Henry Emmons, MD

Today, the overwhelming majority of people with depression are treated using prescription antidepressants like Paxil® and Effexor®. Dr. Henry Emmons has distinguished himself from his colleagues by pioneering an innovative regimen for treating depression, one that incorporates nutritional supplements such as omega-3 fatty acids along with dietary modifications, regular exercise, and “mindfulness meditation” and similar stress-reduction techniques.

In his recent book, The Chemistry of Joy: A Three-Step Program for Overcoming Depression Through Western Science and Eastern Wisdom (Fireside, 2005), Dr. Emmons, a Minnesota-based psychiatrist, details how people can master their moods and correct brain-chemistry imbalances with the help of holistic health strategies that combine the best of Eastern and Western disciplines. The book includes tips on implementing dietary changes to optimize levels of brain neuro-transmitters such as serotonin, norepinephrine, and dopamine.

Depression Rates Keep Rising

“I believe that our ultimate goal is to live every moment fully and peacefully in the present,” says Dr. Emmons. As such, he is committed to helping lower depression rates in the US.

“There is strong epidemiological data showing a 10% increase in rates of depression in the US population every decade for the last 100 years,” he notes. “This is not just a reflection of better detection of depression, or people’s greater willingness to seek help for it. It represents an actual increase in the rate of depression. The National Institute for Mental Health says that over 20 million American adults have a mood disorder in any given year, and this is mostly depression in one form or another.”

While public figures such as former First Lady Barbara Bush, musicians Sting and Sheryl Crow, and actress Lorraine Bracco (who plays psychiatrist Jennifer Melfi on television’s “The Sopranos”) have gone public about their treatment for depression, millions of Americans suffering depression continue to go untreated. Dr. Emmons advises people with moderate or severe depression to “seek professional help and not try to deal with it themselves. There are different ways to define ‘moderate or severe,’ but when it is affecting one’s ability to function in any key role—job, spouse, parent, friend—then it is at least moderate in severity. The quicker people get help, the better it is for them in the long run.”

Observing that most Americans are sleep deprived, sedentary, poorly nourished, or all three, Dr. Emmons maintains that “just a few good nights of sleep can sometimes turn around a mild depression.Studies show that aerobic exercise can help even moderately severe depression within two to four weeks, and that good nutrition coupled with a few choice supplements can help within two to three months.”He adds that “high-quality psychotherapy can change brain chemistry for the better, and sometimes it takes only a few sessions if the symptoms are mild or stress related.”

Medications typically start to work within two to three weeks, but antidepressants do not help everyone. According to Dr. Emmons, the good news is that for those with milder symptoms who wish to avoid medications, “improvements can be felt nearly as quickly with a combination of diet, supplements, exercise, and stress management.” He cautions, however, that “if the depression is mild but rooted in unhealthy relationships or psychological issues, it can be much more efficient and effective to seek out a skilled psychotherapist.”

Omega-3 Fatty Acids Battle Depression

Expounding on the link between diet and depression, Dr. Emmons notes that a common problem underlying many cases of depression is a dietary shortfall of essential fatty acids. Even in people who eat low-fat, apparently healthy diets, there is often a relative deficiency of omega-3 fatty acids, the kind found in fish, flax, and some nuts. Researchers have found that most Americans in 1900 ate a diet supplying a fairly even ratio of omega-3 to omega-6 fatty acids; today, however, that ratio is about 1:20. “This is vitally important to maintaining good moods,” Dr. Emmons explains, “because omega-3s have a role in reducing inflammation, and are also integrated into brain cell membranes, helping them to function properly.”

In countries like Japan and Norway where people regularly consume fish, rates of depression are much lower than in the US. This has led many researchers to try using fish oil supplements in the treatment of mood disorders, and the results have been impressive. “While it may not replace the need for other forms of treatment,” Dr. Emmons says, “fish oil helps to reduce the recurrence, or relapse, of both depression and bipolar (manic-depressive) illness.”

