Clients often ask me about natural remedies and alternatives to antidepressant medications as they are troubled by possible side effects. The hope is that a "natural" remedy or supplement will have no side effects and be totally safe. While psychological therapy is the obvious alternative, there are a range of supplements that have been found to assist with depression that you can discuss with your GP. Two common ones are St John’s Wort (see this) and Omega-3 supplements like Fish Oil (see this). However, it is important to be aware that supplements, like medications, can all have side-effects (note the side-effects for these two supplements mentioned in the links). They can also cause allergic reactions or interact with other medications or natural remedies. Just because a product is “natural” or occurs in a food, does not mean that in a supplement form it is safe.
Many medications and supplements have only demonstrated safety or effectiveness in short-term studies, often with animals. This does not mean that long term use in humans is safe. Don’t get me wrong – I am all for natural alternatives to medications and have spent many hours looking for natural remedies for my own health issues. This is when I became aware of how hard it is for the average person to work out safety of supplements. At least I was able to apply my years of training to both finding relevant studies and evaluating the research I found. Alternative health professionals gave me conflicting information and were often not aware of the risks of some supplements that my research uncovered. It left me wondering if it was better to take a medication with known risks of X, Y and Z, than a natural remedy with no good research on long term side-effects.
Some advantages of medications
While I would prefer to take a natural remedy, there are some advantages to conventional medications. All medications have to go through controlled research trials that demonstrate effectiveness before they can go to market. Research is often ongoing and may reveal side-effects from long term use that then lead to the product being withdrawn from the market (as happened with the arthritis drug Vioxx). With the list of side-effects that pharmaceutical companies are required to provide with their product, patients can do a risk benefit analyses of taking the product with their GP. Interactions with other drugs can also be looked at. Also, with medications, the exact dose of the drug has to be standardised so you know how much you are taking in each tablet.
Some disadvantages of natural remedies
Supplements, on the other hand, are not required to go through the same rigorous testing and standardisation before they go to market and before claims can be made about their benefits. A lot of information about benefits of natural remedies is “anecdotal” which means that testimonials (i.e John Smith says “this really helped me”) are provided by the seller of the supplement to demonstrate their effectiveness. It is assumed that because they are “natural”, or can be bought without a prescription, and can be found in food, they are safe. But research has found that food constituents that may be safe in the diet, can increase the risk of developing certain medical conditions (e.g. cancer, heart disease, liver damage) when taken as supplements. Beta-carotene (an antioxidant found in a range of food sources) noni juice and curcumin are a few examples of this.
Quality of natural remedies?
Another thing to keep in mind is, unlike with medications, the manufacturing of supplements is not always standardised. This means that different brands (and even different lots of the same brand) may have different doses and quality of the constituents. So how well they work, and side-effects may vary and the form you are buying may differ from the form you have found good research on. So you do not always know how good your supplement is if you buy off the shelf. As a guide, higher quality and dose forms are often “practitioner only” (only accessible by seeing a health practitioner) and kept behind the counter of health food stores.
More research on natural remedies needed
Hopefully, as the use of supplements becomes more popular, the government will require higher standards of research to demonstrate efficacy and long term safety before they go to market. A requirement should be that side-effects be listed with the product so we can all make an informed choice about what we take – whether it be medication or supplements. On the positive side, more information is becoming available about risks and interactions of herbal supplements with medications and if you are taking herbal supplements, you should mention this to your GP.
Resource to check out your supplements
If you are looking at taking a vitamin or supplement for any health issue, a good website to help you check out the benefits, risks, side-effects and interactions of what you might be taking is here.