Mother Nature's Little Helpers

By Andrew Weil

In a clinical trial that got a lot of publicity last year, the herb St.-John's-wort failed to work better than a placebo in treating severe depression. The study also showed that Zoloft, one of the most popular prescription antidepressants, did no better than a placebo either, but that result attracted little attention. In the real world, people do not take St.-John's-wort for severe depression--they use it for mild to moderate conditions. Zoloft, on the other hand, is considered a powerful weapon in the ongoing war on mental illness.

With good reason, a lot of people have questions about the efficacy of psychiatric medications, as well as concerns about their side effects and overuse, especially in children. This has led many consumers to explore alternative therapies, most of which have yet to get the fair clinical trials they deserve. But it is safe to say that many work for obvious reasons, some of them so simple they are often overlooked by psychiatrists, psychologists and researchers.

Take aerobic exercise. Not only is it a safe and effective treatment for depression, but it has many other health benefits as well, from improving cardiovascular and immune functions to controlling weight. Aerobic exercise works, in part, by stimulating the release of endorphins, a class of endogenous antidepressants made in the brain. It both treats and prevents depression in susceptible individuals, and I prescribe it frequently. For best results, try to get 45 minutes of sustained aerobic activity an average of five days a week. Any activity that raises your heart rate and gets you breathing fast will do. Walking is fine if you do it quickly enough or include some uphill time.

Another simple intervention I often recommend is breath work. Breath control is the most powerful method I have found to reduce anxiety, even in its most severe form of panic disorder. Conventional drugs suppress anxiety but often cause significant side effects and dependence. I have found it is impossible to be anxious while breathing deeply, slowly, quietly and regularly. By working on those qualities in your breathing, you can develop a practical technique for preventing or cutting short an anxiety attack. Breathing exercises derived from yoga are even more effective. With practice, breath work quiets down the nervous system. This not only blunts anxiety but also lowers blood pressure, slows the heart rate, improves circulation and digestion, and helps protect the body from the damaging effects of stress.

Breath work is a natural segue to meditation, because the simplest meditation technique is concentration on the breath. The association of meditation with Eastern religion is an obstacle for some Americans, but many nonreligious forms exist. In essence, meditation is nothing other than focused awareness. Although it can be used as a relaxation technique, I find it most valuable as a method of restructuring the mind, breaking habitual patterns of thought and creating seeds of balance to oppose erratic mood swings. Over time it can provide great mental-health benefits: relief from ordinary anxiety and depression, better rest and sleep, and increased resistance to disturbing influences on emotional equilibrium. Meditation has also proved quite valuable in preparing patients for surgery (see following story).

Of the nutritional approaches to mental disorders that I have studied, the most promising is dietary supplementation with omega-3 fatty acids, the special fats found in oily fish such as salmon and sardines; in walnuts, soy, flax and hemp seeds; and in fortified eggs. One of the omega-3s, docosahexaenoic acid, or DHA, is the main constituent of cell membranes in the brain. Dietary deficiencies of DHA--probably the rule rather than the exception for most Americans--may be a factor in childhood autism, attention-deficit hyperactivity disorder, bipolar disorder and depression. Treatment of these conditions with supplements of omega-3 fatty acids is a promising area of mental-health research.

I am particularly enthusiastic about the value of omega-3s in the management of bipolar disorder; they may allow patients to reduce the dosage and side effects of conventional medications. Another possibility is that children who did not get enough of these fatty acids in utero or in infancy are more susceptible to mental and emotional problems. Encouraging pregnant women to increase intake of omega-3s in late pregnancy and during nursing might be a simple way to improve mental health in our society.

And what about St.-John's-wort and other herbal remedies? In my view, St.-John's-wort still needs to be properly tested in large populations for the relief of mild to moderate depression. Despite one brief study to the contrary, ginkgo biloba continues to look promising as a means of slowing age-related dementia and improving blood flow to the brain. And we have yet to test the many tonic herbs from China, Tibet and India that are said to enhance physical and mental health, extend longevity and resistance to stress, and promote general well-being. We have a lot of work to do.

Dr. Weil directs the Program in Integrative Medicine at the University of Arizona