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mental health mondays :: as nature intended

it's really, really easy to hate drug companies. they kill hundreds of thousands of lab animals, use the poor as guinea pigs for their concoctions, occasionally fake studies or slant information in order to make their products appear better, they bribe doctors to recommend their product rather than the competition's and they occasionally release poisons that harm or kill innocent people. not warm and cuddly stuff, that.

as a reaction to the harshness of medications and the questionable ethics of pharmaceutical providers, the last few decades has seen the rise of alternative medicine. their credo is simple: nature provides many nutrients that can ease the pain of a wide variety of diseases without incurring the problems of harmful side effects, addiction or difficult withdrawal, or the risks of long-term use of medications.

the downside, which most reasonable naturopaths will admit, is that they are less effective on the whole than pharmaceuticals and they often take a lot longer to reach therapeutic levels. that makes them chancy, but a lot of people would still start with an herbal option rather than jumping into the murky waters of chemical madness (or madness management, as the case may be). after all, if you want to seek treatment, you don't start at the extreme end, because then you'd have no place to go, right?

right. and wrong. maybe. or not. you see, the cases for and against herbal remedies are more complicated than most of us want to imagine. to start with, there is the problem of regulation. in most countries, herbal medicine is unregulated, meaning that the manufacturers can fill their packaging with very nebulous claims and unless they make a specific statement as to the benefits and improvement that can be expected, they don't need any backup whatsoever. i don't mean just that they don't have to have any backup they've done themselves, they don't need any at all. so many herbal medicines are marketed purely on the basis that people have been taking them to help with the same condition for a number of years. it doesn't ever necessarily need to have worked, it just has to have been taken.

that isn't to say that there aren't studies that have been done on natural remedies. there have been some that are extremely well structured and that have important implications for the long-term management of conditions like chronic anxiety, depression and panic disorder. more on that a little later.



although i'd been intending to write about this subject for a while, i got inspired to do so this week by this piece on the always engaging neuroskeptic blog. there are a couple of salient points in there, at least one of which is something that most advocates of homeopathy don't want to admit- their wares are poisons and the reactions they cause are a form of toxic shock. still feel good about taking those green capsules before bed every night?

the other point that i found intriguing there was that many of the pharmaceuticals we now take are actually refined from natural ingredients in order to capture their analgesic, anxiolytic or anti-depressant qualities, while actually stripping away some of the stuff that's going to make you sick or kill you in other ways. the more one investigates it, the harder it becomes to draw a solid line between what constitutes a natural remedy versus a pharmaceutical one. that said, here's a little bit of information on some of the most popular herbs recommended for dealing with mental disorders.
nepeta cataria :: catnip to you

catnip ::
it's not just for watching fluffy get all crazy happy anymore! most people are aware that you can make a nice and fairly tasty tea [the plant itself is a member of the mint family, so that's not surprising]. many, however, also insist that it is an effective anxiolytic at the same time. in fact, there's precious little research that would indicate anything of the sort.

what is known is that nepetalactone, the ingredient in catnip that gives it its mojo, is a weak sedative and anti-spasmolytic, meaning that it is capable of calming you if you're in the throes of a panic attack. its sedative properties also make it appropriate for use as a sleep aid for insomnia resulting from depression or anxiety disorders.

in larger doses, catnip produces effects much like those of marijuana. taken to an extreme, it can cause hallucinations, euphoria, panic and anxiety. kind of a bugger those last two, no? fortunately, the toxic side effects clear pretty quickly once the drug is out of your system. and since it also has emetic properties [i.e., makes you vomit], it's likely to get out of your system in a hurry.

other members of the lamiaceae family [such as lavender and skullcap] have similar properties and uses. like catnip, none of them have been shown effective in the management of depression or other mood disorders. like benzodiapines, they are most effective if taken in response to a panic attack.

valerian :: this is an interesting and quixotic little plant. unlike many other herbal supplements and remedies, the mechanism of action of valerian is reasonably well understood. you can certainly understand why it would be of interest to people studying mental disorders when you look at it.

