NMT150 BOT MED Wk6, Depression Lecture material (1) PDF

The use of Botanicals in Mild-Moderate Depression Chris Pickrell, ND, Herbalist, TCM Practitioner Key Actions: Warming Adaptogen, Hepatic/Alterative Physical activity is the most effective treatment for depression. Key treatment principles:...

The use of Botanicals in Mild-Moderate Depression Chris Pickrell, ND, Herbalist, TCM Practitioner Key Actions: Warming Adaptogen, Hepatic/Alterative Physical activity is the most effective treatment for depression. Key treatment principles: Don’t be afraid to consider herbs that act as stimulants. Expect to use stronger herbs at bigger doses. Mild and moderate depression are very amenable to treatment and have Pro tip: a good prognosis. Severe depression (MDD) is much more difficult and requires a different approach.  Botanicals in Depression Hypericum perforatum (St. John’s wort)  Botanicals in Depression FEATURED HERBS IN THIS SECTION Hypericum perforatum (St. John’s wort) Rhodiola rosea (Rhodiola) Panax ginseng (Korean red ginseng) Smilax officinalis (Sarsaparilla) Panax quinquefolius (North American Coffea arabica (Coffee) ginseng) Theobroma cacao (Chocolate bean) Withania somnifera (Ashwagandha) Capsicum annua (Cayenne) Bupleurum sinensis (Bupleurum) Psilocybin spp. (Psilocybin) CASE PRESENTATION – Depression A 32-year-old woman presents with ongoing feelings of depression manifesting as low mood, lack of joy in her life and in her daily activities, no motivation, and a feeling of hopelessness. Although these symptoms became pronounced when she lost her job six months ago, she suspects the seeds were there before that time, and she confesses she has often felt she was generally less happy than most people around her. Associations: In her current state, she does not feel able to look for work or capable of holding a job. OUTCOME MEASURES Improve quality of life and symptoms of depression Decrease duration, intensity, and frequency of episodes Prevent remission  Botanicals in Depression RELEVANT BOTANICAL ACTIONS TO CONSIDER PRIMARY SECONDARY or OTHERS TO CONSIDER SUPPORTIVE Adaptogen Stimulant Antiviral Hepatic Euphoric Psilocybin mushrooms FEATURED HERBS BY BOTANICAL ACTION Actions Herbs Adaptogen Rhodiola (Rhodiola rosea) North American ginseng (Panax Korean red ginseng (Panax ginseng) quinquefolius) Sarsaparilla (Smilax officinalis) Ashwagandha (Withania somnifera) Hepatic/ Bupleurum (Bupleurum sinensis) St. John’s wort (Hypericum Alterative perforatum) Stimulant Cayenne (Capsicum annua) Theobroma cacao (Chocolate bean) Coffea arabica (Coffee) Ephedra (Epherdra sinensis) Euphoric Kava kava (Piper methysticum) Psilocybin spp. (Psilocybin)  Botanicals in Depression HERB SELECTION Hypericum perf. 60 Bupleurum sinensis 30 Formula 1 Capsicum 10 100mL Dosage Tincture 2 teaspoons (10mL) twice a day between meals or as needed. Cautions, Hypericum perforatum (St. John’s wort) is a known inducer of CYP Contraindications 450 3A4. Use of SJW is contraindicated when patients are taking and Potential Side other medications. Effects Relevant Herb-Drug Use of SJW may cause serotonin syndrome in patients taking SSRIs, Interactions any anti-depressants, and the triptan class of medications (migraines) Rhodiola rosea 50 Bupleurum sinensis 30 Formula 2 Panax ginseng 20 100mL Dosage Tincture 2 teaspoons (10mL) twice a day between meals or as needed. Cautions, This combo is stimulating and may cause dizziness or anxiety in Contraindications patients not experiencing depression. and Potential Side Effects Relevant Herb-Drug None significant  Botanicals in Depression Interactions Other Effective Physical activity is the single most effective treatment for mild and Therapies moderate depression. Omega-3 supplementation has shown benefit Though more challenging to implement, meaningful socializing is important and effective in improving depression. TCM INTEGRATION – Depression Most depression is considered a Kidney Yang deficiency, or, more specifically, a Zhi deficiency. As yang is deficient, Dampness and Phlegm accumulate, which further depresses the Yang. Weakened Kidneys are unable to grasp the Qi, and weakened Kidney Yang is unable to ascend the Qi to the Triple Warmer for dispersal. This failure to disperse Qi and the accumulation of Phlegm can lead to Phlegm misting the Shen. The Liver and Lungs are likewise involved in depression: The Liver is responsible for the smooth flow of Qi and the processing of emotions, and any emotion that is suppressed or not expressed will injure the Liver, placing it in deficiency; the flatness and lack of affect commonly seen in depression is a result of the Hun failing to enter and exit the Shen. If the Lungs are deficient, they are unable to descend and disperse the Qi. The Heart is also involved in depression, and is seen in both the cause and the outcome: a lack of meaningful social connection injures the Heart (and Lung) Qi, and a weakened Heart is less able to connect meaningfully, and therefore withdraws socially. Treatment principles: Tonify yang, especially of the Kidneys; tonify Lung and Heart Qi. Re- establish the smooth flow of Liver Qi.  