An Integrative Approach to Depression Handouts

A Integrative Approach to Depression
With Thomas Easley and Christopher Bennett
About the Teachers
•
Thomas Easley, RH(AHG) is co-author of Modern Herbal Medicine: The
Practical Herbal Reference for Everyone and founder of the Eclectic School
of Herbal Medicine. Thomas is a clinical herbalist and professional
member of the American Herbalists Guild. Thomas’s approach draws on
his extensive clinical experience, which spans 14 years of full-time practice
and over 10,000 clients
•
Christopher Bennett is an herbal medicine student at the Eclectic School
of Herbal Medicine and a board certified family psychiatric nurse
practitioner who specializes in child, adolescent, adult, and addictions
psychiatry. He has 8 years of experience in the field of mental health. He is
a graduate of the Master of Science in Nursing at the University of
Tennessee in 2009, the Bachelor of Science in Nursing at Belmont
University in 2007, and the Bachelor of Science in Social Work fro the
University of Tennessee in 2004.
1
The Ubiquity of Psychiatric Distress
• The lifetime prevalence for mental health disorders
approaches 50%, while even more persons suffer from
emotional distress due to problems with jobs, relationships,
children, and natural transitions that affect us all (Kessler et
al, 2005).
• Nationwide there are nearly 20 million alcoholics (Grant, et al,
2004), tends of thousands of people of commit suicide each
year, and countless others who try but fail (Centers for
Disease Control and Prevention, 2007).
• SAMHSA (2009) reveals that 62% of Americans with
psychiatric illness fail to receive services for their illness.
Cont’d
• Approximately 11.5 per 100,000 persons in the
United States commit suicide each year, accounting
for 35,000 deaths in 2007 (Xu, et al, 2010).
• In 2009 a study commissioned by SAMSHA found an
imputed annual rate of suicidal ideation among 8.3
million individuals, with 1.2% of those attempting
suicide, with a higher incidence in those with
comorbid substance use disorders (Substance Abuse
& Mental Health Services Administration, 2009).
2
“The Invisible Plague: The Rise of mental Illness from 1750 to the
Present” by E. Fuller Torrey, 2002
What is depression?
• Depression is a "wholebody" illness, involving
your body, mood, and
thoughts. It affects the
way you eat and sleep,
the way you feel about
yourself, and the way
you think about things.
3
The History of Mental Illness
• Throughout the ages various psychological problems have been
given many diverse names
–
–
–
–
–
Madness
Hysteria (thus the hysterectomy)
Lunacy
The blues
Melancholia
• The cause of mental illness has been blamed on many things
including:
–
–
–
–
–
Being female
Menstruation
Masturbation
A full moon
Spirits
Depression, It’s Not New
•
Mesopotamia, in 2000 B.C.
•
The Greeks and Romans felt "melancholia" had spiritual and physical causes
•
•
•
Hippocrates described the symptoms of melancholia as persistent sleeplessness,
lack of appetite, and depressed mood, along with occasional aggressive behavior,
sometimes leading to suicide.
Cicero argued that melancholia was "violent rage, fear, and grief,"
Middle Ages
•
Renaissance period
•
Early 20th century, the symptoms of depression were consistent with
"melancholia.“
In the 1950s or 60s another type of depression began emerging, "atypical
depression.“
– Those who were depressed were thought to be possessed by spirits
– bathing, gymnastics, special diets, poppy extract, and donkey's milk were used as remedies.
– back to demonic possession
– baths, humane treatment, and even music therapy.
•
– symptoms include a milder depressed mood, poor energy, increased sleepiness, and increased
appetite and weight gain, higher incidence of anxiety.
4
Bipolar Disorder
• ‘‘ . . . I think that melancholia is the beginning
and a part of mania . . . The development of a
mania is really a worsening of the disease
(melan-cholia) rather than a change into
another disease. . . In most of them
(melancholics) the sadness became better
after various lengths of time and changed into
happiness; the patients then developed a
mania’’. Aretaeus of Cappadocia (150 AD)
Depressive Disorders in DSM V
•
•
•
Disruptive Mood Dysregulation Disorder = New Diagnostic construct created NIMH
under the care of by Dr. Ellen Liebenluft at for children who might have previously
received a diagnosis of pediatric bipolar disorder. These children have severe and
recurrent temper outbursts. Recurrent temper outbursts and behavioral
aggression that are grossly out of proportion or intensity to the situation and are
not appropriate for developmental age.
Major Depressive Disorder. In addition to feeling “down” as in dysthymia, other
characteristics may include excessive feelings of guilt and suicidal ideation, as well
as various physical symptoms like loss of hunger and fatigue. It can be mild,
moderate, or severe.
Dysthymia = This reflects mild constant depressive symptoms for at least two
years. These people are relatively low in energy, slow in acting and can be
indecisive, shy, less sociable, and often thoughtful and introspective. The
diagnostic validity of this diagnosis is poor and there was a push to excise it from
the DSM V. A more scientifically valid way of understanding dysthymia would be
that it is a mood temperament of folks who have unipolar or bipolar depression,
though typically bipolar disorder.
5
Depressive Disorders in DSM V Cont’d
• Premenstrual Dysphoric Disorder = This is a mood disorder
characterized by marked affective lability preceding menses
that ceases with the onset of menses.
• Substance Induced Depressive Disorder = Depression
secondary to substance Use.
• Depressive Disorder Due to Another Medical Conditon =
Formerly called Secondary Depression. Depression due to
an underlying medical disorder like Cushing’s Disease or
hypothyroidism.
• Adjustment Disorder with Depressed Mood. This is grief
due to a loss of some kind (which itself can be classified as
normal or complicated).
Symptoms of depression
•
•
•
•
Changes in Thinking
Changes in feeling
Changes in Behavior
Changes in Physical Well-being
6
Changes in Thinking
• You may experience problems with concentration and
decision making.
• Some people report difficulty with short term memory.
• some may forget things all the time.
• Negative thoughts and thinking are characteristic of
depression.
• Pessimism
• Poor self-esteem, excessive guilt and self-criticism are
all common.
• Some people have self-destructive thoughts during a
more serious depression.
Change in feeling
• You may feel sad for no reason at all.
• No longer enjoy activities that were found
pleasurable.
• Might lack motivation, and become more
apathetic.
• May feel "slowed down" and tired all the time.
• Sometimes irritability is a problem.
• Difficulty in controlling your temper.
• In the extreme, depression is characterized by
feelings of helplessness and hopelessness.
7
Changes in Behavior
• Some people do not feel comfortable with others
• Social withdrawal is common.
• Some have experience of a dramatic change in
appetite, either eating more or less.
• Some people complain about everything, and act out
their anger with temper outbursts.
• Sexual desire may disappear, resulting in lack of sexual
activity.
• In the extreme, people may neglect their personal
appearance, even neglecting basic hygiene.
Changes in Physical Well-being
•
•
•
•
Chronic fatigue
Spending more time sleeping, is common.
Some people can't sleep, or don't sleep soundly.
These individuals lay awake for hours, or awaken many
times during the night, and stare at the ceiling.
• Others sleep many hours, even most of the day,
although they still feel tired.
• Many people lose their appetite, feel slowed down by
depression, and complain of many aches and pains.
8
Bipolar Disorder
•
DSM V differentiates between two types of Bipolar Disorder. Core difference between depressive disorders and
bipolar disorder is the presence of mania or hypomania. Core symptoms of mania/hypomania are:
– Period of abnormally and persistently elevated, expansive, or irritable mood and persistently goal directed
activity, lasting a miniumum of four days (hypomania) or seven days (mania), nearly every day
– During this period , there will be an increased energy or activity with three or more of the following:
• Inflated self-esteem or grandiosity
• Decreased need for sleep (feels rested after only three hours of sleep)
• More talkative than usual (TRUST ME, those who KNOW them will see that this is not their baseline)
or pressured speech.
