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Depression (Mild to Moderate)

Depression is a mental illness. People with it have feelings of sadness and lack of interest in activities. It is a lasting low mood that gets in the way of everyday life. Depression can cause a wide range of symptoms that are physical and emotional. It can last for weeks, months, or years.

Medicine and therapy can help to manage depression. Natural therapies may help to ease symptoms when used with standard care.

Natural Therapies

Therapies that are likely to be effective are:

Likely Effective

  • Mindfulness-based therapies focus on paying attention to thoughts and feelings in the present without judging them K1-K5
  • Music therapy J1-J5

Herbs and supplements that are likely to be effective are:

  • Curcumin (turmeric) is the bright yellow compound in turmeric N1-N5
  • Omega-3 polyunsaturated fatty acids are a major component of fish oil and also found in egg yolksH1
  • Saffron is a spice from the Crocus sativus flowerZ1-Z14
  • Vitamin D is a nutrient food in some foods that helps with bone strength E1, E2
  • Zinc is a nutrient found in cells in the body M1-M6

May Be Effective

Therapies that may be effective are:

  • Acupuncture inserts thin needles into points of the body to promote health A1
  • Massage therapy is the use of touch to ease health problems I1, I2
  • Yoga is the use of breath control, meditation, and poses L1

Herbs and supplements that may be effective are:

  • 5-HTP is a chemical made by the body Y1, Y2
  • B vitamins help the body make energy from foods G1
  • Black cohosh is a plant in the buttercup family R1
  • Chamomile is an herb S1
  • Chasteberry is the fruit of the chaste tree T1
  • Echium is a flowering plant W1
  • Folate is a B-vitamin present in foods B1-B4
  • Galphimia is an herb Q1
  • Kava is a tropical evergreen shrub O1
  • Lavender is a flowering plant in the mint family U1, U2
  • Passionflower is a climbing vine P1, P2
  • Rhodiola rosea is a flowering plant X1
  • S-Adenosylmethionine (SAMe) is a chemical found naturally in the body. ( Note : SAMe should not be taken by people who have bipolar disorder as it may worsen symptoms. It may also interact with drugs and supplements that increase serotonin.)D1-D3
  • St. John's Wort is a supplement made from a plant. ( Note : St. John’s wort is not regulated in the United States. Major organizations advise against routine use because it may cause serious reactions.)C1-C5

Not Enough Data to Assess

Diet and nutritional supplements for perinatal depression.V1

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Herbs and Supplements to Be Used With Caution

Talk with your doctor about all herbs or supplements that you are taking. Some may cause problems with your treatment plan or other health problems, such as:

  • Omega-3 fatty acids may cause problems for people who take blood thinners and those with diabetes.
  • SAMe should not be taken by people who have bipolar disorder. It may also interact with drugs and supplements that increase serotonin.
  • St. John’s wort can cause death when combined with some antidepressants. It may also weaken effects of some medicine, such as antidepressants and birth control pills.
 

References

Acupuncture

A1. Smith CA, Armour M, et al. Acupuncture for depression. Cochrane Database Syst Rev. 2018 Mar 4;3:CD004046.

Folate

B1. Taylor MJ, Carney S, et al. Folate for depressive disorders. Cochrane Database Syst Rev. 2003;(2).

B2. Venkatasubramanian R, Kumar CN, et al. A randomized double-blind comparison of fluoxetine augmentation by high and low dosage folic acid in patients with depressive episodes. J Affect Disord. 2013 Sep 5;150(2):644-648.

B3. Bedson E, Bell D, et al. Folate augmentation of treatment—evaluation for depression (FolATED): randomized trial and economic evaluation. Health Technol Assess. 2014 Jul;18(48):vii-viii, 1-159.

B4. Sarris J, Murphy J, et al. Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses. Am J Psychiatry. 2016 Jun 1;173(6):575-87.

St. John’s Wort

C1. Linde K, Berner MM, et al. St John's wort for major depression. Cochrane Database Syst Rev. 2008;CD000448.

C2. Carpenter DJ. St. John’s wort and S-adenosyl methionine as “natural” alternatives to conventional antidepressants in the era of the suicidality boxed warning: what is the evidence for clinically relevant benefit? Altern Med Rev. 2011 Mar;16(1):17-39.

C3. Kasper S, Volz HP, et al. Continuation and long-term maintenance treatment with Hypericum extract WS 5570 after recovery from an acute episode of moderate depression—a double-blind, randomized, placebo controlled long-term trial. Eur Neuropsychopharmacol. 2008 Nov;18(11):803-813.

