week 11 Flashcards
3 components of the mental wellbeing spiral?
- Dynamic (peak performance)
- Distracted (common stress)
- Debilitated (Depression and anxiety)
The triage theory
when the availability of a micronutrient is
inadequate, nature ensures that micronutrient-dependent functions required
for short-term survival are protected at
the expense of functions whose lack has
only longer-term consequences (during stressful time)
Can increasing nutrient intake through
supplementation support wellbeing when stressed?
Nutrition after a disaster
- Immediately after a natural disaster, nutrient intake decreases at a time
when it should be increased - Some evidence that those who eat more poorly have greater
psychological distress
B vitamins and stress
- 11 RCTs have shown micronutrients decrease stress/anxiety in both
stressed and nonstressed populations
Meta-analysis confirms B vitamins efficacious in reducing stress in healthy
and at risk populations
Poor food choices
+
some good efficacy showing micronutrients
(especially B complex) have positive effect on
stress
=
supplementation with micronutrients
following a natural disaster could be beneficial
The “natural experiment” First earthquake
- What was found control vs those taking micronutrient supplements
After T1 (right after earthquake) both groups showed elevated stress levels
At T2 however, significantly lower stress in the micronutrient supplementation group
Second natural disaster:
Earthquakes
- What was found => control vs b-complex vs broad spectrum supplement (b-complex + minerals)
Order of decrease in stress
- control (lowest decrease in stress)
- B complex
- Broad spectrum = most effective
3rd event: In a repeated study with a flood both 2 and 3 were equally effective and statistically significantly different (more effective) than the control at reducing stress
TAKEAWAY = highly nourished with micronutrients and minerals = better and reducing stress over time
4th event: mosque shooting clinical application
- study findings?
mosque study replicated effect of decreasing stress using micronutrient supplementation
Is our resilience to stress lower due to
our poor nutrient intake?
possibly
Other benefits of B vitamins
- Reductions in fatigue, confusion and improvements in multi-tasking
- Improvements in general mood and resilience
- Improvements in general health and vigour
- Improved cognition and energy
Summary
- There are a lot of products out there
- First try to get your nutrients from your food
- Eat whole food, use lots of culinary herbs and spices, eat the rainbow
- Struggling to eat well, there are supplements that are essentially
foods but condensed - If using supplements to target a problem, stick to the data
Definition of Psychedelic Drugs
- Serotonergic 5-HT2A agonists that alter perception, cognition,
and mood - E.g. LSD, mescaline, and psilocybin
Current Therapeutic Use
MDMA
for patients with alcoholism
Current Therapeutic Use
Psilocybin - Mystical Fun
lead to long term increased wellbring and life satisfaction
Current Therapeutic Use
Psilocybin - Cancer
Significant association between mystical-type experiences and
enduring positive changes
Current Challenges
- Very few RCTs and total number of patients less than 200
- Treatment with psychedelics and MDMA is a complex procedure that
requires a great deal of therapist time and involvement:
How Do Psychedelics Work?
- Disrupt the dysregulated brain circuits that underpin depression
- Switch off the default mode network (DMN) since a much
greater amount of brain is active in subjects with depression than
controls - 5-HT2A receptor stimulation may allow brain to reset itself into a
different, depression-free, state
How Does MDMA Work?
- Serotonin releasing agent
- Main activity in limbic system where it suppresses activity,
especially of amygdala and hippocampus - This damping down may help patients with PTSD relive their
traumas but at the same time overcome and possibly extinguish
the intense emotions that are associated with them
What is a main issue with studies of psychodelic drugs?
Sample sizes gets reduced as they do not qualify for the study (Small sample sizes)
=> * High rates of disqualification of volunteers: 90-96.3% - although justified in terms of safety risk, small size trails, and not reflecting the diversity of the population that could potentially benefit
Most participants know whether they’ve been given the real drug or a control
- Expectancy effects and disappointment of those who know they have received a placebo
- Self-selection bias
- No studies demonstrating efficacy or safety on those already on
antidepressants - High rate of past psychedelic drug use in subjects who entered trials:
36-56% vs 11.5% in general population - 5-HT2B receptor activation may be associated with drug- induced valvular heart disease in chronic ‘micro-dosing’
strategies - Lack of publicly funded research
- Scientists and therapists who identify as minorities under- represented
- Usually coupled with psychotherapy, complicating control for
confounding variables - Current models of psychedelic treatment extremely resource- intensive requiring about 40 hours of healthcare resourcing. May
be only available to the wealthy
If 2% of New Zealanders had psychedelic therapy, the total cost
would be $1.5 billion – more than NZ’s entire medicine budget
per annum => EXTREMELY EXPENSIVE
Preparing for the Bursting of the Psychedelic
Hype Bubble
- 3 phase II clinical trials demonstrate potential therapeutic
actions of psilocybin for treatment of depression - 1 study reported a sustained action up to 6 months after a single
administration - The best designed study (psilocybin versus escitalopram)
revealed no difference in primary outcome - Psilocybin granted FDA Breakthrough Therapy designation
Conclusions
- Scientific evidence supports continued investigation of
psychedelic compounds for treating psychiatric disorders - Probably only in research settings at present
- Paucity of novel pharmacological mechanisms for treating psychiatric disorders means a ‘disruptive pharmacology’ to investigate new treatments might be justified
- Concerns about potential overenthusiasm
- Available to a limited population
