Introduction to Depression


Depression is like an octopus; it reaches its tentacles into so many aspects of life. The spectrum of depression - runs from prolonged, brief, mild feelings of being out of sorts and progresses to feelings of unhappiness, to more severe major depression , with serious persistent, recurring feelings of sadness, hopelessness, helplessness, despair, or suicidal thoughts.

First, it is important to determine whether depression is causing impairments - interfering in any significant way with the person’s life. It may interfere with the ability to function at work, reducing productivity, for example, or it may cause absenteeism the person is just too depressed to get up and go out. These are indicators that we are dealing with serious major depression. If it’s interfering with home life, for example, the person is not taking care of their health, or their children, or the things they have to do. That’s a serious depression.

Women are diagnosed with depression more frequently than men. In part, it may be that women find it easier to admit they’re depressed. Also, because women are far more likely to seek professional help for depression, they get counted. Many men just try to tough it out - white-knuckle through it without seeking professional help because depression is viewed as weak or unmanly.

Middle-aged men, especially if they are alone and have had losses - lost their job or their marriage - can be at very high risk for depression and suicide.

Elderly people are another high risk group. Many are experiencing illnesses - chronic pain everyday that they would like to escape from. They may be alone or isolated. Most of their friends have died. They may have lost a spouse. Their children may be too busy to spend time with them. If they are alone too much of the time, they may feel useless, unhappy and ill. Their quality of life is poor. Because of age, they only see things getting worse - not better. These circumstances can lead to severe depression.

Many people are taking antidepressant medications – for good reason – but unfortunately, they are often only partially effective. Only about 30% of people who are put on prescription antidepressants, actually have a very good response to them. About 30% get partially better and about 30% do not benefit.

Adapted from Andrea Garrison Interviews Dr. Patricia Gerbarg on the Topics of Suicide & Depression
Blog Talk Radio
November 22, 2010

Dr. Richard Brown and Dr Patricia Gerbarg discuss depression in their book:
How to Use Herbs, Nutrients & Yoga in Mental Health

Residual symptoms of depression take the joy out of life. Although the signs and symptoms of depression are well known, it is one of the most undertreated illnesses today. Prescription antidepressants have become the mainstay of treatment. Studies of antidepressant medications show that fewer than one-third of all patients achieve full remission within eight weeks.

Neutraceuticals, herbs and nutrients can be used as first-line treatments for mild to moderate depressions. Although most severe depressions require antidepressant medication for optimal response during the acute response phase (first 2 weeks) and for remission (8 weeks), CAM (complementary alternative medicine) can help by improving the initial response, increasing the rate and degree of remission, supporting long-term remission, and reducing side effects.

How to Use Herbs, Nutrients & Yoga in Mental Health
Richard P. Brown, MD, Patricia L. Gerbarg, MD, Philip R. Muskin, MD
W.W. Norton, 2009

Click here to read more

The Most Natural Antidepressant

S-Adenosylmethionine (SAMe)

Introduction to SAMe

S-adenosylmethionine (SAMe) is a completely natural antidepressant that exists in all the cells of our bodies and is essential for more than 100 chemical pathways that contribute to cellular metabolism. SAMe has been an important antidepressant in Europe for over 25 years. In some countries it requires a prescription and in others it is sold over the counter. The United States FDA approved SAMe as an over-the-counter neutraceutical in the late 1990's. SAMe can be as effective as the most common side effects. Information on clinical studies of SAMe, who is most likely to benefit, how to use it effectively, and where to obtain high quality SAMe can be found in the chapter on disorders of mood in How to Use Herbs, Nutrients and Yoga in Mental Health Care. This chapter also describes the extra benefits of using SAMe for depression in individuals who also suffer from arthritis, HIV or Parkinson’s disease.

How to Use Herbs, Nutrients and Yoga in Mental Health Care
Richard P. Brown, MD; Patricia L. Gerbarg, MD; Philip r. Muskin, MD
W.W. Norton & Company (2009)

Click here to read more

Scientific Articles Reviewing SAMe

Adenosylmethione (SAMe) for Depression: Biochemical and Clinical Evidence
Richard P. Brown, MD; Patricia L. Gerbarg; and Teodoro Bottiglieri, Ph.D.
Psychiatric Annals, 32(1): 29-44, 2002


S-adenosylmethionine (SAMe) occurs naturally in all living cells, and is vital to cellular metabolism. SAMe was known to only a few US physicians and biochemical researchers until 1999, when it became available as an over-the-counter dietary supplement. The delay in recognizing SAMe as a therapeutic agent was caused in part by instability in its native form, necessitating the development of stable SAMe-salts for use in pharmacological and clinical studies.

In over 75 clinical trials with more than 23000 participants, SAMe has been evaluated for treatment of depression, arthritis, liver disease, fibromyalgia, and other medical conditions. It is estimated that over 1 million people in Europe have already used it. SAMe became available in Italy in 1976, in Spain in 1980, in Germany in 1986, and more recently in Russia, China, Central and South America, and other countries. Because of differing regulatory procedures, SAMe is available by prescription in some countries and over the counter in others.

This paper reviews the basic biochemistry of SAMe, the pathways it influences in the body, and the studies of SAMe in depression. Shortcomings of these studies and the recent research that resolves their drawbacks are examined. SAMe’s proper use and its interactions, side effects, contraindications, and usefulness as an adjunct in the treatment of depression are also covered. Preliminary data on the benefits of SAMe in other psychiatric and neurological disorders is introduced. Finally, the authors offer directions for further research.

