If you suffer from depression and seek treatment from a conventional psychiatrist or general practice physician, odds are you will receive a prescription for an antidepressant.

However, your doctor most likely will not tell you about any of the research showing that these drugs may be less effective than we've been led to believe.

Important recent finding: After analyzing published and unpublished data, researchers reported in the journal Public Library of Science - Medicine that four widely prescribed antidepressants-fluoxetine (Prozac), venlafaxine (Effexor), paroxetine (Paxil) and nefazodone (Serzone)—were no more effective in treating most forms of depression than placebos, Only when used to treat patients who were "very severely depressed" were the drugs more effective than placebos.

Also, it's widely known that many antidepressants can cause side effects, such as headache, weight gain and erectile dysfunction, but many people are unaware that discontinuing these drugs can lead to irritability, sweating, diarrhea and other symptoms.

Caution: Never stop taking an antidepressant without the supervision of a doctor.

Overlooked Causes

I see depression as often being a "wakeup call" that a person's life is out of balance. However, it also can be a red flag for an undetected physical illness, so see a primary care physician if you suffer from a low mood that lasts for more than two weeks.

Serious conditions such as diabetes, heart disease, thyroid problems and cancer are widely known to affect mood, but other physical causes of depression often are missed. Among them…

  • Small intestine bacterial overgrowth. Researchers and clinicians have discovered that gastrointestinal problems are sometimes associated with depression. "Friendly" bacteria, which can be reduced by stress, help control harmful bacteria and may improve mood by enhancing absorption of nutrients.

If you have flatulence, diarrhea or abdominal pain along with a low mood, try taking probiotic capsules daily containing 2 billion to 3 billion lactobacillus and bifidus organisms. Probiotics can be taken indefinitely to replenish the healthful bacteria in your gut.

  • Chronic yeast overgrowth. Prolonged use of certain drugs, such as antibiotics, and compromised immunity due to cancer therapy, for example) often lead to yeast infections.

If you have symptoms of a yeast infection, such as itching or rash on the vagina or penis ...or white patches in the mouth (thrush), ask your doctor about testing for this type of infection. If the results are positive, your doctor will probably prescribe an antifungal drug, such as fluconazole (Diflucan).

Also, consider following a yeast-free diet (no fermented products, such as wine, certain cheeses and soy sauce...or sugary foods-all of which are believed to promote yeast growth).

My Non-Drug Approach

Any practice that boosts mood-including exercise, meditation, acupuncture and psychotherapy-can effect lasting, positive changes in the brain. Such changes include increases in certain brain chemicals (such as serotonin and norepinephrine) and positive alterations in brain physiology associated with optimism and happiness.

Even when an antidepressant seems to help, it may be masking your symptoms and should be used, in my opinion, only as an adjunct to a comprehensive program including the strategies described below.

In my 40 years of practice, hundreds of my patients have experienced significant and long-lasting relief from depression after following a nondrug approach.

Important: In rare cases, I do recommend antidepressant medication to my patients in life-threatening emergencies and when nondrug approaches have been tried unsuccessfully

But to uncover and truly heal many of the underlying causes of depression, I recommend whenever possible working with a psychotherapist or physician who uses a nondrug approach, including…

  • "Calming" tool. A calming tool (such as slow, deep breathing) not only lowers levels of the depression-promoting stress hormone cortisol, but also reduces blood pressure and heart rate. You can perform slow, deep breathing on a daily schedule (start with three to five minutes per session, three to five times daily) and also use it whenever you feel agitated or overwhelmed.

What to do: Sit quietly in a comfortable chair and breathe slowly and deeply, in through your nose and out through your mouth. Let your belly be soft, repeating "soft" to yourself as you breathe in and "belly" as you exhale.

  • Energizing exercise. Traditional forms of aerobic exercise, such as walking, jogging or cycling, have been shown to improve mood for some depressed people as well as, or better than, antidepressants.

I often also prescribe "energizing exercise, which helps move you out of the lethargy that so often accompanies depression. This may include yoga or a sequence of shaking and dancing. Yoga allows the body to relax and emotions to be released as you stretch...vigorous shaking breaks up stress-induced physical and emotional patterns...and dancing allows your body to move freely.

What to do: Try moving your body freely to any rhythmic music that you enjoy for five to 10 minutes daily. Even those with physical limitations, such as people who are bedridden, can move at their own pace and capacity.

Helpful: Prepare your own CD or tape with five to 10 minutes of fast, rhythmic music for shaking. It may seem silly at first, but shake from your feet up through your slightly bent knees to your shoulders and head. Follow with a minute or two of silence, during which you can relax and be aware of your body and your breath. Continue with three to five minutes of movement to rhythmic music that you love.

Also helpful: Do not perform these exercises within two hours of bed. The best time is first thing in the morning or early evening. Build up to 20 minutes a day.

  • Light therapy. Seasonal affective disorder (SAD) is widely recognized but still tends to be overlooked by doctors who treat people with depression. If your spirits decline in the winter (when most people get less sun exposure) and improve when the days lengthen, consider sitting in front of a light box that supplies 10,000 lux of full-spectrum light that simulates natural light) for 30 minutes every morning, Light boxes are available at www.sunbox.com (800548-3968) and www.fullspectrumsolutions.com (888-574-7014).
  • Vitamin D. Many people who are depressed have nutritional deficiencies that contribute to their low mood. In addition to taking a multivitamin and multimineral supplement, it's important that you get enough vitamin D. It is produced in the body as a result of sun exposure, but there is increasing evidence that low levels of this vitamin are often present in people who suffer from depression. However, many physicians are unaware of this.

Ask your doctor for a blood test to check your vitamin D level. Depending on the results, he/ she may prescribe a dose that is significantly higher (for example, 2,000 international units daily) than the dose provided in a multivitamin.

  • Omega-3 fatty acids. Numerous studies have linked high dietary intake of omega-3s with decreased incidence of depression and shown a direct positive effect of omega-3 supplements on depression. In addition to increasing your intake of omega-3-rich fish (such as salmon, sardines and mackerel), I suggest taking supplements totaling about 3,000 mg of omega-3s daily, divided in two equal doses.

Caution: A dose this high may have a blood-thinning effect, so consult your doctor if you take a blood-thinning drug.

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