings of sadness. Anti-inflammatory substances are effective
anti-depressants. The omega-3 fatty acid eicosapentaenoic acid,
or EPA, found in fatty fish like salmon and sardines, is a well-known anti-inflammatory
nutrient. One study found that supplementing with EPA
prevented depressive symptoms in individuals who were injected with interferon-a. Fish oil contains the omega-3 fatty acids
EPA and docosahexaenoic acid, or DHA. Both of these marine omegas are found in certain
fatty fish, which can be remembered by the acronym SMASH: sardines, mackerel, anchovy,
salmon and herring (also trout). Fish oil supplements combine EPA and DHA. DHA is a component of our brain mass. It is needed for developing the brain and
nervous system of growing babies, and is indicated in pregnant and breastfeeding women. EPA confers the anti-inflammatory benefits. A meta-analysis composed of 15 randomized
control trials involving almost 1000 participants, found that fish oil was an effective therapy
for treating depression as long as the fish oil contained over 60% EPA relative to DHA. Another review of three studies, showed that
omega-3 fish oil supplementation reduced depressive symptoms in children and adults by 50%. When it comes to supplementing with fish oil
for depression, it’s the EPA that counts, not the DHA. Also, more fish oil seems to be better than
less. Studies that showed the best anti-depressant
actions dosed participants with at least 1 gram of EPA per day. Some studies gave patients 2 grams of EPA
or more per day. Supplements that showed the most benefit contained
higher amounts of EPA relative to DHA. A 100-gram serving of wild Atlantic salmon
contains about 400 mg of EPA, while farmed Atlantic salmon, surprisingly contains more:
700 mg of EPA per 100 grams. While consuming fatty fish, like sardines,
and pasture-raised, rather than grain-fed, animals can increase our dietary ratio of
omega 3 to omega 6, which has general health benefits, supplementation with a high-EPA
fish oil is probably necessary to supply the 1 to 2 grams of EPA per day that have been
shown to reduce depression. 2. An Active B Complex
B vitamins are cofactors for thousands of reactions in the body. Cofactors are “helpers”. They help enzymes and cellular process work—without
these helpers, important jobs just don’t get done. This can have major implications for our mental
health. For example, the vitamins B6 and folate are
needed to convert the amino acids tryptophan and 5HTP to serotonin, the “happy hormone”. Serotonin is a neurotransmitter responsible
for managing mood: soothing depression and anxiety; and regulating appetite, memory,
and sexual desire. Serotonin is the main target of conventional
anti-depressant therapies, SSRI (selective serotonin reuptake inhibitor) medications,
which raise brain levels of this chemical. Both B12, which is important for energy production
and neuronal health, and folate, which is important for DNA repair, detoxification and
reducing inflammation, have been found to be low in patients with depression. A B12 deficiency, resulting in fatigue, memory
loss and low mood, can also mimic the symptoms of depression. It’s important to supplement with an active
form of the B vitamins. This means buying and consuming a B complex
or multivitamin that contains B12 and folate in their active forms: methylcobalamin and
methyl-folate (or 5-methyltetrahydrafolate, or 5-MTHF), respectively. Individuals who have a genetic mutation that
prevents them from efficiently converting folic acid (a synthetic vitamin found in cheap
supplements and fortified grains, like wheat and rice) to active folate, are highly represented
in the major depressive disorder population. This gene is called MTHFR C677T and is associated
with lower blood levels of folate and an increased risk of depression. To learn more about folic acid and MTHFR mutations,
read my article here. B vitamins are also needed by the mitochondria,
the “powerhouses” of our cells. By helping our mitochondria work properly,
they help reduce inflammation, boost energy production and promote antioxidant synthesis. We can find B vitamins in egg yolks and liver. The only dietary sources of B12 are found
in animal foods, making it difficult for vegans and vegetarians to get without supplementing. Folate is abundant in leafy greens. Physical, mental, emotional and environmental
stressors create a higher demand for the B vitamins. The B vitamins are water soluble, excreted
in the urine and not stored. Therefore, to support neurotransmitter synthesis
and energy levels in my depressed patients, I often prescribe a good-quality B complex
supplement to complement their diets. 3. Magnesium
Because my clinical focuses are mental health, hormones and digestion, I prescribe magnesium
to virtually every patient I see—magnesium is an important nutrient for all of these
conditions. Like the B vitamins, magnesium is a cofactor. It’s involved in helping with over 800 chemical
process in the body that simply won’t get done without it. We need magnesium to make cellular energy
in the mitochondria, to produce neurotransmitters, like serotonin, and to repair DNA, among many
other jobs. Due to soil deficiency, low intake, stress
and decreased absorption, it’s estimated that about 40 to 60% of North Americans are
magnesium deficient. Only 1% of the magnesium in our bodies is
present in blood. Blood levels don’t reflect the body’s
magnesium stores, and so testing for deficiency is unreliable. Magnesium is a potent muscle relaxer. Deficiencies show up wherever muscles are
contracted, rather than relaxed: this can include constipation because of poor intestinal
motility, muscle aches and pains, frequent urination due to contracted
bladder muscles, menstrual cramps, and headaches and high blood pressure from constricted blood
vessels. Insomnia, anxiety and sensitivity to loud
noises can also all be signs of a magnesium deficiency. PMS, insulin resistance and sugar cravings
are all further indications for magnesium supplementation. Magnesium can be obtained from leafy greens
