The evidence may be weak, but in applied situations the common sense is strong.

by John McManamy


BEFORE we examine the brain, let's look at an adjacent organ - the eye. There are convincing studies, published in reputable journals such as JAMA, showing that various nutrients - in particular lutein (found in dark green leafy vegetables) significantly reduce the risk, or slow the progress, of age-related macular degeneration (AMD).

These studies are not necessarily conclusive, but why they are so convincing is that:

  1. They address a condition that everyone clearly understands (loss of vision in the center field).
  2. We know this condition's causes and effects (build-up of blood vessels supplying the retina in one form of the illness).
  3. We can identify a specific region of the anatomy (the macula in the retina).
  4. We know this region's function (high resolution vision).
  5. We can identify specific biochemical processes (such as cone cells processing light).
  6. We have linked a specific agent (lutein) to the macula.
  7. We see a clear link all the way down the chain from treatment (lutein) to structure (intact macula) to function (operating macula) to outcome (good vision, lower risk of AMD).

Now, let's switch from the eye to the brain, from AMD to depression. Yes, we have studies, but here's what we're up against:

  1. They attempt to address a condition that no one understands (feeling sad? loss of energy? irrational thinking?).
  2. We don't know this condition's causes and effects (environment? biology?).
  3. We can't identify a specific region of the anatomy (hippocampus? amygdala? anterior cingulate? cortices?)
  4. Even if we could identify a specific region (in all likelihood we are talking many regions), we are a long way from connecting function to the condition we are trying to fix).
  5. Our understanding of the specific biochemical processes is primitive (such as "chemical imbalance" involving serotonin or dopamine).
  6. We have not linked any specific agent to any region or any process.
  7. We cannot show any clear link all the way down the chain from treatment (with any agent) to structure (such as changes to specific brain regions) to function (such as an optimum anterior cingulate) to outcome (feeling good? more energy? rational thinking?).

Just to be clear, I have used these same arguments elsewhere to demonstrate that we have clear lack of evidence for using antidepressants to treat depression.

Here's where I'm going with this: Pharma has invested billions in clinical trials that have been rigged in every conceivable way to make antidepressants look good, and they have failed miserably. In hindsight, it's easy to see why:

They were testing for the wrong condition ("depression," as opposed to something more specific such as loss of energy or lack of motivation) on a wide population (anyone who was "depressed") with no understanding of the underlying biology or the environmental conditions that bring on "depression").

Thus, if you are skeptical of meds for psychiatric conditions, be equally skeptical of supplements for psychiatric conditions. No matter what you may hear - from any source - we have no credible evidence remotely approaching what lutein does for macular degeneration, nor are we likely to for decades to come.



Indeed, owing to "bio-individuality" we must exercise far greater skepticism. An example:

Low folate (vitamin B9) levels have been linked to depression. But only about 30 percent of the population have low folate levels. So - not knowing your folate levels - the odds are seven in ten against you of success with a folate supplement as an antidepressant. Probably much worse. Even if you did have low folate, it doesn't automatically follow that raising your levels will clear your depression, anyway.

So imagine a clinical trial where they test folate for depression (we've never had one). Would they weed out the high-folate people? Of course not. Thus, a trial doomed to fail from the very beginning. (The positive findings we have from folate and other supplements tend to come from after-the-fact number-crunching in very small studies.)

Is it a good idea to take a folate supplement, anyway? Of course. A folate supplement equates to spinach in a pill. We know this stuff is good for you.

Supplement Strategies

If you are looking for a supplement (or supplements) to treat your "depression," then, you are likely to be disappointed. You may get lucky, but you may be better off considering four different - but not necessarily exclusive - strategies, namely:

Getting tested for vitamin/nutrient deficiencies, then working with a nutritionist or other professional to change your diet and/or implement supplements to address these deficiencies. You are treating the deficiency (say for vitamin B6, which is involved in serotonin synthesis) rather than the "depression," per se, but if you address these deficiencies maybe you won't be talking about your depression.

There are standard lab tests, but these are not routine. Doctors tend to order them only when they suspect malnutrition. Don't be afraid to put in your request, even if you have to pay out-of-pocket.

Figuring out what is really going on with your "depression" (or other condition), then addressing these issues. For instance, if you are easilystressed or get anxious, you may want to consider something to help calm you down. If your batteries are run down, something to help boot you up is the obvious choice. (Two opposite symptoms obviously demanding opposite treatments.)




More issues: Messed up sleep? (Perhaps a natural sleep aid.) Difficultyconcentrating? (Maybe something that works on alertness or memory.)

Needless to say, there is no end of snake oil remedies out there (such as "energy" drinks spiked with sugar and caffeine). But at the same time, there is an impressive inventory of folk remedies for conditions such as anxiety (eg kava). Likewise, there is some credibility to supplements working to address specific issues. Caveat emptor.

Using supplements as a way of maintaining healthy brain function, such as taking antioxidants to prevent free radical damage to cells. This is analogous to maintaining a healthy body to reduce the risk of a whole range of physical diseases. For mental health, the scientific evidence is weak but the common sense is strong.

Using supplements as part of an integrated system of wellness. These include non-western approaches such as Chinese medicine and ayurvedic medicine, as well as alternative or complementary western approaches such as orthomolecular medicine, homeopathy, and naturopathy. Approaches to supplements and natural remedies may differ widely across these fields, but they are applied in the context of organized knowledge, each discipline with its own coherency.



Wrapping Up Supplements

You may think supplements are different than meds, but in the medicine cabinet they all look the same. Thus, as with meds:

If a bad relationship or toxic work situation is feeding your depression (or other condition), then a supplement at best will put you in a position to help you address it. Otherwise, you are inviting depression back in.

Like any med, a supplement will work a lot better if you have healthy lifestyle practices and recovery routines in place and don't tempt fate doing stupid things. Diet, exercise, sleep, mindfulness, support - you know the drill.

Even a very small improvement should be regarded as successful. Like meds, supplements are not magic bullets. You will be much happier with the result if you don't expect too much from them.

Reviewed July 5, 2016


Follow me on the road. Check out my New Heart, New Start blog.



Bipolar Stuff in the Shack with John and Maggie