Homeopathic Treatments Flashcards
l-methylfolate (Deplin)
Indication: adjunctive treatment for depression
Dose: 15mg/d (7.5mg has not been shown to be useful)
Monitoring: Vitamin B12 (folate masks B12 deficiency); Check for MTHFR first for polymorphism (homozygous); otherwise, no routine monitoring required
Mechanism: may enhance synthesis of monoamine neurotransmitters; dietary folic acid is converted to l-methylfolate by MTHFR, and l-methylfolate is necessary for the synthesis of serotonin, norepinephrine, and dopamine
Advantages: “medical food” and not a medication
Disadvantages: may mask symptoms of B12 deficiency (reverses the hematologic signs); decreases anticonvulsant levels and is decreased by anticonvulsants
ADEs: none particularly
Fun Facts: try regular folate first or
Treat for twelve weeks minimum before concluding it was ineffective.
l-tryptophan
Indication: (off label): Depression; Premenstrual Dysphoric Disorder; Smoking Cessation
(data best for PMDD and smoking cessation)
Dose: Depression: 300mg daily with ADT; PMDD studied at 6g/d
Smoking Cessation: 500-1000mg BID or 500mg TID
Monitoring: No routine monitoring required
Mechanism: Essential AA—converted to 5-HTP, and then serotonin
Advantages: crosses BBB better than other agents
Disadvantages: risk of serotonin syndrome; scant clinic evidence
ADEs: abdominal pain; nausea; diarrhea; flatulence; headache; eosinophilia-myalgia syndrome (EMS) – eosinophilia, fatigue, myalgia, neuropathy, rash, inflammation (initial, but none since)
Fun Facts: No more l-tryptophan in turkey than any other meats; turkey coma is likely carbs.
melatonin
Indication: (off label) Insomnia; Jet Lag; Work-Shift Sleep Disorder
Dose: Insomnia: 0.5-20mg daily – lower doses shown to be more effective
Jet Lag: Take 1-3mg day of travel at anticipated bedtime; then 3mg for the next 4 days
Monitoring: No routine monitoring required
Mechanism: melatonin receptor agonist; melatonin rises at sunset and peaks in the middle of the night to regulate the sleep-wake cycle
Advantages: no dependence potential; OTC if needed; well-tolerated; minor improvements in subjective experience of sleep quality; improves insensitivity; increases effectiveness of calcium-channel blockers
Disadvantages: does not impact nocturnal sleep; alteration of hormones (ovulation in women and gonadal development in children and adolescents); avoid use in pregnant women
ADEs: drowsiness; headaches; dizziness; irritability (in higher doses, generally related to next-day grogginess); vivid dreams/nightmares (higher doses)
Fun Facts: average time to fall asleep is 12 minutes; older patient have lower levels of endogenous melatonin; only synthetic forms (natural forms are taken from pineal glands of cows – may have prion disease); some countries require a prescription or ban it altogether
N-Acetylcysteine (NAC)
Indication (off-label): OCD; trichotillomania; nail biting; skin picking; SIB; acetaminophen OD; Prader-Willi Syndrome
Dose: 600-6000mg/d; studies look at 1200-2400mg in divided doses (BID)
Monitoring: No monitoring required.
Mechanism: glutamate modulator and antioxidant; has effects on oxidative stress, mitochondrial dysfunction, inflammatory mediators, neurotransmission, and neural plasticity; derived from the amino acid cysteine
Disadvantages: studies generally with bias as most come from a researcher with a patent on a formulation of NAC
ADEs: nausea; flatulence; diarrhea; cramping; may exacerbate asthma
Omega-3 Fatty Acids (Fish Oil; Lovaza)
Indication: high triglycerides (as Lovaza); (off label): unipolar and bipolar depression
Dose: Start 500mg per day; increase as tolerated to 2g/d; desired ratio of 60% EPA; 4g is typical maximum dose (though Innuits have been reported to ingest 16g/d without bad effects)
(Lovaza) as 1000mg capsules (which is fish oil mg)
Monitoring: No clinical monitoring required.
Mechanism: improves cell membrane fluidity and membrane function, changes neurotransmitter binding, and promotes anti-inflammatory effects.
Advantages: Studied in wide variety of psychiatric conditions; more helpful for more severely ill patients than mild-to-moderate; lowers blood pressure and has an additive effect with antihypertensives
Disadvantages: Has not shown a robust effect.
ADEs: nausea; loose stools; fishy aftertaste; caution in those allergic to seafood; increased risk of bleeding
S-Adenosyl-L-Methionine (SAMe)
Indication (off-label): mild to moderate depressions; osteoarthritis; fatty liver disease
Dose: 400-1600mg in BID (1600mg most common)
Monitoring: No monitoring required.
Mechanism: methyl group donor that increases synthesis of neurotransmitters, increases responsiveness of neurotransmitter receptors, and increases fluidity of cell membranes through the production of phospholipids; a derivative of the amino acid methionine and produced by the body
Advantages: As effective as TCAs (though trials small); natural treatment that is helpful as an augmentation agent.
Disadvantages: tablet dissolution may occur, rendering the product ineffective, though one would not know it; some recommend taking folate and B-supplements as a precaution against elevated homocysteine levels
ADEs: well-tolerated overall; flatulence; nausea; diarrhea; constipation; dry mouth; headache; anxiety; mild insomnia; sweating; dizziness; more serious: hypomania; serotonin syndrome theoretically possible; elevated homocysteine level
St. John’s Wort
Indication (off-label): Depression
Dose: Most common 300mg TID, but there are multiple formulations
Monitoring: No monitoring required.
Mechanism: modulation of monoamines; may inhibit reuptake
Advantages: option for short-term treatment
Disadvantages: multiple DDI interactions (e.g., reduces effectiveness of OCPs, immunosuppressants, Lipitor, and HIV medications)
ADEs: insomnia; vivid dreams; restlessness; anxiety; agitation; irritability; GI discomfort; dry mouth; headache; scant reports of sexual dysfunction; photosensitivity; rare cases of phototoxic skin reactions; can create serotonin syndrome.
Fun Facts: Made from active components of Hypericum perforatum (predominantly hypercin and hyperforin) from the flowering buds; Australia makes 20% of it as a cash crop; blooms near June 24th, the Feast of the Nativity of St. John the Baptist; used since Hippocrates who documented its use.
Vitamin D
Indication (off-label): Depression
Dose: 1000 IU to 2000 IU daily
Monitoring: Periodic Vitamin D levels (>30 – normal; 21-29 – insufficiency; <21 – deficiency)
Mechanism: Plays a role in brain placidly, neuroimmunomodulation, and inflammation
Advantages: Difficult to get sufficient daily needs, so supplementation is often welcome;
Disadvantages: Can get from exposure to sunlight; few studies find there is much impact
ADEs: Vitamin D toxicity
Metabolism: Conversion of 7-dehydrocholesterol via UVB to D3 (liver) 25-hydroxyvitamin D (kidneys) calcitrol (1,25-dihydroxyvitamin D)
Sources: D2 from mushrooms and soy milk; D3 from animal sources; D3 3x more potent than D2