• Flights of ideas or subjective experience that that thoughts are racing.
• Distractability (i.e. attention too easily drawn to unimportant or irrelevant stimuli)
• Increase in goal directed activity (socially, at work or school, or sexually), or psychomotor agitation
(purposeless non goal-directed activity)
• Excessive involvement in activities that have a high potential for painful consequences (e.g. entgaging
in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
– Ex. Very socially anxious patient who became manic on Zoloft and had sex with 20 different
people in a period of a month
– In Bipolar I a person can have a history of psychosis, not bipolar II.
– In practice these distinctions are meaningless. The treatment remains the same. In the real world, bipolar II
is often a diagnosis of “affluence”, i.e. what you diagnose your middle to upper middle class college
educated peer with, because it is considered “less bad”.
Appropriate Mood Disorder Diagnosis
is Important
• Failure to appropriately diagnose bipolar disorder
unnecessarily prolongs your patient’s suffering
and potentially places them at risk.
• There are case reports of mania and psychosis
associated with St. John’s Wort (Joshi and
Faubion, 2005; Raja & Azzoni, 2006; Stevinson,
and Ernst, 2004; Fahmi, Huang, and Schweitzer,
2002), and Ginseng (Joshi & Faubion, 2005). This
is potentially true with other serotonergic agents
such as 5-HTP, L-tryptophan, Rhodiola, etc.
9
Bipolar Disorder
• Genetics is the key = If there is a family history
of bipolar illness (as opposed to patients
“thinking” that a family member was bipolar),
the patient has a high probability (60-80%) of
having a bipolar spectrum disorder.
Soft Signs of Bipolar Disorder
• > 3 antidepressant failures/treatment refractory depression
• History of antidepressant induced activation (increased
irritability, anger, anxiety, insomnia), worsened depressive
symptoms, psychosis, or suicidality.
• Very rapid improvement of symptoms within the first week
of antidepressant treatment, followed by antidepressant
“poop out.”
• Age of onset in early 20’s or earlier suggests bipolar
disorder, as typical age of onset of MDD is 30.
• Circadian rhythm disturbance/”Seasonal Affective
Disorder”
• History of post-partum mood episodes
• Psychotic Features
10
Soft Signs of Bipolar Cont’d
• Temperament where person is easily offended
and overly sensitive or irritable/angry
temperament.
– Hx of legal involvement
• Multiple marriages and divorces.
What Causes Depression
• Although an extensive literature exists describing neuroanatomical,
neuroendocrinological, and neurophysiological correlates of major
depressive disorder, no laboratory test has yielded results of
sufficient sensitivity and specificity to be used as a diagnostic tool
for this disorder. Until recently, hypothalamic-pituitary-adrenal axis
hyperactivity had been the most extensively investigated
abnormality associated with major depressive episodes, and it
appears to be associated with melancholia, psychotic features, and
risks for eventual suicide. Molecular studies have also implicated
peripheral factors, including genetic variants in neurotrophic
factors and pro-inflammatory cytokines. Additionally, functional
magnetic resonance imaging studies provide evidence for
functional abnormalities in specific neural systems supporting
emotion processing, reward seeking, and emotion regulation in
adults with major depression. - (DSM-V, p. 165).
11
A Chemical Imbalance?
• A chemical imbalance in your brain is the most
commonly accepted cause.
• The Serotonin Theory of Depression has been
touted for almost 30 years.
• However, a paper in the flagship journal, Archives
of General Psychiatry found evidence of
increased serotonin activity in depressed
persons.
– http://archpsyc.jamanetwork.com/article.aspx?articlei
d=482548
• Although the superiority of antidepressants over
placebos has been shown to be statistically
significant, the observed differences are not
clinically significant. In fact, the average
difference between drug and placebo is
approximately two points on a depression scale
that ranges from 0 to 52. This difference does
not exceed the commonly accepted standard for
a minimally significant clinical improvement of a
3 point improvement on the depression scale.
12
The Exceptions to the Rule
Is This New Research?
• As early as 1994, Brown University School of
Medicine psychiatrist Walter Brown suggested
treating mild to moderately depressed
patients with placebos for an initial 4-6 week
period, and then switching to active
medications if patients did not improve
13
Depression, a Multifaceted State
Psychosomatic
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–
–
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Chronic stress
Abuse
Major life events (trigger)
Early Childhood development
• Epigenetic
Organic
• Genetic
– MTHFR
– COMT
• Systemic Inflammation
– Pro-inflammatory foods
– Nutrient Deficiencies
– Gut dysbiosis
• Hormonal
–
–
–
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Hypothyroidism
PMS
Menopause
Andropause
14
Psychosomatic
• “Of course it is
happening inside your
head, Harry, but why on
earth should that mean
that it is not real?”
Does Depression Have a Purpose
• Depression might come
from a belief that we’re
powerless to solve our
problems. Thus, we
ruminate
15
Major Life Changes
• Positive or negative events can trigger depression.
Examples include the death of a loved one or a promotion.
• Major Illnesses such as heart attack, stroke or cancer may
trigger depression.
• This type causes symptoms that may:
–
–
–
–
Begin suddenly, possibly triggered by a loss, crisis or change
Interfere with normal functioning
Continue for months or years
It is possible for a person to have only one episode of major
depression. It is more common for episodes to be long lasting or
to occur several times during a person’s life
Grief
16
Depression and PTSD
• People who continue to experience extreme
symptoms of stress long after a traumatic
event may have PTSD, which may also lead to
depression.
• These disorders often exist together and their
symptoms may overlap.
• Studies show that depression is up to five
times more common in people who have
PTSD.
What is EMDR
•
•
•
•
•
Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment that was
originally designed to alleviate the distress associated with traumatic memories (Shapiro, 1989a,
1989b).
Shapiro’s (2001) Adaptive Information Processing model posits that EMDR facilitates the accessing
and processing of traumatic memories and other adverse life experience to bring these to an
adaptive resolution. A
After successful treatment with EMDR, affective distress is relieved, negative beliefs are
reformulated, and physiological arousal is reduced.
During EMDR therapy the client attends to emotionally disturbing material in brief sequential doses
while simultaneously focusing on an external stimulus. Therapist directed lateral eye movements
are the most commonly used external stimulus but a variety of other stimuli including hand-tapping
and audio stimulation are often used (Shapiro, 1991). Shapiro (1995, 2001) hypothesizes that EMDR
facilitates the accessing of the traumatic memory network, so that information processing is
enhanced, with new associations forged between the traumatic memory and more adaptive
memories or information. These new associations are thought to result in complete information
processing, new learning, elimination of emotional distress, and development of cognitive insights.
EMDR therapy uses a three pronged protocol: (1) the past events that have laid the groundwork for
dysfunction are processed, forging new associative links with adaptive information; (2) the current
circumstances that elicit distress are targeted, and internal and external triggers are desensitized;
(3) imaginal templates of future events are incorporated, to assist the client in acquiring the skills
needed for adaptive functioning. – EMDR Institute
17
EMDR
• E.M.D.R. therapy is recommended as an effective
treatment for post-traumatic stress disorder in the practice
guidelines of a wide range of organizations, like the
American Psychiatric Association (in 2004), the Department
of Veterans Affairs and Department of Defense (in 2010),
the International Society of Traumatic Stress Studies (in
2009), and other organizations worldwide, including in
Britain, France, the Netherlands and Israel.
• The one exception is a report published in 2007 by the
Institute of Medicine that stated that more research was
needed to establish efficacy. Since that time, six more
randomized E.M.D.R. therapy studies have been conducted.
Does It Work?
• Twenty positive controlled outcome studies have been
done on EMDR.
• Some of the studies show that 84%-90% of singletrauma victims no longer have post-traumatic stress
disorder after only three 90-minute sessions.
• Another study, funded by the HMO Kaiser Permanente,
found that 100% of the single-trauma victims and 77%
of multiple trauma victims no longer were diagnosed
with PTSD after only six 50-minute sessions.
