Table of Contents > Conditions >
Depression
Depression
Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment Approach
Other Considerations
Supporting Research
Depression is a mood disorder in which feelings of loss, anger, sadness, or frustration interfere
with everyday life. Although everyone feels sad sometimes, depression is persistent and disrupts
your daily life. Depression is one of the most common illnesses, affecting about 18 million
Americans each year. It can be mild, moderate, or severe and occur as a single episode,
recurring episodes, or chronic depression (lasting more than 2 years). Many experts consider
depression to be a chronic illness that requires long-term treatment.
The primary types of depression include:
Major depression -- An episode must last at least 2 weeks but tends to continue for 20 weeks.
Dysthymia -- a chronic, less severe form of depression. Symptoms are similar to major
depression but more mild. People with dysthymia have an increased risk of major depression.
Atypical depression -- Unlike those with major depression, people with atypical depression can
feel better temporarily when something good happens. In addition, people with atypical
depression have different symptoms than those with major depression. Despite its name,
atypical depression may be the most common form of depression.
Adjustment disorder -- occurs when a person's response to a life event, such as the death of a
loved one, causes symptoms of depression.
Other common forms of depression include:
Postpartum depression -- about 10% of mothers may have depression after giving birth
Premenstrual dysphoric disorder (PDD) -- Depressive symptoms occur 1 week prior to
menstruation and disappear following menstruation.
Seasonal affective disorder (SAD) -- a pattern of depression related to the seasons and a lack
of sunlight. It occurs during the fall-winter season and disappears during the spring-summer
season.
Bipolar disorder -- characterized by mood swings from depression to mania. Also called
manic-depressive disorder.
Signs and Symptoms
While it is normal for most people to feel "down in the dumps" on occasion, someone with major
depression feels significantly depressed for a prolonged period of time. They have trouble
enjoying acts that were once pleasurable. Symptoms include:
Sleep problems -- at least 90% of people with depression have either insomnia or
hypersomnia, meaning they sleep too much.
Significant change in appetite, often causing either weight loss or weight gain
Fatigue and loss of energy
Feelings of worthlessness, self-hate, and guilt
Problems concentrating
Agitation, restlessness, and irritability or inactivity and withdrawal
Recurring thoughts of death or suicide
Feelings of hopelessness
Loss of interest in sex
Causes
No one knows exactly what causes depression. It's likely that a combination of biologic, genetic,
and environmental factors are involved. People with depression may have abnormal levels of
certain brain chemicals called neurotransmitters, including serotonin, dopamine, and
norepinephrine. These factors may contribute to development of depression:
Heredity -- a recently identified gene called SERT that regulates the brain chemical serotonin
has been linked to depression. In addition, some studies show that people with family
members who have depression are themselves more likely to be depressed.
Biochemical changes in the brain -- some imaging studies suggest that people with depression
may have physical changes in their brains.
Long-term stress, such as from loss, abuse, or deprivation in early childhood
Being exposed to low levels of light, in SAD
Sleep problems
Social isolation
Nutritional deficiencies
Serious medical conditions, such as heart attack or cancer
Certain medications, including those for high blood pressure, high cholesterol, or irregular
heartbeat
Risk Factors
Although depression can affect anyone, no matter what age, race, or gender, the following
factors may increase your risk for depression:
Having had depression
Family history of depression
Suicide attempt -- having made a suicide attempt during a previous depression raises the risk
of another episode of depression.
Being a woman -- more women than men seem to have depression. However, this may be
because women report their symptoms more frequently than men. Or hormonal changes may
make women more likely to have depression.
Stressful life events, such as the death of a loved one
Just having given birth to a baby (postpartum)
Having a chronic illness, including autoimmune diseases (such as lupus), cancer, heart
disease, chronic headaches, chronic pain, anxiety, obsessive-compulsive disorder, and
borderline personality disorder. Medical conditions that cause shifts in hormones, such as
thyroid disorders or menopause, may also contribute to depression.
History of abuse, such as mental, physical, or sexual
Lack of a support system, such as a network of close friends or family
Alcohol or drug abuse -- 25% of people with addictions have depression.
Diagnosis
If you feel depressed or have symptoms of depression, it's important to tell your doctor.
Depression usually doesn't go away on its own. Proper diagnosis is the first step toward
treatment. Talk to your primary care doctor or a mental health provider.
If you have thoughts of suicide, call 911 or a local emergency hotline. It's important to talk to
someone immediately. You can also call a family member or friend, your minister, or someone in
your faith community.
