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Ask the Mental Health Expert Archives 2001-2004

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Help for Depression

Q. I am a 32-year-old mother, wife, and registered nurse. Over the past 4-5 years, I've been seeking help for depression. So far, the doctors I've seen are either in too much of a hurry to listen, too eager to over-medicate, or unable to keep their appointments. I am at my wits end!

I've decided to see what I can accomplish on my own. I've tried Prozac, Wellbutrin, Celexa and am currently on Effexor ER. I refuse to take anything associated with weight gain as obesity runs in my family. I'm trying to increase my energy with exercise and vitamins. Getting past the lack of energy is harder than I thought. I'm also trying to cut back on my carbohydrates. What other natural things can be done or taken that could help me with my energy level?

A. I can appreciate how frustrating this has been for you, after five years of trying to get professional help. And yet, I would strongly discourage you from trying to treat a condition as serious as depression on your own.

I have known several experienced psychiatrists who have tried to self-manage their own depression, and made horrible miscalculations. The problem is, we simply can't be objective when it comes to our own health, particularly when we are in the midst of a serious depressive bout.

I also would encourage you to re-think your opposition to taking anything associated with weight gain because obesity runs in your family. First off, many of the antidepressant agents that people believe can cause weight gain do not clearly do so (most of the SSRIs may cause a few pounds of weight gain, but in many cases, this is merely weight re-gained from before the patient became depressed).

Secondly, whereas obesity is certainly a serious long-term concern, the morbidity and mortality associated with untreated depression is (in my view) a more urgent concern. Third, there are several medications that can help counteract antidepressant-induced weight gain, as may increased exercise and dietary changes.

I am also concerned that you are attributing your lack of energy to depression--are you certain of this? Have you had your thyroid function checked, for example? Have B-12 and folate deficiencies been ruled out? Is it possible that you have an underlying sleep disorder, such as abnormal periodic leg movements, that may be interfering with your getting a refreshing night's sleep?

I suggest these questions to reinforce the point that depression is a symptom, not a diagnosis--and not something that should be managed without careful professional evaluation. All these caveats given, I would answer your question as follows: there is research suggesting that s-adenosyl-methionine (SAM-e) is a relatively safe and natural compound that may be useful in mild-to-moderate, non-bipolar depression [for a review, see Mischoulon & Fava, Am J Clin Nutr. 2002 Nov;76(5):1158S-61S.]

Anecdotal information and several controlled studies suggest that SAM-e may increase energy and mood in some depressed patients. There have been reports of SAM-e induced manic episodes, however, which is another reason I discourage patients from using a do-it-yourself approach to treating their depression.

Inositol is another naturally-occurring compound that may have antidepressant effects, and perhaps lead to increased energy in some patients. And once again, inositol may have side effects in some patients. So, my bottom-line advice: keep trying to find the right match between you and a clinician. With your nursing background, I would guess you could get some good recommendations from physicians you know and trust. I hope you persevere and feel better soon.

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December 2003

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