TREATMENT PROTOCOL

Naturopathic/Holistic Treatment of
Mild to Moderate Depression
By Rena Freedenberg, ND
Depression is a common mental disorder that presents with some or
all of the following symptoms: a depressed mood, a loss of interest in
things that once brought pleasure, feelings of guilt or low self-worth,
disturbed sleep patterns, changes in appetite, a lack of energy, and poor
concentration. These symptoms lead to impairments in an individuals ability to take care of his or her everyday responsibilities and can
become chronic or recurrent.
According the World Health Organization (WHO), depression is
common worldwide, affecting about 121 million people. Untreated
depression can lead to suicide, and the WHO estimates that 850,000
people worldwide commit suicide every year. Depression is the leading
cause of disability worldwide and was the 4th leading contributor to
the global burden of disease for the year 2000, according to the WHO.
Their estimates project that depression will rise to 2nd place in the
global burden of disease listing by the year 2020.
In many patients, mild to moderate depression can be successfully
treated with a variety of naturopathic and holistic options, such as dietary
changes, dietary supplements, exercise, massage, herbs, and sunlight.
Naturopathic medicine is based on the philosophy of addressing
the basic underlying cause of any health condition. Proper nutrition
is a foundational component of any natural medicine program. Nutrition affects mood through the many substrates and nutrients needed
for proper neurotransmitter synthesis and function. A healthy diet is
not only essential for proper neurotransmitter balance, but it affects
the immune system in ways that then affect neurotransmitter function.
The inclusion of exercise is also of utmost importance in any program
addressing mood disorders. In addition to nutritional intervention and
exercise, there are many other therapies that may improve mood in
patients with mild depression. Following are a number of evidencebased, effective alternative/naturopathic treatments for depression,
including dietary supplements, massage, herbs, sunlight, and more.

Anthroposophic Therapy

Anthroposophy is a spiritual science whose practical applications

include biodynamic agriculture, anthroposophical medicinal products, and eurhythmy (movement as visible speech). Anthroposophic
therapy is rooted in a healing method known as anthroposophical
medicine, a branch of anthroposophic philosophy founded by Austrian
philosopher and social thinker Rudolph Steiner in the 1920s. It utilizes
a holistic approach, endeavoring to restore the balance between the
physical, mental, and emotional states of the patient. Anthroposophical practitioners use medicines based on homeopathic principles,
and physical therapies that call upon massage and artistic expression
to trigger the patients self-healing capacity. Anthroposophic medicine
uses the anthroposophic view of the human being as a blend of three
interdependent aspects: the physical body; the life force, understood as
the source of growth and regeneration and sometimes called the soul;
and the astral body, which mediates between the body and the soul,
also called the ego or consciousness.

A 4-year study of the effectiveness of anthroposophic therapies

in the treatment of depression evaluated 97 outpatients from 42
medical practices in Germany. Patients ranged from 2069 years old
and were referred to anthroposophic therapies (art, eurhythmy movement exercises, or rhythmical massage) or started physician-provided
anthroposophic therapy (counseling, medication) for depression.
Participants had suffered from depressed mood and at least two of six
further depressive symptoms for a minimum of six months. Data were
collected from July 1998 to March 2005.
The authors concluded in outpatients with chronic depression,
anthroposophic therapies were followed by long-term clinical improvement. Although the pre-post design of the present study does not allow
for conclusions about comparative effectiveness, study findings suggest
that the anthroposophic approach, with its recourse to nonverbal and
artistic exercising therapies can be useful for patients motivated for
such therapies.1

Aromatherapy Massage

Aromatherapy is the use of essential oils to treat a variety of conditions.

