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Webinar on Supplements in Psychopharmacology

Their Role in Helping and Not Helping with Dr. Paul Putman

Dr. Putman is a Distinguished Life Fellow of the American Psychiatric Association, a Laughlin Fellow and member of the American College of Psychiatrists, and past President of the Central (now American) Neuropsychiatric Association. A practicing psychiatrist for over thirty years, he has performed Phase I-IV studies in psychopharmacology, published in peer-reviewed journals, served as a supervisor for the Austin Graduate Medical Education/UT Medical Branch Residency Program in Psychiatry.

He lectures and consults regularly on psychiatric diagnoses and practice, with a particular focus on mood and anxiety disorders. In addition to his scientific publications, Dr. Putman has authored Rational Psychopharmacology: A Book of Clinical Skills, a text on practicing clinical psychopharmacology for practitioners and students.

Despite our significant progress in clinical psychopharmacology over the past century, some patients ideologically still prefer non-prescription treatments. Even those who are open to prescription medication may still be influenced to consider alternatives by others.
A strong knowledge of dietary supplements, nutraceuticals, herbal and other complementary treatments is therefore important in effective treatment planning.

Paul Putman in his webinar talked about some of the most popular supplements you may encounter with your patients. Clinician knowledge about these alternative treatments enhances therapeutic alliances and outcomes, while guarding patient safety.

In case if someone takes supplements without any consultation, it might happen that it will cause side effects if the patient is allergic to some of the ingredients in the supplement or has lower tolerance. Henceforth, it is recommended to take prescribed supplements for enhanced safety. Natural supplements are preferred over other supplements as they are safe, healthy and effective.

Supplements are expensive and may cost you hundreds of dollars a month. Also there is lesser truth when you get influenced by supplements which are highly advertised as they might not have the quality promised. Also drug-drug interactions may cause serotonin syndrome or cytochromeP450.

Here are a few supplements you may consider:

St. John’s Wort
SAMe
L-Tryptophan
Melatonin
L-Methylfolate
Vitamin B12
Vitamin D
Omega 3 FA
Valerian
Kava kava
Ginkgo biloba
Ginseng

St. John’s Wort (Hypericum Perforatum):

  • No Rx necessary in US
  • Not effective for Major Depression

It may cause the following side effects

  • GI
  • Confusion
  • Dizziness
  • Sedation
  • Tiredness

Talking about SAMe (S-Adenosyl-L-Methionine):

It rarely causes error of metabolism. It leads to lower levels of folate and vitamin B12 which are co-factors in synthesis of SAMe. It interferes with myelination and the biosynthesis of monoamine neurotransmitters which results in dementia and depression

It may cause the following side effects:

  • Hypomania
  • GI
  • Agitation, anxiety

Melatonin (N-acetyl-5-methoxytryptamine):

  • Melatonin is the endogenous hormone released by the pineal gland.GI
  • RCT shows help with initial (or delayed-phase) insomnia
  • Data for jet lag and shift-work or sleep disorders causes lower levels of melatonin in the body.
  • Short-term dosing in RCTs usually ranges from 0.3 to 5.0 mg qhs

L-Methylfolate:

  • Dietary folic acid generates L-methylfolate.
  • Cofactor tetrahydrobiopterin (BH4) activates tryptophan hydroxylase and tyrosine hydroxylase, which limits the synthesis of SE, NE and DA in the human body.

Oral L-Methylfolate:

  • The ideal dosage recommended is 15mg for over 30 days. It shows good benefits if taken for 12 month. Any dosage lesser than 7.5mg is ineffective.
  • It must always be used as supplement and never as a monotherapy.

Oral L-Methylfolate with Normal Serum Levels:

  • It is not always effective.
  • Not all pts have low serum levels at time of treatment
  • It will not allow early detection of cerebral folate.
  • Low BH4 tx with the analog sapropterin plus 5-hydroxytryptophan and carbidopa

Vitamin D and it’s Associations:

Vitamin D plays a very vital role in the functioning of the human body.

Low amount of Vitamin D may cause:

  • Cardiovascular disease
  • Stroke
  • Type 2 Diabetes Mellitus
  • Colorectal Cancer
  • Rickets
  • Osteopenia
  • Osteoporosis

Absense of vitamin D is also known to cause the following mental issues:

  • Mood (depression)
  • Psychosis
  • Eating disorders (anorexia nervosa)
  • Cognitive function in psychosis
  • Cognitive function in aging

Sources of Vitamin D3:

  • It is found in Fatty Fish
  • It is produced in the skin
  • Cognitive function in psychosis
  • Limited by UV B exposure

Omega-3 long chain polyunsaturated fatty acids (LCPUFAs):

  • Omega-3 long chain polyunsaturated fatty acids are highly useful for Major and Perinatal Depression.
  • High ratios of omega-6 to omega-3 have been shown to reversibly alter serotonergic and dopaminergic transmission, including during lactation, at least in animal models.
  • Low serum levels of omega-3 relative to omega-6 are associated with major and perinatal depression.

Other Herbal Supplements you may consider:

Valerian (Valeriana officinalis):

  • It is used for centuries as soporific.
  • It is not effective in contemporary meta-analyses for sleep.
  • It is recommended only for improvement of the subjective sleep experience.
  • It is effective for treating anxiety.
  • It helps remove toxicity.

About Kava kava (Piper methysticum):

  • It is popular in Pacific island communities and is used in cultural ceremonies.
  • It is also available in extract, capsule, and pill form.
  • It can be used for anxiety.
  • It also helps fight severe hepatic toxicity.
  • It is inferior to traditional medications for treatment of long lasting ailments.

Facts about Ginseng:

  • It is popular world-wide
  • It has 10 different varieties or imitators
  • Journals most often refer to Oriental ginseng (Panax ginseng)
  • American wild or cultivated ginseng (P. Quinquefolium) also widely available.
  • White ginseng is unprocessed.
  • Red ginseng is preserved with heat and steam and is of higher potency.

Applications of Ginseng:

  • Ginseng is often taken to fight fatigue.
  • High doses of Ginseng or LT use may lead to insomnia and nervousness.

Key points about Supplements:

  • Remain aware of every substance patients are taking – ask at every contact.
  • Evaluate safety, efficacy the same as prescription medication.
  • Familiarity more likely to influence patients
  • Patient education as essential as for Rx
  • Provider knowledge necessary.

These are important aspects to consider while you think of taking supplements. They should ideally be taken only after due prescription from the doctor.

Do visit www.psychonline.com for more mental health and wellness content. Dr. Pautman hosted this webinar on Group Thera, which is Psychonline group venture. To know more about Group Thera, you may explore www.groupthera.com

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