Originally published 8.15.17. Updated 10.28.20
Women and Depression: The Numbers Tell a Story
The statistics on depression in women are staggering. Antidepressant use in the United States has soared nearly 65% over the past 15 years, from about 8% in 1999-2002 to 13% in 2011-2014, according to new data from the National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention. Close to 1 in 4 women is on an antidepressant. Women experience major depression twice as often as men do, and we’re two and a half times more likely than men to be on an antidepressant. For the period 2011-2014, 68.0% of antidepressant users had been taking the medication for 2 years or longer; and 27.2% of women reported taking antidepressant medication for 10 years or longer.
The fact is that about 50% of the women who try them report never getting benefit – and even among those who reported some benefit in the first few months, 60% showed no improvement in their symptoms one year later. Antidepressants, do improve symptoms for a subset of women, but like all medications, there is always the risk of unintended consequences – a.k.a., side-effects. With antidepressants, this can include:
- increased appetite and weight gain
- loss of sexual desire and decreased orgasm
- fatigue and drowsiness
- dry mouth
- blurred vision
Note those last three side-effects. Aren’t those what the medications are supposed to fix? In fact, a known side-effect is worsening of symptoms related to depression and anxiety. And if you’re already eating emotionally, not sleeping well, or are tired – these medications can exacerbate those problems, too. Antidepressants have also been associated with more severe emotional reactions and dangerous behaviors. Unlike some of my colleagues, I am not 100% against the use of antidepressant medications – I have seen them help a small percentage of women. But overall, the data on their effectiveness isn’t impressive, they can have serious side-effects, and they don’t get to the root causes of depression for most women. I also feel that anytime we can try a natural option first, that’s the ideal way to go – because without exception, this is almost always the safest approach with the fewest side-effects – if any.
We also know that not all of us want to be on pharmaceuticals when there are alternatives – and in this case, there are. So if you’re struggling with depression and are looking alternatives, here’s one of the go-to’s in my medical practice.
Turmeric: An Anti-inflammatory Herbal Ally
As an herbalist in practice now for over 30 years, it always delights me when what so recently was fringe – using plants as medicines – gets recognized for its value. It also thrills me when science validates what women have known for millennia – that plants heal.
One of my favorite herbs for digestion and inflammation – turmeric – has now been found in several studies to be beneficial in treating depression. This shines a light on one of the important facts about depression that most of us have not been informed of – that’s it’s not simply a neurotransmitter imbalance in need of chemical replacement.
Depression has many roots – some circumstantial and some spiritual. But for many people, a major root cause of depression is a phenomenon now referred to as ‘brain-flammation, one focus of my latest book, The Adrenal Thyroid Revolution. If you haven’t gotten your copy yet, please do right here because clearing inflammation and supporting adrenal function is the name of the game even if you don’t think you have an adrenal or thyroid problem.
We have been taught, as a culture, that depression is a result of a deficiency in neurotransmitters – particularly serotonin and norepinephrine. But most of the theories that have been advanced about neurotransmitter deficiencies as the cause of depression have never been proven. What we do know is that study after study shows us that neuroinflammation is an underlying cause of depression and other emotional and mental health challenges – and that there really is no separation between the immune and nervous systems – and this includes as a root cause of depression.
You don't have a neurotransmitter deficiency. Understand brain-flammation and get to a root cause of depression. @avivaromm
Turmeric is a root, technically (properly called a rhizome), that when fresh doesn’t look too dissimilar to its cousin, ginger root. That is, until you cut it open and you see the bright yellow inside! Like ginger, contains ‘phytochemicals’ that reverse inflammation. Curcumin, which is one of the principal active ingredients derived from the spice turmeric, has particularly powerful anti-inflammatory effects and these have been found to be effective in treating depression.
Better than Prozac?
At least 4 high quality studies, plus a recent review of the literature on turmeric, demonstrate the effectiveness of curcumin, either alone or in combination with antidepressant medication or other botanicals, for the treatment of mild to moderate, atypical, and major depressive disorder; significant improvements in anxiety have found with curcumin use as well.
