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AIII-Natural Health Products > L14-Mental Health > Flashcards

L14-Mental Health Flashcards

1
Q

why NHPs?

A

-V common & associated w signif disability & stigma
>1/5 cnds living w mental illness

  • manage sx of illness or se
  • pt preference
  • belief that “natural is better”
  • info from internet/media

-use of CAM ranges from 16-44 (highest in depression) (note this also includes wellness methods)

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2
Q

Depression
Prevalence and burden?
Impacts?

A

11% will get it in life time
13%= global disease burden

Impacts phys health

  • predisposition to obesity/metabolic disorders
  • Increased med co-morbidity

Function

  • high impact on social domain
  • increased work impairment
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3
Q

Depression

neuroscience - list factors

A

• Genes
• Stress
• Dysregulation of the HPA axis reduces hippocampal
volumes and prefrontal cortex activity
• Antidepressants increase BDNF → neuronal growth and activity
• Cytokines→inflammatoryresponse

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4
Q

Depression

Risk factors

A

combo of genetics, bio, psychological, social factors

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5
Q

Depression

Clinical presentation

A
  • S – sleep changes
  • A – anhedonia
  • D – depressed mood
  • A – appetite disturbance
  • F – fatigue
  • A – agitation (psychomotor) or psychomotor retardation
  • C – concentration
  • E – esteem
  • S – suicidal ideation
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6
Q 
Depression
Tx options:
1. pharmacotherapy
2. psychotherapy
3. other
A
  1. Pharmacotherapy: Rx and NHPs
  2. Psychotherapy: CBT, psychoanalytic therapy
  3. Other: yoga, exercise, mindfulness
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7
Q

Depression

List NHPs

A
  1. St.John’swort
  2. SAM-e
  3. L-Tryptophan and 5-Hydroxytryptophan (5-HTP)
  4. Others: Omega-3 fatty acids (fish oils)
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8
Q
  1. St. John’s wort
    Sci name?
    AI?
A

=Hypericum perfoatum

-AI: hypericin 0.3-0.5% or hyperforin 5% (hypericin more traditional)

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9
Q
  1. St. John’s wort

Indications?

A

-mild to mod depression (where bulk of evidence is)
-anxiety, ADHD, insomnia
(300mg po tid, but need to check based on the product that they use)

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10
Q
  1. St. John’s wort

MOA?

A

-similar to conventional antidepressants
>inhibit uptake of 5HT, NE and DA (like SSRI, SNRI, TCA)
>also impacts glutamate and GABA
>direct effects on 5HT receptors

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11
Q
  1. St. John’s wort

Efficacy?

A
  • controversial!
  • vast majority of data suggests benefit at improving mood sx, insomnia and somatic sx in indivs w mild to mod sx
  • systematic reviews confirm comparable efficacy to antidepressants and superiority to placebo for mild-mod MDD
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12
Q
  1. St. John’s wort

T/F: 1st line for mono mild/mod depression

A

TRUE

-2nd line adjunct for mod/severe (no better than conventional therapy)

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13
Q
  1. St. John’s wort

____ questionnaire for pt to use.

A

PHQ9 (patient health questionaire)
-rate their sx & severity
-gives you a score & tells you the severity of the depression
> not a Dx but gives pt an idea
-threshold for improvement for st johns wort= 20%

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14
Q
  1. St. John’s wort

Safety?

A

-overall well tol
>common se= GI upset, headache, skin irritation/ photosens, dry mouth (similar to that of conventional)
>risk of 5HT syndrome and hypomania (esp if using other antidepressants or opioids)
>could cause a hypermania event (other Rx options can also cause this)

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15
Q
  1. St. John’s wort

T/F: safe in preg

A

false - not established so best to avoid

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16
Q
  1. St. John’s wort

DI?

A
  • Potent inducer of CYP 3A4q

* Several clinically significant interactions

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17
Q
  1. St. John’s wort

For anxiety and ADHD?

A

not robust, hence not generally recommended for these disorders as risk likely outweighs benefits

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18
Q
  1. SAM-e

AI?

A

S-adenosyl-L-methionine

-natural substrate in the human body (formed from homocysteine and 5-methylene tetrahydrofolate)

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19
Q
  1. SAM-e

indication?

A

-depression, anxiety, fibromylagia, heart disease, OA, dementia, ADHD, migraine
(doses titrated to 1600mg/d but dividied)

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20
Q
  1. SAM-e

MOA?

A
  1. modulation of monoaminergic neurotransmission
  2. influencing neuronal memb fluidity- which may facilitate signal transduction across membranes
  3. increases 5HT turn over and increases DA/NE
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21
Q
  1. SAM-e

Efficacy?

A

-Rx in Europe (oral or parenteral) for severe conds such as MDD; Canada is OTC supp
-data supports efficacy for tx of sx of major depression >monotherapy for mild-sev MDD= effective
>comparator antidep in mild/mod MDD

-recommended as 2nd line adjunct in mild-mod MDD

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22
Q
  1. SAM-e

Efficacy? Probs w/ studies

A
  • Done against placebo, if you compare against an Rx, they are no longer more effective)
  • Lack of data on maintenance tx or long term tx (therefore unknown if worth it to continue; cost issue)
23
Q
  1. SAM-e

safety?

A
  • Overall well tolerated
  • Common side effects: GI sse, insomnia, sweating, headache, irritability, restlessness, anxiety, tachycardia
  • Potential for serotonin syndrome (rare)
24
Q
  1. SAM-e

T/F: product quality is good!

A

NO

25
Q
  1. L- tryptophan

Describe

A
  • essential aa found in many proteins (also pumpkin seeds)

- precursor of 5HT

26
Q
  1. L- tryptophan

Indication?

