Lecture 64: Complementary and Alternative Medicine Flashcards
What is CAM?
Complementary and alternative medicine
Treatments used to promote WELLNESS, those used ALONGSIDE conventional care, and those used to REPLACE conventional treatments
What are the consequences of lack of communication about CAM?
Implications on dr/patient relationship
Can jeopardize patient safety
Forces patients to get info from less reliable source
Most ppl who use CAM also use conventional doctors…just don’t say shit to MD
What are the supplemental nutrients used for mood disorders?
- Omega-3
- augmentation of depression and BPD
- Folate/B12
- Folate = limited efficacy in depression
- L-MTHF = effective in depression
- S-Adenosyl Methionine (SAMe)
- effective augmenter and REPLACEMENT FOR SSRI
- effective in PD
- AVOID with BPD
- Vitamin D3
- low levels associated with depression but INSUFFICIENT EVIDENCE
- Amino Acids
- N-acetylcysteine adjunct in BPD treatment
- Tryptophan = no evidence
What supplemental nutrients can be used to augment depression treatment?
- Omega-3 (EPA and DHA)
- restablish Omega-3 and omega-6 balance
- L-MTHF (folate, vitamin B supplement)
- SAMe, can be used BY ITSELF
What supplemental nutrients can be used to augment bipolar treatment?
- Omega-3
2. N-acetylcysteine (amino acid)
What should you avoid to treat BPD?
SAMe
Can induce mania
(too much omega-3 can also induce mania)
What supplement can help treat PD?
SAMe, lessens depression
What supplements don’t work in reducing depression and BPD?
Vitamin D3
Tryptophan
Folate
What are the two omega-3 fatty acids used to treat psychiatric conditions?
- Eicosapentaenoic acid (EPA)
2. Docosahexaenoic acid (DHA)
What is the significance of Omega-3 treatment?
Used in treatment of
i. MDD
ii. Bipolar disorder
Use to AUGMENT not REPLACE treatment
What is omega-3 efficacy in MDD?
RCT showed that omega-3 patients 1g/d of EPA WITH treatment showed
-improvement of depressed mood
-improved anxiety
-improved libido, sleep disturbance and suicidality
If you give more than 1g/d of EPA, then you don’t have same effect
Close gap between omega-3 and omega-6 ratio
What is omega-3 efficacy in bipolar disorder?
EPA and DHA both had a significant positive effect for bipolar DEPRESSION
Used IN CONCERT with mood stabilizer
Cant be used to treat mania
What are the side effects of omega-3?
Very safe at moderate doses
- can induce bleeding
- over 6g/d increase MANIA
- possible benefits for CV health due to less inflammation
What is the significance of B vitamins?
Known as the “energy pills”
Folate vs. Cobalamin
B9 vs. B12
Can be used as supplementation to treat MCI and depression
How can folate be taken? What is the evidence?
Folic acid, MTHF, L-MTHF
Evidence = MODERATE
How well does folate treat depression?
Folate was found to have limited efficacy
L-MTHF used in combo with SSRI allowed patients to Have BETTER HAM-DEPRESSION scores
What is SAM-e?
S-adenosyl methionine
Universal methyl group donor
Aberrant methylation has been implicatied in a lot of pathogenic processes
What is the evdiecen for SAMe for depression?
STRONG evidence for anti-depressant use of SAMe
Increases serotonin
Can be used as a REPLACEMENT or augmenter of depression treatment
How can SAMe be used for parkinson’s?
Levodopa depletes SAMe stores and leads to depression
Treat Parkinson’s with SAMe supplementation treats the depression
What are takehome points of SAMe?
Use for depression, esp as augmenter
Favorable side effect profile (feeling jittery)
Improvement can be seen in 10 days!
AVOID in bipolar disorder because it induces mania
What is the significance of vitamin D3?
Suboptimal vitamin D3 = depression
Risk factor for depression
INSUFFICIENT evidence in supplementation
What aminoacids are used to treat mood?
- N-acetylcysteine (cysteine precursor)
2. Tryptophan
What is the takehome point of N-acetylcystein?
Cysteine precursor
Anti-inflammatory effects
Benefit in bipolar depression as adjunctive
What is take home point of Tryptophan?
Evidence is limited
Used to treat depression, insomnia, fibromyalgia
No reports of Serotonin syndrome when used with SSRI
What are the herbal mediciens used to treat mood?
- St. John’s Wort
- Kava
- Chamomile
- Gingko biloba
What are the consequences of herbal medicines?
Herbal preparations are UNREGULATED and may contain contaminants
-herb-drug contraindicaitons
Are not necessarily better than drugs because it is “natural”
What is Kava?
Piper methysticum A traditional ceremonial drink used in south pacific islands Relaxing, non alcoholic drank Helped with anxiety Could increase GABA transmission
What are the safety risks of kava?
- hepatoxicity
- mold
- incorrect use of plant parts
- COMA (with alcohol and benzos)
- GI upset
- fatigue
- headache
- facial swelling
- decreased platelet
What is the recommendation for Kava?
Risk/benefit profile weighs AGAINST its use
What is the use of chamomile?
Inhibits GABA-metabolizing enzymes (increases GABA in synapse)
Used for anxiety and insomnia
Data is limited
Effects are mild so best used as an adjunct
What is Gingko biloba?
Antioxidant and anti-inflammatory effects
Increases cerebral blood flow
Used in Alzheimer’s and dementia
NO CONVINCING EVIDENCE
What are the safety risks of Ginkgo biloba
- Increased Bleeding Risk when used with antiplatelet/anticoagulant
What is MOA of Ginkgo biloba
Done through anti-platelet activating factor
Antioxidant and anti-inflammatory effects
Increases cerebral blood flow
What is recommendation for Ginkgo?
Don’t use it because no convincing evidence
-also safety risks of bleeding
What is hypericum perforatum?
St. John’s Wort
-like a SSRI
What are the risks of St. John’s Wort?
- Risk of mania, AVOID in bipolar
- Can cause serotonin syndrome if used with sSRI
- Induced CYP3A P450 enzymatic pathway
-decrease efficacy of meds depending on hyperforin level - May interact with
-immunosuppressants
-Antiretrovirals
-Hormonal therapy
-chemo
-CNS drugs
-anti-microbials
Makes those other drugs less effective
What is the recommendation for St. John’s Wort?
Use LOW hyperforin formulations in patients for DEPRESSION
-so less herb-drug interaction
Use Schwab
What are the mind-body techniques used to treat depression
- Acupuncture
- Yoga
- Mindfulness
Can you use acupuncture in depression?
Acupuncture CANT be used to treat depression
Can only be used for pain modulation
What does breathing deeply do in Yoga? Can yoga be used for depression?
Stimulation in vagal afferents
Allows you to have a calm alertness
Quality research is lacking
-suggests mood enhancing effect and decreased anxiety
What is mindfulness? Significance?
A mental training that means paying attention in a particular way;; on purpose, in the present moment and non-judgmentally
Can be used to treat depression, anxiety and PTSD
What CAM treatments can be used for depression?
- St. John’s Wort
- Mindfulness
- Kava (but a shitload of side effects!)
- Chamomile (adjunct, mild)
- Omega-3 (adjunct)
- SAMe (replacement or adjunct)
- L-MTHF
What CAM treatments can be used for BPD?
- Omega-3
2. N-acetylcysteine (amino acid)
What CAM treatments do you want to avoid for BPD?
- SAMe
- St John Wort
- both can induce mania
Common CAM side effects?
Serotonin syndrome and increase metabolism of other drugs
Increase bleeding in herbal medicine!
Hepatotoxicity