Naturopathic physicians use aromatherapy to treat depression, anxiety,
insomnia, and stress-related disorders and to manage chronic pain.
Essential oils have been used effectively for centuries as a traditional
medicine, but they have been the subject of few studies. Even in the
absence of sufficient studies to completely explain the pharmacological
effects of many essential oils or their active chemical constituents, the
studies that have been done show measurable pharmacological effects
when essential oils enter the blood stream through either inhalation or
topical application.
Researchers at the Medicinal Plant Research Centre (UK) reviewed
the published clinical trials of psychoaromatherapy in relation to
psychiatric disorders, as well as evidence from mechanistic, neuropharmacological studies of the effects of essential oils. The authors
concluded that aromatherapy may offer effective treatment for a range
of psychiatric disorders. They also found that it does not appear to
pose the risk of adverse effects found with many conventional psychotropic drugs.2
Various aromatherapy oils, diluted in carrier oil like almond or olive
oil, are massaged into the skin, where they are absorbed into the bloodstream. Below is a list of some of the essential oils used in the treatment
of depression and anxiety.
Clary sage is used for treating insomnia, anxiety, and depression.
Basil lifts fatigue, anxiety, and depression.
Rose acts on the nervous system.
Ylang ylang is used for anxiety, depression, insomnia, and stress.
Sandalwood has sedative properties and is good for treating
depression and tension.
Lavender is used for depression, headache, hypertension,
insomnia, migraine, nervous tension, and other stress-related
conditions.
2009 Natural Medicine Journal 1(4), December 2009 | Page 1

 Jasmine increases the beta waves in the frontal lobe, which can
create a more alert and responsive state of mind.
Rosemary relieves headaches and aids clear thinking.
Patchouli has an uplifting effect for depression and anxiety.
Chamomile is very calming; it soothes nerves and helps insomnia.
Geranium is both sedative and uplifting and thus is used
for treating nervous tension, depression, and hormonal and
menstrual problems.
A 2007 clinical study published in the Journal of Clinical Oncology
looked at the effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer. Two hundred
eighty-eight cancer patients in the United Kingdom, referred to
complementary therapy services because of clinical anxiety and/or
depression, were randomized to a course of aromatherapy massage or
usual supportive care alone. The authors concluded that aromatherapy
massage does not appear to confer benefit on cancer patients anxiety
and/or depression in the long-term but is associated with clinically
important benefit up to 2 weeks after the intervention.3 In other words,
aromatherapy is not a cure for depression, but it may be an effective
short-term aid in managing depression and anxiety when used with
other treatment options.
Another study was conducted with nursing students in Korea to
test the effectiveness of lavender essential oil on insomnia and depression. In a 4-week-long, single-blind, repeated-measurements experiment, researchers studied 42 female students who complained of
insomnia. The lavender fragrance had a beneficial effect on insomnia
and depression in the students, though repeated studies would be
needed to confirm effective proportions of lavender oil and carrier oil
for insomnia and depression.4
A controlled trial conducted in Thailand tested the relaxation
properties of ylang ylang oil. The oil caused a significant decrease in
blood pressure, a significant increase in skin temperature, and a greater
sense of calm and more relaxation. The authors conclude that there is
evidence of the effectiveness of ylang ylang oil for relief of depression
and stress in humans.5

Dietary Changes/Supplements

The first line of naturopathic treatment for almost every disease is

improved patient nutrition. Nutrition plays a key role in the onset,
severity, and duration of depression, including daily mood swings.Food
patterns preceding the onset of depression and during a depressive
episode are similar. These patterns may include skipping meals, poor
appetite, and a desire for sweets.Depressive symptoms are exacerbated
by nutritional imbalances, including
frequent consumption of caffeine;
sucrose consumption;
deficiencies in vitamins and minerals (biotin, folic acid, and
other B vitamins; vitamin C; calcium; copper; iron; magnesium;
or potassium);
excesses of vanadium;6,7
imbalances in amino acids; and
food allergies.
A recent study published in Neuropharmocology demonstrates that
physiologically relevant doses of caffeine can significantly depress adult
hippocampal neurogenesis.8 (Adult neurogenesis has been associated
with learning, memory, and depression). A review published by the
Oklahoma State Medical Association finds that caffeine is a widely
used psychoactive substance that has the potential to contribute to
many psychiatric symptoms.9
Sugar intake has been linked to depression. In an article in the
Journal of Depression and Anxiety, the national rate of sugar consumption was shown to directly affect the prevalence of major depression.
The basis for this includes the relationship between sugar consumption,-endorphins, and oxidative stress.10

Dietary Recommendations

The main dietary focus in treating depression is to ensure that the

patients diet is rich in foods containing omega-3 fatty acids and those
containing magnesium, vitamins B and D, and the antioxidant vitamins
A, C, and E. Along with proper food, sufficient water intake plays a vital
role in maintaining proper chemical balance in the body; even mild
dehydration can cause fatigue. The Institute of Medicine advises that
women should consume 2.7 liters (91 ounces) of total water (from all
beverages and foods) each day, and men should average approximately
3.7 liters (125 ounces daily) of total water. The panel did not set an
upper limit for water consumption.11

