Thomson Healthcare, Inc.
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 Depression, Major
A multicenter, randomized, double-blind phase III study was conducted to test and compare the efficacy and safety of Hypericum extract WS 5570 to paroxetine in patients suffering from moderate or severe depression according to DSM-IV criteria. One hundred thirty patients were included. The results showed that WS 5570 and paroxetine were similar in preventing relapse in a continuation treatment after recovery j from an episode of moderate to severe depression (Angheles-cu et al, 2006). |
Bottom Line Health
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| I think that there are a certain number of patients who have severe depression for whom SSRIs do work, who need to continue them during pregnancy. Other patients with less severe depression may want to go off" their medication, she says.
"Pregnant women with depression or other conditions that need treatment have to make decisions, with their clinicians, about what medications they can be best treated with and which medications are the safest," says Chambers. |
Marshall Editions
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 John's wort relieves symptoms of mild to severe depression (with or without anxiety), obsessive compulsive disorder (OCD), and attention deficit-hyperactivity disorder (ADHD), all of which are conditions where feelings of fear and anxiety are prevalent. Begin taking 300 mg of the herb standardized to 0.3% hypericin three times daily. It may take four to six weeks before any improvements are noticed; however, most people notice changes relatively quickly. St. John's wort can cause symptoms of photodermatitis,
853 sensitivity to light, and mania in people with bipolar disorder. |
Jonny Bowden, Ph.D., C.N.S.
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 John's Wort were more effective than a placebo for the treatment of mild to moderately severe depression. The authors emphasized that it's not yet known whether the extracts are more effective for some types of depression than others, but that certainly looks to be the case. It's worth noting that overall, only about 10 percent of the patients in the studies had side effects with St. John's Wort (like dry mouth, allergic reactions, and some gastrointestinal upset), compared with about 35 percent of patients who reported side effects from prescription antidepressants. |
| That's the best—and truest—description of severe depression I've ever heard. I don't remember from whom I heard it, but I remember recognizing it instantly as being a perfect description of the hell that is depression.
I know, because it's exactly how I felt for one horrendous year in my life, right after I moved to Los Angeles and promptly got divorced.
Luckily, it didn't last (feeling horrendous, that is—the divorce has gone quite well, thank you). |
Dr. Abram Hoffer, MD, FRCP (C) and Dr. Harold D. Foster, PhD
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 A third patient, age 72, consulted Dr Hoffer for severe depression. In 1981, she had a coronary. She was advised she would suffer pain after this and she did. In 1988, she was admitted to hospital for severe chest pain. Thereafter, she had recurrent painful episodes every 3 weeks, unrelated to activity or exertion. In 1989, she was in hospital for 1 week for depression. She then started on niacin 500 mg, three times a day, together with doses of antidepressants. She recovered and remained well until April 1993. She was then admitted to hospital with atrial fibrillation. |
Charles Barber
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 For people suffering from moderate to even severe depression, CBT can be as effective as medications.10 For insomnia, CBT has been shown to be more helpful than the sleep aid Ambien. In 2004, CBT was shown to help alleviate hypochondria in six sessions and, in conjunction with drugs, to help depressed adolescents and kids with obsessive-compulsive disorder. There are currendy about 150 clinical trials being conducted to test CBT for an ever-widening number of problems: Tourette's syndrome, gambling addiction, obesity, irritable bowel syndrome, and as a therapy for sexually abused kids. |
Thomson Healthcare, Inc.
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| Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John's wort): randomized controlled double blind non-inferiority trial versus paroxetine. BMJ; 330(7490): 503. 2005.
Thiede HM, Walper A. Inhibition of MAO and COMT by hypericum and hypericum extracts. J Geriatr Psychiatry Neurol 1 (suppl 1):S54-S56. 1994.
Thiele B, Brink I, Ploch M. Modulation of cytokine expression by hypericum extract. J Geriatr Psychiatry Neurol 7(suppl 1 ):S60-S62. 1994.
Uebelhack R, Blohmer JU, Graubaum HJ, et al. Black cohosh and St. |
| Comparison of Hypericum extract WS 5570 and paroxetine in ongoing treatment after recovery from an episode of moderate to severe depression: results from a randomized multicenter study. Pharmacopsychiatry; 39(6): 213-219. 2006.
Anon: ABDA-Datenbank; WuV, Eschborn and Micromedex, Inc. 1996.
Anon: Another adverse effect with St. John's Wort. Adverse Drug Reaction Reports 34:694-696. 1999.
Anon: Drug Facts & Comparisons. Facts & Comparisons Inc, St. Louis, MO 264d. 1999.
Anon: Risk of drug interactions with St. John's Wort. JAMA 283(13): 1679. 2000.
Anon: St. |
| The results showed that WS 5570 and paroxetine were similar in preventing relapse in a continuation treatment after recovery j from an episode of moderate to severe depression (Angheles-cu et al, 2006).
