Stress and Depression

Psychology and Nutraceutical Support Webinar 2 Stress and Depression Presented by: Dr Kamal Karl MBBS, FRNZCGP, FACNEM, FNZCAM, FACCS and Cynthia Hunefeld ND. Dip Med Herb, Dip Clin Nut

Topics Covered Today Mild to Moderate stress levels. How improving nutritional status can improve a persons ability to cope with the effects of stress. What herbs can help with stress and depression and how they can assist the body and mind in overcoming stressful events.

Current Statistics Research shows a major increase in the use of the medical system during times of stress. 2013 New Zealand health survey showed psychiatric illnesses have doubled in the last five years. Research indicates a 4 fold increase in the number of people diagnosed with a disability with an underlying psychiatric disorders. In New Zealand, 500,000 people were prescribed anti-depressants 38% higher than 5years previous. Anti-psychotic medications has doubled. Reference: Professor Julie Rucklidge, University of Canterbury

Stress Short-term they can lead to a wide variety of symptoms such as muscle tension, fatigue, gastrointestinal symptoms, headaches and insomnia. Long-term chronic stress can have major health consequences, and adversely affect our cardiovascular, immune, neuroendocrine and central nervous systems. Untreated chronic stress can result in serious health conditions including high blood pressure, heart disease, anxiety, insomnia, depression, weak immune system.

20-50% of people do not respond to current medical frontline treatment. This could be due to; Gut health of the individual Depleted nutrients in foods Poor food choices Soil is not replenished with nutrients Genetic differences Reference: Professor Julie Rucklidge, University of Canterbury

Stress is a factor in many illnesses. A substantial contributor to stress-induced decline in health appears to be an increased production of stress hormones and subsequent decrease in immune function. Non-pharmaceutical approaches have much to offer.

Stress & Hippocampus Repeated stress affects brain function, especially hippocampus. High concentrations of cortisol and NMDA receptors. Participates in verbal memory and memory context Impairment decreases the reliability and accuracy of contextual memories. Damage may exacerbate stress by preventing access to the information needed to decide that a situation is not a threat Regulates the stress response and acts to inhibit the response of the HPA axis to stress Bruce S. McEwen, Ph.D. Protective and Damaging Effects of Stress Mediators. NEJM. Jan 2008: Volume 338:171-179

B vitamins and homocysteine metabolism. B 6 = vitamin B 6 ; B 12 = vitamin B 12 ; HCY = homocysteine; MTHF = 5-methlytetrahydrofolate; SAH = S-adenosylhomocysteine; SAM = S-adenosyl methionine; THF = tetrahydrofolate. Adapted from Obeid R, Herrmann W. Mechanisms of homocysteine neurotoxicity in neurodegenerative diseases with special reference to dementia. FEBS Letters 2006;580:2994-3005.

Conversion Folic vs Folinic Acid / 5 MTHF

B Vitamin Thiamin (Vitamin B1) Niacinamide (Vitamin B3) Pantethine/ Pantothenic Acid (Vitamin B5) Pyridoxal 5 phosphate (P5P; Vitamin B6) Methylcobalamin (Vitamin B12) 5-Methyltetrahydrofolate (5-MTHF; Folate) Function Regarding Stress Important role in many enzymatic reactions related to energy production, nerve cell function. Protective nutrient for the adrenals; decreases stress-induced cortisol response. Improves sleep quantity and quality; shunts tryptophan to serotonin. Involved in hormone production, energy production, and blood sugar regulation. Essential optimal energy production, hormone production, metabolism of fats and carbohydrates. Protective nutrient for the adrenals; decreases stress-induced cortisol response. Cofactor for synthesis of GABA, serotonin, and dopamine, neurotransmitter formation, essential methylation process. Reset circadian rhythms for improved sleep and normalizing cortisol peak, DNA synthesis, RBC formation. Cell division, nervous system function. Regenerates BH4* essential for neurotransmitter formation (serotonin, dopamine, norepinephrine, epinephrine).