Omega-3 Fatty Acids

Foods that are rich inomega-3 fatty acids have been shown to reduce
neuronal phospholipid turnover. In one study, registered difference
images showed that the omega-3 treatment was accompanied by
structural brain changes including, in particular, a reduction in the
lateral ventricular volume.12 A 2007 meta-analysis of trials involving
patients with major depressive disorder and bipolar disorder provided
evidence that omega-3 PUFA supplementation reduces symptoms of
depression.13 The foods with the highest amounts of omega 3 are flax
seeds, Chia seeds, walnuts, baked/broiled salmon, soybeans, baked/
broiled halibut, sardines, herring, tofu, and winter squash. Other foods
containing omega-3s are canola oil, olive oil, broccoli, cantaloupe,
kidney beans, spinach, grape leaves, Chinese cabbage, and cauliflower.

Dietary Magnesium

Studies have shown an inverse relationship between magnesium intake

and depression and anxiety.14,15,16 Patients with depression should add
foods that are high in magnesium to their diet, such as fish, barley,
artichokes, buckwheat, oat bran, almonds, cashews, pine nuts, black
beans, white beans, cornmeal, spinach, broccoli, tomatoes, pumpkin
seeds, and soybeans. Whole-wheat flour contains magnesium, but the
magnesium-rich germ and bran are removed in the process of making
white flour. All green vegetables are sources of magnesium because the
center of the chlorophyll molecule contains magnesium.

B Vitamins

The B-complex vitamins are water-soluble vitamins that are essential

to mental and emotional well-being. B-vitamin deficiency is common
because B vitamins are easily destroyed by common lifestyle behaviors such as drinking alcohol and caffeinated beverages, smoking, and
eating foods rich in refined sugars.
Studies have shown that vitamin-B deficiency can be a cause of
both depression and epilepsy and that preventive vitamin B supplementation and sufficient intake seem very important for secondary and
primary prevention of neuropsychiatric disorders, especially in subjects
with a low intake or status of the vitamins.17 When advising patients to
supplement with specific B vitamins, it must be remembered that the
patient must also take a B-complex supplement to prevent imbalances.
Nerve tissue requires vitamin B1 to utilize glucose to produce energy;
this vitamin modulates cognitive performance, especially in the elderly.
Folic acid preserves the brain during its development and preserves
memory during aging. Vitamins B6 and B12, among others, are directly
involved in the synthesis of some neurotransmitters. Vitamin B6 is likely
to benefit the treatment of premenstrual depression.
Good sources of B vitamins include the following.
Asparagus, broccoli, spinach, bananas, potatoes
Dried apricots, dates and figs
Milk, eggs, cheese, yogurt
Nuts and legumes (includes rice, corn, soy beans, string beans,
peas, lentils, mustard, sesame seeds, and poppy seeds)
Fish
Brown rice, wheat germ, whole grain cereals
2009 Natural Medicine Journal 1(4), December 2009 | Page 2

