Mental Health Supplements

Introduction to Mental Health Supplements

• Omega-3 fatty acids, particularly EPA at doses of 1-2g daily, are recommended for mental health, especially for depression, with strong support as adjunctive treatment, according to the American College of Psychotherapy and Psychosomatics 1
• Omega-3s may be beneficial for individuals who are overweight (BMI >25) or have elevated inflammatory markers, and may have a role in perinatal depression, as suggested by the American College of Psychotherapy and Psychosomatics 1

Safety and Contraindications

• Many supplements, including St. John's wort, passionflower, and SAM-e, have specific guidelines for use before surgical procedures: St. John's wort and SAM-e should be discontinued 2 weeks and 24 hours before surgery, respectively, while passionflower can be continued, as recommended by the Mayo Clinic Proceedings 2
• St. John's wort requires caution due to significant drug interactions with many medications, and ashwagandha should not be used with anxiety medications without medical supervision, as it may potentiate the effects of other sedatives 2, 3
• Ashwagandha is generally considered safe when used in recommended doses, but its use is not recommended during pregnancy or lactation due to a lack of safety studies, and patients should follow recommended dosages to avoid potential toxicity 2, 4, 3

Treatment Guidelines

• For mild-moderate depression, consider omega-3 fatty acids, with a minimum duration of 8 weeks for therapeutic effect, and a recommended dosage of 1g daily of EPA/DHA ratio >2:1, which can be increased up to 2g daily if no response is seen, as suggested by the American College of Psychotherapy and Psychosomatics 1
• For anxiety, consider ashwagandha, with a dosage of 250-600mg daily, and monitor for response after 4-8 weeks of consistent use, as recommended by the American Herbal Products Association and the Mayo Clinic 2, 3
• The effective dosage range for Ashwagandha extract is 250-600 mg daily, with a typical regimen of 300 mg twice a day for 60 days, showing benefits in reducing perceived stress scores (PSS), as shown in the following table:

2

• Alternative or additional supplements for anxiety management include vitamin B6, with a dosage of 100mg daily, and vitamin C, with a dosage of 500mg daily, which may provide additional benefits for anxiety management 5
• The USPSTF concludes that evidence is insufficient to determine the balance of benefits and harms of multivitamin supplementation for general health outcomes, and recommends against supplementation with beta-carotene or vitamin E for general health outcomes, with no evidence supporting their use for anxiety management 5

Monitoring and Adjustment

• Response to supplements should be assessed after 4-8 weeks of consistent use, using standardized anxiety scales to objectively measure improvement, and supplements that do not provide benefit after an adequate trial should be adjusted or discontinued 4
• Patients should be reminded that supplements should complement rather than replace appropriate medical care for significant anxiety disorders, and should consult healthcare providers before starting supplements if they are taking medications 4, 2, 3