Your doctor may run tests to rule out other conditions. Your doctor will take a medical history
and ask about your symptoms. Your doctor may also order blood tests to check your thyroid
function and other conditions and may refer you to a psychiatrist.
Although most people with depression are treated as outpatients, people with suicidal thoughts
may need to be hospitalized.
Preventive Care
Although there is no guarantee you can prevent depression, the following steps may help or
lower your chances of having it come back:
Getting enough sleep and regular exercise, and eating a balanced, healthy diet may help
prevent depression and reduce symptoms.
Mind-body techniques, such as biofeedback, meditation, and tai chi, may help prevent or
reduce symptoms associated with depression.
Psychotherapy that helps you learn coping skills may help prevent relapse.
Family therapy may prevent children or teens of depressed parents from becoming depressed
later in life.
Taking your medication as prescribed lowers the chance of relapse.
Treatment Approach
People with depression have several options for treatment. Most experts recommend a
combination of psychotherapy and antidepressants, particularly for people with major
depression. Cognitive-behavioral therapy may be the most effective type of psychotherapy,
particularly for teens and people with atypical or postpartum depression.
Most people with depression get better with a combination of psychotherapy and
antidepressants. Some complementary and alternative therapies may help either reduce the side
effects from such medications or the symptoms of mild-to-moderate depression.
Lifestyle
Exercise
Studies show that regular exercise -- either aerobic or strength and flexibility training -- can
reduce depression symptoms in people with mild-to-moderate depression. Exercise also
improves the mood of people with major depression. Some studies even suggest that exercise
may work as well as psychotherapy for people with mild-to-moderate depression, although more
research is needed. In the meantime, adding exercise to any other treatment for depression,
including medications, makes sense.
Light Therapy
Light therapy -- exposure to a bright light as soon as you wake up in the morning -- may help
people with seasonal affective disorder (SAD).
Medications
Antidepressant medications can work well in treating depression, although you may have to try a
few different medications to find the one that works best for you. In general, antidepressants are
taken for at least 4 - 6 months. Most medications take 2 - 4 weeks to have an effect, and may
take up to 12 weeks to have their full effects.
Antidepressants can have unwanted side effects, making it hard for some people to keep taking
their medications. Often you and your doctor can work together to find a medication that has
fewer side effects. Do not stop your medication without first talking to your doctor. Most
antidepressants cause withdrawal symptoms if they are not stopped slowly over time or tapered
down.
Note: The Food and Drug Administration requires all antidepressants to carry a "black-box
warning" saying that people under age 25 may have an increase in suicidal thoughts or behavior
in the first weeks after taking an antidepressant or when the dose is changed. People under 25
should be watched closely when taking antidepressants.
There are several classes of antidepressant medications, including:
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs increase the activity of a chemical in the brain called serotonin. Most doctors prescribe
SSRIs first for depression, in part because their side effects are generally fewer than for other
antidepressants. Typical side effects caused by SSRIs include stomach upset, weight gain or loss,
drowsiness, sexual dysfunction (such as impotence, loss of sex drive, and diminished orgasm),
headache, jaw grinding, and apathy. Very unusual side effects from this class of prescription
drugs include extreme agitation, impulsivity, tremors, and insomnia. People who stop taking
SSRIs due to side effects usually say it is because of sexual side effects.
Drugs classified as SSRIs include:
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil) -- most likely in this class to cause sexual dysfunction
Fluvoxamine (Luvox)
Escitalopram (Lexapro)
Citalopram (Celexa) -- least likely in this class to cause sexual dysfunction
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs are often the second class of antidepressants prescribed. They increase the amount of the
chemicals serotonin and norepinephrine available in the brain, and have fewer side effects that
other kinds of antidepressants. Side effects can include nausea, insomnia, nervousness, rash, or
sexual dysfunction.
Drugs classified as SNRIs include:
Duloxetine (Cymbalta)
Venlafaxine (Effexor)
Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)
An NDRI increases the amount of the chemicals norepinephrine and dopamine available in the
brain. Bupropion (Wellbutrin) is the only approved drug in this class. This medicine does not
appear to cause sexual dysfunction or weight gain, but it should not be used if there is a risk or
history of seizure.
