What You Need to Know about Dietary Supplements

Safety First
The most important thing to remember when thinking about herbal supplements is that just because something is “natural” does not mean it is safe or can be taken without risk. Herbal supplements can interact with medications and cause serious medical problems. They may also cause problems if they are taken in large amounts or mixed with prescriptions or other over-the-counter products. 

People who should use extra caution or completely avoid taking herbal supplements include:

• Women who are pregnant or nursing

• Women taking birth control pills

• People with kidney, liver or heart problems or certain other medical conditions 

• People with HIV infection

• People taking prescription or over the counter medications 

• Children 

• People who have had organ transplants

Are supplements regulated like medications?
No. Supplements are regulated by the Food and Drug Administration as food products rather than drugs. Therefore they do not have to meet the same standards as prescription and over-the-counter medications for proof of safety, effectiveness, or dosage.

Published studies of supplements have found inconsistencies in labeling. Some herbal supplements may contain different amounts of the active ingredients than stated on the label. They may also contain harmful additives or contamination. Supplement labels might refer to the product’s quality being “standardized,” “certified,” or “verified.” There is no legal definition for these terms so they may not guarantee quality.

Just as you would not take a medication without first consulting your doctor, do not try any supplement before discussing it with your doctor.

Omega-3 Fatty Acids
Omega-3 fatty acid supplements, which occur naturally throughout the body, are currently being studied to determine their effectiveness in treating depression and bipolar disorder.  These oils, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) can be found in shellfish, sardines, albacore tuna, salmon, canola oil, soybeans, flaxseed, walnuts, and wheat germ. They are also available in pill form.

Omega-3 fatty acids have been shown to improve heart health, immune function and a variety of other conditions in some studies. In some trials of people with depression or bipolar disorder, many people improved substantially on high doses of Omega-3 oils. As with any treatment, it’s important to discuss it in detail with your doctor and take the supplements under his or her supervision. 

Mild gastrointestinal discomfort is the side effect most reported by people taking Omega-3.

Herbal Supplements
Herbal supplements are dietary additives made from plants. They have been marketed for treating illnesses, including depression. However, not much research has been done to confirm their effectiveness. Two herbal supplements generally used for depression are St. John’s wort and SAM-e.

St. John’s wort
One of the most widely recognized herbal supplement for depression is St. John’s wort (Hypericum perforatum). This plant and its flowers contain many chemical compounds, some of which are believed to be beneficial in treating depression.

It is not known how these compounds work in the body. One theory is that it may prevent nerve cells in the brain from reabsorbing the brain chemical serotonin, similar to the affect of some prescription medications, thereby relieving depression.

St. John’s wort is prescribed in some European countries for depression, although it is not available by prescription in the US. Some studies have shown it to be effective in treating mild to moderate depression. In studies involving people with severe depression, St. John’s wort has had little or no effect.

Common side effects of St. John’s wort are dry mouth, dizziness, diarrhea, nausea, fatigue and increased sensitivity to light. It can also interact with other medications, including birth control pills, and affect the way the body gets rid of or metabolizes them.

SAM-e
S-Adenosyl-L-Methionine (SAM-e) was introduced to the United States in 1999, but has been widely used in some European countries for the treatment of arthritis and depression.

SAM-e is a naturally occurring and essential substance in the human body. It is most concentrated in the liver and brain and plays an important part in regulating serotonin and dopamine, two chemicals which influence mood.

Some studies examining the effectiveness of SAM-e for the treatment of depression have found it to be more effective than a placebo (sugar pill) in relieving depressive symptoms. However, compared with prescription medications commonly used to treat depression, SAM-e yielded no better results.  Another study involved patients with major depression who took SAM-e in addition to their prescribed antidepressants. Half of these patients showed some improvement and nearly half went into remission, no longer experiencing substantial symptoms.

Common side effects associated with SAM-e include nausea and constipation.

Production of this information made possible by an educational grant from Neuronetics.