Update and critique of natural remedies as antidepressant treatments

Postmenopausal Symptoms and Their Correlates among Saudi Women Attending Different Primary Health Centers

(1) Background and objectives: Due to increasing life expectancy, more than one-third of women’s life can be spent in the postmenopausal period. In this period, women have different somatic, psychological, and urogenital symptoms. The present study was done to evaluate postmenopausal symptoms and their correlations among Saudi women attending different primary health centers. (2) Methods: adopting a cross-sectional study was done among 845 postmenopausal women attending different primary health centers. The menopause rating scale (MRS) was utilized to investigate the prevalence and severity of different menopausal manifestations. Data collection was done using a structured anonymous questionnaire disseminated during face-to-face interviews. Analysis of data was done utilizing the SPSS program, version 24. (3) Results: The total MRS score was 15.68 ± 6.85. The mean score of the subscales were: 5.56 ± 2.78 for the somatic domain, 6.04 ± 2.89 for the psychological domain, and 4.08 ± 2.32 for the urogenital domain. Joint and muscle pain (25.2%) and sleep problems (18.6%) were the most prevalent severe/very severe somatic symptoms. The most severe/very severe symptoms of the psychological domain were mental and physical exhaustion (20.2%) and depressed mode (19.2%), while that of the urogenital domain were sexual problems (20.1%) and bladder problems (16.3%). Significant predictors of the subscales of MRS were sociodemographic characteristics such as age, residence, marital status, educational level, and occupation. Furthermore, history of chronic diseases, parity, and menopause duration were significant predictors of the subscales of MRS. (4) Conclusion: women in the present study experience different postmenopausal symptoms. Health care providers should consider this crucial stage of women’s life to help elderly women manage these different postmenopausal manifestations.

Intracellular Signaling Cascades in Bipolar Disorder

Bipolar spectrum disorders carry a significant public health burden. Disproportionately high rates of suicide, incarceration, and comorbid medical conditions necessitate an extraordinary focus on understanding the intricacies of this disease. Elucidating granular, intracellular details seems to be a necessary preamble to advancing promising therapeutic opportunities. In this chapter, we review a wide range of intracellular mechanisms including mitochondrial energetics, calcium signaling, neuroinflammation, the microbiome, neurotransmitter metabolism, glycogen synthase kinase 3-beta (GSK3β), protein kinase C (PKC) and diacylglycerol (DAG), and neurotrophins (especially BDNF), as well as the glutamatergic, dopaminergic, purinergic, and neurohormonal systems. Owing to the relative lack of understanding and effective therapeutic options compared to the rest of the spectrum, special attention is paid in the chapter to the latest developments in bipolar depression. Likewise, from a therapeutic standpoint, special attention should be paid to the pervasive mechanistic actions of lithium as a means of amalgamating numerous, disparate cascades into a digestible cognitive topology.

Therapeutic and nutraceutical potentials of a brown seaweed Sargassum fusiforme

Sargassum fusiforme, also known as Yangqicai () in Chinese and Hijiki in Japanese, is a brown seaweed that grows abundantly along the rocky coastlines of Asian countries such as Japan, Korea, and China. The first use of S. fusiforme as a traditional Chinese medicinal plant was recorded in the Shennong Bencao Jing, dated 200 AD. It was referred to as Haizao (seaweed), renowned for treating Yinglu (tumor-like induration), dysuria, and edema. Currently, it is commonly used in traditional cuisine as it is rich in dietary fiber and minerals such as calcium, iron, and magnesium. Owing to its health benefits, S. fusiforme remains popular in China, Korea, and Japan, as well as in the UK and in North America. Currently, there is a lack of research on S. fusiforme; thus, we review the therapeutic effects of S. fusiforme, such as anticancer, antiangiogenic, and antiviral effects, in vitro and in vivo as reported during the past two decades. This review may promote further research on the therapeutic uses of S. fusiforme. Furthermore, we discuss the processes and considerations involved in using drugs produced from marine sources.

Current Role of Herbal and Natural Preparations

Depression remains difficult to manage, despite the many registered treatments available. For many depressed individuals, particularly those who have not responded to and/or had adverse effects from standard therapies, herbal and natural medications represent a potentially valuable alternative. This chapter will review several natural remedies used in the treatment of depression. Specific remedies covered include St. John's wort (SJW), S-adenosyl-L-methionine (SAMe), omega-3 fatty acids, rhodiola, and others. We will begin by providing some historical and social context about these remedies. Then we will review efficacy and safety data, as well as biological mechanisms of action of these therapies. Finally, we will discuss the limitations of the current state of knowledge and provide suggestions for a productive research agenda focused on natural remedies. While many questions about these treatments remain unanswered and much work needs to be done before we determine their place in the psychiatric armamentarium, we believe that this chapter will give psychiatrists a good perspective on the pros and cons of herbal and natural antidepressants as part of the pharmacological armamentarium and sensible guidelines on how and when they should be used.