C4. Singer A, Schmidt M, et al. Duration of response after treatment of mild to moderate depression with Hypericum extract STW 3-VI, citalopram and placebo: a reanalysis of data from a controlled clinical trial. Phytomedicine. 2011;18(8-9):739-742.

C5. Sarris J. Herbal medicines in the treatment of psychiatric disorders: 10-year updated review. Phytother Res. 2018 Jul;32(7):1147-1162.

S-adenosyl methionine (SAMe)

D1. Papakostas GI, Mischoulon D, et al. S-adenosyl methionine (SAMe) augmentation of serotonin reuptake inhibitors for antidepressant nonresponders with major depressive disorder: a double-blind, randomized clinical trial. Am J Psychiatry. 2010 Aug;167(8):942-948.

D2. Carpenter DJ. St. John’s wort and S-adenosyl methionine as “natural” alternatives to conventional antidepressants in the era of the suicidality boxed warning: what is the evidence for clinically relevant benefit? Altern Med Rev. 2011 Mar;16(1):17-39.

D3. Sarris J, Murphy J, et al. Adjunctive nutraceuticals for depression: a systematic review and meta-analyses. Am J Psychiatry. 2016 Jun 1;173(6):575-587.

Vitamin D

E1. Li G, Mbuagbaw L, et al. Efficacy of vitamin D supplementation in depression in adults: a systematic review. J Clin Endocrinol Metab. 2014 Mar;99(3):757-767.

E2. Sarris J, Murphy J, et al. Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses. Am J Psychiatry. 2016 Jun 1;173(6):575-87.

Chinese Herbal Medicine

F1. Yeung WF, Chung KF, et al. A systematic review on the efficacy, safety, and types of Chinese herbal medicine for depression. J Psychiatr Res. 2014 Oct;57:165-175.

B Vitamins

G1. Almeida OP, Ford AH. B vitamins to enhance treatment response to antidepressants in middle-aged and older adults: results from the B-VITAGE randomized, double-blind, placebo-controlled trial. Br J Psychiatry. 2014 Dec;205(6):450-457.

Omega3 Fatty Acids

H1. Appleton KM, Sallis HM, et al. Omega-3 fatty acids for depression in adults. Cochrane Database Syst Rev. 2015 Nov 5(11). Sarris J, Murphy J, et al. Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses. Am J Psychiatry. 2016 Jun 1;173(6):575-87.

Massage Therapy

I1. Coelho HF, Boddy K, et al. Massage therapy for the treatment of depression: a systematic review. Int J Clin Pract. 2008;62:325-333.

I2. Hou WH, Chiang PT, et al. Treatment effects of massage therapy in depressed people: a meta-analysis. J Clin Psychiatry. 2010 Jul;71(7):894-901.

Music Therapy

J1. Gold C, Solli HP, et al. Dose-response relationship in music therapy for people with serious mental disorders: systematic review and meta-analysis. Clin Psychol Rev. 2009 Apr;29(3):193-207.

J2. Erkkila J, Punkanen M, et al. Individual music therapy for depression: randomised controlled trial. Br J Psychiatry. 2011 Aug;199(2):132-139.

J3. Chan MF, Wong ZY, et al. The effectiveness of music listening in reducing depressive symptoms in adults: a systematic review. Complement Ther Med. 2011 Dec;19(6):332-348.

J4. Chan MF, Wong ZY, et al. Effects of music on depression in older people: a randomised controlled trial. J Clin Nurs. 2012 Mar;21(5-6):776-783.

J5. Aalbers S, Fusar-Poli L, et al. Music therapy for depression. Cochrane Database Syst Rev. 2017 Nov 16;11:CD004517.

Mindfulness

K1. Britton WB, Haynes PL, et al. Polysomnographic and subjective profiles of sleep continuity before and after mindfulness-based cognitive therapy in partially remitted depression. Psychosom Med. 2010 Jul;72(6):529-548.

K2. Klainin-Yobas P, Cho MA, et al. Efficacy of mindfulness-based interventions on depressive symptoms among people with mental disorders: a meta-analysis. Int J Nurs Stud. 2012 Jan;49(1`):109-121.

K3. Strauss C, Cavanagh K, et al. Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomized controlled trials. PLoS One. 2014 Apr 24;9(4):e96110.

K4. Sundguist J, Lilja A, et al. Mindfulness group therapy in primary care patients with depression, anxiety and stress and adjustment disorders: randomised controlled trial. Br J Psychiatry. 2015 Feb206(2):128-135.

