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April 19, 2013

Are There Non-Drug Treatments For Depression?

treatments for depressionWhy We Need Treatments for Depression

Do you want to hear some depressing numbers about depression? Let’s just say it is not uplifting. According to the CDC in any 2 week period 5.4% of us experience depression and 11% of those over age 12 are on prescribed antidepressant medication with 60% taking antidepressants for over 2 years and 14% taking them for over 10 years. But, there are non-drug treatments for depression that get overlooked.

Eighty percent of those with depression have some level of functional impairment related to depression. Anti-depressants are the third most common class of drugs now prescribed, and the number one group of drugs prescribed in the 18 year old to 44 year old age group.

Antidepressants largely work by optimizing how the brain uses one of several neurotransmitters called serotonin.  The most common class of drugs prescribed for depression is the SSRIs or selective serotonin reuptake inhibitors.

Serotonin is released from one nerve cell into something called the synapse and stimulates the adjacent nerve. SSRIs block the metabolism and/or reuptake of serotonin by cells. This is not how the body/brain naturally works, though. Serotonin needs to be metabolized or taken back up by the cell – not hang around the neural synapse that occurs in the presence of SSRIs. Some of the downstream metabolites of serotonin have health benefits. But if serotonin is not broken down those metabolites are not made – one reason for the side effects related to their use.

Though very effective for some, these drugs sometimes do not work at all, and are associated with several side effects some of which are more than a nuisance (sleep disturbance, loss of libido/sexual performance to name a few). Plus, they are associated with an increased risk of suicide.

On average one person obtains enough benefit from an SSRI for every 7 individuals who are prescribed these medications over a 4 to 6 week period. This is called the number to treat. But, since they are more effective than placebo – the criteria that the FDA uses to judge drug effectiveness – they are approved for use.

This raises a question. Are there alternatives to the SSRIs, alternatives that are perhaps more natural and possibly work better than antidepressant medication?

Non-Pharmacologic Treatments for Depression

  • Exercise
  • 5-HTP
  • Eat healthy
  • Correct an underactive thyroid
  • Ginkgo biloba
  • Vitamin D and sunlight


Several studies show exercise to be just as effective as antidepressants in the treatment of depression. Aerobic exercise and strength training both improve mood. Exercise improves delivery of tryptophan (see below) which is necessary to make serotonin. The increase delivery of oxygen during exercise also enhances serotonin production. Ninety minutes of walking can increase serotonin levels 100%.


5-HTP is derived from the amino acid tryptophan and is the immediate precursor to serotonin. It’s been shown in double blind placebo controlled studies to be as effective as antidepressant medicatons with fewer side effects. 5-HTP has been shown to increase serotonin levels 540% compared to 450% for Paxil and  150% to 250% for Prozac (from The Mood Cure). It is an over the counter supplement.

Eat Healthy

Sugar and caffeine can deplete serotonin levels over time if consumed on a regular basis. This leads to even greater craving for these foods. Eliminating them can restore serotonin levels. Artificial sweeteners play havoc on our neurotransmittersincluding serotonin. Eating high quality protein will provide the brain with the tryptophan it needs to make serotonin. Healthy fat consumption increases the availability of tryptophan in the brain.

Low Thyroid

Low thyroid is a treatable cause of depression and is diagnosed based on symptoms and blood levels of thyroid function tests. Other commons symptoms of low thyroid include fatigue,  cold intolerance, constipation, elevation in total and LDL cholesterol, and muscle aches. Thyroid hormone is needed to convert tryptophan into serotonin.

Ginkgo Biloba

Ginkgo biloba is an herb that prevents the reduction in serotonin receptor sites that comes with aging. Therefore, it is more effective in the elderly who get an incomplete response to antidepressant medications as their serotonin receptor decline.

Vitamin D and Sunlight

We make vitamin D in response to sun exposure. And, sunlight stimulates production of serotonin. Vitamin D is co-factor in the synthesis of serotonin. Vitamin D also combats stress that many times coexists with depression.

There are non-drug treatments for depression.




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Dr. Joe Jacko

Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio at Grandview Primary Care. Read more about Dr. Joe Jacko

  1. Hi Dr. Joe, I am a 67-year-old male that has had anxiety and depression problems many times in my lifetime. Besides that I am in generally good health. As I’m getting older, what is some of the things I can do or take naturally that can make me feel better? Especially brain And heart health. Thanks! RICK

    1. Hey, Rick: From diet standpoint avoid added sugars and limit intake of starchy carbs like potatoes, rice, breads, and pastas – especially if you have a weight issue. Too many carbs will drain your energy. From exercise standpoint engage in more weight training focusing on the larger muscles of the body. This will trigger release of growth hormone (repair and longevity hormone) and testosterone. Recommend having your thyroid levels and testosterone level checked too. At 67 if your testosterone is low nutritional supplements are not likely to be effective so you would be looking at some form of testosterone replacement. Read the book the “Longevity Paradox” by Steven Gundry, MD for more ideas. Hope this helps.

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