Vitamin D

Seasonal affective disorder (SAD) is prevalent when vitamin D stores

are typically low. Researchers note that people suffering from depression, particularly those with seasonal affective disorder, tend to improve
as their levels of vitamin D in the body increase.18
It has been hypothesized that vitamin D increases levels of serotonin in the brain.19 There are individual differences in the amount of
vitamin D needed daily based on geographic location, the time of year,
skin type, and amount of sun exposure. Research is ongoing to establish new standards for recommended daily vitamin D intake for adults
as the importance of proper vitamin D levels becomes more obvious;
currently, Tolerable Upper Intake Levels (ULs) for Vitamin D according
to the National Institutes of Health Office of Dietary Supplements is
2,000 IU for adults and children over the age of 13 and 1,000 IU for
children under one year of age.20
In an experiment conducted in 1998, Australian researchers found
that Vitamin D3 [cholecalciferol] given in doses of 400 IU and 800 IU
had significant positive effects on the mood of healthy individuals.
Forty-four people were given either 400 IU of vitamin D, 800 IU of
vitamin D, or a placebo for five days during the late winter. Research
subjects reported that vitamin D3 had the effect of enhancing a positive mood and also reducing a negative mood in some cases. The
authors concluded, Vitamin D3 deficiency provides a compelling and
parsimonious explanation for seasonal variations in mood.21 In 1999, a
study done by Hollis, Gloth, and Alam showed that a one-time dose of
100,000 IU of vitamin D improved symptoms of depression better than
light therapy in a small group of participants who suffered from SAD.22
All of the participants in the vitamin D group improved according to
all depression scale measurements, and the increase of serum serum
25-hydroxyvitamin D [25-(OH)D] levels was strongly associated with
the degree of improvement of SAD symptoms.
A study at the Institute of Clinical Medicine in Norway examined
the relationship between serum 25-(OH)D levels and depression in
overweight and obese subjects and assessed the effect of vitamin D
supplementation on depressive symptoms. Researchers found a significant improvement in Beck Depression Inventory (BDI) scores after 1
year in the 2 groups given vitamin D, but not in the placebo group.
There was a significant decrease in serum parathyroid hormone in the
2 vitamin D groups without a concomitant increase in serum calcium.
There are receptors for parathyroid hormone (PTH) and 1,25dihydroxyvitamin D in the brain, and there are clinical and experimental
data indicating that PTH and vitamin D may affect cerebral function.22
The authors concluded that there appears to be a relation between
serum levels of 25-(OH) D and symptoms of depression. Supplementation with high doses of vitamin D seems to ameliorate these symptoms
indicating a possible causal relationship.23
Dietary sources of vitamin D include milk, salmon, and tuna fish.
The best food source of vitamin D is salmon, with 530 IU per 3 ounces
of canned salmon. Salmon is also rich in omega 3 fatty acids, making
it a very important part of a depression prevention or treatment diet.

Exercise

Research has shown that exercise is an effective but often underused

treatment for mild to moderate depression, even in elderly patients,
and has virtually no side effects.24, 25 Researchers at Duke University demonstrated several years ago that exercise can be an effective antidepressant even for those patients with major depressive
disorder (MDD).26 According to a report from the UK Mental Health
Foundation, exercise may be just as effective at treating depression
as antidepressant medicines, and they also claim that being physically active may help prevent depression in the first place. The UK
report also states that exercise therapy should be used as a first-line
treatment for mild depression because it may be just as effective as
antidepressant medicines.27

Exercise has a number of beneficial physiological effects that make

it ideal for treating depression. Exercise has been proven to increase
activity in both the frontal lobe of the brain and the hippocampus. It
also has been found to increase mood-enhancing brain-derived neurotrophic factor (BDNF) levels.28,29 Studies have also found that exercise
increases levels of serotonin, dopamine and norepinephrine.30,31,32,33,34,35
Physical activity should last at least 20 minutes a session for at least
10 weeks in order to help improve psychological well-being. Aerobic
activities such as brisk walking, jogging, cycling, swimming, and
dancing tend to be the most effective for treating depression.36

Natural Medicines

Several herbs have been proven to have a beneficial effect on depression

and its symptoms of anxiety, sleeplessness, and inability to concentrate.
Following are some of the most common herbs and supplements used
for mild to moderate depression.

St. Johns Wort (Hypericum perforatum)