K5. Biegel GM, Brown KW, et al. Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: a randomized clinical trial. J Consult Clin Psychol. 2009 Oct;77(5):855-866.

Yoga

L1. Cramer H, Lauche R, et al. Yoga for depression: a systematic review and meta-analysis. Depress Anxiety. 2013 Nov;30(11):1068-1083.

Zinc

M1. Li Z, Li B, et al. Dietary zinc and iron intake and risk of depression: A meta-analysis. Psychiatry Res. 2017 May;251:41-47.

M2. Salari S, Khomand P, et al. Zinc sulphate: A reasonable choice for depression management in patients with multiple sclerosis: A randomized, double-blind, placebo-controlled clinical trial. Pharmacol Rep. 2015 Jun;67(3):606-609.

M3. Ranjbar E, Shams J, et al. Effects of zinc supplementation on efficacy of antidepressant therapy, inflammatory cytokines, and brain-derived neurotrophic factor in patients with major depression. Nutr Neurosci. 2014 Feb;17(2):65-71.

M4. Lai J, Moxey A, et al. The efficacy of zinc supplementation in depression: systematic review of randomised controlled trials. J Affect Disord. 2012 Jan;136(1-2):e31-e39.

M5. Sarris J, Murphy J, et al. Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses. Am J Psychiatry. 2016 Jun 1;173(6):575-587.

M6. Sparling TM, Henschke N, et al. The role of diet and nutritional supplementation in perinatal depression: a systematic review. Matern Child Nutr. 2017 Jan;13(1).

Curcumin

N1. Lopresti AL, Drummond PD. Efficacy of curcumin, and a saffron/curcumin combination for the treatment of major depression: A randomised, double-blind, placebo-controlled study. J Affect Disord. 2017 Jan 1;207:188-196.

N2. Al-Karawi D, Al Mamoori DA, et al. The Role of Curcumin Administration in Patients with Major Depressive Disorder: Mini Meta-Analysis of Clinical Trials. Phytother Res. 2016 Feb;30(2):175-183.

N3. Lopresti AL, Maes M, et al. Curcumin for the treatment of major depression: a randomised, double-blind, placebo controlled study. J Affect Disord. 2014;167:368-375.

N4. Sanmukhani J, Satodia V, et al. Efficacy and safety of curcumin in major depressive disorder: a randomized controlled trial. Phytother Res. 2014 Apr;28(4):579-585.

N5. Sarris J. Herbal medicines in the treatment of psychiatric disorders: 10-year updated review. Phytother Res. 2018 Jul;32(7):1147-1162.

Kava

O1. Sarris J. Herbal medicines in the treatment of psychiatric disorders: 10-year updated review. Phytother Res. 2018 Jul;32(7):1147-1162.

Passionflower

P1. Sarris J. Herbal medicines in the treatment of psychiatric disorders: 10-year updated review. Phytother Res. 2018 Jul;32(7):1147-1162.

P2. Yeung KS, Hernandez M, et al. Herbal medicine for depression and anxiety: A systematic review with assessment of potential psycho-oncologic relevance. Phytother Res. 2018 May;32(5):865-891.

Galphimia

Q1. Sarris J. Herbal medicines in the treatment of psychiatric disorders: 10-year updated review. Phytother Res. 2018 Jul;32(7):1147-1162.

Black Cohosh

R1. Yeung KS, Hernandez M, et al. Herbal medicine for depression and anxiety: A systematic review with assessment of potential psycho-oncologic relevance. Phytother Res. 2018 May;32(5):865-891.

Chamomile

S1. Yeung KS, Hernandez M, et al. Herbal medicine for depression and anxiety: A systematic review with assessment of potential psycho-oncologic relevance. Phytother Res. 2018 May;32(5):865-891.

Chasteberry

T1. Yeung KS, Hernandez M, et al. Herbal medicine for depression and anxiety: A systematic review with assessment of potential psycho-oncologic relevance. Phytother Res. 2018 May;32(5):865-891.

Lavender

U1. Yeung KS, Hernandez M, et al. Herbal medicine for depression and anxiety: A systematic review with assessment of potential psycho-oncologic relevance. Phytother Res. 2018 May;32(5):865-891.

U2. Dwyer AV, Whitten DL, et al. Herbal medicines, other than St. John's Wort, in the treatment of depression: a systematic review. Altern Med Rev. 2011 Mar;16(1):40-49.

Diet and Nutritional Supplements

V1. Sparling TM, Henschke N, et al. The role of diet and nutritional supplementation in perinatal depression: a systematic review. Matern Child Nutr. 2017 Jan;13(1).

