Introduction
Well-being in one’s mental state directly determines energy levels and immune function. While the incidence of depression has become more widespread in today’s society, it has substantially increased in adolescents and young adults. Current research indicates that female teenagers are most vulnerable. In the U.S., 25% of women have experienced clinical depression during their life, while 16% of men have been affected. Major depressive episodes are a widespread health issue in the U.S. They affect 20% to 25% of individuals at some point in their lives. Major depression is defined as occurring for at least two weeks and causing disruptions in eating habits, restful sleep, work, and personal relationships. Thoughts of suicide are also common. Although the incidence of depression has been increasing in adolescents and young adults, the number of those who are engaging in mental health treatment has not changed significantly in the past decade.
St. John’s Wort
Also known as Hypericum Perforatum, this herb was prized for having magical powers in ancient Greece. The Grecians believed that the herb’s fragrance would deter evil spirits. It was used for a wide variety of conditions, including sciatica and infectious reptile bites. The Greek physician Hippocrates (the “Father of Medicine”) regularly used St. John’s Wort when treating his patients, including for the disorder of “nervous unrest”. St. John’s Wort has a 2400-year history of being employed as a folk remedy for anxiety, tension, and sleep depravity. Its usage included treating kidney and lung disease, as well as neuralgia, fibrositis, rheumatic pain of the musculoskeletal system, and depression.
In present-day Europe, it is used for easing menopausal symptoms including fatigue, irritability, mood swings, and hot flashes. It is also widely applied as a topical salve to treat wounds and burns, especially sunburn. It heals these ailments by enhancing new cell growth. It is produced throughout the world and grows especially well in southern Oregon and northern California.
The active compounds in St. John’s Wort are hypericins, flavonoids, xanthones, and essential oils. It is the interplay of these compounds which initiates the herb’s antidepressant and antianxiety activities. In our bodies, this herb strengthens the effects of 3 key brain chemicals: serotonin, norepinephrine, and dopamine. By inhibiting monoamine oxidase (MAO), an enzyme responsible for the disintegration of these above neurotransmitters, St. John’s Wort enhances our brain’s mood-elevating functions. It also intensifies the actions of gamma-aminobutyric acid (GABA), an amino acid with a tranquilizer-like function found in the brain, heart, lungs, and kidneys. In addition, it depresses the levels of the stress hormone cortisol.
Hypericum or St. John’s Wort is the foremost antidepressant, synthetic or natural, prescribed in Germany. It accounts for more than 50% and greater than 200,000 prescriptions each year. In comparison, Prozac accounts for 2% of those written. The world model for regulating the usage of herbs, German Kommission E, has approved St. John’s Wort in the treatment of depression, anxiety, and sleep disorders.
Through clinical studies, it has shown its effectiveness in mollifying anxiety that is similar to that achieved by Valium. It is dissimilar, though, in that it does not impair brain function and is not addictive, thereby diminishing the frequency and severity of its side effects to the point of being clinically-insignificant. Those described side effects include fatigue, restlessness, allergic reactions, and stomach irritability, which are mild and transitory. By contrast, antidepressant drugs can cause serious side effects of headaches, nausea, memory impairment, loss of libido, and significant withdrawal problems. When St. John’s Wort is discontinued, there are no withdrawal symptoms.
St. John’s Wort is the most extensively- researched herb consisting of over 5,000 people being involved in clinical studies, including over 2,000 individuals participating in double-blind, placebo-controlled studies. Patients with mild to moderate depression exhibited similar benefits when taking either Hypericum or the anti-depressant drug, Tofranil, the gold standard against which other treatments for depression are evaluated. Yet, Hypericum was much better tolerated and showed milder and fewer side effects. As well as depression, these studies have shown St. John’s Wort to significantly improve anxiety, apathy, anorexia, insomnia, hypersomnia, psychomotor retardation, and feelings of worthlessness.
For mild to moderate depression, the standard dose for adults is 300mg of St. John’s Wort (of 0.3% hypericin extract) taken 3 times per day with meals. After the initial treatment, a lower maintenance dose of 300 to 600 milligrams per day is recommended. Benefits can be felt within the first 2 weeks, with maximum improvement noted after 6 to 8 weeks of continued usage. In some, it may take up to 6 weeks to begin showing its effects. Because of its interaction with antidepressants, including many other drugs, it is best to avoid this herb if you are partaking of a regular medication schedule.
