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Integrative Psychology with Dr Adrian Lopresti

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Integrative Psychology with Dr Adrian Lopresti

Statistics show that almost 1 in 5 Australians suffered from some form of mood disturbance in the previous 12 months.

Unfortunately, the demand for mental health services is an ever increasing burden. What's becoming clear is that there is a strong need for personalised medicine and a multi-modality approach.

Joining us today is clinical psychologist and researcher, Dr Adrian Lopresti. Combined with psychological therapies, Dr Lopresti advocates the importance of diet, exercise, sleep, social integration, gut healing and personalised supplementation for the prevention and treatment of mental health disorders. In addition to his clinical practice as an integrative psychologist, Dr Lopresti is amassing an impressive research portfolio including several interesting trials exploring the role that herbs such as curcumin, sage and saffron play in the management of neuropsychiatric disorders.

Covered in this episode

[00:54] Introducing Dr Adrian Lopresti
[03:36] Integrative psychology acceptance
[05:27] The role of inflammation in depression
[08:42] Defining atypical depression
[12:56] Dr Lopresti's curcumin research
[17:56] Dr Lopresti's saffron research
[21:11] Next research endeavours
[23:42] Affordable personalised medicine
[26:40] Medication interactions
[30:15] The evidence for sage
[31:29] Rapport with patients and other medical professionals
[37:09] Thanks to Dr Lopresti for joining us


Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook and joining me on the line today from Perth, Western Australia is Dr Adrian Lopresti. He's a clinical psychologist in private practice and a senior researcher at Murdoch University in Perth. He's over 20 years of clinical experience working with children through to adults suffering from a range of mental health conditions including depressive and anxiety-related disorders. 

Dr Lopresti has completed his PhD and published several articles in peer-reviewed journals on the effects of diet, nutraceuticals, sleep, and exercise on biological pathways associated with depression, ADHD, and bipolar disorder. He's also completed clinical trials investigating the antidepressant effects of curcumin and saffron in people with depression and anxiety. Dr Lopresti is a strong advocate of psychological, nutritional, and lifestyle-based interventions to enhance mental health and continues to conduct research in this area.  
 
Welcome to FX Medicine, Adrian.  
 
Adrian: Andrew, thanks for that welcome.  
 
Andrew: Well, I've got to say thank you for taking time off on this Western-Australian holiday. I'm just imagining you in your fluffy bunny slippers sitting back there at home. 
 
Adrian: It's a good picture. It's not a good picture actually but we'll go with it. 
 
Andrew: So, I've got to go back to your background. Tell us about how as a psychologist you got interested in nutritional medicine. What tipped the scale? Have you always had this interest? 
 
Adrian: Yeah, I've always had interest in nutrition and exercise just from a personal interest. And, I mean, I went down the traditional routes of psychology, you know, learning more about the psychological therapies and then through my first, I suppose, decade of practice I primarily used the psychological treatment, cognitive behavior therapy, and kind of, off streams of that. 
 
And that was effective for many people but I suppose I really wanted to... I was really interested in that holistic approach. Looking at not just coping skills and belief systems, and ways we can kind of manage our emotions through psychological techniques. But I really wanted to look at how nutrition, and exercise and general lifestyle factors can improve mood. And that's what led me to kind of read up in the area, learn more about the area and I became more and more interested as it went by and from there I did my PhD looking at lifestyle treatments, looking at diet. And in particular, a big part of my PhD was looking at the effects of curcumin in the area depression. 
 
Andrew: Yeah. Now I've got to sort of go back to this because you did some work with Felice Jacka who bow... Professor Felice Jacka has this awesome research with regards to diet in and mood disorders. But I've got to ask you how you were viewed by your colleagues or your cohort during your studies with this weird 'hippy way' of therapy. Were you accepted, were you questioned or were you ridiculed?  
 
Adrian: All in all, I haven't been ridiculed. I think there's a lot of psychologists who are actually quite interested in the effects of diet and supplementation and so forth on mental health disorders. 
 