• In another study, 77% of combat veterans were free of
PTSD in 12 sessions.
18
Early Life Stress and Mental Illness
• Adverse conditions in early life can severely
impact the developing brain and increase
vulnerability to mood disorders in adult life.
• It has been shown that adverse early-life
events can alter the experience-dependent
maturation of the stress systems, such as the
HPA system.
• This again results in higher stress vulnerability
later in life.
19
Stress and Mental Ilness
• Historically the Industrial Revolution began in the 1760’s in
England with the invention of the steal engine and new
methods for using coal to make iron.
• In 1816 David Uwins associated England’s increase in
“nervous and mental affections” with civilization: “In
proportion as man emerges from his primeval state, do the
Furies of disease advance upon him and would seem to
scourge back into the paths of nature and simplicity.”
(Torrey, 2002, Location 6115)
• In 1903 William A. White, using American census data,
noted “an almost exact parallel” between the prevalence of
insanity and “the greatest density of the population.”
(Torrey, Location 6121).
20
Stress and Mental Illness
•
•
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•
•
Bisaz (2012) notes that stress is an adaptive mechanism that helps
organisms respond to environmental stimuli.
When exposed to stressful stimuli, such as when homeostasis is
challenged physically and psychologically, the Hypothalmic-PituitaryAdrenal (HPA) Axis and the Sympathetic-Adrenomedullary system are
activated.
This results in an increase in serum glucocorticoids (i.e. cortisone).
While activation of this system is essential for survival, chronic activation
of this stress system (prolonged stress responses) are associated with the
genesis of an exacerbation of neuropsychiatric disorders.
Studies show that frequent or extensive stress in early life is correlated
with a dramatic increase in late risks of development of psychiatric illness
and behavioral dysfunction.
Stress and Mental Illness
• Bisaz (2012) notes that cognitive, emotional, and
social capacities are intertwined with learning,
behavior, physical and mental health over the course
of an individual’s life.
• Manageable levels of stress are normative and
healthy for organisms, but toxic stress (significant
adversity and the absence of adult protection) can
damage the developing brain and can lead to lifelong
problems in learning and social relationships and
increased susceptibility to illness.
21
Stress and Mental Illness
• Shonkoff (et al, 2012) notes that the architecture of the brain
is continually being myelinated from conception, childhood,
adolescence, and old age.
• The concept of epigenetics entails the notion that genes and
environment/experiences literally shape the circuitry of the
developing brain, and is critically influenced by mutually
responsive adult-child relationships, particularly in early
childhood.
• Skills build upon skills as brain circuits are built in a
hierarchical fashion from the “bottom up”, with increasingly
complex circuits building upon simpler circuits, and more
complex and adaptive skills emerging over time.
22
Help for Early Life Stress
• Mindfulness cognitive therapy (or mindfulness-based
cognitive therapy, MBCT) is a blend of two different
approaches.
• Cognitive behavioral therapy (CBT) which focuses on
changing our thoughts in order to change our behaviors
• The meditative practice of mindfulness, a process of
identifying our thoughts on a moment-to-moment basis
while trying not to pass judgment on them.
• While cognitive behavioral therapy has always emphasized
the end result of change of one’s thoughts, mindfulness
really looks at how a person thinks — the process of
thinking — to help one be more effective in changing
negative thoughts.
MBCT
• Studies show positive
results for those 3 or
more depressive
episodes
• This is one of the few
therapies with efficacy
for people with chronic,
treatment resistant
depression
23
Understanding Stress
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•
•
•
•
The amygdala is a region of the brain that receives and interprets
incoming visual and auditory information.
If it perceives a dangerous sight or sound, the amygdala sends a distress
signal to the hypothalamus, the region of the brain that controls our
endocrine responses
The hypothalamus receives the stress signal. It notifies the adrenal
medulla to make adrenaline and the pituitary gland to begin producing
adrenocorticotropic hormone, which tells the adrenal glands to make
cortisol.
This all happens in the blink of an eye. It’s this rapid, subconscious
response that creates an appropriate, unconscious response to imminent
danger
The neocortex, an area of higher brain function, decides after the fact
whether the amygdala’s response to the perceived stressor was justified
and if we should continue to stay on alert
24
Stress Hormones
Stress Begins with Perception
• Stress chemicals are
released whenever the
brain perceives danger
(whether real or
imaginary)
• Alter your perception
and you alter your
stress level
25
Changing Your Perception of Stress
• Think of the stress response as a preparedness
response
• Dismantle the stressor
–
Ask yourself questions like “Is [the stressor] going to negatively impact my life enough to justify this
physiological response?” or ”How will sweaty palms and an elevated heart rate improve my ability to
pay my car bill?” You’ll often find that answering them honestly and logically removes the stress.
• Don’t sweat the small stuff
– Acknowledge the desire to react to perceived stress but know that these urges are the
result of evolutionary programing prone to exaggerated responses in a modern world.
Tell yourself that you’re better than that
Changing Your Perception
• Try living a life of service. Give to others. A
recent study found that stress only increased mortality risk
in those who had not “provided tangible assistance to
friends or family members.”
• Don’t reaffirm your stress level in a negative way: Never
say “I’m so stressed”
• Practice breathing exercises and meditation daily.
Mindfullness based stress reduction is effective and well
researched.
• Don’t avoid stress; create pleasure.
• Use botanicals to modify the stress response.
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Don’t Avoid Stress; Create Pleasure
A pleasurable
experience does the
body more good than a
stressful experience
does harm
Pleasure Prescription
• Make a list of 10 things
that are physically
pleasurable to you
• Do one thing on that list
every day
27
Examples
•
•
•
•
Epsom salt baths
Soaking in the hot tub
Walking in nature
Listening to beautiful
music
• Having a massage or
foot rub
• Engaging in a favorite
hobby or activity
– Gardening
– Painting
– Golf
• Cuddling
• Making love
Long-term, sleep debt or becoming chronically
sleep deprived can directly increase your risks
for developing the following:
•
•
•
•
•
•
•
•
•
•
•
•
•
Obesity
Cardiovascular diseases (CVD):
Hypertension
Stroke
Heart attack
Heart failure
Diabetes and other disorders of glucose metabolism
Mood disorders:
Depression
Anxiety
Cognitive decline:
Poor recall
Slowed thought processing
28
Deep Sleep
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•
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•
•
•
•
Growth hormone, essential for growth and development, is produced only
during this time
Restorative functions, such as tissue repair and growth, occur and muscles
are rested
Blood pressure is lowered, providing rest to the heart and circulatory
system
Metabolic processes, including glucose utilization and storage, and the
ratio of appetite-controlling hormones are adjusted in an attempt to
preserve healthy weight and normal cell and receptor functions
Important functions of the nervous system (nerves), including memory
consolidation (improves recall), take place only during this time, and the
brain is fueled for the next day
Stress hormone production (cortisol and adrenaline) is decreased to
restore balance to the body
Hormones that fuel the immune system are produced, aiding the body in
fighting off infection
Botanicals for Stress
29
Nerve Tonics
•
•
•
•
•
Hypericum perforatum (St. John’s Wort)
Avena sativa (Oats, milky seed)
Turnera diffusa (Damiana)
Borago off. (Borage)
Scutellaria lateriflora (Skullcap -fresh tincture
only)
• Salvia officinalis (Sage)
Nerve Relaxants
•
•
•
•
•
•
Verbena off. (Vervain)
Avena sativa (Oats)
Lavandula off. (Lavender)
Humulus lupulus (Hops)
Melissa off. (Lemon Balm)
Chamomilla recutita
(Chamomile)
• Stachys betonica (Wood
Betony)
• Scutalleria lateriflora
(Skullcap)
• Valeriana off. (Valerian)
• Passiflora incarnata
(Passion Flower)
• Tilia europea (Linden)
• Lactuca virosa (Wild
Lettuce)
• Borago off. (Borage)
• Leonurus cardiac
(Motherwort)
• Anemone vulgaris
(Pulsatilla)
• Albizia julibrissin (Mimosa)
30
Ashwaganda (Withania somnifera)
• A major Ayurvedic herb
used as an anti-aging and
rejuvenating tonic
• A unique combination of
tonic/resotrative
properties, and sedative
effects.
