Kava Fact of the Day Kava recommended as therapy for GAD by Harvard

[The Kap'n]

Kava was found to be recommended in the Harvard Psychopharmacology Algorithms Project.



Today’s fact of the day will be rather simple. Harvard’s South Shore Psychiatry Residency Training Program has developed an algorithm to help better evaluate pharmacotherapy options for patients with generalized anxiety disorder, and other psychiatric disorders.

This algorithm is a flow chart that asks questions and gives suggestions based on the responses in regards to generalized anxiety disorder in this instance. Various drug therapies are suggested and in one of the last categories for alternative treatments, the author suggests kava.

You can see a live version of this at the following link: https://psychopharm.mobi/algo_live/ you’ll arrive to this section by clicking “Algorithms” at the top, and selecting “Generalized Anxiety Disorder”

Abejuela, Harmony Raylen, and David N. Osser. 2016. “The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An Algorithm for Generalized Anxiety Disorder.” Harvard Review of Psychiatry 24 (4): 243–56. https://doi.org/10.1097/HRP.0000000000000098

 

[Manuel Joao]

In the flowchart 4a, my hypothesis is with kava no need to go past third trial to antipsychotics.

 

[Jacob Bula]

I inadvertently tried this exact flow chart; however, all of these treat symptoms and not causes. Therapy and exposure need to be a priority as well.

 

[Groggy]

however, all of these treat symptoms and not causes.

That's because the figure above is a Psychopharmacology algo for determining proper meds, done by residency students.

Psychologists rarely recommend medications alone, it is usually therapy followed by medications (depending on type psychiatric disorder)

For GAD, in most cases, CBT therapy is almost always the first step.

Source: My mom, Phd in Psychology. (i've been hearing about this stuff my whole life).

 

[Jacob Bula]

Yea I have a Bachelors of Science in psychology. I see what you're saying about the reason for the flow chart.

On another note, I feel like western medicine in general is focused on symptoms instead of root causes. Really looking forward to MAPS changing the way we think about treatment resistant depression, PTSD and anxiety in the coming decades.

 

[jonaspmd]

That's because drug development business is tuned in a way so that the treatment remains profitable for a long period of time. Gilead Sciences (market cap still USD86bn) is the latest good example of what happens when a drug is so successful that it actually treats a chronic disease (hepatitis C): the patient pool shrinks, drug sales fall, share price falls, investors are unhappy and think that next time they will support companies that develop drugs that just suppress the virus like in HIV or keep other disease at bay rather than curing it. Whether it is good or bad is another question. At least there are new drugs being developed.

Anxiety and depression are somewhat special areas, where there has been no real innovation for years if not decades with options mainly SSRIs or worse, not counting the approval of ketamine for a niche indication (which is an old drug anyway).

 

[Jacob Bula]

Anxiety and depression are somewhat special areas, where there has been no real innovation for years if not decades with options mainly SSRIs or worse, not counting the approval of ketamine for a niche indication (which is an old drug anyway).

There are also clinical trials for psilocybin-based medication that look very promising. It shows efficacy for reduction in depression symptoms up to 1 year later with 1 single dose. I'm worried, that what you pointed out may be considered a "negative" when it comes to psychedelic-based medication to treat anxiety/depression. If you just need 1 pill every year or so, that's not a very good business model.

 

[The Kap'n]

There are also clinical trials for psilocybin-based medication that look very promising. It shows efficacy for reduction in depression symptoms up to 1 year later with 1 single dose. I'm worried, that what you pointed out may be considered a "negative" when it comes to psychedelic-based medication to treat anxiety/depression. If you just need 1 pill every year or so, that's not a very good business model.

This reminds me of a pretty recent paper which outlines new studies relating to compounds that cause allosteric modulation at opioid receptors in relation to treating depression. At first it caught me off guard, but after looking into it is makes more sense.

Stanczyk, M. Alexander, Kathryn E. Livingston, Louise Chang, Zara Y. Weinberg, Manojkumar A. Puthenveedu, and John R. Traynor. 2019. “The δ-Opioid Receptor Positive Allosteric Modulator BMS 986187 Is a G-Protein-Biased Allosteric Agonist.” British Journal of Pharmacology 176 (11): 1649–63. https://doi.org/10.1111/bph.14602.

What's interesting is that current antidepressants such as Venlafaxine (effexor) have been found to have an opioid component, as it can have a reduction in effectiveness when given with naloxone (narcan)

Venlafaxine - Wikipedia

en.wikipedia.org

 

[jonaspmd]

There are also clinical trials for psilocybin-based medication that look very promising. It shows efficacy for reduction in depression symptoms up to 1 year later with 1 single dose. I'm worried, that what you pointed out may be considered a "negative" when it comes to psychedelic-based medication to treat anxiety/depression. If you just need 1 pill every year or so, that's not a very good business model.

That's a good point and actually pretty interesting, like DMT and the idea of "resetting" the brain post trauma. Psychedelics are really being re-evaluated when it comes to psychiatric conditions these days. Imperial College in London has an active center of research for that. I am not an "insider" in drug development business, but have been covering it as an analyst for years. I think psychedelics will face same issues as medicinal cannabis in pain for example. On one end is a straightforward inhaled cannabis with some quality controls, which is is a low margin product even if used with a device, so no one will invest in proper clinical trials to accumulate data. And that is the ironic problem of medicinal cannabis - it has become relatively widely available to patients before they tested it in properly designed clinical trials, so physicians don't really know how to use it. On the other end, they try to to create high margin products, some sophisticated formulation, like Epidiolex, highly purified CBD for niche epileptic seizure syndrome. Epidiolex sells for USD32k per patient per year and it will bring in USD730m in sales this year for the originator company, and this is just a CBD extract, obviously more concentrated than in health shops. So, I think they will have to find psychedelic formulations to turn them into viable prodcuts. Academia can kickstart the process with some small clinical trials (and file for patents so that professors can get their share of future profits), but large scale clinical trials and mass marketing are for pharma.

Having said that if you know how to access data and where to access the source material, you can definitely use it wisely for yourself. All reliable clinical trials and sponsoring companies (who will most often post data on their websites in a form of peer reviewed articles) are listed here clinicaltrials.gov. 69 studies with psilocybin listed, of which 52 are still active, so good amount of data are still coming. Plenty of Phase II trials (mid-stage), but no Phase III (which is when they could consider registering it as a drug).