Tricyclic Antidepressants
Tricyclics increase the activity of the brain chemicals serotonin and norepinephrine. They work as
well as SSRIs, but they are an older class of medications with more side effects. They are usually
prescribed only when other antidepressants have not worked. Tricyclic antidepressants include:
Amitriptyline (Elavil)
Amoxapine
Clomipramine (Anafranil)
Desipramine (Norpramin)
Doxepin (Sinequan) -- may help with insomnia
Imipramine (Tofranil)
Nortriptyline (Pamelor)
Protriptyline (Vivactil)
Trimipramine (Surmontil, Rhotrimine)
Side effects of tricyclics may include:
Dry mouth
Blurred vision
Constipation
Sexual dysfunction
Weight gain
Dizziness
Drowsiness
Urinary urgency, a sense that you have to urinate even when your bladder is empty
Drop in blood pressure when going from lying or sitting to standing, which causes dizziness
and lightheadedness
Irregular heart rhythm
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs boost levels of norepinephrine, dopamine, and serotonin in the brain. They are an older
class of antidepressants and are rarely prescribed due to potentially serious side effects. People
who take MAOIs have to avoid certain chemicals, called tyramines, in their diet. Tyramines are
found in fish, alcohol, cheeses, processed meats, and other food. MAOIs also interact with other
medications, including Ritalin, used for attention deficit hyperactivity disorder, and
pseudoephedrine, a decongestant in many over-the-counter and prescription medications. MAOIs
should not be taken with other kinds of antidepressants.
Surgery and Other Procedures
Electroconvulsive Therapy (ECT) for depression is usually used when all other therapies have not
worked. In ECT, a small electrical current is passed through the brain to cause a seizure.
Scientists aren't sure how ECT works, but it may boost levels of neurotransmitters in your brain.
It may cause temporary confusion and memory loss, headache, muscle aches, irregular heart
rhythm, or nausea. It relieves severe depression for some people and works quickly to reduce
symptoms.
Magnetic Resonance Imaging (MRI)-Guided Cingulotomy involves stimulating the brain with
electrodes that are surgically implanted. It is an experimental treatment for people who have
treatment-resistant depression.
Vagus Nerve Stimulation (VNS) involves surgically implanting a device that stimulates the vagus
nerve. This treatment was originally developed for epilepsy, but seems to work for some people
with treatment-resistant depression. The device is implanted under the skin in the chest.
Nutrition and Dietary Supplements
A comprehensive treatment plan for depression may include a range of complementary and
alternative therapies. Preliminary studies suggest some nutritional supplements may reduce the
symptoms of depression for some people. It's important to talk to your team of health care
providers about the best ways to incorporate these therapies into your overall treatment plan.
Don't try to treat moderate or severe depression on your own. Always tell your health care
provider about the herbs and supplements you are using or considering using.
These supplements may help reduce symptoms:
SAMe (s-adenosyl-L-methionine), 1,600 mg daily, is a substance that is made in the body that
may raise levels of the brain chemical dopamine. It has been studied for depression, but
results are mixed and not all of the studies have been of good quality. However, some of the
studies suggest SAMe can help relieve mild-to-moderate depression and may work faster than
prescription antidepressants. If you are taking other medications for depression, speak to your
doctor before taking SAMe because it may interact with them.
5-HTP (5-hydroxytryptophan), 100 mg three times per day, may help raise serotonin levels in
the brain. 5-HTP is a precursor to serotonin -- meaning the body converts it to serotonin -and some early studies suggest it may work like antidepressant drugs. In a few rare cases,
contaminants in 5-HTP were associated with a potentially fatal condition called eosinophiliamyalgia syndrome. Combining 5-HTP with other antidepressants can cause serotonin levels in
the brain to rise to dangerous levels, a condition called serotonin syndrome. You should not
take 5-HTP without the supervision of your doctor.
Omega-3 fatty acids, such as those found in fish oil, 3 - 9 g per day, may help relieve
symptoms of depression, but evidence is mixed. Some studies suggest that fish oil, when
taken with prescription antidepressants, works better than antidepressants alone. However, a
statistical review of a number of studies failed to find any benefit. Fish oil taken in high doses
may increase the risk of bleeding, so do not take it if you also take blood thinners, such as
warfarin (Coumadin).
Vitamin B6, for women with premenstrual dysphoric disorder. A few studies suggest that
vitamin B6 may help relieve depressive symptoms associated with premenstrual syndrome,
although the evidence is mixed. The studies used high doses, which require a doctor's
supervision. Some other studies suggest that B6 may also help with other types of
depression, but there is not enough evidence to say for sure.
Studies have found that some people with depression may have low levels of folic acid,
vitamin B12, or vitamin D. If you have depression, you may want to ask your doctor to check
your levels. So far there is no proof that taking supplements for any of these vitamins helps
relieve depression. But one study suggested that women who took folic acid supplements
along with Prozac had a better response than those who took only Prozac.
Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy,
you should work with your health care provider to get your problem diagnosed before starting
any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites
(glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make
teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and
10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in
combination as noted.
St. John's wort (Hypericum perforatum) standardized extract, 300 mg two to three times per
day, for mild-to-moderate depression. St. John's wort has been studied extensively for
depression. Most studies show it may work as well as antidepressant drugs for mild-tomoderate depression. It has fewer side effects than most antidepressants. It may take 4 - 6
weeks when taking St. John's wort before you see any improvement. St. John's wort interacts
with a large number of medications, including birth control pills, so check with your doctor if
you are taking prescription medications. Do not use St. John's wort to treat severe
depression.
Ginkgo (Ginkgo biloba) standardized extract, 40 - 80 mg three times daily, for depression. A
few studies looking at gingko for treating memory problems in older adults seemed to show
that it also improved symptoms of depression. One laboratory study found that gingko, when
given to older rats, increased the number of serotonin-binding sites in their brains. It had no
effect on younger rats, so researchers thought that it might relieve depression in older adults
by helping their brains respond better to serotonin. However, much more research is needed
to say for sure. Gingko may increase the risk of bleeding, especially if you also take blood
thinners such as warfarin (Coumadin) or aspirin. Ask your doctor before taking gingko.
Acupuncture
Two randomized, controlled, clinical trials suggest that electroacupuncture may reduce
symptoms of depression as well as amitriptyline, a tricyclic antidepressant. In
electroacupuncture, a small current is applied through acupuncture needles. Other studies
suggest that acupuncture may work for people with mild depression and for those with
depression related to a chronic medical illness. Further research is needed.
Homeopathy
Although very few studies have examined the effectiveness of specific homeopathic therapies,
professional homeopaths may consider the following remedies to alleviate the symptoms of
depression based on their knowledge and experience.
Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your
physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these
factors when determining the most appropriate treatment for each individual. A few homeopathic
remedies that may work for depression include:
Ignatia -- for a sudden sense of grief or disappointment following the death of a loved one,
the end of a romantic relationship, or an unexpected loss of one's job
Natrum muriaticum -- for grief following the death of a loved one or sadness from the end of a
romantic relationship
Massage and Physical Therapy
Studies of formerly depressed teen mothers, children hospitalized for depression, and women
with eating disorders suggest that massage can help reduce stress, anxiety, and symptoms of
depression. Giving massage may also help people who are depressed. Elderly volunteers with
depression had fewer symptoms when they massaged infants.
Aromatherapy, or using essential oils in massage therapy, may also be a supplemental treatment
for depression. Aromatherapy seems to work because it helps people relax, and the person's
belief that it will help also has an effect. Essential oils used during massage for depression
include:
Lavender (Lavandula officinalis)
Basil (Ocimum basilicum)
Orange (Citrus aurantium)
Sandalwood (Santalum album)
Lemon (Citrus limonis)
Jasmine (Jasminum spp.)
Sage (Salvia officinalis)
Chamomile (Chamaemelum nobile)
Peppermint (Mentha piperita)
Rosemary (Rosmarinus officinalis)
Mind-Body Medicine
Mind-body therapies and techniques that may be useful as a part of an overall treatment
regimen for depression include:
Psychotherapy
Cognitive-behavioral therapy is a type of therapy where people learn to identify and change
negative thoughts and feelings so they can better cope with the world around them. This therapy
seems to work well for people with mild-to-moderate depression, but it may not be
recommended for those with severe depression. Studies of people with depression show that
cognitive-behavioral therapy works at least as well as tricyclic antidepressants. People treated
with cognitive-behavioral therapy had just as good, or better, results and lower relapse rates
than those taking antidepressants.
Other types of therapy that a psychiatrist, psychologist, or social worker may offer include:
Psychodynamic psychotherapy -- based on Freud's theories about unresolved conflicts in
childhood and depression as a grief process
Interpersonal therapy -- acknowledges that depression has roots in childhood, but focuses on
current problems and relationships. It is considered very effective treatment for depression
Supportive psychotherapy -- nonjudgmental advice, attention, and sympathy. This approach
may help people to keep taking their medication
Tai Chi and Yoga
Several studies suggest that mind-body techniques, such as yoga, qi gong, and tai chi, may
improve symptoms of mild depression.
Meditation
Some researchers believe that mindfulness meditation may prevent depression from coming
back.