Complementary and Integrative Health Practices for Depression

The current article reviews selected complementary health approaches for the treatment of depressive symptoms. Complementary and integrative health (CIH) focuses on the whole person with the goal of optimal health-body, mind, and spirit. Patient use of integrative health practices and products is increasing; therefore, providers must understand these practices and products and be able to recommend or advise for or against their use based on research and guidelines. Difficulty with the current limitations of research on CIH practices is discussed, as these studies often may not have the same rigor or scientific weight as conventional treatment research. Although some individuals may use certain treatment options alone, such as massage therapy, meditation, and supplements to diet, the article discusses ways to combine CIH with allopathic care. Nurse practitioners should be open to considering complementary practices for health care and knowledgeable to guide patients in making safe health decisions. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 22-33.].

Which CAM modalities are worth considering?

This review-with a handy at-a-glance guide-examines 8 modalities, the level of evidence behind them, and the adverse effects you'll need to keep in mind.

ω-3 and major depression: a review

BACKGROUND

The World Health Organization estimates that major depression affects about 350 million people all over the world and reports this disorder as the major contributor to the global burden of diseases. Despite the well-defined symptomatology, major depression is a heterogeneous psychiatric disorder whose pathophysiology is not clearly established. Although several treatments are available, most depressed patients do not achieve the complete remission of symptoms. Factors linked to the persistence of the disorder have been investigated, particularly those related to the way of life. Moreover, it has been suggested that nutritional aspects may influence its development. Among them, a diet rich in ω-3 has been associated with a reduced risk of major depression, although its deficiency is associated with depressive disorders.

METHODS

This review provides a general view about evidences of the use of ω-3 in major depression cases.

RESULTS

Several studies have demonstrated beneficial effects of ω-3 in the prevention and treatment of major depression. However, not all the results have shown significant statistical benefits.

CONCLUSIONS

More studies are necessary to clarify detailed mechanisms of the antidepressant effects of ω-3 and may explain the source of contradictions in results published until the moment.

Herbal products in pregnancy: experimental studies and clinical reports

The aim of this work is to provide an update from an overview of the literature of the most frequently consumed herbal remedies during pregnancy, both alone and concomitantly with prescribed medications and particularly on their side effects to the mother and fetus. We have also analyzed some of the adverse interactions that may occur due to concomitant use of herbal and pharmaceutical products during pregnancy. Herbal remedies are not evaluated according to the same standards as pharmaceuticals, and in the USA some of it are not licensed but sold as food supplements. There is a lack of basic knowledge on the part of both clinicians and patients as to the indications for use and safety of herbal medicines used in pregnancy and lactation. If 'traditional use' is the only available information, the pregnant woman should be made aware of this to enable her to make an informed decision concerning potential use.

What is the role of alternative treatments in late-life depression?

Late-life depression remains challenging to treat. One major limitation to treatment is the concern over medication-related side effects to which the elderly are especially vulnerable. Also, because many elderly people are already taking multiple medications for medical conditions, there is the concern over drug-drug interactions. This article reviews various complementary and alternative medicine interventions for late-life depression, including natural remedies, exercise, yoga, tai chi, massage therapy, music therapy, and religion and spirituality.

Building an evidence base in complementary and integrative healthcare for child and adolescent psychiatry

Complementary and integrative strategies are widely used by families with children who have mental health diagnoses. The therapies used by these children include herbs, dietary supplements, massage, acupuncture, meditation, and naturopathy. The literature on efficacy of complementary and alternative approaches is of limited value, and studies are needed to test efficacy and safety. Interpretation of complementary and integrative health care studies for symptomatic management of mental health conditions is hampered by study design and methodological limitations. Well-designed, adequately powered, and suitably controlled clinical trials on promising complementary and integrative modalities are needed for children and adolescents with psychiatric conditions.

Adjunctive nutraceuticals with standard pharmacotherapies in bipolar disorder: a systematic review of clinical trials

OBJECTIVE

  Studies using augmentation of pharmacotherapies with nutraceuticals in bipolar disorder (BD) have been conducted and preliminary evidence in many cases appears positive. To date, however, no specialized systematic review of this area has been conducted. We present the first systematic review of clinical trials using nutrient-based nutraceuticals in combination with standard pharmacotherapies to treat BD. A subsequent aim of this report was to discuss posited underlying mechanisms of action.

METHODS

  PubMed, CINAHL, Web of Science, and Cochrane Library databases, and grey literature were searched during mid-2010 for human clinical trials in English using nutraceuticals such as omega-3, N-acetyl cysteine (NAC), inositol, and vitamins and minerals, in combination with pharmacotherapies to treat bipolar mania and bipolar depression. A review of the results including an effect size analysis (Cohen's d) was subsequently conducted.

