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Neuropharmacology Key Concepts
For many patients with neurodegenerative disease, outside environmental factors impact cellular mechanisms as well as other co-‐morbidities that contribute to cell death in the central nervous system (CNS). Enough cellular degeneration causes loss of cellular or brain mass, and the cell bodies that utilize various neurotransmitters in their circuitry are no longer capable of function. These are times when medication is certainly viable and sometimes necessary. Sometimes medications are needed earlier and are usable to control symptoms that are a result of degeneration in multiple systems.
Nutrition has the ability to manage mitochondrial failure, glial cell activation or priming
pathologies. Nutrition can stabilize bi-‐lipid cellular membranes, reduce reactive oxygen species, and stabilize some of the intra-‐ and extracellular mechanisms related to neurodegeneration. Many times, the brain also needs to be activated to generate long term potentiation, plasticity, and a better cellular central integrated state. Some medications for the neurodegeneration, including excitotoxicity induced, include Namenda, which is a medication that stops the influx of pathological levels of calcium into a cell, thus avoiding excitotoxicity, cellular apoptosis, and death. When there is enough death, cell volume depletes, cell mass depletes, and the brain atrophies and function is lost. At times, protective nutrients are given along with medications, or one or the other.
Neurotransmitters that need to be manipulated include dopamine, serotonin, acetylcholine,
GABA, glutamate and histamine, to say the least. In the realm of neurodegeneration, the patient might need the cholinergic pathways treated with meds that upregulate that transmitter. This, along with meds that stop excitotoxicity, are the reasonable and customary medications. After this, if there is depression or associated psychosis, a serotonergic medication might be necessary to control these symptoms; often various serotonin medications are used as an atypical antipsychotic. At times, traditional dopamine antagonists are used in the form of typical antipsychotics.
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Sometimes medications are needed to control anxiety and sleep. The benzodiazepine
category for anxiety and the “z” drugs for sleep are utilized for the control of symptoms that are common with degenerative processes. Often, nutritional products combined with medications and brain exercises produce optimal results. A process for thinking in a linear and empirical fashion is very necessary. Here are some forms of thinking when looking at patients. Process of evaluation:
-‐ The patient might need medications initially if symptoms need to be managed due to severity or rapid progression.
o Severe depression, hallucinations, delusions, behavior alterations, possible self-‐harm, cognitive loss, or other symptom not controllable by other methods.
-‐ Nutrition to control energy and mitochondrial function. o Mitochondria has to be managed to give energy and ATP and reduce the rate of
dying cells. -‐ Nutrition to control inflammation or immune dysregulation if present.
o Cytokines, glial priming, and breached blood-‐brain barrier needs to be controlled. -‐ Nutrition to control cellular membranes if necessary.
o With energy loss and inflammation, cellular membranes can become unstable. -‐ Nutrition to control oxidative stress if necessary.
o Reactive oxygen species, super oxide anions, and peroxynitrite damage. -‐ Nutrition to control nitric oxides and vessel function if necessary.
o Can perpetuate immune issues and small vessel disease along with lipid issues and inflammation.
-‐ Dietary changes to deal with protein, carbs, fats, autophagy and energy levels. o Must have energy and the ability to metabolize various types of nutrients. Some
patients do well with higher fat and protein and lower carb levels as long as they are not hypoglycemic and have the kidney function to manage this type of diet.
-‐ Nutritional and dietary management to control transmitter levels. o There may be a need to support monoamines that turn into transmitters. This at
times makes using meds not necessary, or helps medications work optimally. -‐ Nutritional and dietary management to control associated comorbidities.
o A good example of this would be blood sugar. All comorbid factors need to be considered. If it produces inflammation, it can harm a deteriorating brain.