More than just a bout with the blues, depression affects about one in 10 adults, or about 30 million individuals, according to the Centers for Disease Control and Prevention (CDC). Not surprisingly, this sector rakes in big money for the pharmaceutical industry. According to IMS Health, sales for antidepressants alone surpassed $11 billion in 2010, making them the third most-commonly prescribed drugs in the U.S.

Meanwhile, it’s been estimated that 20-45% of antidepressant users fail to respond to treatment, and between 5% and 20% of patients (depending on the type of drug) stop using these medications due to severe adverse effects. As a result, doctors and patients are increasingly likely to explore the realm of alternative medicine.
 
In terms of stress, Suzanne McNeary, president, NutraGenesis, LLC Brattleboro, VT, points out that the number of Americans with stress and anxiety continues to rise. “According to a 2010 American Psychological Association report on stress in America, a majority of Americans reported having moderate to high levels of stress.”, she said. “This has a tremendous impact on society not only because stress can affect a person’s quality of life, but also because stress can negatively impacts a person’s health both physically and psychologically.”

She went on to cite a 2012 American Psychological Association report confirming that Americans continue to have high levels of stress, are negatively affected by it physically and psychologically, and rely on unhealthy behaviors to manage it. She said the report concluded that the U.S. might be “on the verge of a stress-induced public health crisis.”

To that end, Mitch Skop, senior director of new product development, Pharmachem Laboratories Inc., Kearny, NJ, offered some sobering statistics. “A survey conducted by the Hanley Center—a drug and alcohol treatment and recovery facility—found depression or anxiety to be the number one reason older adults are turning to prescription or illicit drugs or alcohol. This is fueled by stressors such as financial worries and retirement,” he said.

Expressing similar concerns, Deanne Dolnick, vice president, Next Pharmaceuticals, Salinas, CA, opined, “I think it’s easier for consumers to walk into a doctor’s office, tell the doctor they are depressed or anxious, and walk out with a prescription they think will solve their problems. It takes more work for a consumer to find the right supplement to help them with these daunting issues, but if they’re willing to make the investment in the research, they can end up taking a supplement that can truly help.”

In the last decade, supplements like St. John’s Wort, SAMe, B vitamins, kava, gamma-aminobutyric acid (GABA) and many others have been mentioned and to some degree studied for their effects on stress and depression. Most recently, two nutrients—curcumin and omega 3 fatty acids—have emerged with promising results, according to new research.

The Curcumin Connection

In a study published in the journal Acta Poloniae Pharmaceutica, a highly absorbable form of curcumin (the chief curcuminoid of the Indian spice turmeric) was compared to fluoxetine (Prozac) and imipramine (Tofranil) in an animal scientific model of depression and was found to be as effective at alleviating depression as either prescription drug. Researchers theorized its antidepressant-like activity “could be due to an increase in serotonin, norepinephrine and dopamine levels in the brain,” and added, “curcumin can be a useful antidepressant especially in cases which respond to drugs having mixed effects on serotonin and catecholamines levels in the brain.”

The form of curcumin studied, BCM-95 curcumin, has been shown in published human studies to have up to 10 times the absorption of standard curcumin, with no significant adverse safety issues. “It does not matter how much you take—it matters how much you absorb. BCM-95 curcumin is not only significantly better absorbed than standard curcumin; the curcuminoids are absorbed in the ratio in which they occur in nature,” commented Dr. Benny Antony, lead author of the absorption trial. “I personally feel this plays a role in BCM-95’s effectiveness, and I am glad to see more studies illuminating the health benefits of this extraordinary herb.”

Omega 3 for Anxiety

Anxiety is often present in patients suffering with depression. In fact, last year researchers in Canada published their discovery confirming the biological link between stress, anxiety and depression.
 
