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DEPRESSION, INFLAMMATION AND BOTANICAL INTERVENTION
(ALMOST DR.)
LYDIA ANNE M BARTHOLOW, PMHNP, CARN-AP
Down in the Dumps: depression, inflammation and
botanical intervention
Who the hell am I?
Agenda
Ancient news Monoamine hypothesis
Psychopharm minute: allopathic antidepressants
Inflammation and Depression 101
Vehicles Allostatic load: Stress & Trauma BDNF and Neurotrophins Epigenetics Food Lifestyle Thoughts
Interventions
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Agenda
Ancient newsMonoamine hypothesisPsychopharm minute: allopathic antidepressants
Inflammation and Depression 101 Vehicles
Allostatic load: Stress & Trauma BDND and neurotophins Epigenetics Food Lifestyle Thoughts
Interventions
Addressing the monoamine hypothesis
SSRIs SNRIs Other common ADs
Prozac Effexor Wellbutrin
Zoloft Cymbalta Mirtazapine
Celexa Pristiq AMT/NRT
Lexapro
Paxil
Luvox
Your psychopharm minute
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Agenda
Ancient news Monoamine hypotheiss Psychopharm minute: allopathic antidepressants
Inflammation and Depression 101 Vehicles
Allostatic load: Stress & TraumaBDNF and NeurotrophinsEpigeneticsFoodLifestyleThoughts
Interventions
Inflammation and depression: 101
Monoamine transporters (receptors) influenced by neuroinflammation
Impaired neuroplasticity
HPA axis dysregulation via inflammation
Agenda
Ancient news Monoamine hypotheiss Psychopharm minute: allopathic antidepressants
Inflammation and Depression 101 Vehicles
Allostatic load: Stress & TraumaBDNF and NeurotrophinsEpigeneticsFoodLifestyleThoughts
Interventions
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Vehicle: Allostatic load
Stressor or Threat:(cop in rearview mirror)
Amygdala
attaches fear to stimuli
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Stressor or Threat:(cop in rearview mirror)
AmygdalaHypothalamus
Stressor or Threat:(cop in rearview mirror)
AmygdalaHypothalamus
Direct stimulation of fight or flight neurons
Adrenal Glands
Stressor or Threat:(cop in rearview mirror)
AmygdalaHypothalamus
Direct stimulation of fight or flight neurons
Adrenal Glands
cortisoladrenaline/
catecholamines
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Adrenal Glands
cortisol
adrenaline/
catecholamines
-- immune system suppression-- suppression of inflammation-- water retention-- hyperglycemia/insulin resistance-- muscle breakdown-- fat redistribution-- decreased gastric integrity-- removal of calcium from bones-- thyroid dysregulation
-- pupil dilation-- sweat-- muscle contractility-- increased HR-- increased BP-- blood flow away from stomach -- bloood flow away from brain (30 IQ points) -- blood flow to vital organs-- increased blood sugar
effects of long term cortisol…
-- immune system suppression/suppression of inflammation:
-- water retention:
-- hyperglycemia/insulin resistance:
-- muscle breakdown:
-- fat redistribution:
-- increased gastric juices:
-- decreased gastric integrity:
-- removal of calcium from bones:
-- thyroid dysregulation:
effects of long term cortisol…
-- immune system suppression/suppression of inflammation:
-- water retention:
-- hyperglycemia/insulin resistance:
-- muscle breakdown:
-- fat redistribution:
-- increased gastric juices:
-- decreased gastric integrity:
-- removal of calcium from bones:
-- thyroid dysregulation:
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Th1
Th2
Systemic inflammation via imbalance
Neuronal Inflammation
Who is stressed out?
Not you, right?
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White folks
Cisgendered folks
Christian folks
Higher SES
Straight Folks
Folks of Color
Transgender folks
Non-Christian folks
Lower SES
LGBTQI Folks
Privilege Oppression
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Agenda
Ancient news Monoamine hypotheiss Psychopharm minute: allopathic antidepressants
Inflammation and Depression 101 Vehicles
Allostatic load: Stress & TraumaBDNF and NeurotrophinsEpigeneticsFoodLifestyleThoughts
Interventions
effects of long term cortisol…
-- immune system suppression/suppression of inflammation:
-- water retention:
-- hyperglycemia/insulin resistance:
-- muscle breakdown:
-- fat redistribution:
-- increased gastric juices:
-- decreased gastric integrity:
-- removal of calcium from bones:
-- thyroid dysregulation:
a quick note on
BDNF
BDNF is a cute little brain helper in the neutrophin family.
Cortisol = BDNF
BDNF = Hippocampalatrophy
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Stressor or Threat:(cop in rearview mirror)
Adrenal Glands
cortisoladrenaline/
catecholamines
Hippocampusnegative feedback
Hypothalamus
Agenda
Ancient news Monoamine hypotheiss Psychopharm minute: allopathic antidepressants
Inflammation and Depression 101 Vehicles
Allostatic load: Stress & TraumaBDNF and NeurotrophinsEpigeneticsFoodLifestyleThoughts
Interventions
Epigenetics
The study of heritable changes in gene expression that are caused by factors such as DNA methylation(primarily) rather than by a change in the sequence of base pairs in DNA itself.
