PSYC 14: NHP for Depression + Anxiety

St John’s Wort

1) What is the mechanism of action (5 receptors)

2) Reduces ___ production which explains its ________ properties

3) What’s a benefit of this compared to SSRIs + specific example

4) Common side effects are the same as SSRIs, what are 3 SERIOUS side effects

5) When should you take this medication in the day and why

6) Who should AVOID this medication (2)

7) How long is this medication safe for (according to studies)

8) Strong ___ of p-glycoprotein + CYP 3A4

9) MAJOR drug interactions with St Johns Wort (6)

10) Evidence for what type of depression

1) Inhibits re-uptake of 5-HT, NE, DA, GABA, L-glutamate

2) Cytokine; anti-inflammatory

3) Less ADRs; LESS SEXUAL DYSFUNCTION!

4) Common = Dry mouth, headache, fatigue, GI upset, insomnia

SERIOUS

• Phototoxicity (avoid sun/use sunscreen)

• Withdrawal symptoms (caution to taper)

• Mania, hypomania

5) Morning, due to insomnia

6) BIPOLAR DISORDER, pregnancy

7) 1 year

8) INDUDER

9) DDIs:

Immunosuppressants (cyclosporine)

Antiretrovirals (Indinavir)

Digoxin

Opiates

Warfarin (decreases lvls)

Oral contraceptives

10) Evidence for mild-moderate depression

SAMe

1) Uses (2)

2) Found where (other than chemically synthesized)

3) MOA (3)

4) Most common side effects + what part of the day should you take this

5) Do you have to worry about serotonin syndrome

6) Who should AVOID this medication, why

7) Monotherapy or adjunct? One clinical pearl

1) Depression, osteoarthritis

2) Found in body (from ATP + methionine); ALSO MEAT

3) Amino acid that acts as methyl donor needed in the synthesis of monoamine transmitters (DA, NE, 5-HT) + membrane phospholipids

• Therefore, increases NE, Serotonin, Dopamine levels

  • Alter cellular membrane fluidity; helps w/ signal transduction

  • Anti-inflammatory effects

4) Headache, dry mouth, insomnia, jitters (take in morning)

5) No

6) Bipolar, can cause mania/hypomania

7) Can be monotherapy or adjunct in mild-moderate but EXPENSIVE

Omega-3 Fatty Acids

1) MOA (hint: more or less PGE2)

2) EPA of > ___% seems to show some benefit

3) Evidence for monotherapy or adjunct therapy

4) ADRs (4)

5) DDI (think synergistic)

6) Can you use it to PREVENT depression

1) Change membrane structure and function leading to:

• Improved cellular communication

• Reduced inflammatory processes (less PGE2)

• Improved neurotransmission

2) 60%

3) Adjunct therapy benefit

4) Diarrhea, nausea, GI, fishy aftertaste

5) HYPOtensive agents can decrease blood pressure more

6) No prevention

Folic Acid / Folate

1) MOA

2) What else does it metabolize into

3) Monotherapy or adjunct

4) What’s one thing to remember

1) MOA:

• Body uses folate to make active form which then synthesizes monoamines (DA, NE, serotonin)

2) SAMe

3) Adjunct

4) Does not improve mood in people who ARE NOT deficient in folate

Kava Kava

1) Where is it used to induce relaxation and decrease anxiety

2) Possible MOA (hint: # of ___ binding sites)

3) What medication does it have similar effects to? What’s the difference

4) What should you AVOID when on it

5) Is it effective

1) Pacific Islands

2) Possibly:

• Increase effects of GABA by increasing number of GABA binding sites

  • May inhibit uptake of NE

3) Benzodiazepines; but non-habit forming

4) Alcohol

5) Eh, possibly effective. Limit to short term use

Passion Flower

MAYBE effective; augment with other anxiolytics (additive effects)

• Safely used for up to 8 weeks

• Less sedating than benzos

Bach Flower Remedy

Effectiveness not proven LOL