In one study, forty patients with a first episode of depression participated in a 5-week, double-blind, randomized, placebo-controlled study. The subjects were treated with either 500-mg/day curcumin or placebo together with antidepressants (escitalopram or venlafaxine). The results based on standard depression rating scales were significant positive changes in both groups throughout the length of the study. The changes became significant after 7 days of treatment. The patients in the curcumin group demonstrated a trend to a more rapid relief of depressive symptoms in comparison to those in the placebo + medication group. No adverse effects were reported.
In 2014, a randomized control study included three groups of 20 participants, all with major depression. Each group was given either Prozac, Prozac + 1g of oil-based curcumin, or curcumin alone for six weeks. The group on curcumin alone did just as well as the group on Prozac only – the combination group had the best outcomes, though there was not a major statistical difference among any of the three groups. This study demonstrated that curcumin was just as effective as Prozac, and that its use was quite safe even at a high dose of 12g daily. The researchers concluded that “This study provides first clinical evidence that curcumin may be used as an effective and safe modality for treatment in patients with MDD [major depressive disorder] without concurrent suicidal ideation or other psychotic disorders.”
Yet another 2014 study showed that curcumin also benefitted major depression disorder. A randomized, double-blind, placebo controlled study showed that 4-8 weeks of curcumin was as beneficial as placebo for treating “atypical depression” characterized by overeating, sleeping too much, and interpersonal sensitivity. This study concurred with a previous study that when used as a standalone treatment, curcumin can be beneficial for patients with mild or moderate depression.
In a recently published randomized, double-blind, placebo-controlled study, 123 individuals with major depressive disorder were allocated to one of four treatment groups: placebo, low-dose curcumin extract (250mg twice daily) high-dose curcumin extract (500mg twice daily.), or a combination of low-dose curcumin extract plus saffron (15mg twice daily) for 12 weeks. Standard depression rating scales were used to assess results. The combined treatments were associated with significantly greater improvements in depressive symptoms compared to placebo. Improvements were also seen in anxiety. No differences were found between the differing doses of curcumin or the curcumin/saffron combination.
How Does Curcumin Work?
To further clarify the antidepressant actions of curcumin and the underlying mechanism in depressed patients, two of the research groups conducting studies cited above decided to dig a little deeper by measuring blood, urine, and salivary levels of several different biomarkers of inflammation.
Supplementation with 1000 mg of curcumin twice daily for 6 weeks in one group, and 8 weeks in the other group were associate with decreases in inflammatory cytokines and salivary cortisol- as well as other findings that clearly demonstrated that curcumin supplementation influences several biomarkers that can lead to decreased depression.
Additionally, along with its anti-inflammatory effects, curcumin possesses adaptogen-like effects on the HPA Axis leading to cortisol regulation and stress modulation, neurotransmitter imbalances, modulation of mitochondrial function (improving cellular energy function), and reduction of oxidative stress – all of which exert a powerful antidepressant effect –even in those with major depression. The image below is from Lopresti AL. Curcumin for neuropsychiatric disorders: a review of in vitro, animal and human studies. J Psychopharmacol. 2017 Mar;31(3):287-302, and illustrates these many likely mechanisms of action.
Use and Safety
Curcumin is readily available and relatively absorbable. I use it in my practice in capsule form in doses ranging from 500 to 1,200 mg twice daily. If you are struggling with depression it is important to get appropriate medical care, and this article is information you can bring to your doctor’s attention. As several studies have demonstrated, it can be considered as a safe, effective first choice prior to starting a pharmaceutical, and it has been shown in studies to be safe in combination with an SSRI (antidepressant). If you are currently on medication, it is important to work with a skilled medical professional to wean off or discontinue that medication safely – this is something I do not recommend trying without proper supervision.
There haven’t been any studies on using it during pregnancy, and limited ‘test tube’ data suggests that it may alter DNA – so I don’t use it during pregnancy. It is reasonable to use while breastfeeding, however it important to make sure that new onset of depression in the postpartum period isn’t due to an underlying issue such as hypothyroidism.
If you don’t have depression but want to consider using turmeric (or curcumin) to just support yourself and prevent inflammation – or if you have depression in your family and you are concerned – then certainly 500 to 1000 mg daily of curcumin extract is very safe. You can also use a couple of teaspoons of turmeric powder in your cooking or in your smoothies.
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