What supplements can help with mental health?

Supplements for Mental Health: Evidence-Based Recommendations

Omega-3 fatty acids, particularly EPA at doses of 1-2g daily, are the most strongly recommended supplements for mental health, especially for depression. 1

First-Line Supplement Options

For Depression:

• Omega-3 fatty acids

  • Dosage: 1-2g/day of EPA or EPA/DHA combination with ratio >2:1 1
  • Evidence: Strong support as adjunctive treatment for depression
  • Duration: Minimum 8 weeks for therapeutic effect
  • Monitoring: Check for mild gastrointestinal symptoms (fishy taste, belching)

• St. John's wort

  • Recommended for mild-to-moderate depression 2
  • Caution: Significant drug interactions with many medications
  • Hold 2 weeks before surgical procedures 1

• Saffron

  • Provisionally recommended for depression 2
  • Shows moderate evidence for effectiveness

For Anxiety:

• Ashwagandha

  • Dosage: 250-600mg daily 3
  • Mechanism: Modulates GABA pathways to regulate anxiety
  • Duration: Typically 60 days at 300mg twice daily
  • Safety: Generally safe but avoid during pregnancy/lactation

• Lavender

  • Moderately supported for anxiety disorders 2
  • Good safety profile

• Passionflower

  • Can be continued even perioperatively 1
  • Known primarily for anxiolytic effects with good safety profile

Second-Line Options

For Depression:

• SAM-e (S-adenosylmethionine)

  • Weakly recommended as adjunctive treatment 2
  • Hold 24 hours before surgical procedures 1

• Vitamin D

  • Weakly recommended for depression 2
  • Also supported for negative symptoms in schizophrenia

• Methylfolate

  • Some evidence for treatment-resistant depression 2

For Anxiety:

• Vitamin B6

  • Dosage: 100mg daily 3
  • Mechanism: Increases GABA synthesis in the brain

• Vitamin C

  • Dosage: 500mg daily 3
  • Some evidence for anxiety reduction after 14 days

Clinical Decision Algorithm

1. Assess severity of mental health condition:

   • For mild-moderate depression: Consider omega-3 fatty acids or St. John's wort
   • For anxiety: Consider ashwagandha or lavender
   • For severe mental illness: Supplements should only be used as adjuncts to standard treatment

2. Check for contraindications:

   • Medication interactions (especially with St. John's wort)
   • Pregnancy/lactation status (avoid ashwagandha)
   • Bleeding disorders (caution with omega-3s at high doses)

3. Initiate treatment:

   • Start with recommended dosage
   • For depression: Omega-3 with EPA/DHA ratio >2:1 at 1g daily
   • For anxiety: Ashwagandha 300mg twice daily

4. Monitor response:

   • Assess after 4-8 weeks of consistent use
   • If no response, consider increasing dose (for omega-3s, up to 2g daily)
   • If still no response after dose adjustment, consider alternative supplement

Important Considerations

• Quality matters: Product quality and standardization vary significantly, especially for herbal supplements 2

• Safety profile: Most supplements have acceptable safety profiles when used appropriately, but monitor for side effects 3

• Not recommended supplements:

  • Vitamin E and beta-carotene are not recommended for mental health 3
  • Folic acid, vitamin C, inositol, and magnesium lack sufficient evidence for depression 2

• Targeted populations:

  • Omega-3s may be particularly beneficial for those who are overweight (BMI >25) or have elevated inflammatory markers 1
  • Omega-3s may have a role in perinatal depression 1

• Timing considerations:

  • Many supplements should be discontinued 2 weeks before surgical procedures 1
  • Some supplements like St. John's wort require 2-4 weeks for full effect

Mental health supplements should be used within a framework of comprehensive mental healthcare, especially for more severe conditions. The evidence base is strongest for omega-3 fatty acids in depression, with emerging evidence for several other supplements in specific conditions.