Herbs for Depression: St. John’s Wort (Hypericum)

Hypericum is an herbaceous perennial weed used since the time of ancient Greece for its many medicinal properties (NIMH 1997; Bombardelli and Morazzoni 1994; Salzman 1998). The plant contains several chemical compounds thought to elevate mood; among them, hyperforin is regarded as the most likely source of this antidepressant action. It is believed that the herb achieves its effect by increasing levels of serotonin, an up (or excitatory) neurotransmitter, in the brain. Hypericum also may inhibit secretion of cortisol, a stress hormone (Wong et al, 1998; Chatterjee et al 1998). Data from clinical trials suggest that hypericum and prescription antidepressants may be equally effective in the treatment of mild-to-moderate depression (Linde et al 1996; Wheatley 1997; Hippius 1998). Moreover, the herb appears to be well tolerated (Hippius 1998), causing fewer side effects than those observed with conventional antidepressants (NIMH 1997; Wheatley 1997).

Only 2% to 3% of people who use hypericum experience side effects. The most common side effects are gastrointestinal problems, allergic reactions, fatigue, delayed hypersensitivity, dizziness, dry mouth, constipation, restlessness, and confusion. Because of these potential side effects, use of hypericum is not advised during pregnancy or lactation. In addition, users should avoid exposure to strong sunlight. Hypericum may interact with several important classes of antidepressant medications such as monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs). It is therefore important for depression sufferers to inform their physicians of all medications, herbs, and vitamin, mineral, and other nutritional supplements used so as to avoid harmful drug interactions.

What to Expect as You Overcome Major Depression

Learn what to expect as you go through treatment and recover from major depression.

After a bout of major depression, it’s a relief when you start to feel like your old self again. Overall, you’re improving as you go through treatment for major depression, “but it’s often two steps forward and one step back,” says Shoshana Bennett, PhD, a clinical psychologist. “It’s rarely a straight line up.” Just knowing to expect some bad days with the good can help you be more patient with yourself. “These are dips, not relapses,” Dr. Bennett says.

A risky time during depression recovery is when you start having several good days in a row. It’s easy to think that — since you’re not having symptoms — you don’t need treatment for depression anymore, but going off medication or quitting therapy for depression too soon can lead to symptoms coming back.

American Psychiatric Association guidelines recommend that people with depression who have been successfully treated with antidepressants keep taking them for at least four to nine months, and sometimes longer. Similarly, people with depression who have fewer symptoms with talk therapy should talk with their therapist about how long to continue treatment.

Keeping Depression Symptoms Away Besides sticking with your depression treatment, you can take steps to keep symptoms under control. Connecting with friends and family, thinking positively, staying active, eating well, and getting enough sleep all help, but there’s a catch, says Jon Allen, PhD, senior staff psychologist at the Menninger Clinic in Houston: “The nature of depression makes it difficult to do those things.”

Don’t be surprised if these healthy steps feel unnatural at first. Depression fosters hopeless thinking, so you may have trouble believing that they’ll ever get easier. “They will,” Dr. Allen notes, “as you pull out of depression.”

Friends and family might see a change in your depression symptoms and depressed behavior before you do. “It’s remarkably common,” Allen says. “People will say, ‘Gosh, you look better,’ or ‘You sound better,’ and the depressed person is thinking, ‘Well, I still feel terrible.'” It can be very frustrating for the depressed person, who ends up feeling that other people don’t understand how tough things really are.

Building a Depression Support Network A support group is one place to find other people who know what you’re going through because they’ve had depression themselves. To locate in-person and online depression support groups, call the Depression and Bipolar Support Alliance (800-826-3632).

If you pulled away from friends and family while depressed, now is the time to start rebuilding those bonds. Allen suggests making concrete plans; for example, to meet a friend for coffee. “By making that commitment to someone else, you may feel obligated to show up,” he says. It’s added motivation to get out and rejoin the world. Friends and family can also be a source of encouragement on days when depression symptoms or worries about symptoms get you down. Gradually, you’ll start to feel more hopeful, too.