Other Considerations
Pregnancy
About 10 - 20% of women experience postpartum depression after giving birth.
Researchers aren’t entirely certain about the safety of SSRIs and tricyclic antidepressant
medications during pregnancy. Follow the advice of your doctor. The risks and benefits to the
mother and the baby must be weighed in each individual case. MAOIs cause birth defects and
should be avoided during pregnancy.
Many of the dietary supplements and herbs mentioned here have not been tested for safety
during pregnancy. Talk with your doctor or pharmacist.
Warnings and Precautions
People with Parkinson's disease should avoid SSRIs.
People with coronary artery disease should avoid tricyclic antidepressants.
Several herbal remedies and supplements should not be combined with antidepressant
medications. Be sure to tell your health care provider about all herbs and supplements you
take to avoid adverse interactions.
Prognosis and Complications
Depression is a serious condition that can have a devastating effect on people's lives. It can
directly and indirectly contribute to chronic medical conditions, such as heart disease and stroke.
Depressed people with these conditions are less likely to do healthy activities, such as exercise)
and more likely to do unhealthy activities, such as smoking.
Suicide is a significant risk for people with depression. About 15 % of people with a major
depressive disorder commit suicide. Depression also significantly shortens the lifespan of the
elderly and is associated with memory problems and dementia.
When left untreated, depression can last up to 2 years or longer. Depression is likely to come
back: 50% of people who have had one depressive episode will have a second one, 70% of those
who have two episodes will have a third, and 90% of those who have three episodes will have a
fourth. For women with premenstrual dysphoric disorder or SAD, symptoms usually go away
after menopause.
Fortunately, there are several treatment options available for people with depression. The
prognosis improves tremendously for people who seek treatment and follow their doctor’s
recommendations.
Supporting Research
Alpert JE, Fava M. Nutrition and depression: the role of folate. Nutrition Rev. 1997;5(5):145149.
Alpert JE, Mischoulon D, Nierenberg AA, Fava M. Nutrition and depression: focus on folate.
Nutrition. 2000;16:544-581.
Anonymous. SAMe for depression. Med Lett Drugs Ther. 1999;41(1065):107-108.
Babyak M, Blumenthal JA, Herman S, et al. Exercise treatment for major depression:
maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000;62(5):633-638.
Birdsall TC. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Altern Med Rev.
1998;3(4):271-280.
Bottiglieri T. Folate, vitamin B12, and neuropsychiatric disorders. Nutrition Rev.
1996;54(12):382-390.
Bottiglieri T, Laundy M, Crellin R, Toone BK, Carney MW, Reynolds EH. Homocysteine, folate,
methylation, and monoamine metabolism in depression. J Neurol Neurosurg Psychiatry.
2000;69(2):228-232.
Bottiglieri T, Hyland K, Reynolds EH. The clinical potential of ademetionine (Sadenosylmethionine) in neurological disorders. Drugs. 1994;48(2):137-152.
Brenner R, Azbel V, Madhusoodanan S, Pawlowska M. Comparison of an extract of hypericum (LI
160) and sertraline in the treatment of depression: a double-blind, randomized pilot study. Clin
Ther. 2000;22(4):411-419.
Bruinsma KA, Taren DL. Dieting, essential fatty acid intake, and depression. Nutrition Rev.
2000;58(4):98-108.
Cauffield JS, Forbes HJ. Dietary supplements used in the treatment of depression, anxiety, and
sleep disorders. Lippincotts Prim Care Pract. 1999;3(3):290-304.
Chiesa A, Serretti A. Mindfulness based cognitive therapy for psychiatric disorders: A systematic
review and meta-analysis. Psychiatry Res. 2010 Sep 14. (Epub ahead of print)
Eich H, Agelink MW, Lehmann E, Lemmer W, Klieser E. Acupuncture in patients with minor
depressive episodes and generalized anxiety. Results of an experimental study. Fortschr Neurol
Psychiatr. 2000;68(3):137-144.
Field TM. Massage therapy effects. Am Psychol. 1998;53(12):1270-1281.
Field T, Grizzle N, Scafidi F, Schanberg S. Massage and relaxation therapies' effects on depressed
adolescent mothers. Adolescence. 1996;31(124):903-911.
Fugh-Berman A, Cott JM. Dietary supplements and natural products as psychotherapeutic
agents. Psychosom Med. 1999;61:712-728.
Gaster B, Holroyd J. St. John's wort for depression. Arch Intern Med. 2000;160:152-156.
