The article and protocol are for informational purposes only, and not intended as medical advice. Please read the Medical Disclaimer below, and consult with your personal physician before starting supplements and acting upon any information on this website. 

Discussion

Anxiety, depression, bipolar depression, postpartum depression, and PTSD, are all related, and very complex, with various causes and effects. Psychological trauma, genetics, hormones, environment, and nutritional status all play a role in these disorders.

For PTSD, please see that article and protocol.

A person with anxiety disorder or depression should be under the care of a properly-trained licensed physician and/or psychologist, as moderate to severe anxiety and depression should not to be taken lightly. The consequences of these disorders can be severe and life threatening.

We know the brain requires neurotransmitters to make connections between neurons (brain cells) for thinking, hormone regulation, and mood stabilization. The major mood-regulating hormones are serotonin, dopamine, and GABA, which are influenced by other hormones and one’s health status, as well as several other factors, including your thoughts. Your conscious and subconscious thoughts can actually change your mood, for better or for worse.

The production of the mood hormones (serotonin, dopamine, and GABA) are dependent upon micronutrients, such as calcium, magnesium, zinc, chromium, iron, folate, vitamin B6, vitamin B12, vitamin D, and omega-3 fatty acids. Micronutrient deficiencies are a known cause or factor of depression and/or anxiety.

Also, a depletion of the amino acid methionine and elevation of homocysteine are associated with both anxiety and depression and in turn, this situation is associated with genetic MTHFR mutations.  I would highly recommend any person suffering from chronic depression or bipolar disorder to be tested for MTHFR mutations.  Please read my article on this subject by clicking here.

Our Thoughts Are Our Reality

Even though we think that it is our mood that affects our thinking, it is actually the other way around. It is our thoughts that first affect our mood! Then our mood, for better or worse, feeds back onto our thinking, which further affects our mood, which can create habitual thinking patterns. For better or for worse, our thinking patterns and our mood, will then determine our behavior. Our habitual behavior (actions) create our lives. All of it begins with our thoughts. It is written, “as a man thinketh in his heart, so is he.” It is true, our continuous thought patterns literally create our reality.

Whether there is an MTHFR mutation or not, and whether a person is on prescribed medication, and/or taking nutritional supplements or not, cognitive therapy is often beneficial to improve both conscious and subconscious thought patterns. When thought patterns are improved, mood is often improved, and productive behaviors usually follow.

The majority of our mood, and anxiety/depressive disorders, are affected by thoughts, and to a lesser degree by hormones.  For example, after delivering a baby, estrogen levels plummet. Women who experience PMS mood changes are more likely to experience postpartum depression and anxiety, because both situations are triggered by a relative decline circulating estrogen.

A chronic lack of sleep results in a deficiency and desynchronization of many hormones in the brain and body, including the mood hormones. Hormone dysregulation results in such things as blood sugar destabilization, weight gain, as well as trouble with thinking and memory, and an increase in stress and anxiety. Prolonged lack of significant sleep can ultimately lead to severe depression and suicidal thoughts.

Micronutrients Help Prevent Anxiety

The brain is mostly made of fat (lipids), and supplementing with at least 2000 mg of omega-3 fatty acids per day (such as fish oil), has been shown to help with anxiety and depression.(1) DHA, found in fish oil, has been shown to help with brain development and cognition. It makes sense that it helps with other functions of the brain, such as maintaining a healthy mood.

The B vitamins, particularly niacin, has been shown to help with bipolar disorders. Vitamin B12 is important for enzymatic conversion of folate/folic acid and homocysteine to methionine. In the liver, methionine is converted into cysteine, as well as S-adenosylmethionine (SAM-e), also known as, ademetionine. SAM-e is a methyl donor in methylation reactions, and is known to increase levels of the neurotransmitters dopamine, serotonin and norepinephrine. It can be taken as a supplement to treat anxiety and depression. It is relatively more expensive than the supplement 5-HTP, also used to treat anxiety and depression.