Last summer a team of researchers at Ohio State University published a promising placebo-controlled, double-blind study in the journal Brain, Behavior and Immunity regarding omega 3s effect on anxiety. Over the course of 12 weeks, researchers gave 68 medical students 2085 mg of eicosapentaenoic acid (EPA) and 348 mg of docosahexaenoic acid (DHA) or a placebo to determine if fish oil had the ability to decrease proinflammatory cytokine production and depressive and anxiety symptoms. The supplements the students received were the equivalent of four to five times the amount of fish oil one would get from an average daily serving of salmon.

According to an article published by the University of Ohio, this study (which was supported in part by a grant from the National Center for Complementary and Alternative Medicine, or NCCAM, a part of the National Institutes of Health, or NIH), hinged on earlier research suggesting the compounds might play a role in reducing the level of cytokines in the body, compounds that promote inflammation, and perhaps even reduce depression. Psychological stress was repeatedly shown to increase cytokine production, prompting researchers to wonder if increasing omega 3s might mitigate that process, reducing inflammation.

“We hypothesized that giving some students omega 3 supplements would decrease their production of proinflammatory cytokines, compared to other students who only received a placebo,” explained Janice Kiecolt-Glaser, professor of psychology and psychiatry. “We thought the omega 3 would reduce the stress-induced increase in cytokines that normally arose from nervousness over the tests.”

Due to a change in the medical curriculum, the students didn’t get as stressed as the researchers had anticipated, however, the psychological surveys clearly showed an important change in anxiety among the students: those receiving the omega 3 showed a 20% reduction in anxiety compared to the placebo group. The researchers reported that a blood sample analysis also showed similarly important results.

“We took measurements of the cytokines in the blood serum, as well as measured the productivity of cells that produced two important cytokines, interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFa),” recalled Ron Glaser, PhD, professor of Molecular Virology, Immunology & Medical Genetics and director of the Institute for Behavioral Medicine Research.

“We saw a 14% reduction in the amounts of IL-6 among the students receiving the omega 3,” he continued. Since the cytokines foster inflammation, “anything we can do to reduce cytokines is a big plus in dealing with the overall health of people at risk for many diseases,” he said.

Although the study demonstrated the positive role omega 3 supplements could play in reducing both anxiety and inflammation, the researchers stopped short of recommending them as part of the daily diet. “It may be too early to recommend a broad use of omega 3 supplements throughout the public, especially considering the cost and the limited supplies of fish needed to supply the oil,” said Martha Belury, PhD, RD, professor of human nutrition and co-author of the study. “People should just consider increasing their omega 3 through their diet.”

Some of the researchers, however, acknowledged that they take omega 3 supplements.

The takeaway, according to the researchers, is that if the young study participants could obtain improvements from specific dietary supplements, then the elderly and people at high risk for certain diseases might also benefit even more.

Other Options

When the body is stressed, a wide range of stress-related symptoms occurs due to an increase in the level of cortisol, the stress hormone. To address this, Ms. McNeary of NutraGenesis said its branded ingredient Sensoril provides resistance to stress because the high levels of glycowithanolide bioactives it contains reduces cortisol levels in the body.
 
“In a 60-day, randomized, double-blind, placebo-controlled human clinical trial, consumption of the recommended dose of Sensoril resulted in a 24% reduction in cortisol levels in subjects,” she explained. “This was accompanied by a 70% reduction in an overall measure of stress-related symptoms as well as improvements in factors affected by stress, including irritability and anxiety, cognitive function, sleeplessness and several physical manifestations of stress.”

Another mood support contender is Lactium, a patented, GRAS, NDI-approved ingredient from Pharmachem Laboratories. “From our perspective, Lactium is a tour de force nutraceutical that effectively addresses stress sensation and sleep, which thus supports healthier mood,” said Mr. Skop. “Studies conducted on Lactium show it reduces stress-related symptoms and promotes relaxation. In total, five separate studies have been conducted in recent years on 90 healthy subjects, confirming the anti-stress efficacy of Lactium.”