Gelenberg AJ, Wojcik JD, Falk WE, et al. Tyrosine for depression: a double-blind trial. J Affect
Disord. 1990;19:125-132.
Hibbeln JR, Salem N. Dietary polyunsaturated fatty acids and depression: when cholesterol does
not satisfy. Am J Clin. 1995;62:1-9.
Horrocks LA, Yeo YK. Health benefits of docosahexaenoic acid (DHA). Pharmacol Res.
1999;40(3):211-225.
Johnson MA. Nutrition and aging--practical advice for healthy eating. J Am Med Womens Assoc.
2004;59(4):262-9.
Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner
Books; 1996: 247-248.
Kasper S, Caraci F, Forti B, Drago F, Aguglia E. Efficacy and tolerability of Hypericum extract for
the treatment of mild to moderate depression. Eur Neuropsychopharmacol. 2010
Nov;20(11):747-65. (Epub 2010 Aug 14.)
Lazarou C, Kapsou M. The role of folic acid in prevention and treatment of depression: an
overview of existing evidence and implications for practice. Complement Ther Clin Pract. 2010
Aug;16(3):161-6.
Lewy AJ, Bauer VK, Cutler NL, Sack RL. Melatonin treatment of winter depression: a pilot study.
Psych Res. 1998;77(1):57-61.
Linde K, Mulrow CD. St. John's wort for depression (Cochrane Review). In: The Cochrane Library,
Issue 4, 2000. Oxford: Update Software.
Maes M, DeVos N, Pioli R, et al. Lower serum vitamin E concentrations in major depression
another marker of lowered antioxidant defenses in that illness. J Affect Disord. 2000;58:241246.
Markus R, Panhuysen G, Tuiten A, Koppeschaar H. Effects of food on cortisol and mood in
vulnerable subjects under controllable and uncontrollable stress. Physiol Behav. 2000;70(34):333-342.
McGinn LK. Cognitive behavioral therapy of depression: theory, treatment, and empirical status.
Am J Psychother. 2000;54(2):257-262.
Meyers S. Use of neurotransmitter precursors for treatment of depression. Altern Med Rev.
2000;5(1):64-71.
Morelli V, Zoorob RJ. Alternative therapies: Part 1. Depression, diabetes, obesity. Am Fam Phys.
2000;62(5):1051-1060.
Obach RS. Inhibition of human cytochrome P450 enzymes by constituents of St. John's wort, and
herbal preparation used in the treatment of depression. J Pharmacol Exp Ther. 2000;294(1):8895.
Paluska SA, Schwenk TL. Physical activity and mental health. Sports Med. 2000;29(3):167-180.
Rondanelli M, Giacosa A, Opizzi A, Pelucchi C, La Vecchia C, Montorfano G, Negroni M, Berra B,
Politi P, Rizzo AM. Effect of omega-3 fatty acids supplementation on depressive symptoms and
on health-related quality of life in the treatment of elderly women with depression: a doubleblind, placebo-controlled, randomized clinical trial. J Am Coll Nutr. 2010 Feb;29(1):55-64.
Roschke J, Wolf CH, Muller MJ, et al. The benefit from whole body acupuncture in major
depression. J Affect Disord. 2000;57:73-81.
Rush AJ, George MS, Sackeim HA, et al. Vagus nerve stimulation (VNS) for treatment of resistant
depressions: a multicenter study. Biol Psychiatry. 2000;47:276-286.
Shaw, K., Turner, J., and Del Mar, C. Tryptophan and 5-hydroxytryptophan for depression.
Cochrane Database Syst Rev. 2002;(1):CD003198.
Tao DJ. Research on the reduction of anxiety and depression with acupunture. Am J Acupunct.
1993;21(4):327-329.
Teasdale JD, Segal Z, Williams MG. How does cognitive therapy prevent depressive relapse and
why should attentional control (mindfulness) training help? Behav Res Ther. 1995;33(1):25-39.
Wurtman RJ, Wurtman JJ. Brain serotonin, carbohydrate-craving, obesity and depression. Obes
Res. 1995;3(suppl4):477S-480S.
Yeung AS, Ameral VE, Chuzi SE, Fava M, Mischoulon D. A pilot study of acupuncture
augmentation therapy in antidepressant partial and non-responders with major depressive
disorder. J Affect Disord. 2010 Aug 5. (Epub ahead of print)
Young SN. The use of diet and dietary components in the study of factors controlling affect in
humans: a review. J Psychiatr Neurosci. 1993;18(5):235-244.