9 Secrets of Motivated People

Real-life strategies that will help you to actually accomplish the goals you’ve set for yourself this year from ©Real Simple

New year, new you. It’s the perennial January catchphrase that holds such conquer-the-world promise. And then, well, you get sidetracked with conquering your to-do list. But even the loftiest resolutions (running a marathon, writing a book) don’t have to fall by the wayside come February. Staying motivated―and achieving what you set out to do on that bright New Year’s Day―is surprisingly possible. Just follow these nine mantras, provided by researchers who study motivation and backed up by women who have used them to realize their biggest ambitions.

1. When you make a plan, anticipate bumps. Before even trying to achieve a goal, target potential pitfalls and troubleshoot them. Peter Gollwitzer, a professor of psychology at New York University, in New York City, says that people who plan for obstacles are more likely to stick with projects than those who don’t. In a 2009 study published in the American Journal of Preventive Medicine, Gollwitzer compared two groups of women who wanted to be more active. Both groups were given information on leading healthy lifestyles. But the second was also taught how to foresee obstacles (example: “The weather forecast is bad, but I’m planning to go for a jog”) and work around them using if-then statements (“If it rains, then I’ll go to the gym and use the treadmill rather than skip exercising altogether”). No surprise, those in the second group fared better. Michelle Tillis Lederman of New York City practiced this strategy when she was writing a book last year. She installed blinds on her home-office door to minimize disruptions and hired an editor to give feedback on each chapter so she wouldn’t get stuck along the way. She also established rules, like checking e-mails only after she had written for two hours. “It was easier to follow this plan,” says Lederman, “than to wrestle with every distraction in the moment.” Her book, The 11 Laws of Likability (American Management Association), will be published later this year.

2. Channel the little engine that could―really. A person’s drive is often based on what she believes about her abilities, not on how objectively talented she is, according to research by Albert Bandura, a professor of psychology at Stanford University. His work has shown that people who have perceived self-efficacy (that is, the belief that they can accomplish what they set out to do) perform better than those who don’t. That self-belief is what helped Ingrid Daniels of Newark, New Jersey, leave a stable corporate job to develop a T-shirt line after the birth of her first child. “It never occurred to me I could fail, even though I had no experience,” she says. Today Daniels runs two successful small businesses (the T-shirt company and a line of stationery), which allows her to stay at home with her three children.

3. Don’t let your goals run wild… When your sights are too ambitious, they can backfire, burn you out, and actually become demotivating, says Lisa Ordóñez, a professor of management and organizations at the Eller College of Management, at the University of Arizona, in Tucson. Instead of aiming unrealistically high (such as trying to save enough money for a down payment on a home in six months), set goals that are a stretch but not an overreach (come up with a doable savings plan for your budget).

…But work on them everyday. According to Daniel Pink, author of Drive: The Surprising Truth About What Motivates Us ($27, amazon.com), taking small steps every day will not only help hold your interest in what you’re trying to achieve but will also ensure that you move slowly, but surely, toward your goal. So, for example, set up a down-payment-fund jar and dump your change into it every night. You’ll get a sense of accomplishment each day, to boot.

4. Go public with it. Instead of keeping your intentions to yourself, make them known to many. “Other people can help reinforce your behavior,” says James Fowler, a political scientist who studies social networks at the University of California, San Diego. After all, it’s harder to abandon a dream when you know that people are tracking your progress. Take Stefanie Samarripa of Dallas, 25, who wanted to lose 20 pounds. She created a blog and told all her friends to read it. “I wanted something to hold me accountable,” she says. Samarripa weighs herself weekly and announces the result on Desperately Seeking Skinny (skinnystefsam.blogspot.com). During her first three weeks, she lost six pounds. “People read my updates and make comments, which helps me keep going,” she says.

5. Lean on a support crew when struggling. Think of the friends and family who truly want to see you succeed. Enlisting those with whom you have authentic relationships is key when your motivation begins to wane. Choose people who may have seen you fail in the past and who know how much success means to you, says Edward L. Deci, a professor of psychology at the University of Rochester, in New York. For Jane Arginteanu of New York City, support came in the form of her fiancé, Glenn. Arginteanu had smoked from the time she was a teenager and had tried to quit before. When she decided to give it another go, Arginteanu says, “Glenn stood by me and told me, without ever issuing an ultimatum, that he wanted to grow old with me. That was terrific motivation.” A year later, she’s smoke-free.

