Sam-E, Ashwagandha, etc: Supplements that help depression/anxiety?
September 2, 2015 12:44 PM   Subscribe

I suffer from anxiety, anhedonia and depression. I just had to wean off of yet another AD, and am tired of searching a medication that treats my symptoms with minimal side effects. My therapist suggested looking into Sam-e and ashwagandha in the meantime, and my psych doc said it would be worth a try. Has anyone had success with supplements such as Sam-E? What did you take, and did you notice a difference? I'm trying to sort through what is scientifically-backed and what is woo. Anecdata is welcome as well.

I'll give a quick summary of what I'm going through and what I've tried/am trying for my depression/anxiety:

I am a dude. I have a therapist, practice meditation, and try my best to exercise and eat well. I'm not sure I'm giving the therapy a fair shake at the moment due to issues with motivation.

I'm plagued by countless "I've ruined my life" and "what's the point of trying" thoughts; these are somewhat mitigated by the meditation and the coping techniques I learned in therapy. I see the worst in myself and others, and have a hard time trusting people. I ruminate on both my mistakes and my memories of being bullied as a teen. I also have pretty severe social anxiety and (sometimes) generalized anxiety. My worst symptom, however, is probably anhedonia - I don't get as much pleasure from activities I once found to be acutely enjoyable, such as piano, reading, and listening to music.

I've gone through a fair number of anti-depressants, including Zoloft, Lexapro, Cymbalta and Wellbutrin. The SSRI/SNRIs worked wonders for my anxiety, but destroyed my libido. The Wellbutrin really helped the anhedonia (I got s*** done! I enjoyed playing piano again! Friends were awesome!), but gave me severe muscle tension. My current medications are Lamictal and Buspar. The Lamictal in particular keeps my mood from spiraling too deep into the nether, but I've still got issues, chief among them being the anhedonia, anxiety, and rumination.

I'd like to try some alternatives to medication, and am willing to give my therapist's supplements a try. I'm looking into the Sam-E, and will probably order some off Amazon. The other supplement my therapist recommended (ashwagandha) looks promising, but I can only find a few studies in minor scientific journals demonstrating its efficacy. The reviews on amazon are great, but I wonder how many were written by naturopaths or those swayed by the placebo effect.

Has anyone had any success with these kinds of supplements for their anxiety/depression? Which worked for you? I've only taken a look at a few others such as rhodiola rosea and St. John's wort, the latter of which is off-limits due to drug interactions. I understand that these supplements are not FDA-approved so I'm skeptical, but I've gone through so many AD's that I'm willing to try some options that are non-pharmaceutical.

(I just ordered the Nature Made brand of Sam-e off Amazon after discovering that it is legitimately prescribed as an AD in many European countries. Fingers crossed!)
posted by anonymous to Health & Fitness (18 answers total) 39 users marked this as a favorite
If the placebo effect kicks in, you still feel better. I'd think it's worth a try based on that alone.

I don't have as serious a mental health history as many others, but I've found a distinct correlation between my own anxiety and depression and low vitamin D levels (and vitamin D supplements make me feel better so fast I call 'em my Happy Pills). So high-dose Vitamin D supplementation for a short while is another thing that can't hurt to try, might help, you just never know.

Good luck to you, I hope you find something that works for you, and quickly.
posted by Andrhia at 12:54 PM on September 2, 2015 [1 favorite]

As anecdata, I can vouch for ashwagandha for helping with stress.
posted by lafemma at 12:56 PM on September 2, 2015

These aren't really woo since they are amino acids that your body will use in the brain. As with anything including ADs I've found that effectivity depends on the person but personally I've benefitted from:

-Sam-E: for depression, take when symptoms start up (when I get that "hello darkness my old friend" feeling start up and meditation/mindfulness can't thwart it), take on an empty stomach. Can cause anxiety (makes me clench my teeth) so be mindful of the pendulum swinging the other way. Start w a low dose and take only the min you need. I also found it makes my sleep less deep - like having mild caffeine. I can sleep but it's not as restful. So I only take it for a few to several days until the coast is clear.

