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B&B Week 9 Flashcards > Lecture 64: Complementary and Alternative Medicine > Flashcards

Lecture 64: Complementary and Alternative Medicine Flashcards

1
Q

What is CAM?

A

Complementary and alternative medicine
Treatments used to promote WELLNESS, those used ALONGSIDE conventional care, and those used to REPLACE conventional treatments

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2
Q

What are the consequences of lack of communication about CAM?

A

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

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3
Q

What are the supplemental nutrients used for mood disorders?

A
  1. Omega-3
    • augmentation of depression and BPD
  2. Folate/B12
    • Folate = limited efficacy in depression
    • L-MTHF = effective in depression
  3. S-Adenosyl Methionine (SAMe)
    • effective augmenter and REPLACEMENT FOR SSRI
    • effective in PD
    • AVOID with BPD
  4. Vitamin D3
    • low levels associated with depression but INSUFFICIENT EVIDENCE
  5. Amino Acids
    • N-acetylcysteine adjunct in BPD treatment
    • Tryptophan = no evidence
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4
Q

What supplemental nutrients can be used to augment depression treatment?

A
  1. Omega-3 (EPA and DHA)
    • restablish Omega-3 and omega-6 balance
  2. L-MTHF (folate, vitamin B supplement)
  3. SAMe, can be used BY ITSELF
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5
Q

What supplemental nutrients can be used to augment bipolar treatment?

A
  1. Omega-3

2. N-acetylcysteine (amino acid)

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6
Q

What should you avoid to treat BPD?

A

SAMe
Can induce mania
(too much omega-3 can also induce mania)

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7
Q

What supplement can help treat PD?

A

SAMe, lessens depression

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8
Q

What supplements don’t work in reducing depression and BPD?

A

Vitamin D3
Tryptophan
Folate

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9
Q

What are the two omega-3 fatty acids used to treat psychiatric conditions?

A
  1. Eicosapentaenoic acid (EPA)

2. Docosahexaenoic acid (DHA)

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10
Q

What is the significance of Omega-3 treatment?

A

Used in treatment of
i. MDD
ii. Bipolar disorder
Use to AUGMENT not REPLACE treatment

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11
Q

What is omega-3 efficacy in MDD?

A

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

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12
Q

What is omega-3 efficacy in bipolar disorder?

A

EPA and DHA both had a significant positive effect for bipolar DEPRESSION
Used IN CONCERT with mood stabilizer
Cant be used to treat mania

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13
Q

What are the side effects of omega-3?

A

Very safe at moderate doses

  • can induce bleeding
  • over 6g/d increase MANIA
  • possible benefits for CV health due to less inflammation
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14
Q

What is the significance of B vitamins?

A

Known as the “energy pills”
Folate vs. Cobalamin
B9 vs. B12
Can be used as supplementation to treat MCI and depression

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15
Q

How can folate be taken? What is the evidence?

A

Folic acid, MTHF, L-MTHF

Evidence = MODERATE

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16
Q

How well does folate treat depression?

A

Folate was found to have limited efficacy

L-MTHF used in combo with SSRI allowed patients to Have BETTER HAM-DEPRESSION scores

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17
Q

What is SAM-e?

A

S-adenosyl methionine
Universal methyl group donor
Aberrant methylation has been implicatied in a lot of pathogenic processes

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18
Q

What is the evdiecen for SAMe for depression?

A

STRONG evidence for anti-depressant use of SAMe
Increases serotonin
Can be used as a REPLACEMENT or augmenter of depression treatment

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19
Q

How can SAMe be used for parkinson’s?

A

Levodopa depletes SAMe stores and leads to depression

Treat Parkinson’s with SAMe supplementation treats the depression

20
Q

What are takehome points of SAMe?

A

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

21
Q

What is the significance of vitamin D3?

A

Suboptimal vitamin D3 = depression
Risk factor for depression
INSUFFICIENT evidence in supplementation

22
Q

What aminoacids are used to treat mood?

A
  1. N-acetylcysteine (cysteine precursor)

2. Tryptophan

23
Q

What is the takehome point of N-acetylcystein?