So I don't think.. I certainly haven't been rejected. I think a lot of psychologists don't quite understand the connection and that confuses them a little bit. But you know, I've had several workshops that I've conducted and it's been very well attended and the reception has been really good. I suppose the issue for psychologists is really just trying to understand the mechanisms behind how kind of diet in particular can affect mood, which we do not cover at all during our training. 
 
Andrew: I think this is a really interesting, very controversial topic. That there are certain you know, proponents of supplements who will say that doctors don't cover diet and then the doctors will say they do. And yet, whenever I've interviewed an integrative doctor they said, "No, we definitely didn't." 
 
So it's really interesting who thinks they do and don't, and to what degree. Certainly not to the degree of a dietician or a nutritionist. 
 
Adrian: No. And I think it I mean, even...you know, in our training, you know, we might talk about having a healthy diet and touch on that. But yeah, even the definition of what a healthy diet, I don't think psychologists necessarily have an understanding of what that is so… 
 
Andrew: Yeah. The assumption of a healthy diet. Yes. 
 
Adrian: Yes. 
 
Andrew: What about this concept of inflammation in depression? I actually covered this with Professor Gordon Parker some years ago and he said, "Look, maybe in certain things" but he wasn't really convinced. And yet the more and more I read about this, it's got to be a player. Maybe not the major cause but it's got to be a player at least in the driver of continued depression. But what do you think? Well, like where did your interest in this spark?  
 
Adrian: Well, I mean, I think the research is pretty convincing that inflammation does play a role in depression and other mental health disorders. So yes, there's increasing body of research to support that. I don't think it's necessarily inflammation or inflammatory processes is not necessarily the driver of all people's depression but I think it's important. And we really...I mean, I suppose the other thing too is while inflammation has a role, still, the key to me is always what's the cause of the inflammation? What's the cause of somebody presenting with depression? 
 
And inflammation doesn't necessarily… having, you know, high CRP for example, doesn't tell you about where that high CRP is coming from. So I wanted to really get into more the nitty gritty and try to identify what it is that might be driving that inflammation for that individual. Which might be very different to somebody else. But absolutely, I think inflammation, oxidative stress has a role, and certainly impacts on neurotransmitter production. And the research is, as I said, is convincing. 
 
Andrew: One of the things you mentioned then was just this key thing about how do we mark inflammation? Do we have to look at the fulminant signal of inflammation, you know, tumor necrosing factor alpha and things like that? 
 
Rather than that should we be looking at lower forms, like for instance, high sensitivity CRP? Where do we look? I have concerns about if we're looking for a fulminant marker of inflammation like we would see in something like Crohn's, that's why we always fail when we're looking at interventions to reduce these. Even NF-κB, for instance, there are trials out there that show that curcumin fails to reduce NF-κB. But I wonder if that's the correct marker we should be looking for. What's your thoughts on this? 
 
Adrian: Yeah. I mean, I wrote a paper a while ago talking a bit about some of the, I suppose, bio-markers that we could use to identify depression and also whether we could use them as markers to determine treatment progress. And the reality is that there is no marker, there's no single marker that can do that and I don't think there ever will be. 
 
You know, I think there's probably some value in developing some type of algorithm to look at a whole collection of different markers and from there maybe identify things. But you know, I think, that to use a marker as an identifier of inflammation is… a single identifier of inflammation, is going to be flawed and it may lead you into the wrong direction. 
 
Andrew: Yeah. And you covered, I think it was another podcast I heard you in, where you were looking at atypical depression. That interests me. Because Mike Ash had this mucosal management sort of thing for atypical depression and it stunned me about the prevalence of it as part of depression as a whole. Can you take our listeners through just how important it is to look for atypical depression and why is it atypical? 
 
Adrian: Well, the first thing with atypical depression is that it is the most typical type of depression so it can confuse people a little bit. So it's about 40% of the population presents with the atypical form. Of which there seems to be immune activities enhanced in atypical depression circle.  
 
