I REMIND ALL PATIENTS THAT OVER-THE-COUNTER MEDICATIONS (OTCs)/SUPPLEMENTS ARE STILL DRUGS. JUST BECAUSE ONE CAN OBTAIN AND USES THESE WITHOUT A PRESCRIPTION, DOES NOT IMPLY THAT THEY ARE SAFE OR EFFECTIVE FOR ANY INDIVIDUAL. THE FDA (FOOD AND DRUG ADMINISTRATION) DOES NOT ASSESS OTCs FOR MANUFACTURING QUALITY, PURITY, SAFETY, OR EFFECTIVENESS.
In addition, I remind patients that they have had symptoms of depression, anxiety, sleep disturbances, etc. for years. Do not expect these items, below, to help fully or immediately.
Pick one or two and try them for a few weeks or for a month before adding in more items to try.
Patients may need to try some of these items for up to 6 months, before deciding that they are not helpful.
Write down HOW you are feeling and WHAT you are feeling (emotional and physical) before starting AND after stopping EACH of the listed treatments. It is very difficult to accurately remember if you had insomnia, constipation, muscle twitching, etc, before you started a treatment or after you started a treatment. If you think that you have symptoms from a treatment, then stop the treatment. Wait to see if the symptoms improve/go away, then restart the treatment to see if your symptoms return. If the symptoms return, then most likely your treatment was causing the problem (so, please stop the treatment permanently and record your “INTOLERANCE” to the product and list your intolerance along with your allergies).
STOP any of these listed treatments which are not helpful. Do not waste time and money if you find no benefits.
I ask patients to continue with all their healthcare professionals and the prescribed medicines, unless they discuss any planned changes to treatments with their healthcare providers.
All medications are over the counter [or are available on AMAZON].
1) Vitamin B12 500-1000 microgram tablets once a day
2) methylfolate (or L-methylfolate) (NOT folic acid) 1 milligram to 15 milligrams by mouth, once per day. MUST CHECK WITH YOUR PHYSICIAN FIRST. ( https://www.psychiatrictimes.com/view/l-methylfolate-augmenting-agent-may-contribute-agitation-and-mania )
Possible cancer risk associated with high folic acid intake ( https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0093465 )
3) SAM-e (s-adenosyl methionine) 200-400 mg by mouth once a day with food ( https://www.mayoclinic.org/drugs-supplements-same/art-20364924 )
4) Tyrosine (or L-tyrosine) 1000 milligrams by mouth once a day ( https://www.webmd.com/diet/health-benefits-l-tyrosine#:~:text=Because%20tyrosine%20is%20turned%20into,mild%2Dto%2Dmoderate%20depression.&text=Some%20children%20and%20adults%20take%20tyrosine%20for%20ADHD. )
5) L-tryptophan 500 milligrams by mouth once a day
6) L-lysine amino acid with L- arginine amino acid to lower anxiety, which often coexists with depression ( https://pubmed.ncbi.nlm.nih.gov/17510493/ )
7) Vitamin D. Best if the body can generate this naturally from 20 minutes of sunshine per day (UV rays cause a chemical reaction in the skin to generate vitamin D), or, use oral Vitamin D3. Your physician should check blood level of 25-hydroxy vitamin D3, with a serum level target of 20-50 nanograms per milliliter.
8) A regular time and location (i.e. bed, not sofa or recliner) for bedtime. To bed and awaken at the same times 7 days a week.
9) At least 40 minutes of exercise, at least 5 days per week (work up to this over several months). Walk, swim, row, bike, or skip rope to start. Eventually add in strength exercises (e.g. push-ups, leg lifts, abdominal crunches…can add in resistance band exercises or machine weights or free weights).
10) Spend time OUTDOORS in NATURE (even in “bad” weather)
11) Journal/write down: thoughts, feelings, observation, insights, events, memories, gratitudes
12) Learn to live with our faulty selves…find understanding and acceptance (and when appropriate, re-attribute): intrusive thoughts, angry thoughts, depressed thoughts, anxious thoughts, obsessive thoughts
13) Find appropriate emotional support from others: ministers, therapists, groups, friends, family, pets
14) Notice excessive (endless) escapism: screen time (TV, desktop, laptop, cell phone, gaming, movies, YouTube, Twitter, Snapchat, Instagram, TikTok, gambling, alcohol use, drug use, pornography, online window shopping, online buying)
15) Understand/seek/find your purpose(s). These do NOT have to be life-changing or money-making. People often gravitate to what they are proficient at, what seems to come to them easily, what they used to like to do when they were younger (before adult thoughts: worries about grades, worries about money, worries about being judged/discouraged).
16) If not employed or going to school, consider being employed by someone (part time or intermittently)…a job where one has human interaction, responsibilities, a schedule, and a routine. Working for an organized boss or a well-run organization, maybe better for the severely depressed person than that person trying to start or run their own business.
17) Cook for one’s self (a few meals per week). This tends to keep calories down, and helps develop/improve skills and habits. “Food is medicine.”
18) ASK FOR HELP for anything where you feel, “STUCK” or where you procrastinate, feel overwhelmed, anxious, self harmful, or suicidal.
19) Recognize interpersonal conflicts (new or old conflicts… including historical conflicts with those who are now deceased) and ask for help to understand these conflicts in order to achieve some sort of mental peace, an internal calm (e.g. by agreeing to disagree; by avoiding the other party; by writing a letter that we do OR do not mail, by asking or offering forgiveness, etc)
20) Thirty minutes every morning of 10,000 lux of light therapy between (especially between November and February)
21) Waking up 1/2 hour earlier (make this move twice so that one is waking up 1 hour earlier) ( https://www.sciencedaily.com/releases/2021/05/210528114107.htm#:~:text=A%20genetic%20study%20of%20840%2C000,major%20depression%20by%2023%20percent.&text=Waking%20up%20just%20one%20hour,in%20the%20journal%20JAMA%20Psychiatry.https://www.sciencedaily.com/releases/2021/05/210528114107.htm#:~:text=A%20genetic%20study%20of%20840%2C000,major%20depression%20by%2023%20percent.&text=Waking%20up%20just%20one%20hour,in%20the%20journal%20JAMA%20Psychiatry. )
22) After each meal (and possibly after every big snack) do something physical for 30-40 minutes in order to avoid napping. Short naps are refreshing. However, lengthy naps may decrease the quantity or quality of nighttime sleep.
23) Alpha stimulation device use ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8978160/#__ffn_sectitle )
24) Electrical acupuncture use ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3768227/#__ffn_sectitle )
25) Binaural beats music use ( https://www.psychologytoday.com/us/blog/two-takes-depression/202005/binaural-beats-music-can-reduce-depression )
Charles Tadros, M.D.
May 22, 2022
Saint Louis, Missouri