Checklist of Simple Treatments For Depression – including in Pregnancy

I have compiled a simple list of measure known to help depression that can be given to patients. It was initially compiled with pregnancy in mind but concerning herbals, there  are Pregnancy issues. However here are suggestions from a recent obstetrical review:

Obstet Gynecol Clin North Am. 2009 Dec;36(4):789-807,
Update and critique of natural remedies as antidepressant treatments.
Mischoulon D abstract here

• If there is significant depression, then traditional antidepressants are necessary

• St. John’s Wort: “One small prospective study found no significant differences in fetal malformations in women exposed to St John’s wort during pregnancy, compared with pregnant women on other antidepressants and pregnant women with no teratogen exposure.49 Studies examining hyperforin and hypericin levels in breast milk have suggested safety for children and mothers,50,51 and one small prospective study suggests no increase in adverse events in children exposed to St John’s wort in mother’s milk, though cases of lethargy and drowsiness were reported.52 The data, however, are scant and long-term studies of safety are required.53 In the absence of safety data, it is recommended that women who are pregnant or intend to become pregnant avoid St John’s wort. “

• SAMe – “As with St John’s wort, there is a lack of data regarding safety during pregnancy and lactation. Some studies have found that pregnancy may result in impaired methylation and lower levels of SAMe,73 suggesting a potential benefit from SAMe administration in pregnant women. SAMe supplementation in pregnant women with intrahepatic cholestasis has been associated with beneficial effects.74 Although SAMe seems to be a mostly safe over-the-counter agent (ie, a chemical that humans already manufacture,with no drug-drug interactions, and minimal and mild adverse effects), consideration for SAMe administration in selected cases may be reasonable. ” [but if significant depression then traditional better]

• Omega 3 – beneficial in pregnancy [but it is not safe to leave a lady depressed in pregnancy that could otherwise be better on traditional antidepressants.]

Below is the list:

Stop Drinking

Proper Diet – notice what foods make you sick

Sleep Hygiene –Tums or Milk of Magnesia at bed if heartburn; don’t sleep in on weekends; no caffeine

Outdoor exercise/phototherapy – walk around block during day

Regular Exercise

Relaxation exercises Yoga Mediation Taped sounds

Time management – make lists, Set a goal daily

Late night sleep deprivation – bed 9:00 PM, up by 1:00 AM; next night sleep recovery – 10:30 PM to 6:30 am

Adopt a support person

Omega 3 – max of EPA 1.7 gm; average ~1.2 gm EPA (plus whatever amount DHA)

Folic acid 0.5 – 5 mg /day

B12 – 1000 mcg shot /wk or 1000 – 2000 mcg orally/day

Bright Light – 10,000 LUX; ½ -1 hour in AM; consider more in PM too

SAMe [S-adenosylmethionine] 600 mg twice daily – up to 1600 mg/day

St. John’s Wort [Hypericum] 300-600 mg – 3 times a day

DHEA (adrenal hormone) – if levels low, then DHEA 100 mg three times daily can help mood (doctor can order it through ebay…

   Testosterone levels are often non-existent in women with chronic pain and Testim gel 0.2-0.3 daily helps