Why prescribe active forms of B-vitamins? Water-soluble B vitamins have to be absorbed in the small intestine and then go to the liver where they are biotransformed into their active coenzyme forms. Gastrointestinal and/or hepatic impairment is likely to affect absorption and the activation process. B-Active contains B1, B2, B6, B12 in their physiologically active forms making them easier to absorb and ready to use. 5-MTHF

Clinical Indications B Vitamins Stress and Fatigue Cognition and Healthy Mood Supports Healthy Nervous System/Adrenal/Immune Function & Healthy Hormone Balance Supports Carbohydrate Metabolism Possibly Reduces the formation of Advanced Glycation End- Products (AGEs) which leads to Inflammation and other chronic inflammatory conditions associated with aging. Supports Cardiovascular Health (including blood cells)

Xymogen B Activ Dosage: 1 capsule once to three times daily

Thorne Research - Rhodiola

Rhodiola Used to enhance physical and mental performance of athletes and cosmonauts. Categorized as an adaptogen, because of its ability to increase resistance to chemical, biological and physical stressors. Rhodiola herb is a good choice for those with fatigue and acute or chronic stress Also demonstrated a number of versatile properties including; Support for occasional mental and physical stress. Cardiovascular and metabolic function. Cellular health.

Rhodiola has been found to inhibit stress-induced depletion of adrenal catecholamine's and to facilitate the transport of neurotransmitters within the brain. Experimental studies found Rhodiola prevented stress-induced cardiac damage. Rhodiola has demonstrated the potential to support liver function glucose and insulin metabolism antioxidant and cellular protection

Clinical Indications - Rhodiola Decline in work performance Sleep disturbances Depression Irritability Poor appetite Hypertension, headaches, or fatigue subsequent to exposure to physiological stressors Intense physical or intellectual strain

Thorne Research Rhodiola Dosage & Interactions Dosage: 1 capsule two to three times daily Are There Any Potential Side Effects Or Precautions? At this time, there are no known side effects or precautions. High doses (1.5g and above) can occasionally result in anxiety or insomnia in some individuals Are There Any Potential Drug Interactions? Rhodiola may be contraindicated for individuals taking adrenergic-blocking and antiarrhythmic medications.

Studies Rhodiola a human, randomized, double-blind, placebocontrolled study of burnout patients with fatigue syndrome (n=30), administration of rhodiola exerted an anti-fatigue effect that increased mental performance, especially concentration and decreased cortisol In response to awakening stress. Maslova LV, Kondrat ev Biu, Malov LN, Lishmanov IuB [ The cardioprotective and antiadrenergic activity of an extract of Rhodiola rosea in stress]. Eksp Klin Farmakol

Studies Rhodiola Recently, a double blind cross-over study examined the effect of Rhodiola rosea on mental performance in healthy physicians. The results suggest : Rhodiola may help to moderate fatigue under stressful conditions and Support short-term memory and concentration. Russian studies suggest a role for Rhodiola in asthenic conditions defined as a decline in work performance, poor appetite, sleep disturbances, irritability, headaches, and fatigue. In a separate, double blind, placebo-controlled pilot study, Rhodiola rosea provided support for physical and mental stress in students. Promoting the activity of neurotransmitters such as serotonin, norepinephrine and dopamine plays a part in this herb s ability to enhance cognitive functioning, memory and attention.

Planta Med. 2009: Panossian AG. Department of Psychology, Uppsala University, Uppsala, Sweden. A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. The aim of the study was to assess the efficacy of the standardised extract SHR-5 of roots of Rhodiola Rosea L. in the treatment of individuals suffering from stress-related fatigue. A total of 60 individuals were randomised into two groups, one of which received four tablets daily of SHR-5 extract (576 mg extract/day), while a second received four placebo tablets daily. We found that repeated administration of Rhodiola rosea extract SHR-5 exerts an anti-fatigue effect that increases mental performance, particularly the ability to concentrate, and decreases cortisol response to awakening stress in burnout patients with fatigue syndrome.

RLC Labs - a...drenal

RLC Labs - a...drenal Comprehensive formulation of organic adrenal tissue and adaptogenic herbs. Provides effective support from stress-induced symptoms. Promotes calm, balanced physical and mental energy. Helps maintain and normalize healthy cortisol and blood sugar levels. Supports healthy adrenal function.