St. Johns Wort is a bushy plant with a turpentine-like odor, with yellow
flowers whose petals have black dots on the margins. Its extract has
been used in various folk remedies and herbal tinctures since Roman
times. It is used extensively in both the United States and Europe to
treat mild to moderate depression.
A German study compared the effectiveness of St. Johns wort with
imipramine, a well-known anti-depressant. The trials involved 40
outpatient clinics in Germany with a total of 324 outpatients suffering
mild to moderate depression. Participants were given either 75 mg
imipramine twice daily or 250 mg Hypericum perforatum extract ZE
117 twice daily for 6 weeks. The study concluded that Hypericum perforatum extract is therapeutically equivalent to imipramine in treating
mild to moderate depression and is better tolerated.37
Another German review investigated the efficacy and side effects of
Hypericum perforatum. This study looked at 27 trials that included a
total of 2,291 patients who met inclusion criteria. Seventeen trials, with
a total of 1,168 patients, were placebo-controlled (16 addressed single
preparations, 1 a combination with 4 other plant extracts). Ten trials
(8 single preparations, 2 combinations of Hypericum and Valeriana)
with a total of 1,123 patients compared Hypericum with other antidepressant or sedative drugs. Most trials were 4 to 6 weeks long. Participants usually had neurotic depression or mild to moderate severe
depressive disorders. The study concluded that there is evidence
that extracts of Hypericum are more effective than placebo for the
short-term treatment of mild to moderately severe depressive disorders. The proportions of patients reporting side effects were 26.3% for
Hypericum single preparations versus 44.7% for standard antidepressants and 14.6% for combinations versus 26.5% with amitriptyline or
desipramine. In other words, patients taking standard antidepressant
medications were almost twice as likely to experience side effects as
patients taking Hypericum.
Until 2004, only one randomized controlled trial had been
conducted using Hypericum in patients with severe depression, but
it was underpowered and so its negative findings were questionable.39
With this in mind, German researchers conducted a study of acute
treatment of moderate to severe depression with Hypericum extract
WS 5570 versus paroxetine. The study involved 251 adult outpatients
with acute major depression with total score 22 on the 17-item
Hamilton depression scale from 21 psychiatric primary care practices
in Germany. Patients were given either 900 mg/day Hypericum extract
WS 5570 [300 mg three times per day] or 20 mg paroxetine once per
day for 6 weeks. (In initial non-responders, doses were increased to
1,800 mg/day Hypericum or 40 mg/day paroxetine after 2 weeks.) The
study concluded that Hypericum extract WS 5570 is at least as effective
as paroxetine in the treatment of moderate to severe major depression
and is better tolerated.40
2009 Natural Medicine Journal 1(4), December 2009 | Page 3

A comprehensive clinical review by British researchers supports

the findings of the various studies above, and the authors note that all
studies have found Hypericum to be less likely to cause side effects than
standard pharmaceutical drugs used currently.41
The mechanism of action with St. Johns wort is being investigated.
Initial biochemical studies report that St. Johns wort inhibits the uptake
of serotonin, dopamine, and noradrenalin (norepinephrine). However,
other in vitro binding assays carried out using St. Johns wort extract
demonstrate significant affinity for adenosine, GABA (A), GABA (B),
and glutamate receptors. In vivo, St. Johns wort extract leads to a
decrease in the number of beta-adrenergic receptors and an increase
in the number of serotonin 5-HT(2) receptors in the rat frontal cortex
and causes changes in neurotransmitter concentrations in brain areas
that are implicated in depression.
However, there are reasons to be cautious when prescribing St.
Johns wort, as it has been found to have significant interactions with
some other drugs. In a study done at the College of Pharmacy in Little
Rock, Arkansas, comparisons of pre and postSt. Johns wort phenotypic ratios revealed significant induction of CYP3A4 and CYP2E1
activity.42 Because CYP3A4 is involved in the oxidative metabolism
of more than 50% of all drugs, this suggests that Hypericum extracts
are likely to interact with many more drugs than previously had been
realized. Examples of medications that could be affected include
carbamazepine (anticonvulsant and analgesic), cyclosporine (immunosuppressant), irinotecan (cancer drug), midazolam (anesthetic),
nifedipine (Ca channel blocker), birth control pills, simvastatin
(cholesterol-lowering drug), theophylline (bronchodilator), tricyclic antidepressants, warfarin (blood thinner), or HIV drugs such as
nonnucleoside reverse transcriptase inhibitors (NNRTIs) or protease
inhibitors (PIs). St. Johns wort may also interact with digoxin or digitoxin (cardiac drug), resulting in a decrease in digoxin blood concentration. There may also be an interaction with triptan-type headache
medications. Examples include naratriptan, rizatriptan, sumatriptan,
and zolmitriptan. In theory, St. Johns wort may also interact with
certain chemotherapy drugs such as anthracyclines and may increase
anti-inflammatory effects of COX-2 inhibitor drugs or NSAIDs such
as ibuprofen.