• Restorative to endocrine
and reproductive function
• Best choice for breaking
the vicious cycle of
deficiency causing
insomnia
Withania
• Indication: Fatigue with low reproductive
function. Temperature neutral to cold. Insomnia,
agitation, and anxiety secondary to exhaustion.
• Contraindication Acute conditions, excess, stuck
energy. Damp accumulations. Heat signs.
• Dose and duration: 3-6 grams of decoction. Milk
decoction is traditional. Standard tincture and
tincture doses have milder effect.
• Suitable for longer term use than other
adaptogens.
31
Tasty Ashwagandha
•
•
•
•
•
3g Ashwagandha
4oz coconut milk
1/8 tsp vanilla
Maple Syrup to taste
Heat for 10min, but don’t boil
Skullcap
• Family: Lamiaceae or
Mint family
• Genus and Species:
Scutellaria lateriflora
• Other Names: Scullcap,
Mad Dog
• Part Used: Aerial parts
32
Specific Indications
• It beneficial for people “at the end of their rope” or
people so frazzled they're about to snap. In fact its
good for people that do snap or flip out over small stuff
• Skullcap works well when people feel as if every sound,
touch and bit of light is personally attacking them. The
are oversensitive to any stimulation
• The are twitchy, even in sleep
• Nervousness manifesting itself in muscular action.
• Skullcap is useful for people that are oversensitive to
stimulation because of burned out adrenals
More Specific Indications
• Skullcap seems to not only help with tension, but it also has a
tonic action. It gives people a bigger capacity for stress.
• If your stress is like a cup full of water, Blue Vervain can empty
your cup when indicated. However Skullcap not only empties
your cup, it give you a bigger cup!
• Skullcap is used for two distinct lines of specific phenomena.
The first is where there is irritability of the nervous system,
with restlessness and nervous excitability; inability to sleep
without pain; general irritability, with insomnia from local
physical causes. The second is where there is nervous
disorder, characterized by irregular muscular action,
twitching, tremors and restlessness, with or without incoordination. - 1919: Ellingwood
33
Preparations and Dosages
• Harvest: Aerial parts while plant is in flower
• Preparation: Fresh plant tincture, dried plant material is not
very potent
• Dosage:
– Fresh plant tincture: 10-50 drops 3 x day.
– The dried plant can be made into a strong decoction as well but
should be steeped for several hours. 1 tsp per cup steeped for 3
hours. Works more as a sedative and less as a tonic.
• Cautions: As a result of adulteration with germander,
scullcap has been accused of being hepatotoxic, but there
are no known warnings for scullcap. Purchase only from
reputable companies.
Linden
• Family: Tiliaceae or Tilia
family
• Genus and Species: Tilia
spp
• Other names: Basswood
• Part Used: Flowers,
brackets
Photo from Wikipedia
34
Modern Uses
• Mild hypertension (particularly high systolic pressure
associated hardening of the arteries)
• Hypertension and palpitations due to stress
• Stress and stress-related headaches, neuralgia,
migraine and dizziness
• Insomnia, hyperactivity; helps to calm the mind
• Anxiety, nervousness, panic attacks
• Indigestion due to nervousness
• Flowers used to make lotions for itchy skin
• Matthew Wood: Tongue is usually red, sometimes
flame shaped and usually somewhat moist
Preparations and Doses
• Parts Used: Leaves, flowers
• Dose:
– Infusion: 1-2 teaspoons per cup of water, 2-6
times per day
– 1:5 dry extract: 20-40 drops 1-4 times per day.
• Safety: Extremely safe remedy, no known
contraindications or safety issues
35
Pulsatilla
• Family:
Ranunculaceae
(Buttercup family)
• Genus and Species:
Anemone vulgaris
and A pratensis
• Other names: Pasque
flower, Wind flower
Kings American Dispensatory (1898)
• “Pulsatilla is a remedy of wide applicability, but more
particularly for those conditions in which the mind is a
prominent factor. A gloomy mentality, a state of nerve
depression and unrest, a disposition to brood over real
or imagined trouble, a tendency to look on the dark
side of life, sadness, mild restlessness, and a state of
mental unrest generally denominated in round terms
“nervousness” are factors in the condition of the
patient requiring pulsatilla. A pulsatilla patient weeps
easily, and the mind is inclined to wander, to be
unsettled. The whole countenancy and movements of
the body depict sadness, moroseness, despondency,
and lack of tone.
36
Dorothy Hall
•
•
•
•
•
The person who needs pulsatilla often says, “I can’t cope!” They may fling
their hands up, cry and walk out of the room
A remedy for when life gets on top of you and you’re at the end of your
rope
Very helpful for emotional fluctuations during menopause
Pulsatilla types may realize that tears and tantrums actually give them a
lot of power – people do things for them to try to make them feel better
Pulsatilla helps a person remain calm and stable through change
Preparations and Doses
• Dose:
– Tincture: 20-30 drops in 4 oz. water, mix. Take 1 tsp.
every 2-3 hours. Do not take straight.
– Homeopathic and flower essence forms are safer. Use
as directed on the preparation
• Safety:
–
–
–
–
–
Herb is not widely used due to toxicity
Should not be taken without proper supervision
Do not take during pregnancy
Do not use fresh plant
Homeopathic form is widely used and completely safe
37
Motherwort
• Family: Lamiaceae or
Mint family
• Genus and Species:
Leonurus cardiaca
• Other names: Throwwort, Lion's Ear, Lion's
Tail
• Part Used: Leaves,
Aerial parts
Photo from Wikipedia
Motherwort for the Nerves
• “Motherwort is especially valuable in female weakness and
disorders (hence the name), allaying nervous irritability and
inducing quiet and passivity of the whole nervous system.”
- Maude Grieve
• “There is no better herb to drive away melancholy vapours
from the heart, to strengthen it and make the mind
cheerful.”
- Nicholas Culpepper
• Depression, restlessness and insomnia from emotional or
physical ailments
• Combine with blue vervain, scullcap or fresh oat for anxiety
(Winston)
38
Preparations and Doses
• Parts Used: Aerial parts before flowering.
• Dosage:
– Infusion: 1 tablespoon per cup of water
– 1:1 fresh plant extract: 20-40 drops 1-4 times per day
– 1:5 tincture: 3-5 ml (1/2 to 1 teaspoon) three times
day
– Capsules: 2-3 500 mg. capsules three times a day
• Safety: Safe remedy, but not recommended
during pregnancy
Nerve Sedative Differentials
•
•
•
•
•
•
•
•
•
Skullcap – lights, noises and smells overwhelm – recovery from mental breakdown
– recovery from stimulant drugs
Hops – stress induced stomach heat – over-planning over-thinking.
Valerian – a knocker outer - palliative sedative
Passion Flower – circular thinking, helps mind disconnect.
Chamomile – whiney “babies of all ages”
Lemon Balm – uplifting but relaxing - for the person who can't stop going- great
for infection induced stress.
Lavender – headaches, anxiety, insomnia and depression that comes from
constant worry – hug in a bottle
Motherwort - fried and frazzled with a tendency to palpitations and other heart
stress – hormonal induced stress
Linden Flower – nerves causing cardio heat and palpations
39
Social Changes
• Changes in family
composition
• More single parent
families/dual wage
earners
• Lack of connection with
culture/identity
• We don’t know our
neighbors
40
41
Epigenetics
• "The human brain does not develop on its own, does not
develop according to a genetic program, depends very much
on the environment. And the essential condition for the
physiological development of these brain circuits that regulate
human behavior, that give us empathy, that give us a social
sense, that give us a connection with other people, that give
us a connection with ourselves, that allows us to mature—the
essential condition for those circuits, for their physiological
development, is the presence of emotionally available,
consistently available, non-stressed, attuned parenting
caregivers" (Gabor Mate, MD).