Vitamin B6 and 5-HTP

The amino acid 5-HTP (hydroxy-L-tryptophan) has been shown to be as effective as SSRI drugs (Prozac, etc.) in alleviating mild-to-moderate anxiety and depression. 5-HTP does not have the side effects of the SSRI drugs. 5-HTP naturally occurs in the brain. 5-HTP is considered generally safe, but caution should be taken if one is taking an SSRI, as there is a theoretical risk of triggering serotonin storm. (Although that can happen with taking SSRI drugs anyway, and not so much with 5-HTP.)

Your brain makes serotonin out of tryptophan, but there is an intermediary molecule, and that is 5-HTP. Vitamin B6 is needed for the brain to convert tryptophan into 5-hydroxy-L-tryptophan (5-HTP), and then again vitamin B6 is needed to convert 5-HTP into serotonin.

With a vitamin B6 deficiency, tryptophan will not be converted into 5-HTP, and 5-HTP will not be converted into serotonin. Even if you supplement with 5-HTP to boost up serotonin, with a vitamin B6 deficiency, the amount of serotonin being produced may be inadequate to maintain mood.

However, supplementing with mega-doses of vitamin B6 (> 300 mg) is not helpful, as too much vitamin B6 will act a B6 deficiency. When one supplements with vitamin B6 (pyridoxine), the body converts it into the bio-active form, pyridoxal 5’-phosphate (P5P). This is the bio-active form utilized by the enzymes in the liver, brain, and elsewhere in the body. When excessive amounts of vitamin B6 (pyridoxine) is available in the body, the conversion to pyridoxal 5’-phosphate (P5P) is shut down, and an effective vitamin B6 deficiency results. Symptoms of a B6 deficiency include anxiety and depression. Therefore, if one supplements with vitamin B6 greater than 100 mg, be sure to supplement with pyridoxal 5’-phosphate (P5P).

A good quality vitamin supplement will provide 32 mg per day of vitamin B6 (pyridoxine), which is enough for most people. This amount easily converts into the bio-active form. If one were to take additional vitamin B6, especially with 5-HTP (as in the protocol below), I suggest taking it in the pyridoxal 5’-phosphate (P5P) form. The 5-HTP product I recommend comes with B6 in the pyridoxal 5’-phosphate (P5P) form. This ensures that 5-HTP is more readily converted to serotonin. This should help with anxiety.

Probiotics

An unlikely factor for mood, anxiety, and depression is the health of the bowel. There is a gut-brain connection, and good bacteria (probiotics) in the bowel produce serotonin, dopamine, GABA, and other mood-enhancing biochemicals which affect mood.(2 – 4) In fact, much of the serotonin in our body is produced by the bacteria in our bowel! Without healthy bacteria, there is a decrease in serotonin production, which can make one susceptible to anxiety and depression. (5, 6)

There have been several studies, such as one controlled study among college students evaluating anxiety levels. The study found that the students who took probiotics experienced a reduction in anxiety (and depression) compared to those students who did not take probiotics.(7)

Collectively, the bacteria in the bowel is called the microbiome, and it is often considered another organ of the body. With nearly 3 pounds of bacteria, numbering in the 50 – 100 trillion range, the diverse species of bacteria is considered the rain forest of the body. There is an intricate balance of friendly bacteria that we have a symbiotic relationship with in order to maintain digestion and a healthy mood. In addition, the bowel microbiome is a key component of the immune system.

Antibiotics, eating unhealthy foods, stress, lack of sleep, coffee, alcohol, lack of hormones, and a micronutrient deficiency, all can alter the balance of bacteria in the bowel. With a lack of healthy gut bacteria, less serotonin, dopamine, and GABA is produced, and one can be at risk for anxiety and/or depressive disorders, let alone infections, and digestive disorders.