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5-HTTLPR
Serotonin-transporter-linked polymorphic region
Two alleles: short (s) and long (l)
S + hypercortisolemia = downregulation of 5HT receptors = depression, “neurosis”, PTSD
D. A. Collier, G. Stober, T. Li, A. Heils, M. Catalano, D. Di Bella, M. J. Arranz, R. M. Murray, D. Bengel, C. R. Muller, G. W. Roberts, E. Smeraldi, G. Kirov, [P. Sham & K. P. Lesch (December 1996). "A novel functional polymorphism within the promoter of the serotonin transporter gene: possible role in susceptibility to affective disorders". Molecular Psychiatry 1 (6): 453–450.
Agenda
Ancient news Monoamine hypotheiss Psychopharm minute: allopathic antidepressants
Inflammation and Depression 101 Vehicles
Allostatic load: Stress & TraumaBDNF and NeurotrophinsEpigeneticsFoodLifestyleThoughts
Interventions
effects of long term cortisol…
-- immune system suppression/suppression of inflammation:
-- water retention:
-- hyperglycemia/insulin resistance:
-- muscle breakdown:
-- fat redistribution:
-- increased gastric juices:
-- decreased gastric integrity:
-- removal of calcium from bones:
-- thyroid dysregulation:
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Gastric Permeability?
Microvilli
Intestinal Lumen
Tight Junctions
Blood Flow
Intestinal Mucosal Cells
Are foods inflammatory?
High Insulin levels = inflammation!Omega 6s (linoleic acids) Omega 3s (alpha-linolenic
acids)
EPA
DHA
Anti-inflammatory
With perfect liver function!
Arachidonic Acid
Pro-inflammatory
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Agenda
Ancient news Monoamine hypotheiss Psychopharm minute: allopathic antidepressants
Inflammation and Depression 101 Vehicles
Allostatic load: Stress & TraumaBDNF and NeurotrophinsEpigeneticsFoodLifestyleThoughts
Interventions
Do you love Netflix as much as I do?
Screen time
Sleep debt
Prolonged sitting
Unhealthy relationships
And so many more!
Agenda
Ancient news Monoamine hypotheiss Psychopharm minute: allopathic antidepressants
Inflammation and Depression 101 Vehicles
Allostatic load: Stress & TraumaBDNF and NeurotrophinsEpigeneticsFoodLifestyleThoughts
Interventions
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Agenda
Ancient news
Monoamine hypotheiss
Psychopharm minute: allopathic antidepressants
Inflammation and Depression
101
Vehicles
Allostatic load: Stress & Trauma
BDNF and Neurotrophins
Epigenetics
Food
Lifestyle
Thoughts
Interventions
Interventions: Behavioral
Cut down on screen time Esp. 1 hr prior to sleep
More Vitamin N
More fun
More sleep
But not over 10 hrs
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Interventions: behavioral
Mindfulness – the ultimate in anti-inflamatoryactivity Yoga
Meditation
Spiritual practice
Coloring books
Psychotherapy Increases neuroplasticity
Decreases (hopefully) inflammatory thoughts
Interventions: Nutritional
Low glycemic diet
High nutrient density
Increase healthy fats – yup, even saturated ones
Gluten inflammatory triad: psych, joints, GI
Dairy must go for some
Interventions: Nervines
Scutellaria Affects GABA in the CNS, aids in raising the threshold for
Fight or Flight response
Avena CNS nutritive tonic Hippocampal health?
Eschscholzia californica Gabanergic effects (see Scuttelaria) Core pain?
Pedicularis Alters the cyclical cycle of F/F response
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Stressor or Threat:(cop in rearview mirror)
AmygdalaHypothalamus
Direct stimulation of fight or flight neurons
Adrenal Glands
cortisoladrenaline/
catecholamines
Anterior Pituitary
Nervines
Scutellaria Affects GABA in the CNS, aids in raising the threshold for
Fight or Flight response
Avena CNS nutritive tonic Awesome “adaptogen” for adrenal exhaustion Hippocampal health?
Eschscholzia californica Gabanergic effects (see Scutellaria) Core pain?
Pedicularis Alters the cyclical cycle of F/F response
Anti-inflammatories
Curcuma longa Cox 2 inhibitor
Stops inflammatory cascades w/o inhibiting healing
Studies show it increases BDNF – what do you know?!!!
Glycyrrhiza glabra and spp.?
Prolongs life of cortisol: why is this good? Why is it bad?
Leaky gut?
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Anti-inflammatories
Zinjiber officinale
Boswellia
Cinnamonum
Allium sativum
Salvia
Questions? Comments?
www.lydiabartholow.com