Ginkgo Biloba

The ginkgo biloba tree is an ancient species of tree native to the Asia.
Chinese herbalists have used ginkgo biloba for thousands of years, and
it is one of the most widely studied botanical products. Ginkgo biloba
is widely used throughout both the United States and Europe. Since
ginkgo biloba nuts are mildly toxic, most of the ginkgo biloba sold is in
the form of a standardized extract of the leaves of the tree.
Ginkgo has a long history in traditional medicine for treating circulatory disorders and enhancing memory. Scientific studies throughout the
years support the effectiveness of ginkgo for these problems.43,44,45,46,47,48
Evidence to date shows that ginkgo biloba extract (GBE) is primarily
effective in the elderly and when treating disorders that are caused by
diminished cerebral blood flow. Laboratory studies have shown that
GBE improves blood circulation by dilating blood vessels and reducing
the stickiness of blood platelets. Ginkgo leaves also contain flavonoids
and terpenoids, which are powerful antioxidants.49,50
Ginkgo biloba can be used to enhance other depression treatments
and sometimes can be used alone instead of pharmaceutical treatments for mild cases of depression. Even in cases where ginkgo is used
as an adjunct to other depression treatments, it can be helpful as an aid
to improving short-term memory by improving cerebral circulation.

S-adenosylmethionine

S-adenosylmethionine is sold as a nutritional supplement under

the marketing name SAMe. SAMe is also marketed as an approved
prescription drug in Russia, Italy, and Germany. The supplement

SAMe is a synthetic form of a compound formed naturally in the body

from the essential amino acid methionine and adenosine triphosphate
(ATP). It was first discovered in 1953.
SAMe serves as a primary methyl group donor in various physiological reactions and is then converted to S-adenosyl-homocysteine.51,52,53,54
Clinical trials have shown that SAMe is effective in treating depression
when taken on a regular basis. Other conditions that SAMe has been
shown to help in clinical trials are liver disease and osteoarthritis. SAMe
is required for the biosynthesis of the neurotransmitters dopamine and
serotonin as well as for cellular growth and repair.
Patients with bipolar disorder or anxiety disorders or other psychiatric disease must be closely monitored while taking SAMe as it has
been associated with hypomania and mania. There are also concerns
that SAMe could cause Levodopa to be less effective when taken over
a long period of time, so patients with Parkinsons disease should be
advised to avoid this supplement.55
There are a number of side effects associated with SAMe; the most
commonly reported are nausea and other digestive disturbances.
Less common side effects include anxiety, insomnia, increased thirst,
increased urination, headache, hyperactivity, decreased blood glucose
levels, skin rashes, dry mouth, and blood in the stool. Therapeutic
doses range from 400mg/day to 1,600mg/day, although higher doses
are used empirically in some cases. In contrast, some physicians
recommend lower doses ranging from 50 to 200 mg/day to treat mild
depression, in an effort to lessen the risk of triggering the side effects
mentioned above.

5-Hydroxytryptophan

5-Hydroxytryptophan (5-HTP) is a naturally occurring amino acid,

aprecursorto the neurotransmitterserotonin,and an intermediate
in tryptophan metabolism. 5-HTP is effective in treating depression, suppressing appetite, and promoting sleep. 5-HTP increases
serotonin synthesis and release, making it useful in the treatment of
conditions thought to be caused or made worse by a lack of serotonin.
Care must be used to avoid serotonin syndrome in patients taking
antidepressant medications. 5-HTP is usually extracted from the
seeds ofGriffonia simplicifolia and sold in 50mg or 100mggelatinor
vegetarian capsules.

Siberian ginseng (Eleutherococcus senticosus)

Siberian ginseng, also known as Eleuthero, is an adaptogen that has

been used for centuries in eastern countries, including China and
Russia. As an adaptogen, it helps to control excess cortisol levels
and thereby reduces depression.56,57 Although a distant relative of
American ginseng (Panax quinquefolius) and Asian ginseng (Panax
ginseng), with some overlap in its uses, Siberian ginseng is a distinct
plant with different active chemical components. Ten compounds have
been isolated from Siberian ginseng. Its pharmacological activities are
mainly due to lignans and iridoid glycosides, such as eleutherosides.58
Prized for its ability to restore vigor, increase longevity, enhance overall
health, and stimulate both a healthy appetite and a good memory, it is
widely used in Russia to help the body adapt to stressful conditions and
to enhance productivity.
Practitioners of Chinese medicine use Siberian ginseng to restore
the balance of qi and to treat a deficiency of yang in the spleen and
kidney. Siberian ginseng is also an antioxidant, a nervine, an anticholesteremic, and mildly anti-inflammatory.
Siberian ginseng is used to help the body deal with physical and
mental stressors such as heat, cold, physical exhaustion, viruses,
bacteria, chemicals, extreme working conditions, noise, and pollution. It works by strengthening the system, thereby helping to prevent
illness. It has been shown to have significant antidepressant effects in
rats that were subjected to the desperation test and neuropharmacological tests based on the antagonist activity with respect to reserpine,
2009 Natural Medicine Journal 1(4), December 2009 | Page 4

