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86 HEALTH VITAMINS MINERALS AND SUPPLEMENTS FROM PAGE 85 ‘Stress management and the role of Rhodiola rosea: A review’. Int J Psych in Clin Prac, 2018. 8. Bone K, Mills S. Principles and practice of phytotherapy (2nd edition). CMs. 9. Chandrasekhar K, Kapoor J, Anishetty S. ‘A prospective, randomised double blind placebo controlled study of safety and efficacy of a high-concentration full- spectrum extract of ashwagandha root in reducing stress and anxiety in adults’. Indian J Psychol Med, 2012. 10.Auddy B, Hazra J, Mitra A, Adedon B, Ghosal S. ‘A standardised Withania somnifera extract significantly reduces stress-related parameters in chronically stressed humans: DB,R, P-C Study. JANA Vol 11, No.1 2008. 11. Choudhary D, Bhattacharyya S, Joshi K. ‘Body weight management in adults under chronic stress through treatment with ashwagandha root extract’. J. Evid- Based CAM, 2017. 12.Fuladi S, Emami SA, Mohammadpour AH, Karimani A, Manteghi AA, Sahebkar A. ‘Assessment of Withania somnifera root extract efficacy in patients with generalised anxiety disorder: A randomised double blind placebo controlled trial’. Curr Clin Pharmacol, 2020 Apr 13. 13. blackmoresinstitute.org/interactions 14.Savage KM, Stough CK, Byrne GJ, Scholey A, Bousman C, Murphy J, Macdonald P, Suo C, Hughes M, Thomas S, Teschke R, Xing C, Sarris J. ‘Kava for the treatment of generalised anxiety disorder (K-GAD): Study protocol for a randomised controlled trial’. Trials, 2015 Nov 2; 16: 493. 15.Pittler MH, Ernst E. ‘Kava extract for treating anxiety’. Cochrane Database Syst Rev, 2003. 16.Sarris J, LaPorte E, Schweitzer I. ‘Kava: a comprehensive review of efficacy, safety, and psychopharmacology’ Aust NZ J Psychiatry, 2011. 17. Sarris J, Stough C, Bousman C, Wahid Z, Murray G, Teschke R, Savage K, Dowell A, Ng C, Schweitzer I. ‘Kava in the treatment of generalised anxiety disorder’, J Clin Psychopharmacol, October 2013. 18.Community herbal monograph on Rhodiola rosea L., rhizoma et radix EMA/ HMPC/232091/2011. 19.Darbinyan V, Aslanyan G, Amroyan E, Gabrielyan E, Malmström C, Panossian A. ‘Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression’. Nord J Psychiatry, 2007. 20. Bystritsky A, Kerwin L, Feusner JD. ‘A pilot study of Rhodiola rosea (Rhodax) for generalised anxiety disorder’. J Altern Complement Med, 2008. 21.Olsson EM, von Schéele B, Panossian AG. ‘A randomised double blind placebo controlled parallel group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue’. Planta Med, 2009. 22. Mao JJ, Xie SX, Zee J, et al. ‘Rhodiola rosea versus sertraline for major depressive disorder: A randomised placebo controlled trial’. Phytomedicine, 2015. 23. Anghelescu IG, Edwards D, Seifritz E, Kasper S. ‘Stress management and the role of Rhodiola rosea: A review’. Int J Psych in Clin Prac, 2018. 24. Woelk H. ‘Comparison of St John’s wort and imipramine for treating depression: Randomised controlled trial’. BMJ, 2000. 25. Linde K, Berner MM, Kriston L. ‘St John’s wort for major depression’. Cochrane Database of Systematic Reviews, 2008; 4. 26. Linde K, Kriston L, Rücker G et al. ‘Efficacy and acceptability of pharmacological treatments for depressive disorders in primary care: Systematic review and network meta-analysis’. Ann Fam Med, 2015. 27. Apaydin E, et al. ‘A systematic review of St John’s wort for major depressive disorder’. Systematic Reviews, 2016 28. Stough C, Scholey A, Lloyd J, Spong J, Myers S and Downey L. ‘The effect of 90-day administration of a high dose vitamin B complex on work stress’. Hum. Psychopharmacol Clin Exp, 2011. 29. Magdalena D, Cuciureanu MD, Vink R. ‘Magnesium and stress: Magnesium in the central nervous system’. NCBI Bookshelf. National Institutes of Health, 2011. 