Why natural treatments for depression are better than drugs.

Winter is here. With it, depressive symptoms worsen each year. Sadly, suicide continues to claim more lives than firearms in the United States, and suicide rates are increasing in nearly every state. The Centers for Disease Control and Prevention reports that deaths by suicide have increased 30% since 1999, and similar trends are seen in Canada.

I was heartened, but not surprised, to learn that these increases occurred at a time when antidepressant use has surged by 65%; by 2014, about one in eight Americans over the age of 12 reported having recently used antidepressants.

I practice critical care medicine in Guelph, Ontario. Sadly, 10% to 15% of my practice is resuscitation and life support of suicide and overdose patients.

It is not uncommon for these patients to overdose on antidepressants prescribed to prevent such desperate acts. Antidepressant failure is clearly present in my clinical experience.

Tied to Medications That Do Little or Nothing
When I graduated from medical school 10 years ago, I carefully considered a career in psychiatry. Ultimately, I abandoned the path because of my impression that psychiatry’s opinion leaders were wrongly wedded to a drug regimen that had little or no effect.

A 2004 review by the Cochrane Foundation found statistically little detectable benefit from antidepressants when compared to “active” placebos (which cause side effects similar to those of antidepressants).

A study comparing antidepressants to a “dummy” placebo showed a larger but still unsatisfactory effect: on the 52-point Hamilton Depression Rating Scale (HDRS), patients who took the antidepressants fluoxetine (Prozac) or venlafaxine (Effexor) had decreased by an average of 11.8 points, compared with an average decrease of 9.6 points for patients taking placebo.

I am not saying that antidepressants do not work. What I am saying is that antidepressants are given an undeserved priority in our thinking about mental health.

I will leave it to the reader to decide for himself whether a 2.5 point drop on the Hamilton Depression Rating Scale is worth taking a medication that has the potential for myriad side effects such as weight gain, erectile dysfunction, and internal bleeding.

It may be, but taking antidepressants does not appear to decrease the risk of suicide.

Natural remedies that work
To me, the more exciting and underappreciated aspect is that multiple non-drug therapies have been shown to be equally effective. As a staunch critic of alternative medicine such as chiropractic, acupuncture, and homeopathy, it is surprising to me that the following “natural” therapies are supported by rigorous, peer-reviewed scientific research:

1. Exercise

In 2007, researchers at Duke University Medical Center in North Carolina randomized patients to walk or jog for 30 minutes three times a week, a commonly prescribed antidepressant (Zoloft), or placebo. Results. Exercise was more effective than medication!

A review of all studies on exercise therapy for depression published in 2016 confirms this: exercise is an effective treatment. And it is free!

2. bright light therapy
   Did you know that spending an hour in the sun makes you feel better? There’s probably something to it. Bright light therapy is an attempt to replicate the sun’s energizing effect in a controlled manner. Typically, patients are asked to sit in front of a “light box” that produces 10,000 lux for 30 to 60 minutes first thing in the morning.

A review of studies using this therapy showed significant benefits. The largest study found a 2.5 point reduction in HDRS, which was roughly equivalent to the effect of antidepressants.

The sun on a clear day can provide 100,000 lux, and if the weather is good, we can think of no reason why sunlight itself would not be effective.

3. geomedian erosion
   This surprised me when it was published last year. Australian researchers randomly assigned depressed patients to receive either nutritional counseling or placebo social support.

Nutritionists recommended a modified Mediterranean diet therapy to include local, unprocessed foods.

32% of depressed patients experienced remission, compared to 8% of those who received social support alone, a much greater effect than in the antidepressant trial.

4. cognitive behavioral therapy (CBT)
   This is the best known of the “natural” treatments for depression, and the evidence is irrefutable.

CBT is as effective as antidepressants, but more expensive in the short term. However, the effects of CBT seem to persist, whereas antidepressants cease to be effective once the patient stops taking them.

As an aside, it is very difficult to overdose on a therapeutic drug and be fatal.

I admit that the trials I mentioned are small compared to the major antidepressant trials. But whereas antidepressants are projected to bring nearly $17 billion annually to the global pharmaceutical industry by 2020, the jogging and sunbathing industry will never have the resources to fund a large-scale international trial. With that in mind, I am convinced that it is at least as valuable as drugs.

Physicians have a responsibility to at least discuss these options with their patients before reaching for a prescription.