A comparison of Western and Eastern Approaches to treatment of depression Kyne Devinsh

A comparison of Western and Eastern approaches to the treatment of depression

Kyne Devinish Upper Sixth

In recent years, diagnosis of depression in the UK has increased, from 17.7% in 2013 to 18.2%in 2014. With the rise of social media and increased scrutiny of mental health within society, the rise of depression is an important question to pose both medically and socially. Depression is recognised as having two forms; whilst it is evident that all humans experience fluctuating happiness over their life, clinical depression however, is more intense and of a longer period which affects the standard aspects of a person’s life and their ability to engage in daily activities.

Uncaria Hook In the Western world, antidepressants were firstly introduced in the 1950s with the first two specific antidepressant drugs being iproniazid; which is a monoamine-oxidase inhibitor and imipramine which was a fundamental in the tricyclic antidepressant family. A major advancement was the discovery of standard serotonin reuptake inhibitors more commonly known as SSRIs. The basic assumption is that antidepressants increase serotonin, however SSRIs inhibit the re-uptake of serotonin thus increasing serotonin levels. Antidepressants bind to the 5-HT receptor and therefore block any further reuptake of serotonin. This results in a build-up of serotonin. This results in high levels of neurotransmitter, thereby improving communication between nerve cells, this can further strengthen circuits in the brain which primarily regulate mood. Understanding this mechanism means it is possible to determine the types of chemical structure that will bind to the 5-HT receptor to form a complementary agonist; therefore, resulting in increasing serotonin levels. The SSRI is a physical block in the pre-synaptic nerve ending. There is evidence that SSRI antidepressant drugs are not well tolerated and can cause physiological withdrawal symptoms such as

[T]he rise of depression is an important question to pose both medically and socially.

vomiting. The Japanese traditional herbal medicine, Kampo, uses 148 different formulations mainly in the form of herbal extracts, and can be prescribed within the national health insurance system of Japan. A drug that can be used as an antidepressant is called Yokukansan (YKS). Yokukansan has been approved by the Japanese Ministry of Health, Labour, and Welfare, typically used to treat patients with conditions such as neurosis, insomnia, irritability and crying at night in children.

Basic research demonstrates an important link between the serotonergic system in the central nervous system (CNS), and psychotropic effects of Yokukansan. This research was obtained conducting an in-vitro kinetic binding study. This was performed in order to estimate the time for the product to reach its specific binding site. The research revealed a successful bond between Yokukansan and the Serotonin 1A receptor (5-HT1A), resulting in a partial agonist being developed.

Among the 7 herbal ingredients that are used in Yokukansan, only the Uncaria hook, had the partial agonistic activity to 5-HT1A receptors. In order to consolidate this research, further testing was conducted where the Uncaria hook was removed from the 7 active ingredients. It was confirmed that the Uncaria hook was the active ingredient as partial agonistic binding of Yokukansan disappeared.

Further in-vitro receptor binding studies identified geissoschizine methyl ether (GM) as the active ingredient, which is an indole alkaloid in Uncaria plants. These in-vitro findings were supported by in-vivo studies on rodents. The studies demonstrated that the oral form of YKS (1.0 g/kg) ameliorated aggressive and social behaviours; these ameliorated behaviours were also counteracted by a 5-HT1A antagonist. This finding was also supported with further research. The Uncaria hook was removed from the active ingredients and the ameliorative effect of YKS on isolation stress-induced aggressive behaviour was completely abolished. This study suggests that the efficacy of YKS is due to the Uncaria hook. A pharmacokinetic study was conducted which revealed that GM was present in the plasma and brain of rats after the oral administration of YKS. This suggests that GM is a potent 5-HT1A receptor agonist and therefore a candidate ingredient of YKS.

The primary reason that GM has the ability to bind to the receptors is because of its unique complementary indole chemical structure. This structure is also present in the structure of the four antidepressants; Fluoxetine, Paroxetine, Sertraline and Escitalopram.

Western and Eastern approaches to the treatment of depression both rely upon prescribing drugs to ameliorate symptoms. Research results and anecdotal evidence suggests that SSRI drugs can have nasty side effects and exacerbate symptoms. More work is needed to explore the potential value of Eastern traditional medicines. In a globalised world, both systems can be valid and beneficial; medical practitioners from the West and East should actively collaborate and share their results.