42
Epigenetics
• the study of changes in organisms caused
by modification of gene expression rather
than alteration of the genetic code itself.
43
The Organic Causes of Depression
• Hormonal
• Genetic
– MTHFR
– COMT
• Systemic Inflammation
– Pro-inflammatory foods
– Nutrient Deficiencies
– Gut dysbiosis
–
–
–
–
Hypothyroidism
PMS
Menopause
Andropause
MTHFR
• The current data suggest that between 6 and 14% of
Caucasians and about 2% of those of African descent
probably have a more severe (two mutated alleles) version
of the MTHFR mutation. In Hispanics, this number may be
as high as 21%
• One function that is particularly important to mental health
is the conversion of an essential B-vitamin, folate, into the
more usable form, l-methylfolate.
• L-Methylfolate enables our bodies to convert the amino
acid homocysteine to another amino acid, methionine. The
body then uses methionine to make proteins and other
important compounds, including neurotransmitters
(serotonin, dopamine, norepinephrine).
44
COMT
• Catechol-O-methyltransferase is one of several
enzymes that degrade catecholamines including
– Dopamine
– Epinephrine
– Norepinephrine.
• Variations at the COMT gene are involved in emotional
processing, as they seem to influence the interaction
between prefrontal and limbic regions.
• The effect of COMT both in patients with bipolar
disorder and in their relatives has been shown in initial
studies
Genetic Testing
45
46
Inflammation as a Mechanism of
Depression
Inflammation
• Inflammation is a normal and beneficial process that occurs when
your body’s white blood cells and chemicals protect you from
foreign invaders like bacteria and viruses.
• However If your immune system mistakenly triggers an
inflammatory response when no threat is present, it can lead to
excess inflammation in your body
• Inflammation is linked to and probably causal in
–
–
–
–
–
–
–
Depression
Asthma
Allergies
Autoimmune disease
Heart disease
Cancer
and many other diseases
47
Inflammation and Depression
• People with generalized inflammatory syndromes (such
as acute viral illness, rheumatoid arthritis, insulin
resistance, and cardiovascular disease) have higher
rates of depression than the general population too.
• Anti-inflammatory agents treat depression, and
pharmacologic agents such as interferon-alpha, that
cause depression, also lead to increases in the
inflammatory proteins IL-6 and TNF-alpha.
• In addition, when someone who is depressed responds
to antidepressant treatment, these same inflammation
markers decrease
– Emily Deans
The Cytokine Hypothesis of Depression
•
•
•
•
The nervous system, the endocrine system, and the immune system are reciprocally linked as both
triggering and mediating pathways of depression.
A variety of proinflammatory cytokines (IL-1, IL-6, TNF-alpha, gamma interferon) act as
neuromodulating mediators affecting behavioral, neurochemical, and endocrine features of
depressive disorders.
The cytokines are thought to account for the HPA overactivity characteristic of melancholic
depression, since cytokines are known to cross and influence the blood-brain barrier (if produced
peripherally) and to disturb the negative feedback inhibition of corticosteroids in the HPA axis.
There is a significantly increased risk for suicide associated with asthma and seasonal allergy.
–
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2761227/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2592251/
•
In a recent national epidemiological study in the United States, a doubling of the rate of suicide in
women during periods of highest pollen counts was demonstrated, after adjustment for
environmental light.
•
In a double-blind, crossover study involving 20 healthy males without a history of psychiatric
disorder, subthreshold doses of non-infectious endotoxin induced elevation of specific cytokines,
including TNF-alpha and IL-6, associated with significantly increased anxiety, impaired memory, and
depressed mood.
–
–
http://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2010.02523.x/pdf
http://www.ncbi.nlm.nih.gov/pubmed/11343523
48
Causes of Inflammation
• Diet
– Pro-inflammatory foods
• Fats
• Glycemic load
• Food allergens
– Nutrient Deficiencies
• Obesity
• Smoking
• Stress
• Sedentary Lifestyle
• Dysbiosis
– Gut
– Oral
• Hormone Imbalance
• Environmental Toxins
Nutrient Deficiencies
49
Diet and Mental Health
• Mixed but mainly positive cross-sectional and
prospective relationships between diet quality
and mental health
• In both adults and adolescents in different
countries
• Not confounded by socioeconomic,
medical/health behaviours. Reverse causality
does not seem to explain the relationships
50
51
Magnesium
Magnesium
• About 1 ounce of magnesium is present in the
body of a 130-pound person
• Over half of the body’s magnesium is in the
bones. Much of the rest is in the muscles and soft
tissues, with only 1 percent in the extracellular
fluid.
• A study published in the Journal of the American
College of Nutrition and sponsored by the
National Institutes of Health found that 68% of
Americans are magnesium deficient
52
Magnesium Uses
• essential to:
– the body’s use of glucose
– the synthesis of protein, fat, and nucleic acids
– the cells’ membrane tranport systems
• Calcium – muscle contraction and blood clotting
• Magnesium – muscle relaxation and prevents
clotting
• This interaction between the two minerals helps
regulate blood pressure and lung functions
RDA: about 400 mg/day
53
Magnesium Dosage
• Dosage: 100-1000mg daily in divided doses.
• Of the commercially available magnesium supplements,
magnesium glycinate offers the best absorption.
• A gentle and well absorbed magnesium supplement
– take 1 tablespoon of milk of magnesia and dissolve it into 4.5
tablespoons of 5% apple cider or white vinegar. 1 tablespoon of
this mixture added to a quart of water and sipped throughout
the day is a great way to increase your magnesium levels.
– Relatively new to the market is magnesium chloride oil. Applied
topically the concentrated magnesium penetrates the skin,
relaxing tense muscles. It is unknown how well topical
magnesium chloride works in restoring intracellular magnesium
levels.
Folate
54
Folate (B9)
• Folic acid technically refers to the synthetic compound used in
dietary supplements and food fortification
• Folate is the correct term for the naturally occurring
tetrahydrofolate derivatives found in food
• Folic acid must undergo reduction and methylation in the liver,
utilizing the enzyme dihydrofolate reductase, unlike natural folates
that are metabolized in the small intestines
• The reduced activity of dihydrofolate reductase in the liver,
combined with ingesting high levels of folic acid in fortified foods,
may result in high levels of synthetic folic acid in the body
• Epidemiological studies have linked elevated levels of synthetic folic
acid in the body to an increase in all forms of cancer
• If you supplement with folic acid, by itself or in a multi, I suggest
only taking products that contain 5-MTHF or folate instead
Folate Deficiency
Folate deficiency causes:
– Megaloblastic anemia
– Neural tube defects
– Miscarriages
– Increase in the risk of
colorectal and cervical
cancer
– Elevated homocysteine
(along with B12 and B6)
• Increased
cardiovascular risk
– Age-related cognitive
decline
– Macular degeneration
– Restless leg syndrome
– Insomnia
– Depression
– Vitiligo
– Periodontal disease
– Peripheral neuropathy
– Sore tongue
55
Medications That Lower Folate
• Antacids, H2 blockers, proton pump inhibitors
• Bile acid sequestrants (cholestyramine, colestipol, and
colesevelam)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Sulfasalazine
• Triamterene
• Birth control medications
• Anticonvulsants (phenytoin and carbamazapine)
• Folic acid antagonists (methotrexate)
Food Sources of Folate (B9)
56
Folate Supplementation
• Folate is readily available in green leafy vegetables and organ
meats, particularly liver. Unless folate levels are low (easily
checked with blood work), and people are reluctant to eat
veggies, most don’t need to supplement
• Dosage: Women trying to become pregnant and pregnant
women should supplement with 800-1,000 mcg of 5-MTHF daily
• To reduce homocysteine levels, take 2-5 mg daily
• For depression up to 15mg a day of 5-MTHF
• Women with cervical dysplasia should supplement with 10,000
mcg (10 mg) of 5-MTHF daily
•
B6
57
Zinc
Zinc
• Severe deficiencies of zinc are rare, but mild to
moderate deficiency occurs regularly in children,
elderly, and those with eating disorders, diabetes,
renal disease, and gastrointestinal disease.