6. Make yourself a priority.Put your needs first, even when it feels utterly selfish. You will derail your progress if you sacrifice yourself for others in order to please them (such as eating a cupcake that a coworker baked even though you’re on a diet). A few years ago, Karen Holtgrefe of Cincinnati was at the bottom of her own priority list. “I had a demanding full-time job as a physical-therapy manager and was teaching physical therapy part-time,” she says. “Plus, I had a husband and two children to care for.” As a result, she found herself stressed-out, overweight, and suffering from constant backaches. “I hit a wall and realized I needed to make some changes for my sanity,” Holtgrefe says. So she quit the part-time teaching job, joined Weight Watchers, and scheduled nonnegotiable walks six days a week―just for her. In a year, she lost 85 pounds, and her back pain (and stress) disappeared.

7. Challenge yourself―and change things up. It’s hard to remain enthusiastic when everything stays the same, says Frank Busch, who has coached three Olympic swimming teams. To keep his athletes motivated, he constantly challenges and surprises them―adding a new exercise to a weight routine or giving them a break from one practice so they can recharge. Amy Litvak of Atlanta did the same thing. She had several half-marathons under her belt but wanted something new, so she signed up for a series of mini triathlons. “Each race was longer than the last or had a slightly different challenge,” she says. She breezed through them and is now training for a full marathon.

8. Keep on learning. To refuel your efforts, focus on enjoying the process of getting to the goal, rather than just eyeing the finish line. Janet Casson of Queens, New York, set out to teach yoga. She completed her training, but finding a position took longer than anticipated. So she wouldn’t lose steam and become discouraged, Casson used the time to perfect her skills. She attended workshops and studied with different teachers. “It was invigorating and kept me working toward my goal,” says Casson, who now teaches five classes a week.

9. Remember the deeper meaning. You’re more likely to realize a goal when it has true personal significance to you, according to Deci. (For example, “I want to learn to speak French so I can communicate with my Canadian relatives” is a more powerful reason than “I should learn French so that I can be a more cultured person.”) And when the process isn’t a pleasant one, it helps to recall that personal meaning. Not all dedicated gym-goers love working out, Deci points out, but because they have a deep desire to be healthy, they exercise week after week. Jennie Perez-Ray of Parsippany, New Jersey, is a good example of this. She was working full-time when she decided to get her master’s degree. However, she knew that pursuing that goal would mean spending less time with her friends and family. “But I was the first person in my family to get a degree, so it was very important to me,” Perez-Ray says. She kept this in mind every evening that she spent in the classroom. Although the sacrifices she made were hard, she reflects, “reaching my goal made it all worthwhile.”

Is Your Major Depression Treatment Plan Working?

Track your progress with a journal of your clinical depression symptoms.

As you start to overcome major depression (also known as clinical depression, major depressive disorder, or MDD), you can boost your success by being an active member of your own treatment team. Once you’ve worked with your doctor and/or a psychotherapist to put a depression treatment plan in place, the next step is to watch for signs that you’re feeling better. Overcoming depression may take some time, but keeping regular tabs on your progress will help your depression-treatment team fine-tune the right mix of antidepressant medication and psychotherapy for you.

Keep a Depression Symptoms Journal

Day-to-day variations in your depression symptoms can be misleading, so it may be more helpful to assess your progress at the end of each week instead of daily. To keep track of subtle changes in your symptoms, use a depression symptoms journal for at least the first month of treatment. Write in it daily.

Use this checklist to assess your progress around the same time each week:

___I feel more rested in the morning.
___I’m interested at work and able to concentrate.
___My energy level seems to be improving.
___Feelings of lethargy or restlessness were less noticeable.
___I tried to eat regularly and healthfully most days of the week.
___I took my antidepressant medication daily (if applicable).
___I exercised at least 3 times this week.
___Feelings of loss, sadness, guilt, or worthlessness were not distracting.
___I engaged in an activity with friends or family.
___Overall, this week was better than last week.

