Pain Medical Musing

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.]- Just taking excessive fish or cheap fish oil might lead to mercury poisoning so needs to be tested.
• Nuts: recent study found walnuts, lamonds and hazelnuts high in serotonin (walnuts highest) and associated with increased excretion of serotonin metabolities – study implied 1 handful/day might help depression – (they used mix –  1/2 walnuts and 1/4 other two)
  Metabolomics Unveils Urinary Changes in Subjects with Metabolic Syndrome following 12-Week Nut Consumption
  Sara Tulipani,†,‡ Rafael Llorach,†,‡ Olga J
  auregui,‡,§ Patricia L
  opez-Uriarte,||,^ Mar Garcia-Aloy,†,‡ Monica Bullo,||,^ Jordi Salas-Salvad
  o,||,^ and Cristina Andr
  es-Lacuev
  J. Proteome Res. 2011, 10, 5047–5058  abstract here
  A discussion of nuts and mood here
• Calm abiding meditation – focusing on breathing and more time breathing out than in for 20 minutes – asssociated with elevated serotonin levels, activation of Prefrontal cortex and improved mood:
  Activation of the anterior prefrontal cortex and serotonergic system is associated with improvements in mood and EEG changes induced by Zen meditation practice in novices
  Xinjun Yu, Masaki Fumoto, Yasushi Nakatani, Tamami Sekiyama, Hiromi Kikuchi, Yoshinari Seki, Ikuko Sato-Suzuki, Hideho Arita
  International Journal of Psychophysiology 80 (2011) 103–111  abstract hereAnother study found remaining mindful of their breathing for 18 minutes was associated with improved mood:
  The Healthy Quality of Mindful Breathing: Associations With Rumination and Depression
  Cognitive Therapy and Research Volume 35, Number 2, 179-185,
  Jan M. Burg and Johannes Michalak    abstract here
• being outdoors helps
  https://journals.lww.com/ajpmr/Fulltext/2019/06000/Ultrasound_Guided_5_in_1_Injection__Trigger_Point.15.aspx

Below is the list: Continue reading →