• Zinc has been shown to help slow the progression
of Alzheimer’s Disease, improve sperm count,
reduce prostate swelling in BPH and increase the
speed of healing from both gastric ulcers and
lower limb ulcers.
58
Symptoms of a Zinc Deficiency
•
•
•
•
•
•
•
•
•
•
Loss of smell (wears strong perfume)
Loss of smell
Delayed sexual maturation
Impaired immune function
Hair loss
Skin lesions
Loss of appetite
Low testosterone (men)
Diarrhea
Dysmenorrhea
Zinc in Foods
59
Dosage
• The rate of zinc absorption varies from about 15 to 40
percent, depending on a person’s zinc status.
• Phytates bind zinc, thus limiting its bioavailability.
• Dosage: 10-100mg.
• If you supplement above 50mg take 2mg of copper to
prevent a copper deficiency.
• Zinc supplementation can reduce the absorption of
some antibiotics.
• Birth control medications and tetracycline can reduce
zinc levels in the body. Take zinc supplements away
from acid reducing medications.
Selenium
60
Selenium
• Selenium is one of the body’s antioxidant
nutrients, working primarily by supporting
enzymatic reactions.
• Selenium is necessary for the production of
glutathione and the active thyroid hormone
T3.
• Selenium supplementation suppresses TPO
antibody production, helping most cases of
hypothyroidism.
Dosage and Toxicity
• 200mcg is often all that is needed. This can be
attained by eating 5 brazil nuts daily.
• Super Selenium Complex by Life Extension is
the best supplemental form.
• Selenium toxicity causes loss and brittleness
of hair and nails, garlic breath odor, skin rash,
fatigue, irritability and nervous system
abnormalities.
61
Lithium
• Lithium remains the gold standard medication for the treatment in
all phases of bipolar spectrum disorders as well as adjunctive
treatment of major depressive disorder. Doses in MDD are usually
less than utilized in bipolar disorder, often 150mg to 300mg.
Average therapeutic dose in adults with lithium is 900mg. This drug
is unique is that it confers a greater “anti-suicidal effect” than other
agents.
• Lithium has a narrow therapeutic index. Therapeutic lithium levels
are 0.6 – 1.2.
• Kidney and thyroid function must be monitored closely with this
agent due to thyrotoxicity and nephrotoxicity. These present as
long term rather than short term risks. This risk does seem to be
mitigated by keeping folks at blood levels of 0.8 or less.
• Lithium is often called “brain fertilizer.” Works by inactivating the
GSK3B enzyme, which allows the brain to produce more BDNF
(brain derived neurotrophic factor) and thus promotes
neurogenesis.
Lithium Cont’d
• Lithium is on the periodic table of elements and is a natural
salt that comes form the earth. It is a naturally occurring
trace element in water supplies of various places in the
world (Ohgami, 2009). Lithium was originally a component
of 7up. Google Lithia Water which you can purchase from
Lithia Springs, GA.
• Patients on lithium must pay special attention to hydration
as lithium is a salt. Common side effects include benign
tremor (can be treated with propanolol), weight gain, dry
mouth, acne, hair loss, blurred vision, polydipsia (excessive
thirst), polyuria (excessive urination).
• Dosage: Initially 300mg BID or 450mg BID (dependent
upon body weight), max is 240mg each day.
• Major teratogen and thus is generally unsafe in pregnancy
as there is a risk for congenital heart defects.
62
Lithium
•
•
Available in short acting and long acting (CR) formulations, as well as liquid
formulation. First agent to be approved by the FDA for treating bipolar disorder in
children and adolescents 12 years of age and older. MOST well studied mood
stabilizer in children and adolescents. VERY effective in bipolar depression.
Studies suggest a 46% response rate. Widely used and generally well tolerated.
Start at 150mg BID in younger children, 300mg BID in adolescents. Lithium level
0.8-1.2. Acne like rash that accompanies it can be problematic for adolescents.
Neuroprotective – should be considered first line in kids who have clear bipolar I
with clear manias, and who have parents that are committed to the extensive lab
monitoring required. Children younger than age 6 are more prone to develop
neurological side effects.
If nausea, emesis, diarrhea – reduce or split dose, take with food, change to citrate
formulation. If tremor, ataxia, slowed mentation – reduce or split dose. Renal –
polyuria, changes in renal function – monitor kidney function every 3 months.
Dermatological --- provide education about SE. Endocrine – wt gain, thyroid
abnormalities – educate pt about appropriate diet and exercise, monitor thyroid
function q 3-6 months.
Lithium Orotate
• Available OTC in 5mg caps (from 120mg)
• Some researchers are suggesting that our RDA
for lithium be 1-2mg a day.
• Low dose lithium is protective against brain
inflammation
• Helps regulate circadian rhythm and sleep.
• 1-20mg a day without concern of kidney
issues (unless in renal failure)
63
Other Sources of Lithium
Vitamin D and Depression
• Vitamin D receptors exist in the brain
• Low level of serum 25-hydroxyvitamin D and
high PTH are significantly associated with a high
depression score (Jorde, 2005)
• 25-hydroxyvitamin D3 and 1,25-dihydroxvitamin
D3 levels are significantly lower in psychiatric
patients than in normal controls (Schneider,
2000)
• Lowest Vit D in fibromyalgia assc with
depression (Armstrong, 2007)
64
Above 40° north latitude vitamin D synthesis
essentially ceases for the four months of winter.
Drugs That Deplete Vitamin D
• Steroids
– All oral and inhaled steroids
•
•
•
•
Barbiturates
Phenytoin (Dilantin) – Seizures
Bile Acid Sequestrants
All Stomach Acid Reducing Medications
65
Forms of Vitamin D
• Plant derived or synthetic = ergocalciferol AKA vitamin D2 or ercalciol.
• Produced by humans from sunlight or found in
supplements = cholecalciferol or calciol AKA
D3.
• Calcitriol (1,25-[OH]2 D3) is the main active
form of vitamin D. It is formed in the kidneys
from D3.
Vitamin D Testing
• The plasma concentration of 25-OH D3 (calcidiol)
is often used as an index of vitamin D status.
• Optimal levels are 50-60ng/ml.
• However some people with VDR polymorphisms
or specific illnesses like autoimmune disorders
need to raise their blood levels to 60-70ng/ml.
• Levels higher that 100ng/ml increase your risk of
kidney stones and possibly heart disease.
66
Dosage
•
•
•
•
•
•
The dose of supplemental vitamin D3 and/or the amount of sunlight
required to get people to the ideal blood range varies.
Digestion, absorption, weight, skin color and genetics are all factors that
have an influence on how much D you need.
Some people, with normal sun exposure don’t need any supplemental
Vitamin D. Some people require 10,000iu daily to achieve adequate blood
levels.
It’s best to supplement with 5,000iu daily of Vitamin D3 and after 1 month
check your blood level. If your blood level of Vitamin D is too low, increase
your dose. If your blood level is too high, decrease your dose.
Vitamin D3 and all other fat soluble vitamins absorb better when taken
with the largest meal of the day.
When supplementing with Vitamin D3 it’s best to also consume food or
supplement with Vitamins A and K2 found in organ meats and fermented
foods.
