Can supplements really help with depression or anxiety?

Can supplements really help with depression or anxiety?
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St. John’s Wort “promotes a positive mood.” Valerian root reduces “anxiety and stress levels”. Lavender oil is “soothing for body and soul”.

If you’re one of the tens of millions of people in the United States who suffer from depression or anxiety, it’s easy to be captivated by the promise of mood-boosting supplements. Take these pills daily, their marketing suggests, and soon you’ll be bouncing happily through lush, sunny fields without a prescription.

But, while experts say some mood-enhancing supplements are better studied than others, the broader evidence of their effectiveness is flimsy at best. “I’m not saying there’s evidence these things aren’t helpful,” said Dr. Gerard Sanacora, professor of psychiatry at the Yale School of Medicine and director of the Yale Depression Research Program. It’s more than “the quality of the evidence is not at the level we can really trust”.

And compared to other treatments such as traditional medicines or psychotherapy, experts said, supplements fall short. Here’s what we know about some of the most common supplements marketed for mental health.

St. John’s wort, omega-3 fatty acids, L-methylfolate, S-adenosyl methionine (SAMe), and N-acetylcysteine ​​(NAC) are some of the most common supplements used to treat symptoms of depression. But some have more research behind them than others.

St. John’s wort. This flowering plant is among the best-studied supplements as a treatment for depression, but not all studies suggest benefits.

“There’s actually been quite a bit of work on St. John’s wort over the years,” Dr. Sanacora said. “But that’s still not the high-quality evidence you would see for a Food and Drug Administration-approved drug.”

A 2016 exam over 35 studies involving around 7,000 people, for example, found that St. John’s wort was better than a placebo at helping people with mild to moderate depression; a 2008 review had similar conclusions. However, two carefully conducted studies published in 2001 and 2002 found no evidence of benefit.

Omega-3 fatty acids. Supplements for these essential fats have some – albeit limited – evidence that they help with mild to moderate depression. “To date, the data suggests that the treatment may have low to modest benefits, but that’s far from a definitive conclusion,” Dr. Sanacora said, adding, “I wouldn’t call the evidence high quality for these studies”.

A 2015 analysis of more than two dozen studies, for example, have concluded that even if omega-3 supplements help with depression, the benefits may not be large enough to be significant.

Dr. Dan Iosifescu, an associate professor of psychiatry at New York University’s Grossman School of Medicine, agreed. “It’s very mixed data and some studies don’t really see that much benefit,” he said. “The data is somewhat controversial.”

L-methylfolate. This metabolically active form of folate, an essential B vitamin, has evidence supporting its use for depression, Dr. Sanacora said, but the overall data is conflicting and does not reach the quality of evidence underlying FDA-approved drugs. And it may only be helpful for specific people, especially those who have trouble metabolizing or properly using folate in the body, he said.

Dr. Sanacora also noted that the existing evidence was mostly for l-methylfolate taken in combination with standard antidepressants, not as a supplement taken on its own, so people should not rely on taking the supplement alone for treatment. .

Everything else. Evidence for the benefits of other supplements in treating depression is rapidly waning, Dr. Sanacora said. He and the other experts said there have been studies of the SAMe and NAC supplements, but “there really isn’t any solid data to support their use,” Dr. Sanacora said. And even for the best, the data is questionable.

The main supplements used for anxiety – including lavender, kava, and valerian root – have even less evidence than those for depression, and they lack strong, high-quality research, at least to the best of knowledge. experts. “That doesn’t mean they aren’t effective,” Dr. Sanacora said. “There simply hasn’t been the rigorous research that is typically done for drugs seeking FDA indications.” Dr. Iosifescu said he thought kava had moderate evidence of benefit; however, he warned that kava may pose a rare but serious risk of liver toxicity.

Some might think that taking a supplement for their depression or anxiety can’t hurt, so why not give it a try? But experts have warned there could be potential risks and disadvantages. Supplements can be expensive and may cause unwanted side effects or drug interactions. And supplements aren’t as tightly regulated as FDA-approved and over-the-counter drugs, and they don’t have to be proven safe and effective before they can be sold. “There’s not as much oversight compared to traditional pharmaceuticals, which require pills to be made consistently, with consistent dosing,” said Dr. Paul Nestadt, co-director of the Johns Hopkins Anxiety Disorders Clinic and assistant professor of psychiatry. and behavioral sciences at Johns Hopkins Medicine.

Megan Olsen, general counsel for the Council for Responsible Nutrition, a supplement industry trade association, wrote in a statement to The New York Times that supplement companies were allowed to make health-related claims about “the ‘effect of their product on the structure or function of the body’ and that these claims must be supported by evidence. But Dr. Pieter Cohen, an associate professor of medicine at Harvard Medical School, said supplement companies are rarely held liable for certain health claims associated with their products. As long as the manufacturer doesn’t claim their product will treat or cure a specific disease, “they can say whatever they want,” he said.

Another potential risk of supplements is paradoxical: they could make a mental health problem worse. Dr. Nestadt said there is some evidencefor example, that St. John’s wort can potentially induce a manic episode in people with bipolar disorder.

Perhaps one of the biggest dangers is that people take a supplement instead of seeking proven treatment for their anxiety or depression. “I’m not that worried about anyone trying lavender or chamomile,” Dr. Sanacora said. “I’m much more concerned about the risks associated with delaying effective treatment.”

If your depression or anxiety is severe, experts say, supplements are unlikely to help and you should see a trained professional instead. In fact, experts recommend consulting a healthcare provider before starting any supplement, no matter what it’s supposed to treat.

Traditional medications and psychotherapy, including antidepressants and cognitive behavioral therapy, have the highest quality evidence of benefits for anxiety and depression, experts said. They also mentioned treatments like Transcranial magnetic stimulation, a non-invasive technique that stimulates a certain area of ​​the brain with magnetic pulses; the FDA has approved this treatment for depression and obsessive-compulsive disorder.

Exercise can also be beneficial, the experts said. Although it doesn’t have as much high-quality evidence as other approaches, Dr. Sanacora said there is still very good data on its effectiveness for mild to moderate anxiety and depression. And, he added, unlike supplements, exercise is free. “It’s always a balance between what’s practical and durable versus the evidence.”

If you are having suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). Here’s what you can do if you are struggling to find help during the pandemic.

Annie Sneed is a science journalist who has written for Scientific American, Wired, Public Radio International and Fast Company.

#supplements #depression #anxiety

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