like spinach and chard. However, most individuals need to supplement
to stock up their magnesium levels, particularly if experiencing stress, fatigue, anxiety or
depression. Like the B vitamins, magnesium is water soluble,
excreted in the urine in response to stress. I prescribe magnesium glycinate, a well-absorbed
form, before bed to help patients sleep better. This means starting with 100 to 200 mg per
night and increasing by that amount every 3 to 4 days or until patients are having a
bowel movement on waking—this is called “prescribing to bowel tolerance”. A side effect of taking too much magnesium
is loose stools, or soft stools that fall apart in the toilet on flushing, which can
be corrected by lowering the dose. I personally take about 900 mg of magnesium
at night to manage my stress, mood, energy levels and muscle tension. 4. Vitamin D
About 70 to 90% of North Americans are deficient in vitamin D, which acts like a steroid hormone
rather than an actual vitamin, and regulates over one thousand genes in the body. Our skin makes vitamin D when it comes into
contact with UVB radiation from the sun. Those of us who live in northern climates
with limited sun exposure don’t make enough vitamin D and need to supplement, especially
during the Winter months. Vitamin D is needed to regulate the gene Tryptophan
Hydroxylase 2, which converts the amino acid tryptophan (a component of protein that can
only be obtained from diet and is found in foods like turkey and pumpkin seeds) to serotonin
in the brain. Low vitamin D concentration has been associated
with depression, however researchers aren’t sure if the relationship is causal: does low
vitamin D status put someone at risk for developing depression? Or do depressed individuals have low vitamin
levels in their bodies because of some other factor? Studies have failed to show that taking vitamin
D supplements impacts depression. I also haven’t found vitamin D to impact
my patients’ moods as a solo therapy. It’s likely that nutrients like vitamin
D acts as part of a network, in conjunction with other vitamins, like magnesium, which
is responsible for converting supplemental vitamin D into the active form. Vitamin D is a fat-soluble vitamin, and taking
it in chalky tablet form may not raise levels. I prescribe vitamin D3, the active form of
the vitamin, in drop form. Vitamin D drops are suspended in fats like
coconut or flax oil, which makes them easier for the body to absorb. Whether a case of the chicken or the egg,
when it comes to vitamin D and mood, we know that supporting vitamin D status is essential
for achieving optimal health, managing immune function, reducing inflammation, reducing
the risk of osteoporosis, and regulating mood, given vitamin D’s role in serotonin synthesis. The Framingham study found that patients who
had low levels of vitamin D had poorer mental functioning and reduced volume of a brain
region called the hippocampus, which is responsible for memory formation and mood regulation. Reduced hippocampal volume is a risk factor
for and consequence of major depression. There is a “sweet spot” to optimal vitamin
D levels; because it’s a fat-soluble vitamin and can be stored, too much vitamin D may
be as bad as too little. Therefore, I like to measure my patients’
blood levels in the Fall to determine the right dose for supplementation. 4000 IU a day is a good, safe dose for most
people during the Winter months. 5. Zinc
Zinc is the catalyst for hundreds of enzymes in the brain, including making serotonin,
norepinephrine and dopamine, all of which are brain chemical targets
of anti-depressant therapies. There is a major concentration of zinc in
the hippocampus, a brain region affected by depression. Studies show that zinc plays a role in supporting
neurogenesis (the creation of new brain cells) by stimulating Brain Derived Neurotrophic
Factor (BDNF). BDNF creates new brain cells and boosts mood. Anti-depressants may work by increasing brain
levels of BNDF, protecting the brain against stress. Plasma zinc concentrations are lower in major
depressive disorder. Animal studies also show that depleting zinc
can lead to major depression. Zinc supplementation has been shown to boost
mood. A study of 50 overweight or obese patients
were assigned to receive either 30 mg of zinc or placebo. After 12 weeks, the group who received zinc
experienced a greater reduction in the severity of their depression and an increase in the
levels of BDNF in their brains. Zinc is also an important nutrient for supporting
the immune system and managing inflammation. Besides depression, other signs of zinc deficiency
include skin issues, like dry skin and acne, infertility, issues with gut membrane integrity
(leaky gut), hair loss, low testosterone, poor immune function and fatigue. Dietary sources of zinc are harder to come
by for vegans and vegetarians, who are at a higher risk for developing a zinc deficiency. Zinc can be found in red meat, shellfish,
lentils and pumpkin seeds. I typically prescribe zinc the way I prescribe
iron, in pulse doses: I recommend that patients work their way through a bottle of zinc (taking
30 to 100 mg per day), while we assess whether symptoms improve. Unlike iron (which we can measure more accurately
by looking at its storage molecule ferritin), zinc can’t be accurately measured in blood. Like magnesium, zinc deficiency in the body’s
tissues may be present long before low zinc levels show up
in blood. While this list can be a great tool for anyone
interested in supporting their mood through boosting nutrient status, keep in mind that
this information is not a substitute for medical advice. I believe it’s essential to work with a
naturopathic doctor, or a functional medical doctor, who can make the appropriate recommendations
for your individual health needs. A personalized consultation that assesses
your diet, blood work, health history and specific symptoms, can help you hone your
list to come up with a dynamite nutrient plan that’s specifically tailored to you.