Botanicals in Depression SELECTED MONOGRAPHS Bupleureum chinensis (Chai hu) Primary Actions: Hepatic, alterative, anti-inflammatory, hepatoprotective Constituents: Triterpene saponins, sterols, volatile oils, polysaccharides Indications: Hepatic congestion, arthritis, chronic inflammation, acute infections with fever Cautions/Contraindications: Avoided in cold conditions or constitutions. Safety rating during pregnancy and lactation not established. Extra Information: Excellent hepatic alterative for long-standing inflammation from physical or emotional accumulation. Useful in hepatitis as both a hepatoprotective and an anti- inflammatory. Part Used: Root Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 3–12 g Pairs Well With: Berberis vulgaris, Uncaria tomentosa, and Harpagophytum procumbens for inflammation, especially of joints. Paeonia alba for stagnant menses with heat presentation. Closest Substitute: Baptisia tinctoria Capsicum frutescens (Cayenne) Primary Actions: Stimulant, circulatory tonic, rubefacient, sialagogue, libido tonic. Constituents: Capsaicinoids (capsaicin), steroidal saponins Indications: Circulatory deficiencies, arthritic conditions, pain relief, depression. Cautions/Contraindications: Non-toxic, but large doses will cause sweating and possible syncope. Safety rating during pregnancy and lactation not established. Extra Information: Acts as pain relief via local topical substance-P depletion. Excellent in salves for arthritis. Avoid contact with mucus membranes; internal use effective, but must be used in low doses. Part Used: Dried or powdered fruit Daily Therapeutic Dose Tincture: 1–5 mL (1:5 in 25%) Daily Therapeutic Dose Infusion or Decoction: 1–2 g powder (potency of starting material can vary considerably) Pairs Well With: Zanthoxylum americanum as warming circulatory tonic.  Botanicals in Depression Closest Substitute: Zingiber officinalis Hypericum perforatum (St. John’s wort) Primary Actions: Uplifting nervine, antiviral, anti-inflammatory, vulnerary Constituents: Volatile oils, hyperforin, naphthodianthones (hypericin), flavonoids Indications: Mood dysregulation, neuralgia, anxiety, viral infections Cautions/Contraindications: Sensitization may occur at higher doses of the herb or its extract. Induces CYP3A4, thus potential drug interactions with numerous substances. Serotonin syndrome possible when taken in combo with SSRIs. Photosensitivity may occur in some indivduals. Preg B, Lact CC. Extra Information: Excellent as topical oil for herpes lesions. Considered by some a specific for irritability and anxiety from menopausal changes. Part Used: Aerial parts Daily Therapeutic Dose Tincture: 2–10 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 2–4 g Pairs Well With: Calendula officinalis and Stachys betonica for depressive states, especially Seasonal Affective Disorder. Glycyrrhiza glabra and Melissa officinalis as a topical for herpes lesions. Closest Substitute: None Panax ginseng (Korean red ginseng) Primary Actions: Stimulating adaptogen, immune stimulant, libido stimulant, cardiotonic Constituents: Triterpene glycosides (ginsenosides), steroidal saponins Indications: Debility and convalescence (low dose), depression, end-of-life care Cautions/Contraindications: Non-toxic, but can be overstimulating to some individuals, particularly where yin has been weakened through excessive use of stimulants. CI in hypertension and other heat conditions. Preg A, Lact C. Extra Information: An excellent herb, often underused out of fear of its stimulating properties or overused because of its stimulating properties. A truly fortifying and whole-system adaptogen when used appropriately (by matching dose to condition and vitality), especially in combo with other herbs. Traditionally used in TCM to mobilize the essence of an elder near death so that the family would have time to gather for farewells.  Botanicals in Depression Part Used: Root. Red ginseng is the steamed root, while white ginseng is the unprepared root of the same species. The steamed red root is preferred. Daily Therapeutic Dose Tincture: 2–10 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 3–10 g dried root Pairs Well With: Astragalus membranaceus and Rehmannia glutinosa for convalescence after blood loss. Ganoderma lucidum for depression. Centella asiatica for mental clarity and focus. Closest Substitute: Rhodiola rosea Panax quinquefolius (American ginseng) Primary Actions: Immune stimulant, immune modulator, antiviral, adaptogen, mild lymphatic Constituents: Triterpene glycosides (ginsenosides), steroidal saponins Indications: Chronic infections, convalescence, debility, ME Cautions/Contraindications: Considered safe. Safety rating during pregnancy and lactation not established. Extra Information: Tonic-adaptogen. Generally considered one of the best immune stimulating herbs. Debate exists as to whether this herb is cooling, neutral, or slightly warming and as to whether it is drying or moistening. Current commercially available varieties tend to be slightly warming, slightly stimulating, and moistening. Part Used: Root Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 3–6 g dried root Pairs Well With: Echinacea spp. for acute viral infections Closest Substitute: Codonopsis pilosula, Panax ginseng Piper methysticum (Kava kava) Primary Actions: Nervine, mild euphoric, analgesic, antispasmodic, antifungal Constituents: Kavalactones, resins Indications: Anxiety, insomnia, nervous tension, depression Cautions/Contraindications: Although acute hepatotoxicity has been effectively disproven, long-term consumption (210 mg Kavalactones qd) shows elevated GGT. A characteristic ichthyosiform skin rash (dry, scaling) has been observed in high-dose, long-term users ingesting for the purpose of intoxication. Preg B, Lact CC.  