RESULTS

  In treating bipolar depression, positive evidence with large effect sizes were found for NAC (d=1.04) and a chelated mineral and vitamin formula (d=1.70). On the outcome of bipolar mania, several nutraceuticals reduced mania with strong clinical effects: a chelated mineral formula (d=0.83), L-tryptophan (d=1.47), magnesium (d=1.44), folic acid (d=0.40), and branched-chain amino acids (d=1.60). Mixed, but mainly positive, evidence was found for omega-3 for bipolar depression, while no evidentiary support was found for use in mania. No significant effect on BD outcome scales was found for inositol (possibly due to small samples).

CONCLUSIONS

  BD treatment outcomes may potentially be improved by additional use of certain nutraceuticals with conventional pharmacotherapies. However, caution should be extended in interpreting the large effects of several isolated studies, as they have not yet been replicated in larger trials.

Second-tier natural antidepressants: review and critique

The use of Complementary and Alternative Medicine (CAM) for physical and mental problems has increased significantly in the US over the past two decades, and depression is one of the leading indications for the use of CAM. This article reviews some of the lesser-known natural products with potential psychiatric applications that are starting to emerge with some scientific and clinical evidence and may constitute a next wave of natural antidepressants: Rhodiola rosea, chromium, 5-Hydroxytryptophan (5-HTP) and inositol. Background information, efficacy data, proposed mechanisms of action, recommended doses, side effects, and precautions are reviewed. We found some encouraging data for the use of these natural products in specific populations of depressed patients. R. rosea is an adaptogen plant that can be especially helpful in treating asthenic or lethargic depression, and may be combined with conventional antidepressants to alleviate some of their common side effects. Chromium has a beneficial effect on eating-related atypical symptoms of depression, and may be a valuable agent in treating atypical depression and seasonal affective disorder. Inositol may be useful in the treatment of bipolar depression when combined with mood stabilizers. Evidence for the clinical efficacy of 5-HTP is also promising but still preliminary. Although more well-designed and larger controlled studies are needed before any substantive conclusions can be drawn, the available evidence is compelling and these natural products deserve further investigation as a possibly significant addition to the antidepressant armamentarium.

Long-chain omega-3 fatty acids and women's mental health in the perinatal period and beyond

Recent research has shown that depression and a range of physical illnesses, including heart disease, metabolic syndrome, and type 2 diabetes, have an inflammatory etiology. The long-chain omega-3 fatty acids (omega-3s) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are found in fish and fish-oil products, may protect against these illnesses, in part because they lower inflammation. This article reviews the recent research on omega-3s and women's mental health, with a particular focus on the perinatal period. These studies include population studies examining fish consumption and studies testing the efficacy of EPA and DHA as treatments for depression. Although the findings are mixed, the majority of studies indicate that EPA has efficacy in treating depression either alone or in combination with DHA and/or antidepressant medications. The role of DHA alone in mental health is less clear, but it is generally combined with EPA and appears to have a beneficial effect. In moderate doses, EPA and DHA appear safe for pregnant and postpartum women, and they are well tolerated by patients.

Eating ourselves to death (and despair): the contribution of adiposity and inflammation to depression

Obesity and related metabolic conditions are of epidemic proportions in most of the world, affecting both adults and children. The accumulation of lipids in the body in the form of white adipose tissue in the abdomen is now known to activate innate immune mechanisms. Lipid accumulation causes adipocytes to directly secrete the cytokines interleukin (IL) 6 and tumor necrosis factor alpha (TNFalpha), but also monocyte chemoattractant protein 1 (MCP-1), which results in the accumulation of leukocytes in fat tissue. This sets up a chronic inflammatory state which is known to mediate the association between obesity and conditions such as cardiovascular disease, type 2 diabetes, and cancer. There is also a substantial literature linking inflammation with risk for depression. This includes the observations that: (1) people with inflammatory diseases such as multiple sclerosis, cardiovascular disease, and psoriasis have elevated rates of depression; (2) many people administered inflammatory cytokines such as interferon alpha develop depression that is indistinguishable from depression in non-medically ill populations; (3) a significant proportion of depressed persons show upregulation of inflammatory factors such as IL-6, C-reactive protein, and TNFalpha; (4) inflammatory cytokines can interact with virtually every pathophysiologic domain relevant to depression, including neurotransmitter metabolism, neuroendocrine function, and synaptic plasticity. While many factors may contribute to the association between inflammatory mediators and depression, we hypothesize that increased adiposity may be one causal pathway. Mediational analysis suggests a bi-directional association between adiposity and depression, with inflammation possibly playing an intermediary role.