Comp. and Alt. Medicine Flashcards
Why might omega 3 fatty acids be anti-inflammatory?
They compete for enzymes that process omega 6 fatty acids into pro-inflammatory things.
Should you discuss complementary and alternative medicine with your pts?
Yes.
For what psych disorders is there evidence of omega 3 FAs helping?
MDD and BPD
Problems with omega 3 FAs?
Very high doses -> increased mood cycling in BPD.
(Fishy burps, GI upset.)
They’re pretty safe.
Deficiency in which B vitamin is strongly associated with depression?
B9 (we always call it folate, though)
Why do MTHF and L-MTHF exist?
Because some people lack the enzyme to activate dietary folate, and thus supplementation with just folate doesn’t help.
Evidence for folate (or MTHF) helping depression?
Very modest… L-MTHF might work a little better, though.
What does SAMe do? What neurotransmitter does it seem to affect?
Methylation of lots of things.
Taking SAMe increases serotonin levels in brain.
Use for SAMe? (2 things)
Adjunct to SSRI in depression. (Doesn’t cause serotonin syndrome)
Parkinson’s - because levodopa depletes SAMe.
In what disease should you avoid SAMe?
Bipolar. It can cause mania.
Utility of vitamin D in depression?
Useful if they’re actually deficient in vitamin D. No data that says it’s useful if they’re not deficient. (Check for deficiency risk factors and check levels)
Use for and usefulness of N-acetylcysteine?
For bipolar. Potentially useful as adjunct.
Use for and usefulness of tryptophan?
For depression. Increases serotonin, doesn’t cause serotonin syndrome.
Efficacy dubious, but it’s safe.
Use of St. John’s Wort? Efficacy?
For depression. It might be just as effective as SSRIs. (must be careful to get preparations with consistent dosing, though)
3 drawbacks of St. John’s Wort?
Can’t use in combo with SSRIs, else serotonin syndrome.
Can’t use in BPD, else mania.
Induces CYP 3A -> many drug interactions.
What can Kava be used for?
Anxiety.
3 very bad things about kava?
Hepatotoxicity.
Can cause coma when used with EtOH, benzos, or muscle relaxants.
Induces CYP450 isozymes -> drug interactions.
Does kava have a favorable risk/benefit profile?
No, probably not. There are safer ways to treat anxiety.
Does that chamomile tea actually make you less anxious? How?
Probably a little (but tea doesn’t give significant dose).
Inhibits enzymes that catabolize GABA.
Shown to be mildly effective in GAD in 1 RCT.
What does gingko do? Does it work?
Anti-platelet-activating -factor.
Increases cerebral blood flow.
Doesn’t work for dementia or cognitive impairment.
Safety risk of gingko?
Increased risk of bleed if on anticoagulants or anti-platelet drugs.
Acupuncture usefulness?
Good for pain, insufficient evidence that it’s good for depression.
Physiological effect of yoga breathing?
May actually be anxiolytic… via vagus nerve… acting on hippocampus and amygdala and hypothalamus and stuff.
“Calm alertness.”
Parts of brain that “mindfulness” activates?
ACC and PFC.
What effect does activation of dorsomedial PFC in mindfulness have on anxiety/stress?
seems to modulate amygdala / other emotional signaling….
What 3 disorders have specific evidence supporting the use of mindfulness training?
GAD, PTSD, depression
