Depression Bondi Aima Workshop 2008

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An overview of the Integrative Medicine of Depression

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Depression Bondi Aima Workshop 2008

  1. 1. Dr Lily Tomas INTEGRATIVE TREATMENT OF DEPRESSION
  2. 2. Exercise Purpose, Body Passion, image Pleasure Social/ Diet Spiritual Environ. Neurotrans Influences mitters Herbal Integrative V&Ms Treatment of Depression Homeo Hormones pathy Psycho EFAs logical BSLs Drugs Heavy Sleep Metals
  3. 3. Anti-Depressant Medications  Tricyclics : May block re-uptake of serotonin, noradrenaline, dopamine and histamine.  SSRIs and SNRIs : Block serotonin and noradrenaline uptake  MAO Inhibitors : Inhibit Monoamine oxidase, Type A blocks the breakdown of serotonin and noradrenaline Type B blocks the breakdown of different neurotransmitters, including adrenaline, dopamine and noradrenaline
  4. 4. Nutritional Treatment Options for Depression  Important neurotransmitters include:  Serotonin  Dopamine, Adrenaline, Noradrenaline  GABA  Histamine  Neurotransmitters are derived from amino acids sourced from quality proteins.
  5. 5. Nutritional Treatment Options for Depression  Depression can be the result of imbalances in neurotransmitters- deficiency or excess  Determine neurotransmitter imbalances and/or specific amino acid deficiencies  Serotonin deficiency – Tryptophan, Vit B6 or zinc deficiency, malabsorption  Oxidative stress can increase serotonin requirements
  6. 6. Serotonin Pathways Iron, Folate Vit. B6 Vit. C, Calcium Zinc 5 Hydroxy Serotonin Tryptophan Tryptophan Melatonin (from Food/ Supplement) Vitamin B3
  7. 7. Dopamine Pathway Iron, Folate Vit. B6 Vit. C Tyrosine DOPA Dopamine (From Food/ Supplement) Vit. C Copper Adrenaline NorAdrenaline
  8. 8. GABA Pathway Vit. B6, Taurine Zinc Glutamine Glutamate GABA ( From Food/ Supplement) Glutathione
  9. 9. Histamine Pathway Vit. B6 Histidine Histamine ( From Food/ Supplement)
  10. 10. Tryptophan  Tryptophan (5HTP) 100-200mg bd  Vitamin B6 100mg or Activated B6(P5P) 25mg  Zinc 40mg nocte  Magnesium 250mg bd  B Complex
  11. 11. Tryptophan  Trial at this dose for 1 month, then reduce to half as per patient’s own judgement.  Do not use tryptophan with anti-depressant drugs unless under professional supervision.
  12. 12. Tyrosine  Precursor to Dopamine, Noradrenaline, Adrenaline  These neurotransmitters have a role in depression and drug dependence  Can be in excess, however, in schizophrenia  Tyrosine 500-100omgs coupled with co- nutrients (Predop ingredients)  Tyrosine also used to enhance thyroid function
  13. 13. Glutamine  Related to the neurotransmitter, GABA, our primary inhibitory neurotransmitter  Therefore aids in mental anxiety and relaxation  Glutamine 500mg-1000mgs coupled with co- nutrients (Pre-GABA ingredients)
  14. 14. Pfeiffer Treatment Centre  Health Research Institute, Illinois, US.  Extensive database of information regarding all mental health conditions  3500 patients with depression  Highly individualised nutritionally-based approach to treating depression and other health conditions (e.g. Autism, ADHD, Alzheimers etc)
  15. 15. Pfeiffer Treatment Centre  5 main biochemical subtypes of depression  High Histamine (Undermethylation)  Low Histamine (Overmethylation)  Pyroluria (Genetic condition resulting in Zinc, Vit B6 deficiencies)  Hypercupraemia (High Copper- Excess Oestrogen)  Toxic Overload (High levels of Heavy Metals)
  16. 16. Histamine High Histamine  Under methylated  Deficiency of methyl groups/ Neurotransmitters (Serotonin, Dopamine, Noradrenaline)  Generally a good response to SSRIs  May have adverse reactions from benzodiazepines
  17. 17. Histamine High Histamine  Low methionine, zinc, Vitamin B6, calcium with high folic acid.  Benefit from SAMe, P5P, zinc, methionine, Vitamin C, calcium, magnesium  Potentially harmful supplement : folate  Improvement expectation: 8-12 months.
  18. 18. Histamine Low Histamine  Over methylated  Excess of methyl groups/ Neurotransmitters (Serotonin, Dopamine, Noradrenalin)  Generally a good response to benzodiazepines  May have adverse reactions to SSRIs, anti- histamines, oestrogen
  19. 19. Histamine Low Histamine  Low folate, Vitamin B12, B3  Benefit from folate, vitamin B12, B3,P5P, zinc, Vitamin C, E  Potentially harmful supplements : methionine, SAMe, tryptophan, tyrosine, St John’s Wort.  Improvement expectation : 3-6 months
  20. 20. Histamine, Methylation and SAMe  Histamine is intricately connected to the Methylation pathway.  The process of Methylation is a major factor in the synthesis of serotonin, dopamine and noradrenaline in the brain.  SAMe is the primary source of methyl for most reactions in the body