clofelin, andL-DOPA,59 and a Chinese study has shown that Siberian

ginseng exhibited anti-fatigue, antistress, immuno-enhancing effect,
central nervous system activity, and antidepressive effects.60

Phototherapy

Phototherapy is the use of light to treat disease and is a treatment of

choice for seasonal affective disorder. Other indications for bright
light therapy include non-seasonal depression, bipolar depression,
chronic depressive disorder, ante- and postpartum depression, late
luteal phase dysphoric disorder, circadian phase sleep disorders, jet
lag, shift work problems, and behavioral disturbance and insomnia in
organic dementia.
A 2004 study combining bright light exposure and physical exercise showed that this treatment may be an effective way of relieving
depressive symptoms. The study concluded that problems with sleep,
especially initial insomnia, may predict a good response to treatment
using combined light and exercise. Bright light exposure and physical
exercise, even in combination, seem to be well tolerated and effective
on depressive symptoms.61
At the Beer Yaakov mental health center associated with Tel Aviv
University, a pilot study, was conducted using partial sleep deprivation during the second half of the night, medium (green) wavelength
light in combination with dawn simulation, bright light therapy,
and sleep phase advance. The results showed the procedure to be
effective and well-tolerated. It affords many advantages, such as the
achievement of a rapid response, no extinction of the therapeutic
effect after 4 weeks of follow-up, safety, high patient compliance, and
cost effectiveness.62

Energy Psychology

Many of the bodys electrical systems and energy fields are understood,
readily verified, and a focus of established interventions. The application of lasers and magnetic pulsation, for example, can be described in
terms of specific, measurable wavelengths and frequencies that have
been found to be therapeutic.63 Other energies are considered to be of a
more subtle nature and have not been directly measured by reproducible methods. While such subtle energies are generally not recognized
in Western health care frameworks, they are at the root of numerous
ancient systems of healing and spiritual development that are not only
still in wide use throughout the world but increasingly being utilized
in the West.
Energy psychology has been referred to as acupuncture without
needles in treating mental health disorders. More than two dozen
variations of Energy Psychology can be identified, with the most
well-known being Thought Field Therapy (TFT), the Tapas Acupressure Technique (TAT), and the Emotional Freedom Techniques
(EFT). Many of these adapt practices and concepts from acupuncture and acupressure; others borrow from yoga, meditation, qigong,
and other traditional practices. Some practitioners of these modalities describe their therapeutic mechanism as the activation of electrical signals that are said to influence brain activity;64 others as
describe them as catalyzing shifts in putative energy fields, such as
the bodys biofield.65 TFT, TAT, and EFT, each utilizing techniques
derived from acupuncture and acupressure, have received by far the
most attention.
But what is the proof that there is any real effectiveness to these
methods? Evidence is still preliminary, but energy psychology is
gaining credence as an evidence-based treatment. In fact, one form
has met the American Psychological Associations criteria as a probably efficacious treatment for specific phobias;another has met the
criteria for maintaining weight loss.66 The limited scientific evidence,
combined with extensive clinical reports, suggests that energy
psychology holds promise as a rapid and potent treatmentfor a range
of psychological conditions.

Conclusion

A number of alternatives to standard antidepressant medications exist

for patients with mild to moderate depression. An essential first step
is to work with the patient to ensure proper diet and regular exercise.
Once this has been done, nutritional supplementation, herbal medicines, phototherapy, and energy psychologies can be utilized according
to patient needs as described above.
Rena Freedenberg, ND, graduated from
Michlelet Eden college of Natural Medicine
in Jerusalem, Israel, where she did two years of
internship in internal medicine. Dr. Freedenbergs
practice is located in Beitar Illit, Israel, where she
specializes in womens and childrens health care.
Her primary interest is in addressing the underlying causes of illness and improving the health
and quality of life of women and their families.

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