Nutraceuticals such as omega-3, N-acetyl cysteine (NAC), S-adenosyl methionine (SAMe), L-Tryptophan/5-HTP, vitamin D, zinc, and creatine, have shown positive effects on depression treatment, wrote Jerome Sarris, Professor of Integrative Mental Health at Western Sydney University.
“While the potential of enhancing the effects of anti-depressants via nutraceuticals is compelling, only recently have enough human clinical trials become available to provide a clearer determination of their effectiveness,” he said.
The review states that Omega-3 (mainly the EPA-dominant formulations) may boost a particular neurobiological activity in an anti-depressant medication.
“As detailed in a recent general meta-analysis, it is advised that EPA or ethyl-EPA-dominant formulas be used, as DHA may not be effective,” Sarris wrote. “In summation, EPA-rich omega-3 fish oil may be recommended for the adjunctive treatment of depression and is relatively inexpensive.”
In other studies, one randomised controlled trial (RCT) showed the effectiveness of NAC in reducing bipolar depression, the review said.
“NAC has antioxidant and anti-inflammatory properties, replenishes glutathione, enhances neurogenesis, protects against mitochondrial toxicity and modulates [the] glutamate pathway,” the paper stated.
Meanwhile SAMe has demonstrated increased response and remission rates in antidepressant non-responders – when taken orally or by injection.
On the other hand, tryptophan augmentation with a range of anti-depressants has also found to be effective in increasing effect of the medications.
Sarris also pointed out that wo clinical studies have showed the beneficial effects of vitamin D in reducing depression. However, a large preventative study using a very large one-off seasonal vitamin D dose was not effective.
Two other clinical trials and epidemiological studies support having adequate consumption of zinc, which may be of benefit as an adjunctive prescription with anti-depressants, according to the review.
One clinical study also showed a beneficial effect in using creatine as an augmentation agent with anti-depressant medication Escitalopram.
While there are evidences of nutraceuticals’ positive benefits, the review stressed the importance for clinicians to prescribe only standardised, stable, high-quality nutrient products, especially with SAMe, due to it being an unstable compound.
“The prescription of correct formulations and dosages is vital. Expense may also be an issue in the case of SAMe and methyl folate. Clinicians may be confused as to which products to prescribe or recommend, and in such cases, referral to specialised health professional with knowledge of nutritional medicine is advised,” wrote Sarris.
Source: Australasian Psychiatry
“Clinical use of nutraceuticals in the adjunctive treatment of depression in mood disorders”
Author: Jerome Sarris