  21. 21. Methylation and SAMe  The primary way humans receive most of their methyl groups is from dietary methionine (egg white, halibut fish, orange roughy fish, salmon, tuna, ling, turkey)  SAMe : 400-800mg daily  Trial at this dose for 1 month
  22. 22. Essential Fatty Acids  Omega 3 fatty acids are essential components of brain cell membranes.  Alter signal transduction and electrical activity in brain cells, controlling the synthesis of chemicals such as eicosanoids and cytokines which may have a direct effect on mood.  Humans do not make their own Omega 3 EFAs!  WE ARE WHAT WE EAT!
  23. 23. Essential Fatty Acids  Our change in diets (land animal fats and many vegetables oils) from 4:1 to 16:1 Omega6: Omega 3 ratio.  EFA levels can now be measured directly through blood tests performed in specialised laboratories.  Plethora of studies demonstrating the benefits of adequate EPA/DHA to our mental state.
  24. 24. Essential Fatty Acids HOWEVER  There is a subgroup of people with depression that may get worse from EPA/DHA supplementation.  These are people who are deficient in arachidonic acid, an Omega 6 EFA – Evening Primrose Oil.  These are people who produce and excrete kryptopyrroles in their urine. 
  25. 25. Kryptopyrroluria  Genetic disorder linked to depression, anxiety and mood swings  Approx 10% population produce KPs, indicating higher needs for Vitamin B6 and zinc .  Zinc and Vitamin B6 necessary to produce serotonin and GABA  Vitamin B6 necessary to produce dopamine, noradrenaline and histamine.
  26. 26. Kryptopyrroles  First discovered in late 1950s by Hoffer  1960’s : research on schizophrenics, “mentally retarded” and “disturbed” children and criminals  1970’s : Dr Carl Pfeiffer devised a simple quantitative urine test and demonstrated a reduction in kryptopyroles and clinical improvement with high doses of vitamin B6 and zinc.
  27. 27. Kryptopyrroluria  Pale appearance, white marks on nails, poor dream recall, heightened sensitivities – bothered by bright lights, loud noises, tags on clothes, skip breakfast, food/chemical allergies.  Testing by SAFE Laboratories in QLD.
  28. 28. Kryptopyrroluria  Tend to do better on Omega 6 EFAs (evening primrose oil) rather then Omega 3 EFAs (fish oils) secondary to low levels of arachidonic acid.  Beneficial supplements: zinc, P5P, Vitamin B6, Vit C  Improvement expectation: 1-3 months
  29. 29. Hormones and Depression  Progesterone – Like serotonin, another “Feel good” hormone.  Produced in the luteal phase  Most women are oestrogen dominant. “How much of your depression do you relate to your hormones?”
  30. 30. Hormones and Depression  Oestrogen dominance is often associated with copper overload.  During pregnancy, blood copper levels more than double.  Soon after birth, copper levels return to normal.  Subgroup of people who have a genetic tendency for copper overload.  Excess copper leads to decreased dopamine and elevated noradrenalin in the brain.
  31. 31. Hormones and Depression POST-NATAL DEPRESSION  Many women with PND exhibit an excess of copper and a deficiency of zinc.  The cause appears to be genetic; abnormal functioning of the metallothionein/ glutathione system resulting in an inability to regulate copper/zinc metals in the body.
  32. 32. Hormones and Depression  Serum copper and plasma zinc.  Stop pregnancy supplements containing copper.  Beneficial supplements: Zinc, Manganese, Vitamin B6, Vitamin C, Vitamin E.
  33. 33. Putting it all together: Case History  36 year old woman presents with history of depression and IBS for 2 years  Prescribed conventional anti-depressant 6 months ago, but wishes to wean.  Not suicidal  Full history and examination
  34. 34. Case History  Management:  Mental Health Care Plan (Item 2710)  Pathology testing  3 morning temps during periods
  35. 35. Case History  Management:  Probiotics  SAMe 400mg morning  Continue current anti-depressant  Review in 1 month
  36. 36. Review after 4 weeks  Feeling better wrt moods and digestion  36.2, 36.4, 36.5  Food Elimination Regime (not all IBS symptoms resolved)  Mental Health Care Plan (continued)  Continue probiotics and SAMe. May trial half dose of anti-depressant over next month.
  37. 37. Review after further 6 weeks  Realisation of gluten intolerance, resulting in bloating , fatigue and low moods associated with these symptoms.  Still depression 1 week prior to periods  Patient still keen to cease anti-depressant  Commencement of 3 month regime Magnesium 250mg twice daily, B Complex and Vitex agnes castes 1g twice daily  Regular exercise
  38. 38. Review after further 8 weeks  Feeling much better  Continuing to avoid gluten  SAMe reduced to 200mg morning  Future dosing of SAMe and probiotics according to patient’s judgement  After another month, may halve hormone balancing regime  Mental Health Plan Review

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