Botanicals in Depression Extra Information: A unique nervine and anxiolytic with mild euphoric properties when used at appropriate dose. At larger doses (greater than 500 mL of properly extracted decoction), kava induces a mild euphoric intoxication. Although debate exists, it is thought that kavalactones found in Piper methysticum are best extracted in fat-based liquid (such as coconut milk), though tincture extracts at 40% ethanol or above are still effective as anxiolytics. Part Used: Root Daily Therapeutic Dose Tincture: 5–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 4–12 g dried root or powder Pairs Well With: Theobroma cacao as a euphoric nervine Closest Substitute: Valeriana officinalis Rhodiola rosea (Rhodiola) Primary Actions: Adaptogen, vascular tonic Constituents: Polyphenols (rosavin, salidroside), proanthrocyanidins, quercitin Indications: Fatigue from overwork, lowered libido, ongoing physical or mental stress, altitude sickness, ischemic heart disease Cautions/Contraindications: Though not considered toxic, like Panax ginseng, rhodiola may be too stimulating for individuals showing signs of restlessness, insomnia, dizziness, or anxiety. Safety rating during pregnancy and lactation not established. Extra Information: A potent adaptogen. Works best when used in three-week cycles. Used acutely during or preceding times of known physical or mental stress. Part Used: Root Daily Therapeutic Dose Tincture: 6–15 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 4–12 g dried herb or powder Pairs Well With: Centella asiatica and Bacopa monnierii for cognitive enhancement. Eleutherococcus senticosus as fortifying adaptogen. Closest Substitute: Smilax officinalis Smilax officinalis (Sarsaparilla) Primary Actions: Adaptogen, alterative, anti-inflammatory Constituents: Saponins based on the aglycone sarsapogenin, sterols, volatile oils Indications: Eczema, psoriasis, BPH, waning libido, RA, gout  Botanicals in Depression Cautions/Contraindications: Considered safe. Safety rating during pregnancy and lactation not established. Extra Information: Excellent tonic, useful in cases of fatigue following intense physical activity, especially when associated with joint pain. One of the original roots in root beer. Part Used: Root and rhizomes Daily Therapeutic Dose Tincture: 3–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 6–12 g dried root Pairs Well With: Polygonum multiflorum and Urtica dioica root as a male tonic. Vanilla extract, soda water, and a tsp of honey as a pleasant fortifying beverage. Closest Substitute: Hemidesmus indicus, Rhodiola rosea Theobroma cacao (Chocolate bean) Primary Actions: Mild stimulant, adaptogen, nutritive Constituents: Methylxanthines, theobromine, flavonoids, fatty acids Indications: Asthma, COPD, low mood, stress, convalescence Cautions/Contraindications: Considered safe and tasty. Lowers tone of lower esophageal sphincter, so avoided in GERD. Safety rating during pregnancy and lactation not established. Extra Information: Excellent as a nutritive restorative. Roasted beans preferred to raw; raw may contain fungal elements. Part Used: Bean Daily Therapeutic Dose Tincture: 3–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 6–12 g dried roasted nib Pairs Well With: Ephedra sinica and Coleus forskohlii for asthma and COPD. Rehmannia glutinosa, Angelica sinensis, and Schisandra sinensis for female convalescence. Closest Substitute: Coffea arabica, Innonotus obliquus Withania somnifera (Withania) Primary Actions: Adaptogen, hypotensive, immune modulator, anti-inflammatory, nootropic Constituents: Steroidal lactones (withanolides), alkaloids Indications: Fatigue, nervous exhaustion, chronic inflammatory disease, anemia, lowered libido, convalescence, hypothyroid presentations Cautions/Contraindications: Considered safe. Preg B, Lact C.  Botanicals in Depression Extra Information: An excellent non-stimulating adaptogen useful in promoting performance and recovery without the symptoms of overstimulation. Sometimes thought of specifically as being useful as an adaptogen for the thyroid. Part Used: Root Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 6–10 g dried herb or powder Pairs Well With: Schisandra sinensis and Zingiber officinalis as non-stimulating tonic for weakened vitality (Qi) with excess fluids, especially of the digestive system. Rumex crispus, Centella asiatica, and Ganoderma spp. for physical endurance and improving red and white blood cell counts. Closest Substitute: Eleutherococcus senticosus