If you’re taking an antidepressant, take note of the following potential side effects and contact your doctor or therapist right away if you have them:

  • Feelings of worthlessness or thoughts of self-harm
  • Worsening depression
  • Changes in your sexual interest

Modifying Your Depression Treatment Plan

Research shows that a combination of antidepressant medication plus psychotherapy offers the best chance for lasting relief from major depression, says Gerry Neely, MA, LMFT, who works with clients in her Seattle practice. For people who feel a stigma about taking medication, Neely adds, “finding the right medication can serve as a short-term bridge to feeling better and being able to fully engage with life.”

If you don’t see improvement right away, don’t give up hope. Research funded by the National Institutes of Mental Health (NIMH) shows that switching antidepressants or adding a medication to your depression treatment plan can help. If your symptoms persist, your doctor will review your current plan and your overall health to be sure nothing was missed. Your psychotherapist can try a variety of techniques to find the right match.

Exercise and Major Depression

Learn how exercise and physical activity can change your brain chemistry and support your major depression treatment plan.

Exercise is prescribed for a wide variety of health conditions — from heart disease to diabetes. Science shows being active can improve your physical and mental health, and make positive changes in your brain chemistry. But if you’re battling major depression, the thought of working out may seem unthinkable. Here’s some information about the benefits of exercise that may change your mind.

Exercise and Nerve Growth    Early brain chemistry research found that mice living in an exercise-friendly environment stopped acting depressed after a stressful social experience — while mice who didn’t exercise stayed depressed. Scientists attribute the mice’s recovery to the growth of new brain nerves caused by exercise.  This and other research has led scientists to understand how brain nerve growth works in humans, too. Adults affect their brain chemistry through experiences — such as physical activities — and how they respond to them. The proteins largely responsible for the brain’s ability to adapt and change are called neurotrophins. Antidepressants affect neurotrophins in the brain — and so does exercise.

Benefits of Exercise Therapy for Depression In addition to stimulating new nerve growth and improving your ability to think, remember, and learn, exercise boosts serotonin, dopamine, norepinephrine, and endorphins in your brain. These neurotransmitters help you calm down and focus. In studies, exercise therapy has also shown an antidepressant effect.

One Duke University researcher, James Blumenthal, PhD, has been studying exercise and MDD for over a decade. “Based on the best available evidence to date,” Dr. Blumenthal believes that “exercise may be generally comparable to medication in the treatment of MDD.” Similar studies continue to find at least modest clinical benefit for exercise and better mental health. But don’t self-treat your depression symptoms or try to get through your recovery with exercise alone. Talk to your doctor about treatment and self-care options — including exercise — that are right for you.

Adding Exercise to Your Treatment Plan Once you start exercising, you’re likely to notice some changes in your symptoms right away. “Simply moving more and sitting less will make a difference in how you feel,” says exercise physiologist and dietitian Amy Ogle, MS, RD. “And if you typically exercise alone, consider working out with a group or partner because the social connection helps lessen depressive symptoms.”

Shoot for at least 2 1/2 hours of exercise in a week. Strength training counts toward that time, too. Just remember to check with your doctor first, especially if you have another medical condition.

“Sticking to a plan and following your progress,” Ms. Ogle adds, “will renew your sense of self-mastery and control.”  You can progress to the following routine:

  • 5-10 min warm-up, gently moving upper and lower body in full range of motion
  • 30 min aerobic exercise, such as walking, light jogging, swimming, biking or a group exercise class. You should be able to talk, but not comfortably sing.
  • 5 min cool-down and stretching

Boost Your Energy Level in 11 Steps

Learn how to recharge your batteries so you can keep on going like the Energizer bunny.

Tired of Having No Energy?

Everyone feels tired now and then, but are your energy stores totally depleted? Think of it this way: If you blow a fuse in your house, you can’t expect to get power back by lighting a few candles and searching for food with a flashlight. You’ve got to find the bad fuse, replace it, and reset the system. Same goes for your energy. Before you reach for the big Cs to snap out of your sluggishness (you know . . . cookies, candy, carbs, and caffeine concoctions), we’ve got an 11-step plan to pep you up.

