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America has a mental health problem. According to the National Institute for Mental Health (NAMI), more than one in five adults in the US experience mental illness every year, and rates of anxiety and depression increased 25% during the pandemic. For men, the situation is especially dire, made worse by the fact that they’re less likely to seek out help or opt for prescription treatment.
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While women are twice as likely to experience depression, men are less likely to be medicated for it. Between 2015 and 2018, antidepressant use over the course of 30 days was higher for women than men (17.7 percent versus 8.4 percent), with men ages 18 to 39 having the lowest rate, according to a 2020 report from the Centers for Disease Control (CDC). Antidepressant use shot up for women between 2009 and 2018, but rates among men were flat during the same time period.
Male aversion to antidepressants isn’t all that surprising. Besides the multitude of reasons why anyone avoids clinical intervention — stigma, fear, shame — many men may avoid antidepressants because of one potential side effect: erectile dysfunction. That’s precisely what makes over-the-counter alternatives attractive, particularly for those who suffer from less severe forms of depression including seasonal affective disorder (SAD) and shorter dips in mood that may not require a clinical-strength boost. They’re also an interesting prospect for people hesitant to add another medication with uncomfortable side effects to their routine.
Over-the-counter (OTC) medications aren’t backed by the same research, but they can help ease mild to moderate symptoms of depression, according to Dr. Mikhail Kogan, medical director of George Washington University’s Center for Integrative Medicine.
“For a psychiatrist who [didn’t] have training in evidence-based integrative practice, for anxiety or depression they would probably start straight away with medications or therapy and then [up the dosage] at a later time depending on how severe the symptoms are,” said Dr. Noshene Ranjbar, an associate professor of psychiatry at the University of Arizona College of Medicine in Tucson.
According to the National Institutes of Health (NIH), the most commonly prescribed antidepressants, selective serotonin reuptake inhibitors (SSRIs) like Zoloft and Prozac, prevent neurons from reabsorbing neurotransmitters and can help regulate mood. Anti-anxiety drugs, like Benzodiazepines, throttle the central nervous system, which helps reduce symptoms like extreme worry and panic attacks according to the Center for Addiction and Mental Health (CAMH).
According to a mountain of clinical research, these types of medications work really well for those with severe depression symptoms. The data regarding their long-term effectiveness, though, is more mixed according to a 2022 study published in the journal PLoS.
Though no one is suggesting you chuck your Zoloft prescription in favor of a bunch of supplements, Kogan said St. John’s wort has been used for mood regulation for centuries, and St. John’s wort and valerian, as well as supplements like omega-3 fatty acids and 5-hydroxytryptophan (or 5-HTP), can treat some mild depression symptoms. That said, more research is necessary to understand the risks of taking them instead of SSRIs or other chemical interventions, and they are not recommended for those with severe depression. They may be a path to avoiding doctors and potential sexual performance issues, but there are obvious downsides, including risk for serotonin syndrome or reduced efficacy of other medications.
Ranjbar said other go-to supplements that work reasonably well for anxiety and depression include lavender oil capsules like Lavella or Silexan and L-theanine, an amino acid and an active ingredient in green tea. According to a 2021 review and meta-analysis conducted by the Tehran University of Medical Sciences of over 342 screened studies, lavender in capsule formation significantly aided in symptoms of depression compared to a control group.
“[For] L-theanine, the best research for it is for kids with ADHD who also have sleep problems,” said Ranjbar, referring to research done at the University of British Columbia on boys between the ages of eight and twelve. “We use it to help improve sleep because it allows for a little bit of a calming effect without making people sedated. Some people with anxiety can also benefit from L-theanine because it’s mild and not a super-intense sedating drug,” said Ranjbar, referencing mild cases of both anxiety and depression.
For some folks, symptoms of anxiety and depression may stem from nutritional deficiencies, especially low levels of vitamin B, folate, and omega-3 fatty acids, according to the Indian Journal of Psychiatry. Kogan said broad-spectrum micronutrients are necessary for building neurotransmitters like dopamine and serotonin, so supplements like B complex and folate may help. Researchers out of the California Institute of Behavioral Neurosciences & Psychology have also concluded that vitamin B-12 can help delay the onset of depression symptoms and improve the effects of antidepressants when taken in conjunction.