RLC Labs - a...drenal Key Nutrients Pantothenic Acid (Vitamin B5) Supports optimum adrenal function and hormone synthesis. Cordyceps Weakness and fatigue, and used as an overall rejuvenator for increased energy. Adrenal tissue The adrenal cortex is responsible for synthesis of corticosteroids, therefore adrenal Hormone-free organic bovine adrenal glandular extracts play a role in supporting normal adrenal function and healthy cortisol levels.

Ashwagandha It acts as an adaptogen and immune modulator. Enhances the body s ability to deal with stress on a physical and psychological basis. Rhodiola An adaptogenic herb that supports the functioning of the adrenal glands. Encourages a healthy response to physical, emotional and mental stress by normalizing cortisol levels and other stress-related hormones without causing drowsiness or fatigue.

Siberian Ginseng and Korean Ginseng Adaptogenic herbs that enhance homeostasis and counteract negative effects brought about by stressors. They support normal immune function, revitalize energy levels and improve physical and mental performance and concentration. Astragalus An adaptogen, antibacterial, antioxidant and antiinflammatory properties Promotes normal levels of specific immune cells and aids their function

Epimedium grandiflorum Epimedium extracts have been shown to stimulate the immune system. L-Theanine A unique amino acid that aids balance in the neurotransmitter system with its ability to enhance the production of dopamine, serotonin and in the formation of GABA, resulting in improvements in mental, emotional and physical function. Ginger Promotes normal production of inflammatory markers which aids immune system function. Promotes healthy circulation and inflammatory responses. Beta-Sitosterol As a plant sterol, it has been known to aid the immune system by maintaining a healthy balance between Th-1 and Th-2 white blood cells. Helps to modulate the stress response by supporting normal cortisol and DHEA levels.

RLC Labs a Drenal Dosage up to 2 capsules twice daily Avoid in pregnancy

Depression

Depression The characteristics of depression can include; Depressed mood Fatigue Insomnia Excessive sleeping Feelings of worthlessness Poor memory and concentration Weight loss or weight gain Suicidal thoughts

Depression and Malnutrition Research shows malnutrition can have a significant impact on our brain function, which has a direct effect on how we feel. There is evidence for the efficacy of micronutrients in the treatment of stress and antisocial behaviors as well as depressed mood in nonclinical and elderly populations. Professor Julie Rucklidge from University of Canterbury has conducted a few clinical studies using micronutrients and research is ongoing.

Multi Vitamin and Mineral Due to depleted soils, enhanced chemical fertilisers, pesticides, fungicides. Highly processed foods, depleted diets. Multi- vitamin/mineral is a good option for those depleted clients. FxMed have a variety of multivitamin-minerals available.

Vitamin D

Vitamin D and Depression A systematic review and meta-analysis of observational studies and randomized controlled trials was conducted. One case control study, ten cross-sectional studies and three cohort studies with a total of 31 424 participants were analyzed. Lower vitamin D levels were found in people with depression compared with controls. Increased odds ratio of depression for the lowest v. highest vitamin D categories in the cross-sectional studies. The cohort studies showed a significantly increased hazard ratio of depression for the lowest v. highest vitamin D categories. Vitamin D deficiency and depression in adults: systematic review and meta-analysis - Rebecca E. S. Anglin, Zainab Samaan, Stephen D. Walter, Sarah D. McDonald - The British Journal of Psychiatry Feb 2013, 202 (2) 100-107; DOI: 10.1192/bjp.bp.111.106666

Vitamin D Deficiency Vitamin D levels have been shown to decline with age, due primarily to a reduction in either absorption or metabolism by the liver. Research shows depression may occur when deficient in vitamin D. Decreased exposure to sunlight. Vegetarian diet, or a low intake of vitamin D fortified foods also play a role in inadequate vitamin D levels. Vitamin D levels can be checked by a simple blood test by their local GP.

Vitamin D Enhances calcium absorption and retention. a key nutritional role in supporting healthy bones May play a potential role in cardiovascular, colon and cellular health. Vitamin D levels have been shown to decline with age, due primarily to a reduction in either absorption or metabolism by the liver. Low levels are found in those with depression.