- GABA: for anxiety, I use platinum brand called "stressentials" which also include inositol, cordyceps and fish oils. Can cause mania so be cautious. But again I've found it helpful on an as-needed basis when I'm unable to combat my anxiety on my own and need a calming agent to make it through.

- you could also research NAC (n-acetyl l-cysteine) and inositol and see if they are right for you, I have used them on occasion but the most help I've had are from the first two I mentioned.

These don't take away the symptoms 100% but they have definitely helped me ride it out until the tide has passed if you know what I mean. Especially the sam-E.

Don't forget your b-vitamin! I hope you feel better soon.
posted by serenity soonish at 1:16 PM on September 2, 2015 [1 favorite]

I have had fantastic results taking 400mg of SAM-e daily - even better than the prescription antidepressants I've tried and with very few side effects. It's been approved as a prescription antidepressant in Europe for years, as you note, and the clinical literature mostly backs it up as an effective treatment (with some dosage caveats). It's a little expensive - especially since insurance doesn't cover it - but it's been incredibly helpful for me. I try to take it along with bioavailable forms of the main B-vitamins involved in the methylation pathway that uses SAM-e (so folate, B6, and B12). I've tried a number of brands and I swear to god I can tell the difference and get the best results when I'm using the Nature Made brand. It's usually on some sort of sale at Costco, too. Hope that helps!
posted by dialetheia at 1:36 PM on September 2, 2015 [6 favorites]

I've answered a similar question here, with info about 5-HTP and DLPA, which I took for depression on and off for years.

Before you start taking anything, pick up a copy of The Mood Cure. It's an amazing resource for figuring out which amino acid and/or supplements would be right for your particular brand of depression/anxiety, and gives you optimal doses and what time of day to take things (which can be super important). It's not woo at all, easy to read. Good luck!
posted by Specklet at 1:43 PM on September 2, 2015 [6 favorites]

Try Valerian root. I took 2-3 every day and it did seem to help me with my anxiety.
posted by samcivic at 1:54 PM on September 2, 2015

I eat an antiinflammatory diet to manage an inflammatory medical condition. I have seen articles that link brain inflammation to depression and I have seen stuff about how diet can interact with depression. They often list certain oils, like olive oil, as being a good thing.

My understanding is that peanut oil is incredibly inflammatory. It does a real number on me. In addition to making my medical symptoms worse, it can make me suddenly suicidal.

So, I will suggest you start a food diary, look up some articles on depression and inflammation, look up some info on antiinflammatory diets and see if that angle helps.

When I had sudden onset anxiety attacks and a clear idea of the cause, I did some research and then I posted this ask. Eating foods with rosemary or dill really helped take the edge off my anxiety. I never found a snack with sage.
posted by Michele in California at 2:05 PM on September 2, 2015 [2 favorites]

I have "failed out of" many different ADs and finally my PsyD sort of threw up his hands and suggested trying supplements. Here are some that he recommended I try based on medical research (ish). He was a straight PsyD, but a bit on the woo side.

- by far the most effective is O3 capsules (though it may be placebo effect, who knows, I swear I can tell within two days if I have forgotten a dose because my anxiety creeps up)
- I am usually vitamin D deficient, so taking D helps my baseline mental health and energy. (I get blood tests to monitor my level and take prescription levels, YMMV)
- St John's Wort and Evening Primrose-- I believe these are frequently recommended together. I don't think they had much effect on me.
- SAM-e: I am one of the unfortunate people who were triggered to SEVERE anxiety. I felt amazing for the first three or four days, then I basically huddled in a corner and tried not to freak out until they wore off. It was fairly terrifying, and I was actually glad that I didn't live alone and had another adult to help me cope until it left my system.
- NAC, 5HTP, and inositol- meh, they may have helped a little? Not really enough to notice. I take GABA as an ingredient paired with melatonin for occasional sleep aid, and I think it kind of actually does make me feel a bit less anxious.

