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SEASONAL AFFECTIVE DISORDER (2)
Nita Bishop, Clinical Herbalist
Phototherapy: Bring in the Light
Dawn is more than a pretty sunrise phenomenon-it sends signals to your brain which actually reset your body rhythm for the day and tell the pineal gland to stop producing melatonin. One possible way to treat SAD is to produce an artifical dawn through "phototherapy." Although the antidepressant effect of various light intensities is inconclusive with SAD patients, there have been studies that indicate a correlation. Columbia University researchers Michael and Jiuan Su Terman reported that bright morning light, or "twilight" works best, but the question of exactly what the most helpful light intensity is remains debatable. In an article in the American Journal of Psychiatry, Dr. David Avery, Associate Professor of Psychiatry and Behavioral Sciences at the University of Washington's Harborview Medical Center in Seattle, also concluded that dawn simulation was an effective treatment for winter depression.
Phototherapy and Phytotherapy: St. John's Wort is Nature's Antidepressant
Phytotherapy in conjunction with phototherapy may be the best combination of all. More than 26 double-blind placebo controlled stud-ies indicate that St. John's Wort increases melatonin secretion and is effective in relieving the symptoms of mild to moderate depression. In an Austrian/German study where SAD patients were given daily doses of 900 mg of St. John's Wort, the herbal medicine was even more potent taken along with light therapy. St. John's Wort treatments lower the amount of light necessary to obtain a therapeutic effect, even improving the effects of normal daylight exposure without additional intensive light therapy.
Various species of Hypericum, have been used orally for years to treat anxiety, excitability, exhaustion, hysteria, insomnia, and irritability. Hypericum perforatum has specifically been used for the short-term treatment of mild to moderate mental depression. A study published in the British Medical Journal in 1996 gave worldwide attention to this promising herb. An analysis of randomized clinical trials concluded that, "for cases of mild-to- moderate depression, St. John's Wort is superior to the placebo and as effective as a pharmaceutical antidepressant, with fewer side effects."
Hypericin was originally thought to be the component that was responsible for the antidepressant activity in St. John's Wort. St. John's Wort extracts (from the leaves and flowers) are currently standardized to hypericin content (0.2 or 0.3%). However, hyperforin is also naturally present in St. John's Wort in larger amounts than hypericin. Although it is highly unlikely that any one compound is responsible for the antidepressant effectiveness of the herb, one laboratory study showed that hyperforin inhibited uptake of serotonin, dopamine, noradrenaline, gamma aminobutyric acid (GABA) and L-gluta-mate. According to the results of a double blind study with 147 patients with mild or moderate depression, a 5 percent hyperforin extract was significantly more effective than placebo in alleviating symptoms of depression.
Antidepressants potentiate norepinephrine, dopamine, and serotonin in the brain. Tricyclic antidepressants increase serotonin. MAO inhibitors also increase the available serotonin, as do the SSRIs (specific serotonin reuptake inhibitors). In a recent study, over 60% of the patients with severe depression improved with a combined treatment of imiprimine and St. John's Wort. SJW may be slightly faster acting, as per the 14 day therapeutic effects. The study concluded that the Hypericum extract standardized to 5 percent hyperforin was "an effective option in the treatment of mildly or moderately depressed patients." Adverse events were reported by 41% taking imiprimine and 23% taking St. John's Wort.
Indeed, as an alternative to the dry mouth, gastric distress, and fatigue that patients report as the reasons for not taking antidepressants, one of the advantages of St. John's Wort seems to be that it avoids these side effects. Another important advantage is that is eliminates the abuse potential of benzodiazepine drugs.
St. John's Wort should not be taken with an SSRI since toxicity may result in Serotonin syndrome. Usually the SSRI should be tapered and a baseline established before starting St. John's Wort. Physicians should advise patients not to combine the herb with certain antidepressants and to take the necessary precautions against the herb creating photosensitivity in certain individuals.
Ginkgo Biloba and Kava Extract
Patients with SAD exhibit a globally lower metabolic rate than healthy people, as measured by PET (positron emission tomography) scans. Only depressed patients with SAD had asymmetrical (left more than right) metabolic activity of the medial prefrontal cortex. Ginkgo biloba is remarkable for its ability to prevent metabolic and neuronal disturbances in experimental models of cerebral ischemia and hypoxia. It accomplishes this by enhancing oxygen utilization and increasing cellular uptake of glucose, thus restoring aerobic glycolysis. Ginkgo promotes increased nerve transmission rate, improves synthesis and turnover of cerebral neurotransmitters, and normalizes acetylcholine receptors in the hippocampus. Recent double blind studies showed a memory increase due to the proposed action of vasodilation of the blood vessels via release of nitric oxide. With regard to increasing the number of serotonin binding sites in the brain, Ginkgo biloba extract appears to also be effective.
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