Consider Your Sleep Habits

It’s pretty basic, but you need to get your ZZZs. Sleep loss is a major energy drain. Our bodies and brains need 6 to 9 hours of sleep to restore good brain-cell functioning (i.e., the ability to perform physically as well as mentally, since both coordination and thinking require those brain cells to work well). Getting on a regular bedtime schedule will help set your internal clock so your body knows when to sleep and when to wake. Find out what’s causing any sleep issues you may have.

Train Your Brain

Tell your body you want to watch Glee reruns all night and — thanks to mechanisms called feedback loops — you downshift energy production. This explains why you can feel too tired to move even though you’ve been sitting around all day. Tell your body to move and it responds by giving you the energy to get moving. Your body teaches your brain. That’s how healthy behaviors become automatic habits. This may be tough the first few times you try, but it gets easier.

Stay Hydrated

Getting to the point where you’re just starting to feel thirsty (a mere 2.6% drop in hydration levels) is one of the quickest ways to take the spring out of your step. In fact, being even just a little dehydrated can lead to unpleasant feelings, such as fatigue, crankiness, and foggy thinking. When you feel yourself dragging, grab a tall glass of water. Another plus of H20: people who drink water throughout the day consume a whopping 9 percent fewer daily calories.

Cut Back on Sugar

A sugar-filled diet gives you about a birthday candle’s worth of energy, while a healthy diet is more like an eternal flame. Work on limiting simple sugars (they end in –ose, such as glucose, sucrose, maltose, and dextrose — ribose is OK), syrups, and any grain that’s not 100% whole. Ribose is the exception because it’s a special sugar made in your body. It doesn’t come from food, but does come in supplement form and can help build the energy factories of your body. It’s not for everyone, so talk to your doctor first.

Trade TV Time for Exercise

No time to exercise, but plenty of time to watch TV? Exercise can do a world of good to boost your energy, so even on days when you don’t feel up to it, try to do some kind of physical activity, such as walking, strength training or cardio to kick your feel-good endorphins into high gear. Still uninspired? Try the 10-minute rule. Make a deal with yourself to get moving for at least 10 minutes. Chances are, once you start, you’ll feel so much better that you’ll keep going.

Spend Time in the Sun

Short days can causes seasonal affective disorder (SAD) — neurochemical changes in your brain due to lack of sunlight. From late fall until spring, people with SAD become depressed, sleep too much, withdraw from friends, and battle low energy and relentless carb cravings. To prevent SAD and get energized, try to spend some time in the sunshine. If there isn’t any, ask your doctor about light therapy, which involves sitting in front of a special box that shines ultrabright lights.

Sip Tea

Black, green, and white teas all contain the energizing amino acid L-theanine, which isn’t found in coffee. Green tea contains free-radical-fighting compounds that help you stay younger and avoid the aging and decrease in energy that accompany chronic disease. Although green tea has one-third the caffeine of black tea, it’s been shown to yield the same level of energy and attentiveness.

Get a Daily Dose of Magnesium

For a little extra get-through-the-day energy, top your veggies with toasted sesame seeds. They’re loaded with magnesium — a mineral that cells need in order to convert food to energy. Other magnesium-rich foods include: whole grains, dark leafy greens, pumpkin seeds, and cashews. Magnesium not only boosts your energy, it also helps strengthen your bones and keep your heart, nerves, muscles, and immune system functioning well.

Take a Power Nap

Close your office door or slip out to your car for a quick snooze. Power naps, or “cat naps,” can boost your mood, memory, and productivity. They also increase your alertness and energy while lowering your blood pressure. To get the most out of your siesta, keep it short (10 to 30 minutes), aim for midafternoon, and get comfy (kick of your shoes, loosen tight clothing and darken the room). Can’t take a nap? Opt for an afternoon walk or office-gym workout.

Eat More Mini-Meals

To stay energized all day, you have to eat often. That means shifting away from three big meals toward five to six balanced mini meals. To maintain steady energy levels, pair complex carbs that are high in fiber (e.g., beans, peas, and whole grains) with unsaturated fats (e.g., avocado, walnuts, or mixed greens with olive oil). Add protein, such as lean meat, nuts, fish, and edamame, as an accent rather than as a main dish.