I also made a lot of mental health-related lifestyle changes: I do yoga, meditate, journal, try to spend time outside every day, and try to eat and sleep as healthily as I can. Of everything I do, I think the O3 and yoga have helped the most. Good luck-- it is such an uncomfortable feeling when you are having trouble with medications for depression or anxiety. I wish you well.
posted by instamatic at 2:35 PM on September 2, 2015 [2 favorites]

YMMV on all of this:

I've lately been into several Kings Road Apothecary products. I've used her Milky oat + Ashwagandha elixir daily and had good results for addressing my anxiety. It definitely tastes a little gnarly at first, but you get used to it. I also really like her white sage based Clarity and Focus elixir, which has definitely helped with my concentration on my dissertation. Maybe it's the novelty of old-timey apothecary style products on my particular placebo effect or the effect of the actually herbs. I guess I don't really care which it is, as long as it works! ::shrug:: I also love, love this Kava tea for before bed and supporting sleep and restfulness.


Not sure where you live and what's available, but you might want to try some type of bodywork in addition to psychotherapy. Maybe look into Somatic Experiencing if you want a method that is more empirically-based, as Peter Levine holds Phds in medical biophysics and psychology. Bessel Van Der Kolk, MD also does a good job surveying the field of body based interventions from his experience as a psychiatrist and trauma expert. Basically the revolution is that much of anxiety and depression is not just a "mental" experience, but chronic sympathetic nervous system dysregulation (likely due to trauma) for which talking and insight is middlingly effective at best. Anxiety is an over-arousal, fight or flight, survival experience, and depression is basically under-arousal, in a frozen, helplessness state. Bodywork attempts to help an individual better regulate their own nervous system through using touch and various movements.

In my own experience, working with a bodyworker was very helpful and was able to move me through some stuck places somatically and emotionally in ways that psychotherapy did not. Bodywork helped me become more aware of my bodily state and much less disembodied. I came to experience how I chronically stiffened my body, especially my chest and neck, which made it hard for me to feel supported and to be able to relax into support. It took me awhile to even feel my bodyworker's touch. My stiffness also made it hard for me to know what I was feeling, and so I was unable to articulate my emotions well to others. It really is indescribable what it feels like to finally relax into a table with my neck supported in my bodyworkers hands, only then did I get how super on edge I have been most of my life. As with psychotherapists, bodyworkers have different ability/experience/training, so it's worth doing your research and hopefully getting a recommendation.

I know bodywork tends to sound woo, but it really is not. We are biological beings, animals, and the ways that we somatically live in the world really impacts how we experience it and how much we are open to trust and engage with other people. Levine and Van Der Kolk talk a lot about right hemispheric processes that we are not conscious of, patterning that comes about from interactions in our first few months/years of life, which we cannot remember, but our bodies carry forward. A good search term for researching this stuff is "affective neuroscience" and Dr. Allan N. Schore is another good resource. I am almost done training to be a psychologist, and I really believe that body-based interventions are the next frontier in so-called "mental health." It's a brave new world. :)
posted by amileighs at 3:04 PM on September 2, 2015 [11 favorites]

Friend, I know your struggle, and this is a thing I work on daily. From my experience:

I am also very keen to try SAM-e for both its anti-inflammatory properties and its general "feel good" effects, but it is stupidly expensive here in Australia.

Recent research is making some very interesting links between gut health and mental well-being. A good, fun, easy read on this is Gut by Giulia Enders.

I would certainly recommend (and am doing it for myself) a good course of prebiotics and probiotics, as well as fiber supplementation with psyllium husk. Please note that only a handful of probiotic strains that are readily available actually survive the journey from your mouth to your large intestine, so do a little research first. Activa yoghurt certainly contains one of these sturdy strains.

Another good idea is healthy fats in the form of e.g. olive oil and flax seed oil. I can no longer in good conscience recommend fish oil.
posted by turbid dahlia at 4:46 PM on September 2, 2015 [3 favorites]

Trying All The Meds is so much fun. I've been there, I feel for you. Wellbutrin is the only AD that actually works for me. New pharmacists and techs give me suspicious side-eye when they look at my array of presciptions. I've done a lot of research into psych meds because I've taken a lot of them.