Pro-inflammatory Foods
67
Diets = Religions
Everybody thinks theirs is the right one and the only one
Everybody wants to convert you to theirs
At their core they all have some commonality
Take a look at the history of food and the science behind
various diets and see what fits you, make an informed
decision.
Universal Diet Fundamentals
• Get off the crack: sugars and refined/simple starches
• One slice of your kid’s birthday cake won’t kill you, your daily
lowfat bagel and tall caramel latte might
• Shop the outside aisles: Fresh = Good
• Read labels
• Be anti-chemical additives
68
Diet: 9 word summary
• From Michael Pollan:
– Eat Food
– Don’t eat a lot
– Eat mostly vegetables
– New York Times Magazine Jan 28, 2007.
(Also See Michael Pollan’s book: The
Omnivore’s Dilemma)
Diet Philosophy
• Humans can adapt to a WIDE range of diets, they can even thrive on
extremely varied diets.
• Some people can live off of nothing but meat, blubber, seaweed
and blueberries, i.e. Inuit people. Some people can do well on
primarily rice with veggies and a little fish and beans i.e.
Okinawan's. But the fact that people can live on a widely varied diet
doesn't mean that those diets are ideal.
• ANY diet will make you feel better, by eliminating sugar and
processed foods. Therefor diets should be judges not by their ability
to reduce inflammation, or balance blood sugar, or improve
cholesterol, or any other single marker.
• They should be judged by their ability to go beyond what an
elimination of junk food will do, by their sustainability and by their
ability to provide adequate balanced nutrients.
69
What Does An Ideal Diet Look Like?
A nutrient dense diet that has all of the nutrients your body requires,
consist of:
• Lots of vibrantly colored vegetables, varied and in season
• Fruits of any type, unless you have substantial obesity, in which case
low glycemic fruits are best
– blueberries, blackberries and strawberries
• Healthy animal fats
– butter, ghee, homemade full fat yogurt and kefir (from healthy, grass
fed, organic animals)
• Healthy vegetable fats
– Coconut, olives, avacado
• Healthy protein sources
– eggs, fatty cold water fish, organ meats and muscle meats (if you have
low stomach acid, these can create problems)
70
71
Problem Foods
• A lot of the nutrients in grains and legumes are not
available for absorption due to anti-nutrients like lectins
and phytates.
• Grains and legumes should be totally eliminated if you have
IR, and minimized if your insulin is ok but you’re trying to
loose weight.
• If you don’t have digestive issues or IR, gluten free grains
and legumes can be consumed regularly, but not as a major
caloric staple.
• All industrial nut and seed oils high in omega 6’s should be
avoided.
– Canola, corn, soy, “vegetable oil”, margarine, and any trans fat
72
Omega-3 Sources
• Deep ocean fish
–mackerel, sardines, anchovies,
albacore tuna, wild-caught salmon
• Plant based omega 3s are
short chain, not long chain.
Only 5% are converted to EPA
or DHA
–Seeds (flax, hemp, pumpkin,
sesame)
–Nuts (walnuts, Brazil nuts)
–Dark green veggies (mustard
and collard greens, kale)
–Avocados
Omega-3 (from fish)
May Be Helpful For:
•
•
•
•
•
•
•
•
•
•
•
•
Allergies
Arthritis
Autoimmune Disorders
Blood Clots (preventing)
Blood Pressure
Cardiovascular Disease
Prevention
Cholesterol (balances)
Cold Sores
Colitis
Dermatitis
Diabetes (Type II)
Dizziness
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Depression
Bipolar disorder
Eczema
Fibroids
Immune Deficiency
Inflammation
Multiple Sclerosis
Nerve Damage
Psoriasis
Seborrhea
Schizophrenia
Senility
Skin Problems (dry or flaky)
Strokes (prevention)
73
Unhealthy Fats
•Modern processed fats
are NOT healthy
•These include:
– Hydrogenated or
partially hydrogenated
fats
• Shortening
• Margarine
• Partially hydrogenated
vegetable oils
– Refined vegetable oils
74
The Expert’s Opinion on Gluten
• Dr. Fasano is an internationally renowned
pediatric gastroenterologist and one of the
foremost specialists on celiac disease.
• Dr. Fasano was ask by a student if he ever ate
gluten-containing foods.
• His response, “Do you ever text while driving?”
• The students answer, “Well, it’s dangerous so I try
not to, but sometimes it happens…”
• His reply, “Exactly.”
A 6 Week Elimination Diet is
Warranted if You Have
•
Chronic nutritional deficiencies,
– Chronic anemia, B vitamin deficiencies
– Numbness and tingling in the hands and feet
•
All digestive problems
•
•
•
•
•
•
•
•
•
Arthritis, or joint pain
Brain fog (memory and concentration problems)
Depression, anxiety, irritability, behavioral problems in kids
Weight gain or difficulty achieving weight loss
All autoimmune conditions
Chronic skin rashes, canker sores, eczema
Chronic sinus problems
Infertility
Insulin Resistance and Diabetes
– IBS, diarrhea, constipation, gas, bloating, cramping, or reflux
75
My Opinion on a Healthy Diet
GF Grains and
Legumes
5%
Fruit, Nuts
and Seeds
10%
Animal Protein
20%
Starchy
Root
Veggies
15%
Leafy Green and
Non-Starchy
Veggies
50%
Exercise
• The best exercise is the type you enjoy.
• What did people 100 years ago call exercise?
• Amish men walk on average more than 18,000
steps a day, and Amish women averaged more
than 14,000 steps a day.
• American men average 5,340 steps women
averaged 4,912 steps a day.
• Sedentary = < 5000 steps daily
76
Ideal Exercise
• Conduct an average of one sprint workout a
week, two brief, but intense, strength sessions a
week, accompanied by plenty of low level aerobic
activity (your choice), play and rest.
• Low level aerobic activity means 3–5 hours a
week of walking, hiking, cycling, swimming,
puttering in the garden, playing golf, etc.
• If you are unused to all exercise please find a
personal trainer or do more research before
starting an exercise program. CHEK Institute
certified trainers are among the best.
Smoking
77
Dysbiosis
78
Gut-Brain Axis
79
80
81
82
Picture Post Apples & Sauerkraut
83
Environmental Contaminants as
Inflammatory trigger for Mental
Illness
84
Pesticides and ADHD
Kuehn, B.M. (2010). Increased risk of ADHD
associated with early exposure to pesticides, PCBS.
JAMA, 304, 1, 27-28.
85
Anti-inflammatory Herbs for
Depression
•
•
•
In the meta-analysis/Cochrane Review by Linde, et al (2008), which
reviewed 29 trials (5489 patients) including 18 comparisons with placebo
and 17 comparisons, Hypericum Perforatum was shown to be superior to
placebo in major depression (definite on mild-to moderate depression,
controversy on severe depression), as effective as standard
antidepressants, and with reduced side effects.
Bhutani (et al., 2009) shows that curcumin (tumeric) has theoretical
antidepressant properties, at least in rats. Kulkarni (2008) shows, again in
rats, increases in dopamine and serotonin and synergistic effects with
fluoxetine, venlafaxine, imipramine, desipramine,and buproprion. Hurleya
(et al, 2013) show an increase in BDNF, which would indicate
antidepressant effects via neurotrophic actions.
Aboul-Fotouh (2013) shows that Co-Enzyme Q10 appears to have antidepressant activities via reduction in DNA damage from oxidative stress in
chronically stressed rats.
86
Cont’d
• Moshiria (et al, 2006), in a 6 week, randomized, placebo
controlled trial (N=40) in mild-moderate depression
showed that saffron had statistically significant effects on
HAM-D scores. Akhondzadeh (2007) shows equal efficacy
to fluoxetine. Amr (et al, 2013) showed in a randomized
double-blind placebo controlled trial in pediatric
depression that fluoxetine + 1000mg of Vitamin C showed
significantly better results than Fluoxetine alone.