A

depression, incomnia, PMS, cognitive impairement, ADHD

standard dosing: 2-4mg/d w duration of 3-4m

27
Q
  1. L- tryptophan

Efficacy?

A

-‘may’ potentiate serotonergic neurotransmission which may mediate antidepressant effects BUT no clear evidence and is NOT recommended

28
Q
  1. L- tryptophan

Safety?

A
  • Overall well tolerated
  • Common se’s: Sedation, dry mouth, GI upset
  • Risk of serotonin syndrome
  • Potential to increase lithium toxicity - monitor levels
  • Potential risk of Eosinophilia-myalgia syndrome (EMS) (1500 reports of EMS and 37 deaths)-> this is why you should not use (and NO proven benefit)
29
Q
  1. 5-hydroxytryptophan (5-HTP)

T/F: also called tryptophan, which is produced in body from essential aa L-try

A

TRUE

30
Q
  1. 5-hydroxytryptophan (5-HTP)

Indications?

A
  • Indications: depression, sleep disorders, anxiety, ADHD
  • Standard Dosing: 150-800 mg daily for up to one year
  • Data is of generally poor quality - not routinely recommended
31
Q
  1. 5-hydroxytryptophan (5-HTP)

MOA?

A

• Increases production of serotonin by the CNS

32
Q
  1. fish oils (O3)

indications?

A

(DHA or EPA)

  • depression, coronary heart disease, cancer
  • wide range of doses (ie 3-9g/d of O3 fa)
33
Q
  1. fish oils (O3)

efficacy?

A

Contradictory
>Most rigorous meta-analyses found efficacy w/ good effect size

Recommended as 2nd line monotherapy for mild-mod MDD and adjunctive to antidepressants for mod- severe MDD.

34
Q
  1. fish oils (O3)

safety?

A
  • well tol
  • SE: GI upset, fishy aftertaste, bruising, headache
  • increase bleed risk at high doses (caution in pts on antiplate/coag tx OR if they have alcohol dependency)
35
Q

Insomnia.

Describe.

A
  • most prevalent sleep disorder
  • difficulty falling asleep/ staying asleep or non-restorative sleep
  • sleep difficulty despite adequate opportunity
  • associated w impairment in daytime fxn
  • sleep diffiuclty at least 3x/wk and problem for at least 1m
36
Q

Insomnia.

NHP options - list e.g.

A
  • valerian
  • melatonin
  • kava
  • others
37
Q
  1. Valerian

Indication?

A

-insomnia, anxiety, ADHA

400-900mg depending on formulation; often in tea

38
Q
  1. Valerian

Efficacy for insomnia?

A
  • modest efficacy data-> suggests reduce time to sleep onset (latency)
  • take up to 2 hours before bed for best results
39
Q
  1. Valerian

T/F: Not efficacious for anxiety, depression, ADHD

A

TRUE

-maybe ok if had insomnia + one of these conditions

40
Q
  1. Valerian

Safety?

A
  • well tol

- se: headache, excitability, GI upset

41
Q
  1. Kaka
    Sci name?
    Indication?
A
  • Piper methysticum

- anxiety, insomnia, ADHD

42
Q
  1. Kaka

Efficacy?

A

likely effective for anxiety but not others (ie not insomnia)

43
Q
  1. Kaka

Safety?

A

hepatotox!! (removed from cnd market BUT may order online)

44
Q
  1. Melatonin

AI?

A

N-acetyl-5-methoxytryptamine

-neurohormone naturally produced in brain by pineal gland

45
Q
  1. Melatonin

Indication?

A
  • indicated in insomnia, jet lag, shift work disorder, circadian rhyhm disorder, dementia, bipolar disorder
    (dose: 203g qhs)
46
Q
  1. Melatonin

MOA?

A

-synthesis and release of melatonin in body stimulated by darkness and suppressed by light suggesting involvement in circadian rhythm

47
Q
  1. Melatonin

efficacy?

A
  • For primary insomnia, short term modestly reduces sleep latency (~12 min)
  • Does not improve sleep efficiency
  • Subjective improvements in sleep quality noted for some (which is important!!
  • May be most effective in elderly patients with insomnia who may be deficient in melatonin.
48
Q
  1. others

list e.g. and are they efficacious?

A

• German Chamomile
• Passion flower
• Siberian Ginseng
• Lavender
• Hops
• Limited efficacy data for all of these-> not routinely recommended.
->If used check for drug interactions to minimize safety risks. (and allowing them to stay on may increase their trust in you)

49
Q

Dementia
NHPs gucci or nah?
List e.g. products

A

Efficacy lacking

  1. ginko kiloba (most common)
  2. ginseng (some potential benefits; improve cognitive fxn)
  3. Vit E (potential benefit such as slowing disease progression BUT weigh against potential for increased mortality)
50
Q
  1. Ginko biloba
    AI?
    Indications?
A
  • active flavonoids and terpenoids in leaf extracts

- indicated in dementia, cognitive fxn, anxiety, PNS, tardive dyskinesia

51
Q
  1. Ginko biloba

MOA?

A

unknown

52
Q
  1. Ginko biloba

efficacy?

A
  • no efficacy in preventing dementia but may improve Sx
  • may improve cog fxn in indivs w no complaints of memory impairment
  • not more effective in pts w neuropsych sx
53
Q
  1. Ginko biloba

safety?

A

well tol

-se: GI upset, headache, potential bleeding

54
Q

Medical cannabis

A
  • becoming increasingly popular in indivs w mental illness
  • small amount of data
  • risks likely outweigh benefits (bc in those w psych disorders it can actually precipitate schiz)
  • area that will continue to have lots of attention in future

AIII-Natural Health Products (19 decks)

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