In my protocol, I recommend a quality probiotic supplement with a combination of Lactobacillus rhamnosus LGG and Bifidobacterium BB-12, the two probiotic strains which scientific studies have shown to be important for establishing a foundation for the growth of numerous other healthy gut bacterial strains. By supplementing with these two strains of probiotics on a regular basis, one can maintain a healthy microbiome, which will produce healthy levels of serotonin, dopamine, and GABA, and help support a better mood without the risk of serotonin storm.

Numerous probiotic strains are available, many of which have very little-to-no clinical data regarding their benefit or physiological activity. The two strains mentioned above are backed by numerous human trials to prove viability and benefit in humans. They are designed for long shelf-life, and importantly, for withstanding the harsh acidic environment of the stomach so they can pass into the intestines intact, where they multiply and create a healthy environment for the microbiome to flourish.

Beta Glucans (Mushroom Extracts)

Beta glucans, derived from the cell membranes of the reishi and shiitake mushrooms, and baker’s yeast extract, providing mood stabilizing benefits, especially for anxiety and depression, as well as mood. (8 – 14)  In addition they provide immune support against infections and cancer.

Controlled studies have been done on women marathoners who took beta glucan (mushroom extracts), before and after marathons. (15) Researchers found that the women who took the beta glucan supplements had less colds and flus than the women who did not take the beta glucans, showing that the beta glucans supported the immune system, but also the women who took the beta glucans had less post-marathon depression and anxiety. Apparently, it is common to have mood disorders following a marathon, as the marathon taxes the body, including the production of mood hormones.

I had my own experience with beta glucans elevating my mood. I was on a flight from San Diego to Atlanta a few year ago. The person sitting next to me was extremely sick with a productive cold. Mucus was flying every where with each cough and sneeze, which was frequent. I was sure I was going to catch this guy’s cold.

As soon as I could after we took off, I got into my carry on luggage and took 2 tablets (in addition to the one I took that morning) of the beta glucan supplements, and then four hours later, I took two more beta glucan tablets. That night, I took two more tablets, and the following two days I took two beta glucan tablets three times per day.  Not only did I not get sick, Three days later, I was feeling better than I had in years. I was wondering why I was feeling so good. I didn’t feel any stress, anxiety, or feelings of overwhelm. I kept telling people how good I felt.

It was about two weeks later when I read about the women marathoners and beta glucans, and did further research that I understood about the effects of beta glucans and mood. I now recommend beta glucan supplements for supporting the immune system, cancer prevention, and prevention of anxiety and depression.

Bacopa monnieri Extract

Bacopa extract is a powerful antioxidant and safe anti-inflammatory micronutrient. It has been shown to improve memory, in those without memory deficits, as well as those with dementia. It has been shown to help attention, focus, cognition processing speed, improve spatial learning, and induce neuroplasticity, that is help the brain rewire damaged neuro connections.

Bacopa extract is used to help prevent neurogenerative disorders such as Alzheimer’s disease and Parkinson’s disease. It may also help prevent cancer, diabetes, and heart disease.

Bacopa extract helps reduce ADD/ADHD symptoms, OCD symptoms, as well as anxiety and stress. It helps your body adapt to stress, by becoming more resistant to stress.  It helps reduce the feelings of being overwhelmed and anxiety by elevating the mood. One study found that taking 300 mg per day of Bacopa monnieri significantly reduced anxiety and depression compared to placebo. (16, 17)

There are several other micronutrients that help alleviate depression and anxiety. Those are listed in the Protocol below, and I recommend that people consider the supplements, and discuss these with their doctor to see if these are right for them.

Saffron Extract

In Ancient Greece, saffron was used to boost libido, reduce anxiety, improve mood, and enhance memory. Saffron is rich in plant compounds that act as antioxidants, such as crocin, crocetin, safranal, and kaempferol. These compounds have even been found to induce apoptosis of cancer cells. Studies haves found that taking 30 mg of saffron daily was just as effective as fluoxetine (Prozac), imipramine (Tofranil), and citalopram (Celexa) in alleviating mild-to-moderate depression.

