AN HERB FOR DEPRESSION?

Curcumin (the colorful component of turmeric, an Indian cooking herb) seems to work just as well as fluoxetine (Prozac ™) for treatment of unipolar depression.

It is related to ginger, and grows wild and cultivated throughout Southeast Asia. Curry’s yellow coloring is due to tumeric.

The good news is that curcumin has a number of attractive features. One of them is that if one consumes turmeric all of one’s life, the incidence of Alzheimer’s is practically nil. Other advantages include a possible reduction in various cancers. It reportedly reduces inflammation in patients with arthritis. I cannot find any contraindications.

Here is the report’s abstract:

     Curcumin, an active ingredient of Curcuma longa Linn (Zingiberaceae), has shown potential            antidepressant-like activity in animal studies. The objectives of this trial were to compare the efficacy and safety of curcumin with fluoxetine in patients with major depressive disorder (MDD). Herein, 60 patients diagnosed with MDD were randomized in a 1:1:1 ratio for six weeks observer-masked treatment with fluoxetine (20?mg) and curcumin (1000?mg) individually or their combination. The primary efficacy variable was response rates according to Hamilton Depression Rating Scale, 17-item version (HAM-D17). The secondary efficacy variable was the mean change in HAM-D17 score after six weeks. We observed that curcumin was well tolerated by all the patients. The proportion of responders as measured by the HAM-D17 scale was higher in the combination group (77.8%) than in the fluoxetine (64.7%) and the curcumin (62.5%) groups; however, these data were not statistically significant (P?=?0.58). Interestingly, the mean change in HAM-D17 score at the end of six weeks was comparable in all three groups (P? =?0.77). This study provides first clinical evidence that curcumin may be used as an effective and safe modality for treatment in patients with MDD without concurrent suicidal ideation or other psychotic disorders.

What is a therapist to do? Well, doses up to 12 grams a day are tolerated, and unlike St. John’s wort where you have a short serum half-life (the time it takes for your body to excrete half of the active substance) and have to take it three times a day, you only take this once a day. Also, St. John’s wort has some interaction with other drugs. I haven’t found any so far for curcumin, except that it may potentiate anti-inflammatories.

Further, there is no reason you cannot combine it with existing antidepressants therapies, since the combo with fluoxetine didn’t reveal problems. You may say that it wasn’t quite as good as Prozac, but actually you would be wrong. There is no statistical difference between 62.5% responding to curcumin and 64.7% responding to fluoxetine. Twenty people in each group, that difference in response is entirely trivial.

(The term “response” in psychiatric literature means that your score on the Hamilton or on the Beck Depression Inventory has dropped by 50%. So if your initial Beck score is 24, you are not a responder until your score is 12. Bear in mind, on the Beck you have to score at 9 or less to be considered recovered, and 7 or less on the Hamilton. “Response” means improved, not necessarily cured.)

Curcumin does not metabolize well, and some authorities recommend you combine it with pepper (piperine, a component of black pepper) or in recipes cooked with oil. It may turn out that if you combine it with pepper, you could see a good effect with half a gram a day.

Should we recommend it to our patients? Well, you ought to get the original article and read it through, a challenge unless you ask the first author for a reprint. If you have a good post-grad education in dietary and lifestyle counseling, this would be worth while. Maybe this report will motivate you to master this type of mind-body medicine. Early adoption seems to have no down-side risk that I can see. You do need to touch base with the patient’s primary care physician or psychiatrist.

The journal reference is found at: http://onlinelibrary.wiley.com/doi/10.1002/ptr.5025/abstract

Author contact <> & <>

<jayesh_sanmukhani@yahoo.co.in> <ajay.goel@baylorhealth.edu> and if you write to them, they just might send you a reprint. The report will appear in *Phytotherapy Research* entitled”Efficacy and Safety of Curcumin in Major Depressive Disorder: A Randomized Controlled Trial.”

The sample size is small, typical for an initial study. A large study would likely show whether there is actually any significence in combining the curcumin with fluoxitine. I will guess there is, based on other studies which combine anti-inflammatory agents with SSRIs. As you likely already know, larger sample sizes give more accurate data. Another question would be whether combining the curcumin with piperine, which increases bioavailability of curcumin significently, would allow more therapy impact.

<jayesh_sanmukhani@yahoo.co.in><ajay.goel@baylorhealth.edu>One more point: At another level, I see this sort of information as challenging most mental health professionals to broaden our education and our practice model. We in the mental health business are typically interested in changing thinking patterns. But there are other approaches to achieve the same outcome. Lifestyle interventions are useful and valuable to enhance mental health. Good sleep, daily exercise, wise eating, and social connection all give better emotional health. My friend Allen “Zak” Zaklad has had good results engaging highly at risk patients in Tai Chi. Now we see there are even particular recipes we ought to recommend, namely Indian/Asian cooking with turmeric.

(All thanks to the indefatigable Ken Pope for calling this to my attention.)