Is there really a single isolated cause of depression?

If not, a multifactorial answer is likely to be needed.

Also there are clearly exogenous factors which can exacerbate depressive symptoms such as relationship-family occurrences, global crises, traumatic events such as injuries or wars and a multitude of others. Cultural elements include how persons are treated differently in various cultures based on age, gender, sexual orientation. Therapy is likely to continue to have importance in the treatment of depression.

Depression and Diet

From WEB-MD

Written by Debra Fulghum Bruce, PhD

Medically Reviewed by Melinda Ratini, DO, MS on May 14, 2021

08:1505:29

• Antioxidants Prevent Cell Damage
• "Smart" Carbs Can Have a Calming Effect
• Protein-Rich Foods Boost Alertness
• Try a Mediterranean Diet for B Vitamins
• Get Enough Vitamin D
• Select Selenium-Rich Foods
• Include Omega-3 Fatty Acids
• Your Weight and Lifestyle Matter, Too

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From neuropsychiatric disease and treatment

Neuropsychiatr Dis Treat. 2013; 9: 639–658.

Published online 2013 May 14. doi: 10.2147/NDT.S43419

PMCID: PMC3660126

PMID: 23700366

Mood disorders and complementary and alternative medicine: a literature review

Naseem Akhtar Qureshi1 and Abdullah Mohammed Al-Bedah2

Author information Copyright and License information Disclaimer

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Abstract

Mood disorders are a major public health problem and are associated with considerable burden of disease, suicides, physical comorbidities, high economic costs, and poor quality of life. Approximately 30%–40% of patients with major depression have only a partial response to available pharmacological and psychotherapeutic interventions. Complementary and alternative medicine (CAM) has been used either alone or in combination with conventional therapies in patients with mood disorders. This review of the literature examines evidence-based data on the use of CAM in mood disorders. A search of the PubMed, Medline, Google Scholar, and Quertile databases using keywords was conducted, and relevant articles published in the English language in the peer-reviewed journals over the past two decades were retrieved. Evidence-based data suggest that light therapy, St John’s wort, Rhodiola rosea, omega-3 fatty acids, yoga, acupuncture, mindfulness therapies, exercise, sleep deprivation, and S-adenosylmethionine are effective in the treatment of mood disorders. Clinical trials of vitamin B complex, vitamin D, and methylfolate found that, while these were useful in physical illness, results were equivocal in patients with mood disorders. Studies support the adjunctive role of omega-3 fatty acids, eicosapentaenoic acid, and docosahexaenoic acid in unipolar and bipolar depression, although manic symptoms are not affected and higher doses are required in patients with resistant bipolar depression and rapid cycling. Omega-3 fatty acids are useful in pregnant women with major depression, and have no adverse effects on the fetus. Choline, inositol, 5-hydroxy-L-tryptophan, and N-acetylcysteine are effective adjuncts in bipolar patients. Dehydroepiandrosterone is effective both in bipolar depression and depression in the setting of comorbid physical disease, although doses should be titrated to avoid adverse effects. Ayurvedic and homeopathic therapies have the potential to improve symptoms of depression, although larger controlled trials are needed. Mind-body-spirit and integrative medicine approaches can be used effectively in mild to moderate depression and in treatment-resistant depression. Currently, although CAM therapies are not the primary treatment of mood disorders, level 1 evidence could emerge in the future showing that such treatments are effective.

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From Mayo clinic

Answer From Daniel K. Hall-Flavin, M.D.I've heard natural remedies for depression, such as St. John's wort, can work as well as antidepressants. Is that true?

So-called natural remedies for depression aren't a replacement for medical diagnosis and treatment. And natural doesn't always mean safe. However, for some people certain herbal and dietary supplements do seem to work well, but more studies are needed to determine which are most likely to help and what side effects they might cause.

Here are some supplements that are promoted by marketers as helping with depression:

• St. John's wort. This herbal supplement is not approved by the Food and Drug Administration (FDA) to treat depression in the U.S., but it's available. Although it may be helpful for mild or moderate depression, use it with caution. St. John's wort can interfere with many medications, including blood-thinning drugs, birth control pills, chemotherapy, HIV/AIDS medications and drugs to prevent organ rejection after a transplant. Also, avoid taking St. John's wort while taking antidepressants — the combination can cause serious side effects.
• SAMe. This dietary supplement is a synthetic form of a chemical that occurs naturally in the body. SAMe (pronounced sam-E) is short for S-adenosylmethionine (es-uh-den-o-sul-muh-THIE-o-neen). SAMe is not approved by the FDA to treat depression in the U.S., though it's available. More research is needed to determine if SAMe is helpful for depression. In higher doses, SAMe can cause nausea and constipation. Do not use SAMe if you're taking a prescription antidepressant — the combination may lead to serious side effects. SAMe may trigger mania in people with bipolar disorder.
• Omega-3 fatty acids. These fats are found in cold-water fish, flaxseed, flax oil, walnuts and some other foods. Omega-3 supplements are being studied as a possible treatment for depression and for depressive symptoms in people with bipolar disorder. While considered generally safe, the supplement can have a fishy taste, and in high doses, it may interact with other medications. Although eating foods with omega-3 fatty acids appears to have heart-healthy benefits, more research is needed to determine if it has an effect on preventing or improving depression.
• Saffron. Saffron extract may improve symptoms of depression, but more study is needed. High doses can cause significant side effects.
• 5-HTP. The supplement called 5-hydroxytryptophan (hi-drok-see-TRIP-to-fan), also known as 5-HTP, may play a role in improving serotonin levels, a chemical that affects mood. But evidence is only preliminary and more research is needed. There is a safety concern that using 5-HTP may cause a severe neurological condition, but the link is not clear. Another safety concern is that 5-HTP could increase the risk of serotonin syndrome — a serious side effect — if taken with certain prescription antidepressants.
• DHEA. Dehydroepiandrosterone (dee-hi-droe-ep-e-an-DROS-tur-own), also called DHEA, is a hormone that your body makes. Changes in levels of DHEA have been linked to depression. Several preliminary studies show improvement in depression symptoms when taking DHEA as a dietary supplement, but more research is needed. Although it's usually well-tolerated, DHEA has potentially serious side effects, especially if used in high doses or long term. DHEA made from soy or wild yam is not effective.

Hypericine from Hypericum perforatum.

Hypericin is a naphthodianthrone, an anthraquinone derivative.

Mainly compounds inhibiting PDE4 activity

Mainly compounds inhibiting PDE4 activity

Kanshone compounds from Nardostachys jatamansi (muskroot )

Also commonly known as Billilotan, Balchad in Ayurveda

MAo A and MAO B inhibitors also have antidepressant effects.