Mar 30, 2022

Disclaimer 

Our Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By following this protocol, you understand and accept that the recommendations in the protocol are for initial guidance and need to seek medical professional advise.  

Mood Support

Fluctuations in mood are common and normal; however, prolonged disruptive patterns in mood can present themselves at various times in life. One of the most common mood conditions is that of depression or depressive symptoms, with an overall pooled prevalence cited at 27%. (28)

Specific populations may be more susceptible to these symptoms. Factors such as gender and age play a role in risk factors associated with depressed moods. (23)  Depressed moods may be present in conjunction with other cognitive dysfunction such as anxiety, memory problems, and sleep disorders.
Depending on the individual patient’s needs, there are a variety of options to address their symptoms. Pharmaceutical interventions such as antidepressants are typically used to address prolonged periods of low mood or diagnosed depression. Supplements such as the herb St. John’s Wort (Hypericum perforatum) and 5-HTP have shown potential promising effects on mood symptoms. (11)(19) Omega-3 fatty acids are another option that might also have benefits on memory and sleep symptoms. (10)  Moderating stress with an adaptogen such as Rhodiola can also play a role in assisting with mood function. (1)

The ingredients presented in the protocol below reflect research findings demonstrating the efficacy of herbs and supplements that might be used to support mood and associated symptoms.

St. John’s Wort

600 mg, total per day of 0.3 % hypericin and 1-4 % hyperforin standardized formula, minimum 6 weeks (2)(4)(5)(6)(7)

  • Hypericum perforatum demonstrated similar efficacy to SSRIs for remission rate and HAM-D symptom scores after 4-12 weeks in patients with mild to moderate depression (3)(19)
  • Improvement in relapse rates, Hamilton-Anxiety Scale, Beck Depression Inventory time courses, and greater overall improvement (Clinical Global Impressions (CGI) scale) was observed; additional potential for a prophylactic effect on symptoms in patients with chronic depression or depression alone (13)(15)(25)
  • May have a similar magnitude of effect as antidepressant medications, including an increased memory for positive words, and a decreased ability to recognize disgusted faces or fearful faces (29)

Magnesium

800 mg magnesium oxide (240 mg elemental magnesium), once per day, from admission to discharge, or 2 g (or 5-50 mg/kg) of intravenous magnesium in the form of levulinate, gluconate, sulfate, or chloride, on day of surgery (3)(8)(11)(12)

  • Incidences of hypomagnesemia, associated with high occurrences in cardiac surgery, were decreased by 29.3% in oral magnesium oxide supplementation, demonstrating an overall decrease in postoperative complications; additionally, reduced gastrointestinal incidences of nausea, vomiting, and constipation in postoperative coronary artery bypass graft surgery when compared to control (12)
  • Decreased postoperative ventricular dysrhythmias, ventilatory support, and increased stroke volume in postoperative cardiac patients treated with intravenous magnesium chloride (3)
  • Systematic review of 14 randomized trials found perioperative magnesium supplementation decreased the risk of postoperative shivering (11)
  • Meta-analysis of 5 randomized controlled trials found magnesium supplementation in pediatric patients undergoing cardiopulmonary bypass decreased incidence of arrhythmia postoperatively (8)

Rhodiola rosea

340 mg, total per day, minimum of 6 weeks (7)(16)

  • May improve mood symptoms through improved cell response to stress and neuroendocrine-immune and neurotransmitter effects (1)
  • Improved symptoms of insomnia, somatization, and emotional instability (7)
  • A decrease in HAM-D score was observed with fewer adverse effects than sertraline (16)
  • Improved self-rated symptoms for mood and anxiety, as well as decreased serum superoxide dismutase and malondialdehyde levels, suggesting improvements in oxidative stress (30)

Omega-3 fatty acids

0.1-0.2 g/kg once per day of omega-3 fatty acids, seven days subsequent to surgery (1)(9)

Note: Changes in blood flow or coagulation related to altered levels of fibrinogen, factor V, and triglycerides may occur in select populations (13)(14)(20)

  • Neutrophil phagocytosis increased for postoperative colorectal cancer patients whose standard total parenteral nutrition was supplemented with omega-3 fatty acids
  • Postoperative immune function improved and inflammation as indicated by lower levels of IL-6, TNFα, and C-reactive protein in postoperative colorectal cancer patients who had a radical resection; additionally, length of hospital stay decreased (9)
  • Meta-analysis of 16 randomized controlled trials found omega-3 fatty acid emulsion improved immune function, inflammation, and postoperative curative effect in postoperative gastrointestinal cancer (25)
  • Decreased risk of olfactory loss in patients undergoing endoscopic resection for sellar or parasellar tumors (21)

5-HTP

100-400 mg per day, up to 8 weeks, either alone or with an antidepressant (1)(2)(22)

  • A systematic review of 13 studies supported the use of 5-HTP for improving remission rate (0.65), as determined by questionnaire results (12)
  • Patients receiving L-5-hydroxytryptophan (73%) experienced similar improvements in HAM-D mood scores compared to those receiving fluoxetine medication (80%) for two to eight weeks following their first depressive episode (11)
  • Patients receiving chlorimipramine with concomitant L-5-HTP (vs. placebo) experienced greater improvements in HAM-D mood scores after 28 days (18)

Attachments

Support your prescription with these additional resources