Doctors, unsurprisingly, are skeptical, citing a lack of evidence to support the use of supplements for mental health conditions. Paul Blenkiron, Consultant Psychiatrist and Fellow of the Royal College of Psychiatrists, says: “I would never blame anyone for wanting to find a solution to their depression or anxiety, especially if nothing else has worked, but I would never recommend anything to a member of my family that didn’t work. It had been rigorously examined.
Their concern is that supplements are not required to undergo the same level of research as drugs, meaning you cannot be sure of the quality, purity, and quantity of the active ingredient. “So if you look at something like CBD [cannabidiol, a compound found in cannabis plants] supplements, it is by no means certain that the right amount is there to have an effect, even if there might be a benefit at a different concentration,” he says.
What’s more, we might think that “natural” means “safe,” but Dr. Blenkiron points out that’s not always true. “Botulinum toxin (from a bacterium) is used in cosmetic procedures, and digoxin (from the foxglove plant) is a treatment for heart problems,” he says. “Both are 100 percent natural. But in the wrong amounts and in the wrong hands they can be very dangerous.”
Other concerns arise around the lack of evidence that some of these products work. “Compared to other treatments, such as traditional medications or psychotherapy, supplements fall short,” says Carmine Pariante, professor of biological psychiatry at King’s College London.
While some may be harmless, others carry risks if taken in combination with other medications. St. John’s wort, for example, can make the birth control pill stop working.
“I work in complementary health, and if someone came to me with depression, I wouldn’t recommend supplements in the first place, and never as the only approach,” says Ian Marber, a nutritional therapist.
“First of all, it is not my purview – I would recommend that you talk to your GP first and seek their guidance. Second, the people who tell you about these products are, 99 percent of the time, the people who sell them, so often what we read about the potential of complementary nutrients comes from people with a vested interest. .
“I’m not cynical about these things, I know their potential, but unless people go to a responsible complementary doctor, they have no way of measuring the outcome. We need someone to agree when to finish with [a supplement]; agree when to review. At the moment, too often they are self-prescribed and people take some supplements ‘just in case’.”
Marber suggests that some degree of certainty is needed. “If you have a headache and you take ibuprofen… we know what dose to take to affect an outcome that we can predict or want. Natural products do not always have that benefit. The optimal dose cannot necessarily be established, because there are other things at play, such as diet, physiology, medical history, etc.
No universal remedies
Medical herbalist Pamela Spence agrees that such supplements should be taken under expert supervision. “I absolutely see herbs changing people’s moods and turning depression from mild to moderate,” she says. “But one size doesn’t fit all; all of our lifestyles are different.
“St. John’s wort, for example, is a helpful herb for mild to moderate depression, but it’s not right for everyone. I have come across a couple of people who felt terrible after taking it, while others swear by it.
“If your depression is related to a hormonal imbalance, then that is what needs to be treated. You have to understand what is going on in the body to cause the symptom. You need to ask, ‘What is my lifestyle like right now? What’s my diet like?’”
It also suggests that there’s a reason why, anecdotally, people trust herbal remedies, but scientific support for their efficacy may be weak: Laboratories often test only one chemical at a time (for example, the curcumin in turmeric), while many plants are better when used as a whole.
However, Spence still urges caution. “I wouldn’t use herbs to treat major depression,” she says. “I think it’s a place where pharmaceuticals work much better.”
Pariante and Blenkiron agree with Spence that by self-diagnosing and treating anxiety or depression with over-the-counter remedies, people may be missing an underlying health condition, such as hormonal or thyroid problems or another chronic illness.
They also share concerns about the cost of some of these supplements. “I’ve come across people buying CBD oil for hundreds of pounds,” says Spence. “It shouldn’t cost that much.”
Blenkiron agrees. “We used to have various charms and ways to ward off evil spirits,” he says. “We do the exact same thing these days by going to Boots or Holland & Barrett. Looking at what’s on the shelf, many supplements will include a strong placebo effect.”
The power of placebos
Some experts believe that the only reason people report feeling better after taking vitamin supplements is because of their expectations: if a person expects a pill to do something, then it’s possible that the body’s own chemistry could cause effects similar to those that you expect to happen.
For example, in one study people were given a placebo and told it was a stimulant. After taking the pill, her pulse quickened, her blood pressure increased, and her reaction speed improved. When people were given the same pill and told it was to help them fall asleep, they experienced the opposite effects.
In another study, published in the journal Psychosomatic Medicine, 40 asthmatics were given an inhaler containing a placebo that was just water vapor, but told it contained allergens that would constrict their airways. Nineteen suffered significant airway constriction, while 12 of them experienced a full-blown asthma attack. When they were given a different inhaler and told it would relieve their symptoms, it did, even though it was also a placebo.
“Some people think there is a genuine biological effect on the brain and immune system, but we don’t know exactly why,” says Blenkiron. “And interestingly, even if people know they’re being given a placebo, it can help.”
Beyond laboratory conditions, there are many other reasons a supplement might help, even if the active ingredient is unproven. “Sometimes the person gets better naturally anyway,” says Blenkiron. “Or it could be that if you expect something to improve you, you change your behavior in other ways. So if you think a supplement will make you feel more energetic, you might hit the gym more.
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