Studies found that the Greeks weren’t wrong; taking 30 mg of saffron daily was shown to enhance libido in both men and women, including improving erectile dysfunction in men taking medications with a side-effect of erectile dysfunction.

In addition to alleviating anxiety, saffron has been found to help reduce appetite and assist with weight loss.

Lemon Balm Extract

Lemon Balm Extract is a lemon-scented herb belonging to the mint family. It has been found to relieve symptoms of stress, help with relaxation in those with anxiety, and boost mood in those with mild-to-moderate depression.

A 2014 double-blind, placebo controlled cross-over study showed Lemon Balm to improve cognitive function. Participants who took Lemon Balm performed better in cognitive tasks involving memory, mathematics, and concentration, than those who took a placebo. This study also showed that Lemon Balm Extract helped to with alleviate insomnia.

It is best to take lemon balm extract with food, to not only reduce gastro-intestinal side effects, but to increase absorption.

Ashwagandha Extract

Ashwagandha (Withania somnifera) an Ayurvedic herb, combats and reduces stress and anxiety, while it alleviates mild-to-moderate depression, elevating mood, which helps improve one’s general sense of well-being.

Studies have shown that ashwagandha helps improve memory, task performance, and mental focus. When a person is feeling anxiety or depression, attention and focus suffers. This micronutrient, especially when combined with saffron extract and lemon balm extract, helps improve focus, attention, and performance, while elevating mood.

Ashwagnadha can assist with weight loss, as it helps to boost free testosterone in men. In both men and women, ashwagandha helps to reduce blood sugar levels (as well as cortisol), which also aids in weight loss and reduction of body fat. With the boost in testosterone, this herb has been found to improve semen and sperm quantity and quality, as well as muscle mass.

In both men and women, ashwagandha helps improve libido, and in women helps with sexual satisfaction, particularly helping to resolve anorgasmia caused by antidepressant medications.

Melatonin

Melatonin helps support production and function of both serotonin, dopamine, and growth hormone, especially during sleep. Melatonin also supports a healthy immune system, by decreasing the risk for cancer and infections.  In addition, melatonin helps with clear thinking and improved mood.

Melatonin has been studied among patients prior to undergoing surgery, and was found to reduce anxiety just as well as anti-anxiety medications. It has also been found to help reduce generalized anxiety among many people. I have not found it helpful to be used alone, but only as an adjunct to the other supplements in the protocol (below). It is part of a system to improve the way the body and mind should work.

Relora Plex

There are several other nutrients that help alleviate anxiety. Research has shown that a blend of extracts of Magnolia officinalis and Phellodendron amurense, found in a brand product called Relora, helps reduce anxiety and stress.(18, 19) I often recommend the use of this product for those suffering with anxiety, stress, and/or depression, along with 5-HTP, and the other micronutrients in the protocol below. I find that it takes more than one supplement to make the difference, but a good balance of many micronutrients, along with a healthy diet, quality sleep, and moderate exercise, to make the difference that people desire.

Supplement Protocol for Anxiety and Depression

The protocols should not be seen as a cure. They cannot be called a treatment either; but they can offer brain and mood support, in conjunction with proper diet, adequate sleep, and avoidance of toxic substances. Please discuss these things with your doctor to see if they are right for you.

The article and protocol are for informational purposes only, and not intended as medical advice. Please read the Medical Disclaimer below, and consult with your personal physician before starting supplements and acting upon any information on this website. 

Minimal Protocol for Mild-to-Moderate Anxiety and Depression

Basic Protocol for Mild-to-Moderate Anxiety and Depression

Average Protocol for Mild-to-Moderate Anxiety and Depression

Advanced Protocol for Mild-to-Moderate Anxiety and Depression

* Within the United States, there are a couple of specific products listed, such as 5-HTP Plus, Relora Plex, Seditol Plus, and DHEA that you can buy from Douglas Labs by first creating a customer account by  CLICKING HERE.  (If this link does not work for you, simply type “douglaslabs.com/patient-account” into a new browser tab.) And, please use Referral Code 2074214. Then, simply search for the products by name.  Be sure to purchase the 5-HTP Plus, not just the 5-HTP, as you want the P5P that is provided in the “plus” formula.  See the article above, which explains this.

