Antidepressants

Question 1

What are the 3 herbals used in depression?

Answer 1

St John’s Wort, 5HTP, and SAMe

Question 2

How does St Johns Wort work?

Answer 2

Hypericin - inhibits enzymes involved in NT synthesis, degradation, etc.

Hyperforin - Inhibits NT reuptake

Question 3

Which active metabolite of St Johns Wort is involved in DDI?

Answer 3

Hyperforin

Question 4

Which active metabolite of St Johns Wort is involved in photosens?

Answer 4

Hypericin

Question 5

What are the major counseling points for St Johns Wort?

Answer 5

Abortifacient; drug intx; do not use with other AD (serotonin syndrome); Photosensitivity inc; takes 4 weeks to work like other standard AD’s

Question 6

What evidence grade is St Johns Wort

Answer 6

Grade A

Question 7

Daily dose of St Johns Wort?

Answer 7

500-1800 mg

Question 8

How does SAMe work?

Answer 8

Converts to methionine, which is naturally produced in the body by the liver but is thought to help inc levels of 5HT and NE

Question 9

Counseling points for SAMe?

Answer 9

Mild AE (nausea, diarrhea, insomnia); avoid other antidepressants (serotonin syndrome); avoid aged cheese and red wine (contain tryptamine, a serotonin precursor)

Question 10

Daily dose for SAMe?

Answer 10

400-1600 mg

Question 11

Evidence for SAMe?

Answer 11

Grade C; lacking evidence, not recommended

Question 12

How does 5HTP work?

Answer 12

Converts to 5HT in the CNS and periphery; thought to increase Serotonin levels

Question 13

Counseling for 5HTP?

Answer 13

Food increases absorption; Mild AE (N/v/d); serious: can cause eosinophilia myalgia syndrome if contaminated product - leads to excessive eosinophil granulocytes