A

Cysteine precursor
Anti-inflammatory effects
Benefit in bipolar depression as adjunctive

24
Q

What is take home point of Tryptophan?

A

Evidence is limited
Used to treat depression, insomnia, fibromyalgia
No reports of Serotonin syndrome when used with SSRI

25
Q

What are the herbal mediciens used to treat mood?

A
  1. St. John’s Wort
  2. Kava
  3. Chamomile
  4. Gingko biloba
26
Q

What are the consequences of herbal medicines?

A

Herbal preparations are UNREGULATED and may contain contaminants
-herb-drug contraindicaitons
Are not necessarily better than drugs because it is “natural”

27
Q

What is Kava?

A 
Piper methysticum
A traditional ceremonial drink used in south pacific islands
Relaxing, non alcoholic drank
Helped with anxiety
Could increase GABA transmission
28
Q

What are the safety risks of kava?

A
  1. hepatoxicity
    • mold
    • incorrect use of plant parts
  2. COMA (with alcohol and benzos)
  3. GI upset
  4. fatigue
  5. headache
  6. facial swelling
  7. decreased platelet
29
Q

What is the recommendation for Kava?

A

Risk/benefit profile weighs AGAINST its use

30
Q

What is the use of chamomile?

A

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

31
Q

What is Gingko biloba?

A

Antioxidant and anti-inflammatory effects
Increases cerebral blood flow
Used in Alzheimer’s and dementia
NO CONVINCING EVIDENCE

32
Q

What are the safety risks of Ginkgo biloba

A
  1. Increased Bleeding Risk when used with antiplatelet/anticoagulant
33
Q

What is MOA of Ginkgo biloba

A

Done through anti-platelet activating factor
Antioxidant and anti-inflammatory effects
Increases cerebral blood flow

34
Q

What is recommendation for Ginkgo?

A

Don’t use it because no convincing evidence

-also safety risks of bleeding

35
Q

What is hypericum perforatum?

A

St. John’s Wort

-like a SSRI

36
Q

What are the risks of St. John’s Wort?

A
  1. Risk of mania, AVOID in bipolar
  2. Can cause serotonin syndrome if used with sSRI
  3. Induced CYP3A P450 enzymatic pathway
    -decrease efficacy of meds depending on hyperforin level
  4. May interact with
    -immunosuppressants
    -Antiretrovirals
    -Hormonal therapy
    -chemo
    -CNS drugs
    -anti-microbials
    Makes those other drugs less effective
37
Q

What is the recommendation for St. John’s Wort?

A

Use LOW hyperforin formulations in patients for DEPRESSION
-so less herb-drug interaction
Use Schwab

38
Q

What are the mind-body techniques used to treat depression

A
  1. Acupuncture
  2. Yoga
  3. Mindfulness
39
Q

Can you use acupuncture in depression?

A

Acupuncture CANT be used to treat depression

Can only be used for pain modulation

40
Q

What does breathing deeply do in Yoga? Can yoga be used for depression?

A

Stimulation in vagal afferents
Allows you to have a calm alertness
Quality research is lacking
-suggests mood enhancing effect and decreased anxiety

41
Q

What is mindfulness? Significance?

A

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

42
Q

What CAM treatments can be used for depression?

A
  1. St. John’s Wort
  2. Mindfulness
  3. Kava (but a shitload of side effects!)
  4. Chamomile (adjunct, mild)
  5. Omega-3 (adjunct)
  6. SAMe (replacement or adjunct)
  7. L-MTHF
43
Q

What CAM treatments can be used for BPD?

A
  1. Omega-3

2. N-acetylcysteine (amino acid)

44
Q

What CAM treatments do you want to avoid for BPD?

A
  1. SAMe
  2. St John Wort
    - both can induce mania
45
Q

Common CAM side effects?

A

Serotonin syndrome and increase metabolism of other drugs
Increase bleeding in herbal medicine!
Hepatotoxicity

B&B Week 9 Flashcards (8 decks)

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