Folate, Vitamin B12, and S-Adenosylmethionine
Teodoro Bottiglieri, Ph.D.
Psychiatric Clinics of North America, March 2013, 36(1):1-14

This article review the metabolic and clinical importance of folate, vitamin B12 and SAMe, as well as clinical trials in relation to depression and dementia.

Click here to view this entire article

Investigating SAMe for Depression
Psychiatric Times, May 01, 2001

Since 1983, Richard P. Brown, M.D., associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons, has used the natural dietary supplement S-adenosylmethionine (SAMe) to treat more than an estimated 400 patients suffering from depression, many of whom were treatment-resistant.

Brown has also co-authored the book Stop Depression Now: SAMe, the Breakthrough Supplement that Works as Well as Prescription Drugs in Half the Time . . . With No Side Effects. His primary collaborator on the book project was Teodoro Bottiglieri, Ph.D., Director of Neuropharmacology and Senior Research Scientist at Baylor University’s Institute for Metabolic Disease. Bottiglieri, also an associate professor of biomedical studies at Baylor, has been conducting research on SAMe for 15 years.

In an interview with Psychiatric Times, Brown reviewed research on SAMe and discussed his clinical experience with it.

Although SAMe has only been on the U.S. market since 1999, it has been studied for decades internationally and is approved as a prescription drug in Spain, Italy, Russia and Germany. More than 1 million Europeans have used it, primarily for depression and arthritis.

“I first heard about SAMe 20 years ago when I was doing my residency in psychiatry at New York Hospital, Cornell Medical center,” Brown recalled. “At a meeting of the American College of Neuropsychopharmacology, a colleague had learned about an exciting new antidepressant being studied in Europe that was non-toxic, without side effects, and worked better and faster than traditional medications.”

Fifteen years later, after Brown had developed a subspecialty practice treating patients resistant to conventional drug therapy by integrating alternative approaches such as nutrients and herbs with prescription medications, a patient brought him information about SAMe from the internet. That launched his investigation and clinical use of SAMe.

Click here to view this entire article

S-adenosylmethionine (SAMe) in the Clinical Practice of Psychiatry, Neurology and Internal Medicine
Brown RP, Gerbarg PL, Bottiglieri T
Clinical Practice of Alternative Medicine, 1(4): 230-241, 2000

Mind-Body Practices

Scientific Paper

Controlled studies have found yoga-based interventions to be effective in treating depression ranging from mild depression to major depressive disorder (MDD). The success of yoga-based therapies in alleviating depressive symptoms is consistent with the following hypothesis: yoga breathing induces increased parasympathetic tone which increases GABAergic activity associated with improved mood and anxiety reduction. GABA (gamma aminobutyric acid) is the main inhibitory transmitter in the brain.

Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression and post-traumatic stress disorder
C.C. Streeter, P.L. Gerbarg, R.B. Saper, D.A. Ciraulo, R.P. Brown
Medical Hypotheses 78 (2012)

Click here to read complete abstract

Andrea Garrison interviews author Dr. Patricia Gerbarg and Author Letricia Hendrix on overcoming depression and thoughts of suicide.
November 11, 2010
Online with Andrea, BlogTalk Radio

In this interview, Andrea Garrison, Dr. Patricia Gerbarg and author Letricia Hendrix discuss a number issues related to depression and suicidal depression. Letricia shares her personal experience of dealing with suicidal depression.

Topics discussed include:

  • Recognizing suicidal depression in children

  • How effective are antidepressants?

  • How to work with a counselor or therapist

  • Letricia Hendrix relays her personal experience of battling suicidal depression

  • Dr. Gerbarg explains the many aspects of depression

  • Worldwide statistics of suicide and depression

  • Suicide is the 3rd leading cause of death among children ages 12-25

  • Who is at risk for suicide?

  • What can you do to help a friend or family member with suicidal depression?

  • How depression differs in women versus men

  • Depression in the elderly

  • What is cranio-electrotherapy stimulation and how does it help with depression?

  • Rhodiola as a complement to standard treatment for depression

  • Vitamins/minerals for optimal brain health

  • How stress contributes to depression

  • Seasonal Affective disorder (SAD)

  • Utilizing your breath as a tool to fight depression

Chris Killam, the Medicine Hunter, interviews Drs. Richard Brown and Patricia Gerbarg on how Rhodiola rosea offers broad benefits to cope with stress. Juliette describes how Rhodiola helped her recover from severe PTSD after she escaped from the 80th floor during the 9/11 World Trade Center attacks.


How do I find a certified BBM teacher in my area?

At this time, only Dr. Brown and Dr. Gerbarg teach BBM workshops. However, they have been training health care providers, yoga therapists and school teachers to integrate BBM techniques into their work settings.

On the BBM teachers page you will find a list of caregivers who have completed one or more BBM Teacher Training courses. You may be able to find one in your area.

If you cannot locate a BBM teacher nearby, you can start learning basic BBM practices from the book & CD set - The Healing Power of the Breath or, by participating in a workshop or online webinar. Visit the schedule page to see what programs are being offered.


Amy Weintraub
Yoga for Depression


Suicide Crisis Hotline: (800) 273-8255
Veterans Crisis Hotline: (800) 273-8255 press 1
Lifeline for Vets: (888) 777-4443


American Foundation for Suicide Prevention
(212) 363-3500


Charting the Future of Suicide Prevention
A 2010 Progress Review of the National Strategy and Recommendations for the Decade Ahead

Click here to read the full report