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An overview of the Integrative Medicine of Depression
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INTEGRATIVE TREATMENT OF DEPRESSION
Dr Lily Tomas
Integrative Treatment
of Depression
ExerciseBodyimage
Social/ Spiritual
Neurotransmitters
V & M s
Hormones
EFAs
Drugs
Heavy Metals
Sleep
BSLs
Psycho logical
Homeo
pathy
Herbal
Environ. Influences
Diet
Purpose, Passion, Pleasure
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
Nutritional Treatment Options for Depression
Important neurotransmitters include:
Serotonin
Dopamine, Adrenaline, Noradrenaline
GABA
Histamine
Neurotransmitters are derived from amino acids sourced from quality proteins.
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
Serotonin Pathways
Iron, Folate Vit. B6
Vit. C, Calcium Zinc
5 Hydroxy Serotonin
Tryptophan
Tryptophan Melatonin(from Food/ Supplement)
Vitamin B3
Dopamine Pathway
Iron, Folate Vit. B6
Vit. C
Tyrosine DOPA Dopamine(From Food/
Supplement) Vit. C
Copper
Adrenaline NorAdrenaline
GABA Pathway
Vit. B6, Taurine
Zinc
Glutamine Glutamate GABA( From Food/
Supplement)
Glutathione
Histamine Pathway
Vit. B6
Histidine Histamine ( From Food/
Supplement)
Tryptophan
Tryptophan (5HTP) 100-200mg bd
Vitamin B6 100mg or Activated B6(P5P) 25mg
Zinc 40mg nocte
Magnesium 250mg bd
B Complex
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.
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
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)
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)
Pfeiffer Treatment Centre
5 main biochemical subtypes of depression
High Histamine (Undermethylation)
Low Histamine (Overmethylation)
Pyroluria (Genetic condition resulting in Zinc, VitB6 deficiencies)
Hypercupraemia (High Copper- Excess Oestrogen)
Toxic Overload (High levels of Heavy Metals)
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
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.
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
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
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
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
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 eicosanoidsand cytokines which may have a direct effect on mood.
Humans do not make their own Omega 3 EFAs!
WE ARE WHAT WE EAT!
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 specialisedlaboratories.
Plethora of studies demonstrating the benefits of adequate EPA/DHA to our mental state.
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.
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.
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.
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.
Kryptopyrroluria
Tend to do better on Omega 6 EFAs (evening primrose oil) rather then Omega 3 EFAs (fish oils) secondary to low levels of arachidonicacid.
Beneficial supplements: zinc, P5P, Vitamin B6, Vit C
Improvement expectation: 1-3 months
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?”
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.
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.
Hormones and Depression
Serum copper and plasma zinc.
Stop pregnancy supplements containing copper.
Beneficial supplements: Zinc, Manganese, Vitamin B6, Vitamin C, Vitamin E.
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
Case History
Management:
Mental Health Care Plan (Item 2710)
Pathology testing
3 morning temps during periods
Case History
Management:
Probiotics
SAMe 400mg morning
Continue current anti-depressant
Review in 1 month
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.
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
Review after further 8 weeks
Feeling much better
Continuing to avoid gluten
SAMe reduced to 200mg morning
Future dosing of SAMe and probioticsaccording to patient’s judgement
After another month, may halve hormone balancing regime
Mental Health Plan Review
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