So here is my bit of advice: When on any psychoactive medications, don't take herbal supplements. Herbs are like very complex drugs, but there's no quality control and little to no testing for efficacy or interactions. I wouldn't touch ashwaganda or rhodiola rosea with a ten meter pole.

Trying simpler supplements is safer. SAME-e is the only thing you mentioned that I consider reasonably safe. There has been actual testing. It might even help. I've never tried it because it was too expensive when I would have been willing to take it. It is unlikely to hurt you.

The two supplements that have helped me, beyond prescriptions meds, are magnesium and acetyl l-carnitine. A mineral and an amino acid. Unlikely to hurt you.

Magnesium glycinate specifically, 200-400 mg per day every day, has been very helpful for muscle aches and tension secondary to anxiety and it made my Restless Leg Syndrome go away. Nothing has helped more than being able to fall asleep. The bottoms of my feet are burning just remembering how bad it was. Yes, the tablets are huge, but surprisingly easy to swallow. Start at 1 per day, ease up to 2. May cause lots of pooping, but this is one of the most absorbable forms and your body adjusts.

The acetyl l-carnitine is harder to describe. I take about 2 grams per day and it seems to keep brain fog at bay. I'm afraid to stop because it might come back. The brand I linked is the only one I know of that always sources their product from Sigma Tau and I have noticed a difference when taking cheaper brands. Start with 500 mg in the am and increase from there. Some people find that it makes them anxious or gives them insomnia. I have both already, and I didn't notice an increase, but it is still worth it because everything is better with less brain fog.

I take other stuff too, but they are more situational. Like vitamin D, because I was incredibly deficient even before I started having PMLE. I do take a nice fish oil for long term health. Other vitamins and minerals to make up for a limited diet.

Since SSRIs didn't help much, you might not want to bother with 5-HTP. Did nothing for me.

Lastly, only change one thing at a time. Otherwise how can you tell if a thing is having an effect? (I often ignore this, but it is totally a good thing to do.)

Good luck. I hope you find something that works.
posted by monopas at 5:51 PM on September 2, 2015 [4 favorites]

Anecdotally, I have a family member (male) who has seen good improvement in his anxiety levels with SAM-e (taking it for about 3 years now); excellent improvement with chronic pain by taking magnesium (for about a year), and virtually no improvement at all from St Johns Wort (taking it for about 4mos now). I think it's relatively cheap and easy to try supplements, so why not? Be sure to document your moods, good and bad, as well as what's happening in your life, so you can look back in a few months and gauge if they are really working or not.
posted by vignettist at 6:58 PM on September 2, 2015 [1 favorite]

Beware St John's Wort. It interferes with many medications because it is metabolized by the same pathway. Please discuss this with your doctor if you decide to try it so he/she can make sure you will not be at risk.
posted by citygirl at 8:03 PM on September 2, 2015

I did a course of Sam-e and all it did was make me anxious/panicky. I did not notice any mood changes.

I tried tryptophan, and took 2 bottles worth religiously. It didn't do anything at all.

I tried 5-HTP, which miraculously did change my mood within a few days. Where before I had felt depressed, miserable, drained of energy, and even got to the point of thinking I didn't really want to die but suicide was probably my only way out, after the 5-HTP I just started feeling okay - not happy, just okay - but it felt good to feel fine instead of bad. Unfortunately there isn't enough info about 5-HTP out there and I read some stuff about it potentially damaging heart valves when it is taken as a supplement, so I stopped taking it. Also it can affect your sleep and give you very vivid dreams, which was actually a cool side effect.

I also did a course of neem (leaves in capsules, not oil or any of the other products), which changed my mood dramatically. I was actually taking it for something else and noticed a week or so in by sheer coincidence that suddenly I felt okay instead of depressed. However, I recently bought another bottle and started taking it, a couple years after that first time, and it doesn't seem to have any noticable effect this time around. But I'm also not as depressed as I was then.