The objective of a double-blind, randomized, placebo-controlled trial was to study the antidepressant efficacy and safety of Hypericum perforatum extract WS 5570 at doses of 600 mg/day (once daily) and 1200 mg/day (600 mg twice daily). |
| John's wort—WS 5570—is at least as effective as paroxetine, a selective serotonin reuptake inhibitor (SSRI), and also is better tolerated than this drug, when taken over the course of six weeks in people with moderate or severe depression. In all, 251 adults with acute major depression at 21 psychiatric primary care practices in Germany were randomized to St. John's wort [900 mg three times daily) or paroxetine (20 mg once daily). Those who did not respond sufficiently to the initial dose after two weeks got benefit from an increased dose. |
Mike Adams, the Health Ranger
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 Once one has become addicted to these substances, stopping could cause withdrawal symptoms similar to those with cocaine, such as: severe depression psychosis restlessness extreme feelings of agitation
You may think that you are safer and more frugal by snorting Ritalin and Adderall, rather than cocaine, but you are harming yourself in similar ways. You also run the risk of arrest for having and using these substances without a prescription. |
Steven V. Joyal
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 Treating Depression Without Drugs: Cognitive-Behavioral Therapy
For many years, it was widely believed that antidepressants were the only effective, initial treatment for people who suffered from moderate to severe depression. Recent studies, however, are proving that wrong. Cognitive-behavioral therapy, in fact, can be just as effective as medication.
ARE YOU DEPRESSED?
Very often, people with major depression don't realize they are depressed. |
John J. Ratey, MD
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 If you have severe depression, you may feel like you're at the bottom of a pit, in a state of slow death, and that it's almost impossible to make it outside or go to the gym or even think about moving. First, see your doctor about medication and get yourself some omega-3 supplements, which are proven to have antidepressant effects. This will, I hope, loosen up the brain lock enough for you to at least go for a walk. Ask for help. Get a friend or family member to agree to come by every day, at the same time if possible, to escort you outside and around the block. |
Herbert Ross, DC with Keri Brenner, L.Ac.
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 In 23 separate clinical trials involving 1,757 patients who reported mild to moderately severe depression, taking 500 to 900 mg daily of St. John's wort extract (containing up to 2.7% hypericin, the active component of the herb) was three times more effective than a placebo and as effective as standard antidepressants such as Prozac and Zoloft. The researchers noted that it generally takes two to four weeks of steady use before the mood-elevating benefits of St. John's wort takes place.43
Christopher Hobbs has found St. John's wort useful in sleep disorders as well. |
Marshall Editions
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| Electroconvulsive therapy, which involves passing an electrical current through the brain, is still used for severe depression that does not respond to medication.
TRADITIONAL CHINESE MEDICINE
Traditional Chinese medicine views depression as both a cause and a result of illness. Treatment for depression varies according to each individual patient's condition. Patients' physical conditions vary as well, and usually can be defined as excessive or deficient.
840
Herbs: The herbs listed below are available from Chinese pharmacies or online. |
Mary-Ann Shearer
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 I used to suffer from severe low blood sugar levels, or hypoglycemia, with dizzy spells and mood swings ranging to severe depression. When I included plenty of fresh fruit in my diet, this became a thing of the past. I have since seen that this is the case in many other people with whom I have consulted. Imagine no therapy or drugs; just a diet that includes plenty of fresh fruit. This brings to mind one particular case where a young woman was institutionalized for mental observation due to extremely severe depression. |
Marshall Editions
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| John's wort has been shown to be effective in treating severe depression and the depressive symptoms of SAD. Take 300-900 mg daily on an empty stomach. St. John's wort can increase sensitivity to sunlight, so minimize your exposure to the sun when taking it to avoid getting a sunburn.
TIP: GO IN THE SUN EVERY DAY
Get 15-30 minutes of natural light daily, especially in the morning so that your body stays in tune with its normal biological rhythms. Studies of patients with SAD indicate that bright light therapy in the morning has a greater therapeutic effect than evening light therapy. |
Bottom Line Health
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| Drugs, such as the cancer medication interferon, steroids and some antihypertensives, can induce very severe depression.
•Isn't depression a type of mental illness?
Research in the last decade has found that depression is associated with physical changes in the brain, similar to those that might occur with any neurological disease, such as epilepsy, Parkinson's or Alzheimer's. Depression causes atrophy—that is, brain cells die—and a loss of connections between brain cells. The longer the depression persists—or goes untreated—the greater the damage. |
Joan Liebmann-Smith, Ph. D., and Jacqueline Nardi Egan
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 Here are just a few:
¦ In Spanish: salud (to your health)
¦ In German: gesundheit (good health to you)
¦ In Polish: sto lat (one hundred years)
¦ In French: d vos souhaits (to your wishes)
¦ In Finnish: terveydeski (for your good health)
¦ In Hebrew: labriut (bless you)
¦ In Romanian: noroc (good luck)
India, who dubbed this condition asneezia, found it fairly common in patients with schizophrenia or severe depression.