Dr. Emmons notes that a recent symposium sponsored by the National Institutes of Mental Health was devoted entirely to the therapeutic use of fats in mental illness. Several presenters reported the beneficial effects of essential fatty acid supplementation on depression, bipolar illness, and schizophrenia. Adding essential fatty acids to the diets of research subjects has been associated with improvements in dyslexia and attention deficit hyperactivity disorder (ADHD), as well as with improved intelligence measures in infants and in adults with Alzheimer’s disease.

Regarding the connection between chronic inflammation and depression, Dr. Emmons believes that healthy fats can positively affect mood. “Certain inflammatory substances—eicosanoids and cytokines—are elevated in major depression,” he explains. “These elements promote low-level inflammation, which may affect brain tissue as well as other parts of the body. Antidepressants suppress this harmful activity, but so can increased levels of omega-3s, and probably more efficiently. Interestingly, people who consume more omega-3s seem to have higher levels of serotonin and dopamine byproducts in their spinal fluid, suggesting that their brain levels of these vital neurochemicals are also higher.”

Most people who eat a reasonably healthy diet do not need to supplement with omega-6 fats. However, since so few Americans ingest adequate amounts of omega-3s, Dr. Emmons suggests that most people supplement with 1-2 grams daily of omega-3s. For most fish oil products, that would be 2-4 large capsules daily, and for flax, about 1 tablespoon of the oil or 2 tablespoons of ground flaxseeds.

Vitamin/Mineral Deficit May Fuel Depression

A great deal of research suggests that certain vitamin and mineral deficiencies play a role in the onset of depression. A survey of European studies found that B vitamins were low in 35-50% of patients hospitalized for depression. This is especially significant because multivitamin/mineral supplements have been shown to reduce violent or oppositional behavior.

Another important component of Dr. Emmons’ approach to resolving depression involves the use of mindfulness-based exercise and stress-reduction techniques, which integrate Buddhist principles with medical science. A perfect example of mindfulness-based exercise and stress reduction is walking meditation.

“Try to do this meditation without focusing on a goal,” Dr. Emmons advises. “Try walking just for the sake of being aware of walking, and not for exercise, seeing the sights, or getting somewhere.” As with any meditation, your mind will occasionally wander. “As soon as you notice this loss of focus,” Dr. Emmons says, “just bring your awareness back to the present moment and to your experience of walking. Practice walking meditation in the morning before going to work, during your lunch hour, or at the end of the day.”

According to Emmons, other mindfulness-based stress-reduction strategies include such easy, enjoyable, and inexpensive behaviors as being generous with your time, attention, or emotions. “Giving and receiving are one and the same,” he says. “Whatever you do for others, you also do for yourself. The best way to feel rich and full is to make a heartfelt gift to someone else.”

Henry Emmons, MD, is a faculty member at the Center for Spirituality and Healing at the University of Minnesota, and author of The Chemistry of Joy: A Three-Step Program for Overcoming Depression Through Western Science and Eastern Wisdom (Fireside, 2005).

Dr. Emmons’ Supplement Program for Preventing Depression

While Dr. Emmons advocates consuming various supplements to help prevent and manage depression, he cautions against discontinuing the use of antidepressants, or even lowering their dosage, without the supervision of an experienced primary-care doctor or psychiatrist. For preventing depression, Dr. Emmons suggests taking a multivitamin that provides adequate doses of the B vitamins folic acid, B6, and B12, along with antioxidants like natural carotenoids, vitamins C and E, and selenium. In his book The Chemistry of Joy, Dr. Emmons goes on to recommend fish oil supplements containing omega-3 fatty acids be added to your diet in the amount of 1000 to 3000 mg a day. If you have been diagnosed with bipolar disorder, you can take up to 9000-10,000 mg per day of fish oil. If you are a vegetarian or do not wish to take fish oil, you can substitute flaxseed oil. Fish oil is preferred, if you can manage it. Additionally, you may wish to try S-adenosylmethionine (SAMe): For a starting dose, take 200 mg twice daily, preferably 30 minutes before meals or two hours after eating. The dose may be increased slowly, up to 800 mg twice a day, if tolerated. A response is usually evident within 15 days. SAMe should not be used by patients with bipolar disorder.