Complimentary and Alternative Medicine in
Anxiety
• Hosseinzadeh (2009) shows that saffron has
similar anti-anxiety, sedative, and skeletal
muscle relaxant effects similar to diazepam in
rats.
• Grant, (et al, 2009) in a study (N=50) showed
statistically significant improvement in
trichotillomania, an OCD spectrum disorder,
with NAC.
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SAM-E
• Add-on therapy with SAMe in patients with drugresistant depression produced double the response
rate AND remission rate compared with placebo
within a 6-week period.
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Turmeric
• Family: Zingiberaceae
• Genus and Species:
Curcuma longa
• Other names: Indian
Saffron, Haldi
• Part(s) Used: Rhizome
Photo from Wikipedia
Turmeric
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A Sample Plan for Depression
•
A moderate glycemic diet (100150g carbs), with a goal of:
–
–
–
–
•
No processed food
Dirty Dozen, Clean 15
1 pound of leafy greens a day
4-5 cans of sardines a week (in
water)
Daily exercise:
– 10,000 steps a day
– Fun physical activity 4 x week
•
•
•
O.N.E. Multi (Pure
Encapsulations), 2 x day
Vitamin D3 - 10k iu a day for a
month, then back down to 2k iu
(+4k iu from multi) daily.
Magnesium glycinate 600mg a
day in divided doses
Lithium orotate 5-15mg a day
Combination of Ashwagandha,
Mimosa bark (Albizia julibrissin),
Saffron, Boswellia
Digestive bitters before meals
Eating as only activity
•
•
Screen for Hypothyroidism
Screen for Dysbiosis
•
•
•
•
Sleep Hygiene
– No electronic devices past 8pm
– 10 hours in bed nightly
•
•
Mindfullness Based Meditation
– 30 min a day
– no driving, watching TV etc.
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Bipolar Disorder
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Complimentary and Alternative
Medicine & Bipolar Disorder
• Magalhães (et al, 2013) conducted a study (N=15) of NAC (N-acetyl
cysteine) showing improvement in manic symptoms in bipolar
disorder. Its efficacy is theoretically due to the notion that oxidative
imbalances are common in bipolar disorder. This agent is a
gluthionine pre-cursor and gluthionine is a non-enzymatic, cellular,
free-radical scavenger. It is noted that mood stabilizers improve
oxidative stress parameters. Berk (2012) in a randomized, placebo
controlled trial (N=149) showed statistically significant
improvement in depression parameters in the first round of the
clinical trial but not in the second.
• Forester (et al., 2012) showed that co-enzyme q10 (mean dose of
1040mg) shows statistically significant results in parameters of
depression in geriatric bipolar disorder (N=10).
A Sample Plan for Bipolar
•
A low glycemic diet <50g , with a goal
of:
–
–
–
–
–
•
Ketosis
No processed food
Dirty Dozen, Clean 15
1 pound of leafy greens a day
4-5 cans of sardines a week (in water)
Eating as only activity
– no driving, watching TV etc.
•
Daily exercise:
•
•
•
•
•
– 10,000 steps a day
– Fun physical activity 4 x week
•
–
–
–
–
–
Sleep Hygiene
– No electronic devices past 8pm
– 10 hours in bed nightly
•
Mindfullness Based Meditation
– 30 min a day
O.N.E. Multi (Pure Encapsulations), 2
x day
Vitamin D3 - 10k iu a day for a
month, then back down to 2k iu (+4k
iu from multi) daily.
Magnesium glycinate 600mg a day in
divided doses
Lithium orotate 15-20mg a day
Combination of strong antiinflammatories
•
•
Saffron
Boswellia (AKBA)
Curcumin
NAC (1200-2400mg)
EPA/DHA 4-10g daily
Screen for Hypothyroidism
Screen for Dysbiosis
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An Eclectic Holistic Model
Symptom
Control
Support
Weakened
Body Systems
Stimulate Self Healing
Vis medicatrix naturae
Real Food, Sleep, Exercise,
Stress Management, Spiritual
Health, Social Health
Awareness of Heart Energy and
Connection to World
The Spiritual Heart
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Chinese and Greek/Arabic (Unani)
Philosophy
• The Heart includes the physical heart and the
entire arterial system, but also the conscious
mind.
• In Chinese medicine, night mares or anxiety
might just as likely be termed a Heart disorder
as would an arrhythmia or low blood pressure.
• In Unani medicine, joylessness, resentment,
and hatred are considered to be maladies of
the Heart.
Avicenna on the Sources of Joy
•
•
•
•
•
•
•
•
•
•
•
•
•
•
1. Gazing upon daylight amid cheerful people
2. Associating with those of like beliefs
3. Obtaining what it is one wishes for
4. Satisfying an intention without meeting opposition
5. Preferring to do something peaceful
6. Confidence
7. The memory of past and future joys and hopes
8. Thinking about high aspirations
9. Mutual discussion and argument with kindred minds
10. Relief from pain
11. Contact with curious, interesting, remarkable new things
12. Uplifting of the mind
13. Meeting friends and friendly surroundings
14. Overcoming deception (discovering the truth, removing an illusion) in small
matters
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Avicenna on the Causes of Sadness
•
•
•
•
•
•
•
•
1. Reflecting that one’s homeland is distant
2. Pondering over many injuries already past and done with
3. Hatred and rancor
4. Bad health
5. Difficult circumstances of life
6. Thinking terrible things are going to happen in the future
7. Thinking of the necessity of death
8. Thinking about something that is disturbing to meditate
upon
• 9. Being away from an agreeable occupation
• 10. Having thoughts that distract from one’s occupation
• 11. Distraction from that which is desired and hoped for
Qualities of the Heart
•
•
•
•
•
•
•
•
•
Emotional and spiritual perception
Steadiness
Relationships
Love
Boundaries/protection
The seat of spiritual guidance
Wisdom
Knowing without logic or mental activity.
“When the Heart is not healthy, the entire system
is diseased.” --Prophet Muhammad
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Listening to Our Hearts
•
•
•
•
Drop out of your head (thinking and words)
Feel the emotion
Acknowledge it
Breathe with it and accept it rather than trying to
make it go away
• Allow your body to express the emotion (in
private or with a safe person)
• Insights and self-awareness will follow
• To feel your emotions you have to be in the
present moment
Unani Exhilarants
•
A sub stance which arouses the vitality in the spiritual heart and inclines
the spirit toward joy
–
–
–
–
–
–
–
–
–
–
–
–
–
Basil (Ocimum basilicum, O. sanc tum)
Cassia (Cinnamomum cassia)
Cinnamon (Cinnamomum zeylanicum)
Coriander (Coriandrum sativum)
Fir (Abies alba)
Frank in cense (Boswellia glabra)
Lavender (Lavandula officinalis)
Lemon Balm (Melissa officinalis)
Lemon peel (Cit rus medica)
Mint (Mentha arvensis)
Rose (Rose damascena)
Saffron (Crocus sativa)
Sandalwood (Santalum alba)
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European Heart Remedies
• Cordials, in the European tradition, are medicines that
benefit the heart.
• They were usually sweet and warming to taste and
often made of a combination of syrups and tinctures.
• Rose cordials are an excellent example.
• “Regard the heart, keep that upon the wheels, because
the sun is the foundation of life, and therefore those
universal remedies Aurum Potabile cure all diseases by
fortifying the heart”. -Culpeper
An Assignment
• Take a herbal formula to
bring your energy/focus on
your heart.
• Practice listening to your
heart.
• Practice bringing your
consciousness to the
present moment
completely, twice a day.
• Every morning you wake up
write down 5 things you’re
grateful for.
• Crataegus 3 parts
(protecting)
• Oplopanax 3 parts
(protecting)
• Leonurus 2 parts
• Scutellaria 1 part
• Albizia 1 part
• Cinnamomum 1 part
(exhilarant)
• Coriandrum 1 part
(exhilarant)
• 10 drops, 2 x day.
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