The body is also incapable of producing omega-3 fatty acids, a nutrient necessary for abating inflammation and blood clotting, on its own. A 2019 study published in Translational Psychiatry found that omega-3 fatty acids helped mitigate symptoms of depression, especially in the test groups that were given pure EPA (one of several omega-3 fatty acids) as opposed to DHA (another one). Rich in omega-3s, foods like salmon and nuts are some of the best sources of it, but adding a supplement can help fill in where diet falls short.
Before this all starts to sound too woo-woo, it’s worth noting that effectiveness of OTC remedies varies, and they’re not subject to the same types of regulations as prescription drugs. Ranjbar said websites like ConsumerLabs.com are helpful resources to verify which supplements have undergone third-party testing and follow good manufacturing practices.
While it sounds appealing to replace prescription meds that come with a whole host of unpleasant side effects with a more natural option, are these OTC mood boosters as effective as your run-of-the-mill Zoloft or Ativan? Not exactly. A 2018 meta-analysis conducted by psychiatrists and researchers in Germany, Switzerland and Texas, and published by the Cambridge University Press, found that 5-HTP, depending on the study, was either not substantially effective or on par with a standard antidepressant. Ultimately, experts say it depends on a number of personal and clinical factors.
Kogan said, for instance, if an individual is trying to wean off antidepressants, including an herbal or dietary supplement may help someone deal with the accompanying withdrawal symptoms.
But for some individuals, said Ranjbar, OTC herbal and dietary supplements can help punch up traditional prescription antidepressants, especially if their symptoms are not getting better or they need something stronger to be adequately managed.
Supplements can be used alongside prescription drugs or therapies like cognitive behavioral therapy (or CBT), said Dr. Debra Kissen, a cognitive behavior therapist specializing in anxiety and author of Break Free From Intrusive Thoughts: An Evidence-Based Guide for Managing Fear and Finding Peace.
Avoiding the annoying aspects of the health care system could be a perk of OTC options, but every expert interviewed for this story emphasized that people shouldn’t explore alternative therapies totally unsupervised.
“Sometimes when people are looking for over-the-counter solutions, it’s because they’re trying to figure it out on their own versus actually getting help,” said Kissen. “As long as you’re doing it in this way [of recognizing] you deserve help and support, and [supplements] are just a tool, that’s fine… But it shouldn’t be a lonely process.”
If you’re interested in trying one of the active ingredients mentioned above, here are the specific products SPY recommends. Every product on this list has been vetted by a trustworthy third-party agency for the quality of its ingredients and contains minimal unnecessary additives.
Check out our guide for buying trustworthy supplements online here.
Doctor's Best L-Theanine
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This L-theanine from Doctor’s Best contains Suntheanine, a pure form of the supplement that’s meant to support relaxation without causing drowsiness. It contains 150 milligrams of L-theanine per dose and minimal other ingredients.
BEST ST. JOHN'S WORT
Gaia St. John's Wort
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These vegan St. John’s wort capsules from Gaia are made in the USA. Each bottle comes with a tracking feature with which the user can find where the herbs inside were grown and cultivated.
Spring Valley Omega-3 From Fish Oil
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Spring Valley is both a large and, by all measurable accounts, trustworthy supplements label that’s somewhat affordable. The brand’s Omega-3 supplement from fish oil contains both EPA and DHA (two key omega fatty acids) with minimal other junky ingredients.
Natrol 5-HTP Time Release Tablets
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Natrol’s 5-HTP supplement is formulated as a 100% drug-free way to elevate one’s mood and lower one’s stress. It’s made with no artificial ingredients, sweeteners, or preservatives and the time-release formula is designed to sustain the effects throughout the day.
BEST VITAMIN B COMPLEX
Nature Made Super B Complex
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Nature Made’s super B complex supplement contains all 8 essential B vitamins including folic acid and B-12. It’s formulated so you only have to take one tablet daily to get a full dose, and it’s made without artificial flavors or colors.
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