Why your doctor never told you about the 10 supplements you can take alongside an antidepressant to help it work better
Here are ten well-researched and clinically tested supplements that you can take alongside antidepressants to make them more effective:
Zinc
Omega-3 fatty acids
Creatine
Folate
Rhodiola
Curcumin
NAC
Thyroid hormone*
SAMe (S-adenosyl-L-methionine)*
Low-dose nutritional lithium*
I always recommend working with a medical professional when starting a supplement, both for safety and so that they can tailor the supplements to you specifically.
*Thyroid hormone, SAMe, and low-dose nutritional lithium MUST be taken under the care of an experienced doctor. SAMe can interact poorly with antidepressants and other psychiatric medications. Thyroid hormone supplements often have different amounts of active thyroid hormone in them than the label states, so a prescription is necessary for accurate dosing. There are different forms and dosing formulations of lithium, so an experienced doctor must guide treatment with it.
But wait, why did your doctor say medications are the only option to treat depression and didn’t tell you about these supplements? The short answer is that although these non-medication options are well-researched and clinically proven, they weren't trained in using them.
Let’s take a look at a typical scenario:
You tell your primary care doctor that you’ve been feeling tired for months, you can barely muster up the energy to do what you used to, you’re often on the verge of crying, and you feel like life is overwhelming and nothing you do can change it. She has you fill out a 9-question screening questionnaire and asks you about your mood, appetite, sleep, and energy in the last two weeks. She says it sounds like you’re depressed and starts you on an antidepressant. Let’s say it’s Lexapro.
She starts you on the lowest dose possible, 5 mg a day, even though it could be started at 10 mg daily, to decrease the chance of side effects. You notice some nausea for the first few days, but it goes away, and you don’t feel any other side effects. You were told you might start noticing a benefit 1-2 weeks after starting it, but haven’t noticed any improvement yet. You reach out to your doctor and let her know. She reminds you that it takes 4-8 weeks to see the full effect of the current dose.
She wants to help you and tells you that the dose can safely be increased every week, even though the effects might not be apparent for another 7 weeks after that. Since you started below the typical starting dose, your doctor increases the dose to 10 mg daily. This time you wait the whole 8 weeks to see if you find a benefit, but still nothing. You reach out to the doctor again, and she increases it to 15 mg daily.
Four weeks later, you finally feel a bit different. The same things that felt completely overwhelming before seem a bit more manageable now. Instead of feeling like nothing you do makes a difference, you feel like your efforts could result in something positive. Your brain comes up with fewer doomsday thoughts, making it easier to accomplish your daily tasks. Doing everything you used to do without a second thought is still difficult, but this is an improvement.
After 8 weeks on 15 mg a day, you don’t feel any better than at 6 weeks and wonder whether increasing the dose might have more of a positive effect. Your doctor lets you know that 20 mg a day is the maximum dose allowed. After several weeks on the 20 mg a day, you notice that you’re more tired than usual, but your sleep schedule hasn’t changed. You let your doctor know. She tells you that fatigue is a potential side effect of Lexapro and suggests you go back down to 15 mg a day. You do so, and about a week later, you feel less fatigued, and still, your sleep schedule hasn’t changed. Based on the pattern, it seems like the fatigue was tied to the higher dose, and you decide to stay on the 15 mg a day.
You wonder what sorts of positive benefits you might’ve missed out on at the higher dose. Your doctor says you have two options. The first is to add another antidepressant medication to the one you’re currently on. The second is to come off the Lexapro and try a different antidepressant to see if it might work better.
You’re apprehensive about adding another medication and don’t want to give up the benefits you’ve gotten from the Lexapro. You feel stuck with limited options, wondering if there’s anything else you could do that could help you feel better.
The above doctor I described is a primary care physician, conventionally trained in either internal medicine or family medicine. She went to medical school to get her MD or DO degree, then completed a 3-year residency training program in Internal or Family Medicine. She was taught a few things about depression and anxiety:
It should always be treated with an antidepressant unless there’s a history of mania.
Once you start a medication, it will most likely need to be continued indefinitely.
If the medication isn’t effective, keep increasing the dose until it’s maxed out.
If it still isn’t effective at the max dose, either add another psychiatric medication or stop this one and start a different one to see if it might work better.
The only alternatives to medication are transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT).
This is very limited information. However, if you ask her how to treat diabetes, high blood pressure, or asthma, she’d be reciting textbooks at you. The point is that although primary care doctors prescribe 79% of antidepressants, they have little training in psychiatry.
An internal medicine or family medicine doctor receives lectures about psychiatric conditions and medications in a med school classroom and spends 6 weeks in the hospital working on the psychiatric unit in their third year of medical school. During their 3 years of internal medicine residency, they do not work on the psychiatric unit or in a psychiatric outpatient clinic. Classroom lectures and 6 weeks in person are the extent of their training in psychiatry.
Psychiatrists also graduate medical school and spend 6 weeks in the hospital working on the psychiatric unit in their third year of medical school. Additionally, they spend 3-6 months working on psychiatric units or outpatient clinics in their fourth year of medical school. Then they spend 4 years completing a psychiatry residency training program. Quite the difference.
Primary care doctors typically refer to specialists, doctors who received extra training in an area they didn’t. They send people to see cardiologists for heart issues and endocrinologists for hormone conditions. Why not for psychiatric problems?
There’s no definitive answer, but most likely, it’s because psychiatric treatment seems simple, as in “just pick an antidepressant medication and try a different one if it doesn’t work,” and because there’s a shortage of psychiatrists, making primary care doctors more accessible than psychiatrists.
Nonetheless, if you have the ability to ask your primary care physician for a referral to a psychiatrist, I recommend it. Why would you not want treatment from the person who has the most experience treating the condition you have?
What I HIGHLY recommend, though, is seeing a holistic psychiatrist. What’s that, and why?
Although not widely known, there are medical treatment frameworks outside of conventional medicine. Some include functional, integrative, nutritional, lifestyle, orthomolecular, and mind-body medicine.
Holistic psychiatrists take the best of their conventional medical training (4 years of medical school + 4 years of psychiatry residency) and combine it with non-conventional treatments like root cause analysis, individualized nutrient therapy, diet, movement, sleep, herbs and supplements, and wellness coaching.
The result is a wide-scope approach to mental health. It goes beyond the “pill for an ill” approach of conventional medicine. Rather, it aims to find and modify the underlying cause of symptoms, from low stomach acid preventing proper food digestion to your daily habits and relationships. It doesn’t give out a diagnosis and pill and hope for the best. It leads to evaluating each person as a whole in order to provide the most comprehensive treatment path to feeling better, whether that includes psychiatric medications or not.
Holistic psychiatry recognizes that mental health symptoms are multifactorial, meaning they’re not caused by one thing. Rather, they result from a combination of different causes and contributors. Mental health treatment is complex because these causes and contributors are many. The good news is that evaluating them leads to various treatment options.
Overall, holistic psychiatry provides treatment aside from and alongside psychiatric medication to help you feel fully better now and long term.
Brain-Body Psychiatry was created to bring you better mental health treatment through holistic psychiatry.
We all need support, guidance and accountability in making changes to positively impact our mental health.
Brain-Body Psychiatry partners with you to guide you to your full potential.
Carefully yours,
Dr. Luisa Cacciaguida
Disclaimer:
This blog post is intended to be informative and does not replace individual medical advice. Always consult with your healthcare provider or a professional for any personal medical decisions or concerns you may have. Everyone's health situation is unique and should be evaluated by a healthcare professional.
This blog post is designed as a general guide. This is not a substitute for personalized medical advice, nor is a patient-physician relationship established in this blog post.
