Fullscript Protocols

Neurological Health – Nervous Tension

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Protocols Fullscript Protocols
Neurological Health – Nervous Tension

Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.

To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.

The following protocols were developed using only A through C-quality evidence.

A
Systematic review or meta-analysis of human trials
B
RDBPC human trials
2+ studies and/or 1 study with 50 + subjects
C
RDBPC human trials
1 study

Neurological Health – Nervous Tension

Nervous tension is one of the most prevalent mental health symptoms and may lead to significant impairment in both emotional and physical health.1 It not only impacts the quality of life of the patient, but evidence shows that it may also increase the risk of all-cause mortality.1 The development of this symptom can be multifactorial and may include commonly known factors such as traumatic experiences, as well as the involvement of inflammatory cytokines, genetic susceptibility, and nutrient deficiencies1,2,3

Omega-3 fatty acids

2,500 mg, total per day of 2,085 mg EPA and 348 mg DHA, minimum 12 weeks2

  • Administration of omega-3 polyunsaturated fatty acids (PUFAs) demonstrated a reduction in anxiety, particularly in those with a clinical diagnosis of the disorder. However, the positive effects were limited to those receiving a minimum dose of 2,000 mg per day1
  • Lipopolysaccharide (LPS)-induced interleukin 6 (IL-6) has been shown to be reduced by omega-3 fatty acid intake, suggesting an anti-inflammatory effect2
  • An inverse correlation was shown between plasma omega-3 fatty acid levels and anxiety levels with omega-3 supplementation, leading to a 20% decrease in symptoms of anxiety in study participants2
Omega-3 fatty acids in the Fullscript catalog

L-theanine

200-400 mg, once per day, minimum 4 weeks4,5,6

  • Supplementation with L-theanine increased alpha brain wave activity indicating a potential mechanism for its ability to induce a relaxed, but alert state5
  • L-theanine has been shown to reduce stress-induced blood pressure elevation5
  • L-theanine supplementation improved self-rated anxiety scores, using the State-Trait Anxiety Inventory (STAI)6
L-theanine in the Fullscript catalog

Ashwagandha (Withania somnifera

240-600 mg, total per day of standardized extract containing between 35% and 1.5% of withanolides, respectively, for a minimum 8 weeks7,8,9

  • A statistically significant reduction in Hamilton-Anxiety scale scores and morning cortisol levels was demonstrated with the use of ashwagandha7
  • One proposed mechanism of action was the moderating effect of ashwagandha on the hypothalamic-pituitary-adrenal axis (HPA axis) response to stressors; however, further investigation was suggested7
  • A study assessed the intervention of psychotherapy treatment (PT) alone versus Naturopathic treatments, which included the use of ashwagandha as well as dietary counseling, breathing techniques for relaxation, and a multivitamin. Symptoms, including anxiety as rated with the Beck Anxiety Inventory, social functioning, overall quality of life, fatigue, and concentration showed further improvement in the Naturopathic treatment group compared to the group receiving only psychotherapy8
  • Ashwagandha was shown to reduce serum cortisol levels from baseline levels which was correlated with a reduction in scores on stress assessment scales9
Ashwagandha in the Fullscript catalog

Magnesium

300 mg, once per day, minimum 8 weeks10

  • Magnesium may act as a modulator for the HPA axis by reducing adrenocorticotropic hormone (ACTH) and cortisol, and may be an important factor in the stress response3
  • Stress exposure has been shown to increase renal excretion of magnesium3
  • In participants with both anxiety and low serum magnesium, supplementation led to a reduction in scores on the Depression Anxiety Stress Scales (DASS-42) with consistent results in as little as four weeks10
Magnesium in the Fullscript catalog

Vitamin D

50,000 IU vitamin D3, once per one or two weeks, minimum 12 weeks11,12

  • An increase in serum serotonin levels and a decrease in serum neopterin levels were shown in the study group treated with vitamin D, in addition to standard of care (SOC), compared to a group receiving only SOC; additionally, the vitamin D treated participants also saw a decrease in Generalized Anxiety Disorder (GAD) scores, while no changes were seen in the SOC group11
  • In women with type 2 diabetes, vitamin D supplementation decreased anxiety levels from moderate to mild on the Depression, Anxiety and Stress Scales (DASS- 21) questionnaire, over the course of the study12
  • Inflammatory markers TNF-α and CRP are both increased in diabetic patients with anxiety; vitamin D supplementation was shown to reduce hs-CRP levels and increase IL-10 concentrations12
  • In a population subset of vitamin D-deficient adolescent females experiencing anxiety associated with PMS, vitamin D repletion demonstrated decreases in anxiety and irritability scores13
Vitamin D in the Fullscript catalog

Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

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References

1
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324500/
3
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452159/
4
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/31758301