Echium

W1. Dwyer AV, Whitten DL, et al. Herbal medicines, other than St. John's Wort, in the treatment of depression: a systematic review. Altern Med Rev. 2011 Mar;16(1):40-49.

Rhodiola

X1. Dwyer AV, Whitten DL, et al. Herbal medicines, other than St. John's Wort, in the treatment of depression: a systematic review. Altern Med Rev. 2011 Mar;16(1):40-49.

5-HTP

Y1. Shaw K, Turner J, et al. Tryptophan and 5-hydroxytryptophan for depression. Cochrane Database Syst Rev. 2002;(1):CD003198.

Y2. Jangid P, Malik P, et al. Comparative study of efficacy of l-5-hydroxytryptophan and fluoxetine in patients presenting with first depressive episode. Asian J Psychiatr. 2013 Feb;6(1):29-34.

Saffron

Z1. Lopresti AL, Drummond PD, et al. affron(®), a standardised extract from saffron (Crocus sativus L.) for the treatment of youth anxiety and depressive symptoms: A randomised, double-blind, placebo-controlled study. J Affect Disord. 2018 May;232:349-357.

Z2. Kashani L, Esalatmanesh S, et al. Efficacy of Crocus sativus (saffron) in treatment of major depressive disorder associated with post-menopausal hot flashes: a double-blind, randomized, placebo-controlled trial. Arch Gynecol Obstet. 2018 Mar;297(3):717-724.

Z3. Tabeshpour J, Sobhani F, et al. A double-blind, randomized, placebo-controlled trial of saffron stigma (Crocus sativus L.) in mothers suffering from mild-to-moderate postpartum depression. Phytomedicine. 2017 Dec 1;36:145-152.

Z4. Lopresti AL, Drummond PD. Efficacy of curcumin, and a saffron/curcumin combination for the treatment of major depression: A randomised, double-blind, placebo-controlled study. J Affect Disord. 2017 Jan 1;207:188-196.

Z5. Ghajar A, Neishabouri SM, et al. Crocus sativus L. versus Citalopram in the Treatment of Major Depressive Disorder with Anxious Distress: A Double-Blind, Controlled Clinical Trial. Pharmacopsychiatry. 2017 Jul;50(4):152-160.

Z6. Kashani L, Eslatmanesh S, et al. Comparison of Saffron versus Fluoxetine in Treatment of Mild to Moderate Postpartum Depression: A Double-Blind, Randomized Clinical Trial. Pharmacopsychiatry. 2017 Mar;50(2):64-68.

Z7. Mazidi M, Shemshian M, et al. A double-blind, randomized and placebo-controlled trial of Saffron (Crocus sativus L.) in the treatment of anxiety and depression. J Complement Integr Med. 2016 Jun 1;13(2):195-199.

Z8. Dwyer AV, Whitten DL, et al. Herbal medicines, other than St. John's Wort, in the treatment of depression: a systematic review. Altern Med Rev. 2011 Mar;16(1):40-49.

Z9. Hausenblas HA, Heekin K, et al. A systematic review of randomized controlled trials examining the effectiveness of saffron (Crocus sativus L.) on psychological and behavioral outcomes. J Integr Med. 2015 Jul;13(4):231-240.

Z10. Talaei A, Hassanpour Moghadam M, et al. Crocin, the main active saffron constituent, as an adjunctive treatment in major depressive disorder: a randomized, double-blind, placebo-controlled, pilot clinical trial. J Affect Disord. 2015 Mar 15;174:51-56.

Z11. Yeung KS, Hernandez M, et al. Herbal medicine for depression and anxiety: A systematic review with assessment of potential psycho-oncologic relevance. Phytother Res. 2018 May;32(5):865-891.

Z12. Shahmansouri N, Farokhnia M, et al. A randomized, double-blind, clinical trial comparing the efficacy and safety of Crocus Sativus L. with fluoxetine for improving mild to moderate depression in post percutaneous coronary intervention patients. J Affect Disord. 2014 Feb;155:216-222.

Z13. Sarris J. Herbal medicines in the treatment of psychiatric disorders: 10-year updated review. Phytother Res. 2018 Jul;32(7):1147-1162.

Z14. Tóth B, Hegyi P, et al. The Efficacy of Saffron in the Treatment of Mild to Moderate Depression: A Meta-analysis. Planta Med. 2019 Jan;85(1):24-31.

Last reviewed February 2020 by EBSCO NAT Review Board Eric Hurwitz, DC  Last Updated: 11/13/2020