it's been widely known for many years that valerian is effective in combating insomnia and other sleep disorders, but what is interesting for students of mental health is that its sedative effect appears to be the result of its affinity for a particular gaba receptor. huh? ok, we're falling into medical talk here, but the important thing about that, is that it is the same way that benzodiazepines work on the brain. so you'd think that there might be some potential for it as an anti-depressant or anxiolytic.

that sounds great, except that this is one of the drugs that people have been trying to study in a clinical setting and the tests have come back with squat. some show that it can be used as an alternative therapy to benzos. other tests show it's completely ineffective. everyone thinks that it should work, but no one can come up with a clear answer one way or another and no one can replicate anyone else's findings. even worse, some of the studies have even called into question its sedative properties.

it seems like the only thing more confusing than having no information on these remedies is actually getting information on them.

in the end, there is more data supporting valerian's effectiveness at combating anxiety in the short term, more effectively than catnip and its cousins, for that matter. it does not have the risk of overdose that catnip has, although, as with any sedative, you shouldn't plan on driving or mowing the lawn if you've taken it. two things you'll want to keep in mind, however: 1. valerian doesn't get along with other depressants meaning alcohol, opiates or other herbs [like catnip]; and 2. valerian can start to cause side effects similar to benzodiazepines when taken regularly, even over a relatively short term.


kava :: brought to us from the south sea islands, kava is a relative newcomer to the herbal anti-depressant scene. traditionally, it is consumed as a beverage that, after about half an hour, makes you feel relaxed, social, slightly numb and happy. at first glance, this might seem like treating depression with beer, but the science is a little more complicated. kava also works on gaba receptors, meaning that it works in a similar method as benzodiazepines and valerian.

the difference is that kava, while not extensively studied, has yielded more consistent results, indicating that it outperforms a placebo and that it can function quite well as an anxiolytic. it's even being investigated for its potential in helping fight certain forms of cancer [nothing confirmed yet, but initial results seem positive].

there being no good news without bad news, the bad news is that there is a lot of controversy surrounding kava and not just because there are some obvious parallels with alcohol.
kava

first, kava is known to cause problems with basically all other drugs you might take for a mental disorder- anti-depressants, anti-convulsants, mood stabilisers, the works.

second, sustained use of kava is associated with rashes, particularly skin that turns scaly and yellow. this goes away once one stops taking the herb, but nothing else seems to help.

third, if you are going to take kava, be very, very, very careful. kava was banned in many countries in the early 2000s and is still illegal in many places. the european union has only recently listed its outright ban, in light of kava's potential use as an anti-cancer agent. in canada, its legal status is confusing at best- retailers were ordered to stop selling it in 2002, but this is not the same as its being declared a banned substance. good luck figuring that out.

the story behind this relates to all the same horrors that are normally associated with the pharmaceutical trade. in the late 90s and early 00s, kava became something of a darling amongst those interested in exploiting the various properties of plants. as a result, demand for kava shot through the roof. suppliers could never get their hands on enough of it to process into pills and elixirs to be sold to the public. as a result, manufacturers ended up using parts of the plant that were normally discarded in traditional preparations. turns out they were discarded for a reason. the natives of the south pacific islands, it seems, have evolved a perfect system for preparing kava and that when you prepare it in other ways, it becomes a fairly virulent toxin capable of causing moderate to severe liver damage. oops.

in the subsequent ten years, kava has been exonerated from many of the charges leveled against it, largely because australia was careful to point out that its manufacturers followed the traditional method of preparation and no one got sick. still, there are always unscrupulous vendors out there [don't kid yourself- there is a lot of money in herbal supplements, as a quick perusal of your junk mail folder will reveal] and with something that can cause liver damage when it's made wrong, you want to make sure what you're getting is premium.

st. john's wort :: this is probably the herb that most people have heard of when it comes to alleviating depression. it's actually been used as an anti-depressant for years and it's even prescribed in some countries as a first-line treatment, particularly for children.