• AM: With, or after breakfast
• Noon: At lunchtime with food, or shortly thereafter
• PM: Late afternoon with food, or at, or after dinner
• Please see my list of ingredients (below) that I like to see provided by a foundational vitamin and mineral supplement, as well as what is in the liver health supplement I use.
• Stress Relief Supplement; a quality supplement providing Saffron Extract, Lemon Balm Extract, and Ashwagandha Extract.
• Bacopa extract, combined with coffee cherry fruit extract, and American ginseng.
• Beta-glucans derived from Shiitake and Reishi mushrooms and baker’s yeast extract provide numerous benefits beyond supporting brain health and immune support.  (Those with autoimmune diseases should not use the beta glucan supplement.)
• Probiotics, at least take 12 billion colony-forming bacteria, providing Lactobacillus rhamnosus LGG® and Bifidobacterium BB12®, every other day or daily.
• Liver Support Supplement is needed to support the liver to carry out its several functions, including production of many hormones, and biochemical processes (methylation), which ultimately can affect mood. A liver support product will provide ingredients such as milk thistle extract, N-acetyl-L-cysteine, alpha lipoic acid, olive extract, broccoli extract, green tea extract, curcurmin (turmeric extract), and biotin.

Ingredients that I like to see provided collectively by vitamin-antioxidant & chelated mineral tablets

Vitamin A, mostly as Beta Carotene
Vitamin C
Vitamin D3
Vitamin E
Vitamin K (K1 & K2)
B-Complex Vitamins
Curcumin (turmeric extract)
Quercetin
Green Tea Extract
Olive Extract
Rutin
Resveratrol
Choline
Lutein
Lycopene
N-Acetyl-L-Cysteine (NAC)
Calcium
Magnesium
Iodine (as potassium iodide)
Zinc
Selenium
Copper
Manganese
Chromium
Molybdenum
Including Ultra Trace Minerals

Medical Disclaimer

Information on this website, written, spoken, or in any other communication by Dr. Ladd McNamara or any other information or reference is for informational purposes only. The information provided on this website is a result of years of practice, experience, and study by the author. This information is not intended as a substitute for the advice provided by someone’s personal licensed physician or other healthcare professional, or any information contained on or in any product label or packaging. Do not use the information on this website, or any other form of communication from Dr. Ladd McNamara or the Dr. Ladd VIP Program, for diagnosing or treatment of a health issue or disease, or for the prescribing of medication or the use of supplementation without a discussion with your licensed health professional first.  At best, the information provided on this website is only meant to supplement information provided by your own doctor or health professional, not to replace medical advice.  The information from this website is not meant to cover all possible uses, precautions, interactions or possible adverse effects of nutritional supplements with or without medications, or in conjunction with specific medical conditions.  The information from this website may not fit your specific health circumstances.  Never delay seeking medical care or disregard advice from your health care professional because of information you have received directly or indirectly from this website, from the Dr. Ladd VIP Program, or from Dr. Ladd McNamara himself.   Always speak with your physician or other healthcare professional before making any changes to your medication or embarking on a nutritional, herbal or homeopathic supplement program, or before using any treatment for a health concern. If you have, or suspect that you have, a medical problem, contact your health care provider promptly.  Do not disregard professional medical advice or delay in seeking professional advice because of something you have read or heard on this website, or due to any other information from Dr. Ladd McNamara or his representatives. Information provided on this website or the V.I.P. Program, and the use of any products or services mentioned on this website (or as a result of information provided this program, article, or website) by you DOES NOT create a doctor-patient relationship between you and Ladd McNamara, M.D.  Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.

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