Supplements should not replace depression and anxiety treatment

John’s wort “promotes a positive mood”. Valerian root reduces “anxiety and stress levels”. Lavender oil is “soothing to body and mind”.

If you’re among the tens of millions of people who suffer from depression or anxiety, it’s easy to be lured by the promise of mood-enhancing supplements. Take these pills daily, the marketing suggests, and soon you’ll be bouncing blissfully through lush, sunny fields, no prescription needed.

While experts say that some mood-enhancing supplements are better studied than others, the broader evidence about their effectiveness is shaky at best.

“I’m not saying there’s evidence that these things aren’t helpful,” said Dr. Gerard Sanacora, professor of psychiatry at the Yale School of Medicine and director of the Depression Research Program at Yale in the United States. It’s more that “the quality of evidence is not at a level we can really trust”.

When compared to other treatments, such as traditional medications or psychotherapy, experts said, supplements fall short. Here’s what we know about some of the most common supplements marketed for mental health.

John’s wort, omega-3 fatty acids, l-methylfolate, s-adenosylmethionine (SAMe) and n-acetylcysteine ​​(NAC) are among the most common supplements used to treat symptoms of depression. But some have more research to back them up than others.

John’s Wort

This flowering plant is among the best-studied supplements as a treatment for depression, but not all studies suggest benefits.

“Actually, there’s been a fair amount of work done with St. John’s wort over the years,” Sanacora said. “But it’s still not the high-quality evidence you’d see for a drug approved by the Food and Drug Administration. [FDA, na sigla em inglês].”

An analysis of 35 studies in 2016 that included about 7,000 people, for example, found that St John’s wort was better than a placebo at helping people with mild to moderate depression; a 2008 review came to similar conclusions. However, two carefully conducted studies published in 2001 and 2002 found no evidence of benefit.

That’s why health experts – including at the National Institute of Health – advise people not to use St. John’s wort instead of conventional treatments. Experts also advise caution when taking it because of the potential for adverse interactions with other medications.

omega-3 fatty acids

Supplements for these essential fats have some — albeit limited — evidence indicating they help with mild to moderate depression.

“So far, the data suggest the treatment may have small to modest benefits, but this is far from a definitive finding,” Sanacora said, adding, “I wouldn’t say the evidence for these studies is high quality.”

A 2015 analysis of more than two dozen studies, for example, concluded that even if omega-3 supplements did help with depression, the benefit might not be large enough to be significant.

Dr Dan Iosifescu, an associate professor of psychiatry at New York University’s Grossman School of Medicine, agreed. “It’s very mixed data, and some studies don’t see much benefit,” he said. “The data is somewhat controversial.”

L-methylfolate

This metabolically active form of folate, an essential B vitamin, has some evidence to support its use for depression, according to Sanacora, but overall data are conflicting and fall short of the quality of evidence supporting approved drugs. And it may only be useful for specific people, particularly those who have trouble metabolizing or using folate properly in the body, he said.

The Doctor. Sanacora also noted that the existing evidence was primarily for l-methylfolate taken in combination with standard antidepressants, not as a supplement taken alone, so people should not rely on using the supplement alone for treatment.

All others

Evidence for benefits from other supplements in treating depression is also not entirely reliable, Sanacora said. He and other experts said there have been studies of SAMe and NAC supplements, but “there is no solid data to support their use.”

“And even for the best the data is questionable,” Sanacora said.

supplements for anxiety

The main supplements used against anxiety — including lavender, kava and valerian root — have even less evidence than those for depression and lack strong, high-quality research, at least as far as experts knew.

“That doesn’t mean they aren’t effective,” said Dr. Sanacora. “There just hasn’t been the rigorous research that is normally done for drugs that claim FDA indications.”

The Doctor. Iosifescu said he thinks kava has moderate evidence of benefit; however, he warned that she may have a rare but serious risk of liver toxicity.

Have a problem trying it out?

Some might think taking a supplement for depression or anxiety wouldn’t hurt, so why not give it a try? But experts warned that there could be potential risks and downsides.

Supplements can be expensive and can cause side effects or adverse drug interactions. And supplements aren’t as tightly regulated as US agency-approved and over-the-counter drugs, and don’t need to be proven safe and effective before they’re sold.

“There’s not as much oversight compared to traditional pharmaceuticals, which require pills to be manufactured consistently, with consistent dosage,” said Paul Nestadt, co-director of the Anxiety Disorders Clinic at Johns Hopkins University and assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine.

Megan Olsen, general counsel for the Council on Responsible Nutrition, a supplement industry trade association, wrote in a statement to The New York Times that supplement companies were allowed to make health-related claims about the “effect of their products on the structure or body function” and that these claims must be supported by evidence.

But Dr. Pieter Cohen, an associate professor at Harvard Medical School, said supplement companies are rarely held accountable for certain health claims associated with their products. As long as the manufacturer doesn’t claim the product will treat or cure a specific disease, “he can say whatever he wants,” explained Cohen.

Another potential risk of supplements is paradoxical: they can exacerbate a mental health condition. Nestadt said there is some evidence, for example, that St. John’s wort could induce a manic episode in people with bipolar disorder.

Perhaps one of the biggest risks is that people might take a supplement instead of seeking a proven treatment for anxiety or depression.

“I’m not that worried about anyone trying lavender or chamomile,” Sanacora said. “I’m much more concerned about the risks associated with delaying effective treatment.”

If depression or anxiety is severe, experts say, supplements are unlikely to help, and a person should consult a qualified professional. In fact, experts recommend consulting a healthcare professional before taking any supplement, regardless of what it is intended to treat.

Which treatments really work?

Traditional medications and psychotherapy, including antidepressants and cognitive behavioral therapy, have the highest-quality evidence of benefit for anxiety and depression, experts said.

They also mentioned treatments such as transcranial magnetic stimulation, a non-invasive technique that stimulates a certain area of ​​the brain with magnetic pulses; the FDA has approved this treatment for depression and obsessive-compulsive disorder.

Physical exercise can also be beneficial, experts said. While there is not as much high-quality evidence as the other approaches, Dr. Sanacora said there is still very good data on its effectiveness for mild to moderate anxiety and depression. And, he added, unlike supplements, exercise is free. “It’s always a balance between what’s practical and sustainable versus the evidence.”

Translated by Luiz Roberto M. Gonçalves