I would suggest trying neem from personal experience. Even if it doesn't work, there aren't any serious side effects (it can lower blood sugar but is otherwise pretty benign), so it's worth a shot, and it's easy to find and relatively cheap.
posted by atinna at 2:01 AM on September 3, 2015 [1 favorite]

On EarthClinic (which is where I want to go when I want natural remedies without the woo), 5-HTP and Rhodiola seem popular for depression. You may want to look up anxiety in the "ailments" section.
posted by Ms. Moonlight at 7:06 AM on September 3, 2015

I can no longer in good conscience recommend fish oil.

My anecdatum disagrees.

I am a five alarm GAD sufferer who has fantasized about suicide over the years off and on because sometimes it just seems so... practical in the face of the invisible madness that is my life.

I have taken many pharmaceuticals from anti-depressants to mood stabilizers to anti-psychotics and the end result is always disaster.

For the past 6 months or so, I have been slowly titrating up my consumption of omega-3s via wild Alaskan salmon oil (I use New Chapter's Wholemega and am currently taking 4 times the daily dose the bottle states, for a total of 8 grams oil and just under 2.1 grams combined EPA/DHA.)

I started taking it as recommended by my PCP for borderline high cholesterol and noticed that it really substantially reduced my anxiety. I have never gone this long without having a major panic attack/meltdown, and I have a long way to go but this may tentatively qualify as "life-changing."

Caveat: My research has taught me that price is not directly correlated to quality when parsing the many available brands of fish oil. I will be switching to the Vitamin Cottage's higher level supplement once I run out of what I have. It will triple my omega 3 amount for $20 less/month.

Another caveat: I am morbidly obese. An average weight person would probably not need as much.
posted by dissolvedgirl22 at 8:39 AM on September 3, 2015 [1 favorite]

I am clinically deficient in vitamin D and therefore supplement and by golly, I genuinely do think that's helped. I also take valerian-- not all the time, but just when I'm having a REALLY bad anxiety day. It sort of helps me "drop" the anxiety down to levels that I can deal with so I'm not keyed up all the time, and the side effects (a little bit sleepy) are totally manageable. For me, anxiety manifests as muscle tension and fidgeting, so the muscle relaxant/sedative effects of valerian are just perfect. I've tried other drugs, like Xanax, and they're all too strong for me, so if you are used to those you may find valerian ineffective as it's just too weak, but it's cheap and probably worth a try.

The other thing I take is 5-HTP. Starting it has been correlated with some other changes in my life (school starting again, coming back to a circle of friends) so it's difficult to isolate what's the 5-HTP and what's life changes, but I do think it's had an effect. I don't feel wonderful, but I feel much more functional and capable and less classically depressed (no interest in doing anything, everything seems pointless.) Also, it's clearly doing something to my brain chemistry, because I have all the symptoms of taking an SSRI when I drink alcohol now-- I get drunk uncomfortably quickly, stay drunk longer, and the hangovers are terrible. If I stop 5-HTP for a few days, it goes away. That makes me think that maybe it's not all entirely placebo effect.

Anyway I'll be watching this thread with interest, so thanks for posting, and hope you find something that works for you.
posted by WidgetAlley at 9:39 AM on September 3, 2015

Total anecdata: I have GAD, agoraphobia, panic attacks, OCD, and mood disorder-NOS (both long cycles and short cycles of mood dysregulation, but my PsyD won't let me add bipolar I and bipolar II to get bipolar III). My psy meds and meds that have psy effects: gabapentin, trileptal, elavil, atarax. My PCP is adding Lyrica.

I supplement with B-complex and high dose D vitamins, rhodiola, and 5-HTP. I'm struggling with taking the first 3 regularly. If I miss the 5-HTP, I'm waking up several times through the night, and my neurologist, therapist, and psyd keep telling me that regular sleep is hella important. When I take the B, D, and rhodiola, I feel almost kinda sorta normalish. There's still a little niggling something at the back of my brain, but it mostly stays there.
posted by The Almighty Mommy Goddess at 10:37 AM on September 10, 2015

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