Vitamin D – Part 4
Low blood levels of vitamin D have been associated with clinically-significant symptoms of depression. In the blood or serum, the active form of vitamin D is called 25-hydroxycholecalciferol. For the healthy person, 20 to 50 nanograms per milliliter (ng/ml) of 25-hydroxycholecalciferol is considered normal. Serum insufficiency is less than 20 to 12 ng/ml, whereas deficiency is less than 12 ng/ml. There is no established level of vitamin D sufficiency for normal mental health.
Depression and vitamin D insufficiency are common risks for young women living in the Pacific Northwest. In March 2015, a 5-week study performed by the School of Psychological Science at Oregon State University was published online in Psychiatry Research. 185 female college students between the ages of 18 and 25 with clinically-significant depressive symptoms were examined and tested. Vitamin D serum levels were measured and a depression symptom survey was completed each week for 5 weeks. More than half of these women had insufficient 25-hydroxycholecalciferol levels. These rates were higher in African Americans at 61% compared to other women at 31%. More than one-third of the women reported depressive symptoms during each week of the 5 week study.
Decreased vitamin D levels are typical in the older people. This condition is especially prevalent in African Americans and Hispanics, who tend to be more prone to a decline in mental health in later years. There have been an increasing number of studies associating lower levels of 25-hydroxycholecalciferol with a greater risk for cognitive decline, brain atrophy, and Alzheimer’s disease, the most common type of dementia. Specifically, decreased serum concentrations of vitamin D are strongly related to faster declines in episodic memory and executive function which are firmly characteristic of Alzheimer’s disease.
In September 2015, a study published in Neurology of the Journal of the American Medical Association (JAMA) by the Department of Nutritional Sciences at Rutgers University in Brunswick, New Jersey, examined 382 adults with an average age of 75.5 years. Of these participants, 62% were women, 41% were white, 30% were African American, and 25% were Hispanic. The average blood level of vitamin D for the entire group was deemed insufficient at 19.2 ng/ml. Lower average serum levels were recorded in Hispanics (17.2 ng/ml) and African Americans (17.9 ng/ml) than that in whites (21.7 ng/ml). Concerning these individuals, 17.5% had dementia, 32.7% had mild cognitive impairment (MCI), and 49.5% were cognitively normal. Average 25-hydroxycholecalciferol levels were lower in those with dementia (16.2 ng/ml) compared with MCI (20.0 ng/ml) and normal cognitive function (19.7 ng/ml). A post-examination performed after 4.5 years corroborated greater declines in episodic memory and executive function in vitamin D deficient and insufficient adults compared to those with adequate levels.
It has been previously established in studies that individuals who have suffered a spinal cord injury are four to five times more likely to have insufficient serum vitamin D levels than those who were uninjured. In October 2016, an abstract by the Department of Orthopedic Surgery at Stanford University in Palo Alta, CA, that was presented at the Annual Assembly of the American Academy of Physical Medicine and Rehab, had examined the effect of vitamin D supplementation on depression, fatigue, and pain in 44 individuals who had suffered acute or chronic spinal cord injuries. All of the subjects had 25-hydroxycholecalciferol levels less than 30 ng/ml. These participants were randomly assigned into two groups, one taking a low-dose and the other taking a high dose of vitamin D. The low-dose group consumed 800 IU of vitamin D for 6 months. The high-dose group was split into two further groups: Those whose blood level of 25-hydroxycholecalciferol was between 20 to 30 ng/ml consumed 2000 IU daily for 6 months. Those whose blood levels were below 20 ng/ml consumed 4000 IU daily for 1 month and 2000 IU daily for the following 5 months. While all the subjects showed a significant increase in 25-hydroxycholecalciferol levels, those who took the high-dose supplementation reported a significant decrease in depression and pain compared to the low-dose subjects.
As explained in parts 1 and 3 of vitamin D of previous newsletters, this vitamin allows for greater bone and heart health which is needed in those who have suffered from a spinal cord injury, as these people would not be able to exercise as much as healthy, able-bodied people could.