30. Boyle N, Lawton C, Dye L. ‘The effects of magnesium supplementation on subjective anxiety and stress: A systematic review’. Nutrients, 2017. 31.Berk M, Sarris J, Coulson C, Jacka F. ‘Lifestyle management of unipolar depression’. Acta Psychiatr Scand Suppl, 2013. 32. Jacka F, Berk M. ‘Depression, diet and exercise’. Med J Aust, 2013. 33. Saeed S, Cunningham K, Bloch R. ‘Depression and anxiety disorders: Benefits of exercise, yoga and meditation’. Am Fam Physician, 2019. 34. Schuch F, Vancampfort D, Firth J, et al. ‘Physical activity and incident depression: A meta-analysis of prospective cohort studies’. Am J Psychiatry, July 2018. 35. Morres ID, Hatzigeorgiadis A, Stathi A, et al. ‘Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis’. Depress Anxiety, 2019. 36. DiMauro J, Domingues J, Fernandez G, Tolin D. ‘Long-term effectiveness of CBT for anxiety disorders in an adult outpatient clinic sample: A follow-up study’. Behaviour Research and Therapy – ScienceDirect, 2013. 37. Orme-Johnson D, Barnes V. ‘Effects of the transcendental meditation technique on trait anxiety: A meta-analysis of randomised controlled trials’. Journal of Alt and Comp Med, 2014; 20. 38. Nidich S, Mills P, Rainforth M, et al. ‘Non-trauma focused meditation versus exposure therapy in veterans with post-traumatic stress disorder: A randomised controlled trial’. Lancet Psychiatry, 2018. 39. Anderson J, Liu C, Kryscio R. ‘Blood pressure response to transcendental meditation: A meta-analysis’. American Journal of Hypertension Ltd, 2008. 40. Otte C. ‘Cognitive behavioural therapy in anxiety disorders: Current state of the evidence’. Dialogues in clinical neuroscience, 2011. 41.Marx W, Moseley G, Berk M, Jacka F. ‘Nutritional psychiatry: The present state of the evidence’. Proc Nutr Soc, 2017. Accreditation number: A2105RP2 (exp: 30/04/2023). This activity has been accredited for 1 hour of Group One CPD (or 1 CPD credit) suitable for inclusion in an individual pharmacist’s CPD plan which can be converted to 1 hour of Group Two CPD (or 2 CPD credits) upon successful completion of relevant assessment activities. 1. A patient in their mid-40s asks you for something to help with stress. On questioning, you discover that they have a very busy, stressful job and have been working long hours. Which of the following treatments have evidence to specifically support their use to reduce the symptoms of ‘burnout’? A) St John’s wort. B) Rhodiola. C) Kava. D) Ashwagandha. 2. Which is the most researched herbal medicine showing potential to treat generalised anxiety? A) Kava. B) St John’s wort. C) Ashwagandha. D) Rhodiola. 3. Current evidence suggests which of the following statements is CORRECT: A) Rhodiola is less effective than placebo for generalised anxiety disorder. B) St John’s wort is superior to placebo for treatment of mild to moderate depression and not significantly different to antidepressant medication. C) Kava should be viewed with caution due to potential for addiction. D) Ashwagandha increases resistance to stress by increasing serum cortisol levels. 4. Which of the following questions would be relevant to a mental health-related patient history? A) Current patterns with alcohol, smoking and exercise? B) Have you sought advice from your GP? C) How are you sleeping? D) All the above. 5. Which one of the following statements is CORRECT? A) There is no evidence suggesting benefit of meditation, yoga or acupuncture for anxiety. B) Complementary medicines can always be safely taken concurrently with conventional antidepressant and anxiolytic medications. C) CBT is regarded as being a useful first-line intervention for both short-term and long-term management of anxiety disorders. D) Evidence does not support a role for exercise in helping maintain good mental health. Complementary and alternative medicines for improving mental health 2 CPD CREDITS RETAIL PHARMACY • MAY 2021