Switching gears, Relora helps to alleviate stress and stress-related eating. Developed from a blend of Magnolia officinalis and Phellodendron amurense, natural ingredients used in Traditional Chinese Medicine, Relora helps quiet the part of the brain that responds to stress (the hypothalamic-pituitary-adrenal axis) without causing drowsiness. Launched by Next Pharmaceuticals in 2000, the company added a liquid version to the line last year.            
Editor’s Note: A large portion of this article originally appeared as an Online Exclusive on NutraceuticalsWorld.com.

Kava: One of the Safest Ways to Treat Anxiety Kava deserves another chance in the anxiety world, especially because it is so useful and side effect-free. By Ryan Rivera Founder Calm Clinic Stress and anxiety affect nearly everyone on different levels. These include mild anxiety, which is common and pretty easy to manage; moderate anxiety, which affects your life often but doesn’t cause you to lose control; and intense anxiety, which prevents you from engaging in any activity. Mild anxiety can often be treated with lifestyle changes. However, intense anxiety is more serious and can require more than medicine or supplements. Typically those suffering from this level of anxiousness need to seek therapy in addition to any nutritional plan.   Moderate anxiety, on the other hand, is trickier. Therapy can be a useful form of support, but it’s often too expensive for those with moderate anxiety, especially since it  is “manageable” despite the way it affects your quality of life. Pharmaceutical medications can also be a problem because of the of side effects and personality changes these drugs can cause. Further, while numerous herbal supplements are designed for mild anxiety, the evidence for moderate anxiety is less well known, unless of course you are talking about kava. What About Kava? The relationship between kava and anxiety is so strong that it has even been accepted by much of the medical community in a way that other herbal supplements can only strive for. In addition, it has benefited from extensive research speaking to its capabilities as an anxiety treatment. A meta-analysis published in 2000 in the Journal of Clinical Psychopharmacology attested to its bright future in this regard. The authors of that study concluded: “These data imply that kava extract is superior to placebo as a symptomatic treatment for anxiety. Therefore, kava extract is an herbal treatment option for anxiety that is worthy of consideration.” No discussion of the benefits of kava is complete without discussing the health implications of the herbal supplement. Nearly a decade ago, the government claimed it caused liver damage, and while they did not ban the sale of kava in most states, they did strongly suggest the public stop taking the powerful herb. But there were problems with this data. Namely, that the studies showing a health issue all indicated that there were problems with abuse, along with serious drug and alcohol consumption in addition to using kava. In many ways people weren’t using kava to relieve them of stress; they were using kava along with other drugs to destructively self-medicate.   Since then, scientists have found that—like many other drugs and herbs—there are interactions. And these studies found that kava interacts poorly with alcohol, so those who drink were experiencing marked side effects brought on by combining these two with drugs. When kava is taken safely, in the absence of alcohol or underlying health conditions, it’s completely side effect-free. In addition, kava is not known to cause dependency. Since alcohol is also a drug that is known to stimulate anxiety, those who are suffering from moderate anxiety should not drink, so kava can offer its full potential.   Kava, Diet & Lifestyle Changes Finally, anxiety is a powerful emotion—one easily affected by the behaviors you perform in your daily life. If you continue to engage in activities that cause you anxiety or surround yourself with situations that are known to lead to an increase in stress, you will diminish the strength of the herb’s benefits. Kava use should only be adopted when you are also willing to make lifestyle changes, including eating a healthy diet, getting a full night’s sleep, avoiding stressful situations, and maintaining an active lifestyle.   Anxiety is a cumulative condition. The more anxious you are regularly, the more stress symptoms will surface when you are in a situation. Kava can and will mitigate a large percentage of anxiety, but if you continue to engage in anxiety-causing behaviors, you will still experience some of that stress and tension that caused you to seek treatment in the first place. If you suffer from some degree of anxiety that doesn’t yet warrant mental health counseling but does affect your life on a regular basis, it might be wise to consider starting a kava regimen and combining it with beneficial lifestyle changes. About the Author: Ryan Rivera is a natural herb supporter and writer of numerous health information articles about anxiety, stress and panic, many of which can be found at www.calmclinic.com.