SNORING
SIGNIFICANT FACT m) Sleep apnea leads to more than a poor night's sleep. People with sleep apnea are 2 to 7 times more likely to get into a car accident. |
Jack Challem
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 The herb was also more effective than Paxil (paraxetine) in treating severe depression and better than Tofranil in reducing anxiety. Furthermore, St. John's wort causes few side effects compared with drugs. Drug side effects include reduced interest in sex and erectile dysfunction in men—which, ironically, are reasons to feel depressed! Occasionally, taking these drugs will lead to an increase in suicidal thoughts and behavior.
St. John's wort is widely used to treat depression in Europe, where herbs have been used medicinally for at least two thousand years, but the U.S. |
| DHEA
Principal use: For moderately severe depression, lack of sexual desire, and erectile dysfunction.
What else you should know: DHEA (dehydroepiandrosterone) is a steroid hormone and a precursor to estrogen and testosterone. In the mid-1990s, it became a popular over-the-counter supplement because it could improve muscle tone, enhance sexual desire and performance, and increase general feelings of well-being. The drawback is that it can be abused by people who have normal hormone levels, and it could conceivably increase the risk of estrogen-dependent and testosterone-dependent cancers. |
| What else you should know: Low intake of vitamin B12 is strongly associated with severe depression. In addition, deficiencies of vitamin B12 can sometimes mimic symptoms of severe brain fog and Alzheimer's disease. Because vitamin B12 is relatively inexpensive, everyone who is suspected of having Alzheimer's or another type of dementia should be tested for his or her levels of vitamin B12 and methylmalonic acid, which reflect vitamin B12 activity. Some people may have normal vitamin B12 levels but abnormal methylmalonic acid levels. |
| Major depression is difficult to treat with any therapy, and, not surprisingly, one study questioned the herb's benefits in severe depression. Another study, however, found that very high doses of the herb were helpful.
St. John's wort can also relieve many of the mood and behavioral symptoms associated with premenstrual syndrome. In one study, virtually all PMS symptoms decreased, with the greatest improvements in anxiety, depression, nervous tension, confusion, and crying.
Take 300 mg of a standardized extract of St. John's wort (such as Carlson Laboratories' St. |
| That said, DHEA may help moderately severe depression. If you want to try DHEA, have your DHEA-S levels measured by your doctor and follow his or her guidelines for use. In a recent study, researchers found that high doses of DHEA relieved depression in elderly men and women and led to improvements in arousal, orgasm, and other aspects of sexual activity.
Dosage: When it comes to DHEA, follow your doctor's advice. If your DHEA levels are low, you may need only 25 to 50 mg daily when combined with B-complex vitamins. |
| How Liz Dealt with Depression
Liz, a successful artist and writer, was in her midthirties when feelings of severe depression turned her life upside-down. Antidepressant medications didn't help, and she came close to committing suicide.
She kept thinking that low thyroid might have something to do with her symptoms. She lived in the Southwest, but she never sweated.Thyroid tests showed her levels of thyroid hormones to be in the normal range. Meanwhile, Liz said that her energy level was low and she felt as weak as an old woman. |
Brigitte Mars, A.H.G.
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 Avoid in cases of Parkinson's disease and severe depression. Do not take in conjunction with alcohol, sedatives, tranquilizers, or antidepressants, as it can potentiate their effects. Remain aware of kava kava's soporific effects; try to avoid driving, operating heavy machinery, or other activities that require fast reaction times after taking kava kava. On the plus side, kava kava, unlike many sedatives, is not habit forming. Daily use of kava shouldn't exceed three months, though occasional use on an ongoing basis is fine for those in good health. |
Bottom Line Health
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| Other patients with less severe depression may want to go off" their medication, she says.
"Pregnant women with depression or other conditions that need treatment have to make decisions, with their clinicians, about what medications they can be best treated with and which medications are the safest," says Chambers.
Kweder adds, "This isn't a cause for panic among women who are taking these medicines, and they should not stop their medication on their own. Stopping these medications on your own can sometimes create more problems than it solves. |
John J. Ratey, MD
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| This was a shock: These drugs were really just being introduced, and the results were forcing us to change the way we thought about treatment, yet here was a hospital offering exercise for people with severe depression. And it was working! But the results were lost in the shuffle. At a time when we were just plumbing the depths of the brain, the need was for hard science.
When I settled in Boston for my residency at the Massachusetts Mental Health Center, I landed in another epicenter—the running craze—just as it was taking off. |
J. Douglas Bremner
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 The report, published in The Journal of Preventive Medicine (January 2005), found that a half hour a day of exercise six days a week is the ideal "dosage" to improve the mood of people who have mild to severe depression. Researchers compared two groups of depressed patients and found that while the group that performed eighty minutes of exercise a week received little to no mental-health benefit (a 30% reduction vs. 29% in a "placebo exercise" group), the three-hour-a-week group had a substantial (47%) reduction in symptoms. |
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