Still Tired? Talk to Your Doctor

If you’ve tried everything under the sun to boost your energy but still feel tired, it’s probably time to make an appointment with your doctor. Share how you’ve been feeling, when your fatigue began, and what factors may be causing it. Don’t be afraid to ask questions and to find out what treatment options may be available to you.

Top Ways to Get Your Energy Back — Now

February 21, 2010 12:00 AM by Mehmet C. Oz, MD, and Michael F. Roizen, MD

You’re grumpy at the groundhog (who needed extra weeks of winter?) and a little short with your spouse, and you have been spending more time with the mac-and-cheese casserole than the treadmill. Winter can do that. But it doesn’t have to. Use these strategies to cuff the classic energy thieves that are still hanging around this time of year, and get your mojo back before spring hits:

Energy thief #1: Short, dark days.
What happens: Short days can cause seasonal affective disorder (SAD) — neurochemical changes in your brain due to lack of sunlight. This results in depression in up to 6% of Americans (the further north you go, the more likely you are to be a SAD sufferer). From late fall until spring, people with SAD become depressed, sleep too much, withdraw from friends, and battle low energy and relentless carb cravings.
Turn it around: Light therapy — sitting in front of a special box that shines ultra bright lights — has long been considered to be the best way to combat SAD. But a new University of Vermont study reveals that cognitive-behavioral therapy (CBT) may be even better. CBT is a type of psychotherapy that helps people outsmart depression by teaching them to change their negative ways of thinking. In fact, in this study, CBT alone was able to stomp out SAD with a success rate of 81% (compared with 49% for CBT plus light therapy and 32% for light therapy alone). Why wouldn’t more therapies be better? Researchers surmise that trying to balance two therapies was just too confusing, but CBT alone allowed people to focus on the coping skills they needed to banish their winter blues.

Energy thief #2: You can’t get enough comfort.
What happens: When the mercury heads south, we crave calories, carbs (they help our brains make the calming neurotransmitter serotonin), and fat. In fact, a 2006 University of Massachusetts Medical School study found that once the days become shorter, we pack away an average of 86 extra calories a day and weigh more than at any other time of year. We also snarf down more total and artery-clogging saturated fat.
Turn it around: Just cozy up to good-for-you carbs and healthy omega-3 and omega-9 fats that will satisfy your biology and your brain without packing on a gratuitous layer of blubber.

Trade meatloaf and pot roast for hearty whole grains like whole-wheat pasta and brown rice, or try polenta, a veggie burger, or salmon. Or warm up with a satisfying bean-based vegetable chili or Tuscan white bean soup. Since beans and whole grains are digested slowly, they’ll keep you full longer, so you’ll eat less overall. And if it seems like there are slim pickings in the produce department, now is actually the prime time to load up on nutrient-packed starches, including sweet potatoes and winter squash (roast or bake them with a drizzle of olive oil). Finish your feast with seasonal winter fruit (think apples, pears, oranges, grapefruit, and tangerines, or even frozen berries) topped with a sprinkle of heart-healthy walnuts or almonds and you’ll get all the carbs and fats your body craves — but you’ll do it the healthy way.

Energy thief #3: You stay in. On the couch.
What happens: Your workout plan bites the dust. We log less exercise in winter than any other time of year, with a paltry 45% of Americans and 36% of Canadians keeping active. Pretty ironic, since exercise can lift you out of the winter doldrums by boosting energy, improving mood, and helping you sleep better.
Turn it around: Start with your schedule. Make regular exercise appointments on your calendar the same way you’d ink in any other non-negotiable activity. But give yourself a bit of a break: Don’t think exercise needs to be a hard-core trip to the gym. Taking the dog for an extra-long walk or doing crunches and lifting weights in front of the TV count, too. Still uninspired? Try the 10-minute rule. Make a deal with yourself to get moving for at least 10 minutes. Chances are, once you start, you’ll feel so much better that you’ll keep going.