Integrative Approaches to Anxiety and Depression. Chris Krumm, ND, LAc, HealthPoint

Transcription

1 Integrative Approaches to Anxiety and Depression Chris Krumm, ND, LAc, HealthPoint

2 Naturopathic Physicians - Complete same standard pre-medical coursework before admission - Attend accredited 4-5 year postgraduate naturopathic medical schools, such as Bastyr University in Seattle area. - Complete minimum of 4,100 hours of training, including all basic and clinical medical sciences and with addition of extensive additional coursework in areas such as physical medicine, nutrition, botanical medicine, counseling, and much more. Last 2-3 years complete clinical shifts. - Must pass national board exams (NPLEX) before licensure - Compete for residency positions post-grad (All HP NDs completed residencies) - Trained as PCPs, but practices vary greatly by area and provider

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4 NDs at HealthPoint - Washington State NDs recognized in law as primary care providers along with MDs, NPs, PAs, DOs. - Broad scope of practice and prescriptive rights -- can prescribe all noncontrolled pharmaceuticals, can provide minor surgical procedures, naturopathic manipulation (osteo/chiro similar), and can do most things a general/family practitioner can do in primary care settings. - HP NDs manage the same acute and chronic conditions as other providers -- but often have other treatment options to consider if patients desire. - Are not all the same -- some have unique, specific skills and interests - Covered by Medicaid plans (State), but not Medicare (Federal)

5 Six guiding principles of naturopathic medicine Identify and treat the cause Do no harm Doctor as teacher The healing power of nature Treat the whole person Prevention

6 Considerations in patients with psychological issues - Stress -- financial, social, familial, abuse, work - Lifestyle - diet, exercise, sleep, work - Genetics - family history, personal history - Medical - underlying metabolic or hormonal factors? -- blood sugar, thyroid, menopausal changes, menstrual changes, anemia, major digestive issues, post-partum or current pregnancy, chronic pain, etc. - Medication side effects?

7 Review treatment history - Past diagnoses, other comorbidities and personal view of those diagnoses - Hospitalizations - Therapies and counseling history - Medications tried, effects and side effects, duration, doses tried - Natural therapies tried - Lifestyle modification tried - Current medications, potential for interactions with any new treatment being considered

8 Developing a plan Considerations: - Critical to assess patient preference and weigh against severity of issue - Cultural preferences or biases - Depth of desire for natural treatment versus conventional medications - Financial barriers and cost of treatments compared - Willingness to use more than just medication (lifestyle change, behavioral health counseling, etc.)

9 Lifestyle foundation regardless of diagnosis - Optimize sleep - Exercise daily in some form - Emphasize importance of healthy diet - Plan to begin addressing obstacles to cure - Behavioral health/counseling support

10 Medical therapy -- so many options SSRIs (list out some examples for each category, look for more classes) SNRIs Benzos (not in ND scope) Antipsychotics Mood stablizers Natural medicine (herbal medicine, vitamin/mineral, amino acids, omegas )

11 Major depressive disorder - natural options Saint John s Wort (Hypericum perforatum) - Major depressive disorder - Studies consistently show effectiveness - As effective as SSRIs with less side effects and easier to d/c - Typical dose 900mg mg each day (divided bid usually) - Potential med interactions main concern - Speeds metabolism of meds through CYP450 (OCPs and antivirals biggest concerns) - Rare photosensitivity rash

12 Major depressive disorder - natural options Adrenal Support -- concept of adaptogens to help resilience to chronic stress, fatigue, to build vitality - Most cultures with long history of traditional medicinal herbs for this purpose - Ginseng, Maca, Rhodiola, Licorice root, Ashwaganda, many others. HPA Axis by Gaia Herbs (formerly called Adrenal Support ) - Ashwaganda, Rhodiola, Holy Basil - Nice, gentle anxiolytic formula, very helpful to add this to other antidepressant therapy especially if fatigue, anxiety still predominate, or ongoing chronic stress - Typical dose 2 capsules twice daily

13 Major depressive disorder - natural options 5-HTP (5-hydroxytryptophan) - Serotonin precursor - More easily crosses blood-brain barrier than straight tryptophan - Sedative in some - Helpful for insomnia as add-on - Helpful to stem food cravings, stress-eating, increases satiety - Disappointing as stand-alone therapy for depression - Typical dose 200mg-300mg divided bid-tid, higher doses common

14 Major depressive disorder - natural options SAM-E - S-adenosylmethionine (SAMe) is a natural compound found in nearly every body tissue and fluid; participates in myriad biochemical reactions - Influences dopamine and serotonin synthesis - Effective anti-inflammatory/antioxidant effects, especially useful for arthritis - Newer research shows effective as add-on for treatment resistant depression to SSRIs and other medications - Expensive at therapeutic dose of 800mg-1600mg qd

15 - Kava Anxiety - natural options - Exercise daily, very helpful - Regular meals, protein-rich breakfast - Behavioral health support so important - B-complex -- B-vits important in neurotransmitter pathways - Paradoxical aggravation in some; likely MTHFR mutation issues... - Valerian, passionflower, chamomile, hops - Gentle, might be best in tea form, paradoxical stimulation with valerian in some - Adrenal Support formula

16 Anxiety - natural options Kava kava (Piper methisticum) - Anxiety primarily - Benzodiazepine-like actions, much more gentle, not addictive - Fast-acting - Tincture form can be used for acute stress/anxiety flares - Typical dose 2-3 droppers full mixed in a little water 2-3 times each day - Or higher dose, 4-5 droppers full in a little water for more acute anxiety flare, panic - Strong taste, tingly tongue! Capsule form optional, less dramatic - Old reports of liver damage, most likely d/t poor quality manufacturing, wrong plant parts

17 Insomnia - natural options - All the usual behavioral health, sleep hygiene, lifestyle, exercise, etc - Diet -- consider small carb-rich snack before bed - If muscle tension -- consider cal-mag citrate powder before bed - 5HTP - 50 to 100 mg before bed - Melatonin - 1 to 3 mg, best if sleep onset the issue, short half-life - Sleep Blend by Vitanica -- combo melatonin, B12, magnesium, valerian, 5HTP, passion flower, cal/mag; Sig 2-3 capsules ~ ½ hr before bed - Progesterone -- perimenopausal can be very helpful sleep aid - Lavella (lavender extract) -- interesting research, anxiety/insomnia

18 Bipolar - Limited research on effective natural medicines - High dose omega-3 oils (6-9 grams daily) - Emphasize diet/lifestyle, multimodal care - Conventional medications usually needed, psychiatry referral usually done - Add-ons may help - Adrenal Support - Sleep support - Acupuncture

19 Acupuncture - Ancient Chinese medical system now practiced worldwide - Chi, Yin/Yang energy concepts, meridian therapy - Helpful for many issues - Great for anxiety especially if pain, tension, stress predominate - Weekly treatments typical to start - Great to jump-start treatment with medications - Can treat many issues at once - Insurance coverage limited

20 Summary - Lifestyle/diet/exercise must be emphasized - Consider cultural and personal preferences - BH critical regardless of medication/treatment used - Treat the whole person - Many supportive natural options with less potential for SEs - Cost considerations the biggest barrier to natural meds and other supportive treatments - And -- remember that NDs work with conventional medications as well, it s not an either/or choice!