Pure Encapsulations Vitamin D liquid Dosage & Interactions Dosage: 1-3 drops daily, with food 1 drop = 1,000IU Contains D3 cholecalciferol Are There Any Potential Drug Interactions? Vitamin D may result in hypercalcemia in certain individuals taking digoxin or thiazide diuretics.

What are Essential Fatty Acids? Essential Fatty Acids are: Polyunsaturated long chain fatty acids that are essential in human nutrition. Required for proper functioning of all living cells. Essential because the human body cannot make them; they must be absorbed from the diet. Essential Fatty Acids exist in cell membranes There are 2 main families of essential fats: omega-3 and omega-6. In the body, omega-3s reside in the cell membrane, where they compete with omega-6s. Proper cell function is dependent on a balanced intake of these fats. An overabundance of omega-6 fats (from refined vegetable oils, processed foods, and meat) can disrupt this delicate balance. Stillwell W et al, Chem Phys Lipids 2003 Cordain L, AJCN 2005 Linus Pauling Institute, Corvallis OR 2006

Cell Membrane Lipid Bilayer EPA and DHA are structural components of every cell and therefore influence: cell membrane stability and fluidity receptor action membrane-bound enzyme activity hormone binding signal transduction action potentials

Omega 3 fatty acids- EPA and DHA Fish oil supplies the omega-3 essential fatty acids EPA+DHA. This increase in omega-3s promotes the natural antiinflammatory response, which in turn optimizes heart, brain, circulatory, metabolic, join and tissue health. In the cell, EPA and DHA have metabolic, regulatory, and structural functions Cells become less flexible, less permeable, and functionally compromised when Omega-3 intake is inadequate Fish oil supplements are recognized as key elements in improving overall human health

EPA - DHA EPA (Eicosapentaenoic Acid) - healthy heart and body Omega-3 Maintains a healthy heart and circulatory system Supports joint flexibility and movement Maintains healthy immune function Supports optimal metabolism and body composition Maintains balanced blood sugar levels Supports the body s natural anti-inflammatory response DHA (Docosahexaenoic Acid) - healthy mood, mind, and memory Omega-3 Supports developing brain and eyes Promotes positive mood and well-being Supports and protects the brain, eyes, and nervous and immune systems Essential for the proper development of infants and children Recommended by doctors for pregnant and lactating women

Omega3 on Nervous System Functioning

Proven Benefits of Fish Oil Mental health Reduces depression, anger, and aggression Reduces risk for suicide Maintains cognitive function, particularly agerelated DHA is essential for proper brain functioning Children and behavior Infant development Maternal health

Clinical Indications Depression Mood health Cardiovascular health Memory and eye support Joint and tissue health Natural anti-inflammatory response

Nordic Naturals ProOmega 2000 Dosage 2 capsules daily

Case Study A randomized trial of nutrient supplements to minimize psychological stress after a natural disaster. Residents of southern Alberta were invited to participate in a study on the potential benefit of nutrient supplements following a natural disaster. Fifty-six adults aged 23 66 were randomized to receive a single nutrient (vitamin D, n=17), a few-nutrients formula (B-Complex, n=21), or a broad-spectrum mineral/vitamin formula (BSMV, n=18). Self-reported changes in depression, anxiety and stress were monitored for six weeks.

Case Study All groups showed substantial decreases on all measures. Those consuming the B-Complex and the BSMV formulas showed significantly greater improvement in stress and anxiety compared with those consuming the single nutrient. There were no group differences between those consuming the B-Complex and BSMV. The use of nutrient formulas with multiple minerals and/or vitamins to minimize stress associated with natural disasters is now supported by three studies. http://www.sciencedirect.com.helicon.vuw.ac.nz/science/ article/pii/s0165178115003935

Summary First address stress Xymogen B Activ Thorne - Rhodiola RLC Labs - a Drenal Depression Nordic Naturals - ProOmega 2000 Pure Encapsulations - Vitamin D Refer to Chart by conditions

FxMed Support Suggested additional learning about Stress and the HPA Axis available from FxMed: Seminar recording and notes by Dr Andrew Heyman Stress A Multi-System Disorder $35 FxMed s Free Stress Solutions Booklet NB: These resources are available to account holders only FxMed have a team of qualified regional Practitioner Consultants and a Technical Support Team available to support Practitioners.

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