and there's a reason for that. it does work. that isn't a surprise, because its active ingredients [hypericin and hyperforin if you're interested] inhibit the reuptake of neurotransmitters serotonin and norepinephrine. that's right, st. john's wort is an herbal version of the pills your doctor would prescribe. not only that, but st. john's wort is also a monoamine oxidase inhibitor. what does that mean in english? it means that this weed is like every anti-depressant on the market all rolled into one perfect little package.

st. john's wort
studies have established that it is more effective than a placebo and comparably effective to tricyclic anti-depressants and ssri's at managing mild depression, or incidental [non-chronic] depression. even better, it won't make your skin fall off, turn your eyes inside out or anything else scary. it has a lower side effect profile and was generally better tolerated than its pharmaceutical counterparts. its effectiveness on major or chronic depression is a lot sketchier, but put it this way: if you're feeling low and you're not sure what you have constitutes a severe depressive episode, st. john's wort is a pretty solid alternative treatment to start with.

let me stress something there: alternative. the biggest problem with st. john's wort is that, because it works in the same way as other anti-depressants,  it can't be taken with any other anti-depressants. doing so can result in something called serotonin syndrome, which can be fatal. so you really do have to choose one line of treatment at a time. don't ever cross the streams.

omega-3 :: is there anything these nifty little acids can't do? omega-3 is the new kava, that thing that needs to be consumed in foods, taken in supplements and added to everything. the good news is, there's lots of research that's been done that shows that omega-3s absolutely do have an effect on the brain. even better news, you can take omega-3 supplements at the same time as other psychiatric medications and it won't make you die or turn crazier.

one of the most interesting aspects of omega-3 supplements is the way they work. i'm not medically competent enough to describe this in detail, but, in a nutshell, it seems that the active components of omega-3s are actually able to replenish parts of the brain [which is approximately 8% omega-3 anyway]. that's pretty remarkable and completely different than the mechanism of action of any current psychiatric medications.

and more news keeps on coming. a study conducted by the université de montréal, the largest of its kind to date, established that omega-3 fatty acids are effective on their own at treating unipolar major depressive disorder. that's a pretty substantial result and the clearest-cut evidence to date that these little miracle-workers are capable of doing as much on their own as pharmaceuticals.

still being studied are the potential for fatty acids to treatment of complex disorders like bipolar and schizophrenia. there are interesting links because the propensity for omega-3s to, as i mentioned, "replenish" the brain may dovetail with evidence suggesting that those suffering from bipolar disorder and schizophrenia may have less brain density in their pre-frontal cortex.

although omega-3s are found in a variety of foods, particularly oily fish, trying to eat yourself sane at the sushi buffet is likely to give you mercury poisoning before it cures you. the components that the body needs to get the benefits of omega-3s are extracted with only about 5% efficiency [women are slightly more efficient than men in this regard], meaning that you'd have to eat a lot of tuna to get a therapeutic dose. chances are, supplements are your only bet and the future of supplements is likely to be controlled by the sort of companies you were trying to escape by turning to natural medicine in the first place.

and there you have a brief outline of nature versus depression and anxiety. there are many, many natural or naturally-derived treatments on the market and i can't hope to deal with all of them. if you have any questions about specific ones, please feel free to leave me a note in the comments section and i'll see what i can do.

you might remember during previous pieces on psychiatric drugs that i mentioned an interesting study that indicated that when people who were only mildly depressed took heavier anti-depressants, they generally didn't work. sadly, i don't think that that gives most doctors any hesitation in prescribing drugs, but it really should. rather than handing out benzos and ssri's like some kind of lab-coated pez dispenser, it would be nice if doctors started off [and some of them do] by trying to deal with the depression and anxiety through other channels. there are proven links between depression and inactivity, between mental disorders and bad sleep habits, well, between anxiety, depression and a lot of things really. psychiatric meds are fairly harsh things and, in my opinion, they should be reserved for use on the people who aren't going to get better any other way.

just my opinion, of course. but it generally seems like there's a paucity of hard facts in this area anyway.

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