So, for the listeners who don't know some of the symptoms associated with atypical depression, I'll just list them. So, you know, the first one is...one of them is weight gain or kind of increased appetites can occur. People with atypical depression will also have hypersomnia. So they'll want to sleep more rather than sleep less. There's the heavy limbs, leaden paralysis, which often can occur in people with atypical depression. 

They also have a sensitivity to interpersonal rejections. So I'm kind of asking questions around that. And then finally, with people with atypical depression, they react to positive events. So their mood can lift when they're experiencing a positive event. So they're kind of the symptoms if you want to identify whether somebody is presenting with atypical depression. 
 
And as I said, there's an immune kind of response there. And what was interesting that I found in my study with the curcumin was that, when I looked at curcumin, for depression as a whole, it was effective through a double-blind placebo controlled study. But what I actually found with curcumin in particular, and now it's been confirmed in two studies that I've done, was particularly effective for people with atypical depression. So there was enhanced effectiveness in that subgroup of individuals. 

So, I think that's one of the things, if you wanted to look at, rather than look at biomarkers, but look at symptoms. People presenting with these types of symptoms, there's probably some immune-inflammatory process going on. And then we need to look at some form of anti-inflammatory treatment. 
 
Andrew: One of the symptoms of the atypical depression...sorry to harp on about this, but it really interests me is that interpersonal rejection. And how that would maybe marry with inflammation? You know, I'm scratching at here, I don't know. But is there any sort of gender difference with regards to who might suffer from atypical depression? Females more than males, for instance, who might be more in touch with their feelings? 
 
Adrian: Yeah, I think the research is indicating that more women suffer from the atypical form. And so I think that plays a part. There's some really interesting… interesting research also showing that inflammation increases sensitization to stressors and to negativity. And there's been some studies showing that if you expose somebody to inflammatory toxin… inflammatory endotoxin, then they might become more reactive to rejection. So, somewhere around that anti-inflammatory process then affects neural structures that are associated with that, I suppose, sensitization to rejection and negativity. 
 
Andrew: So I guess that ties in with the gut-brain axis, right?  
 
Adrian: Yeah, absolutely. I think that the gut is the key for a lot of diseases and we're confirming that now more with mental health disorders. Which is again one that, you know, unfortunately, my colleagues don't necessarily quite understand the connection. Certainly, we know that stress can affect the gut, but as many of your listeners are already aware of, that the gut can also affect the brain and if we can do something through some gut healing, then we may have a positive effect on brain function. 
 
Andrew: Absolutely. Now you chose Curcumin BCM-95, and saffron, and sage as interventions for your research. Other researcher's use different forms of curcumin. You know, there's the C3 plus the piperine, there's Longvida. I don't know of any others at the moment but there's probably more coming out. There's a bit of a war, in fact, there's a lot of a war. "Ours is best. Ours is always best." And yet you know a lot of the pre-clinical stuff was done on even the lowest absorption...dare I say that word. 
 
Do you think the type of formulation is critical or do you think there's a lot of turf war going on here? 
 
Adrian: Oh, look, I think a lot of it. Yeah, there is a lot of marketing going on around the bioavailability and our's is more bioavailable than yours. And there's always questions around how people assess bioavailability and some of the markers that they use to identify that. And so there's issues around that. 

I think, yeah, that currently, they key around the kind of the marketing side of things… But as you've mentioned already, even a standard curcumin has shown to have some benefits. And you know, I've struggled with this bioavailability issue for quite some time and I'm actually in the process of writing a paper at the moment, talking a bit about, "Well, maybe it's not bioavailability that's the issue, maybe it's about, you know, the issue I just talked about earlier, is about the curcumin and it's gut-enhancing effect." 
 
And so, you know, what I'm, you know, learning from the research is that curcumin certainly has...may have a positive effect on microbial ecology and from that point of view. And also have, in animal studies, is shown to have an impact on intestinal permeability. And so maybe by enhancing gut function and therefore reducing inflammation via that way, and therefore also improving kind of nutrient absorption and hormonal production, maybe that's how at least partly how curcumin works through it's enhancement of gut function. 
 
Andrew: I think it's really interesting about even the term bioavailability. I think that's even been bastardised a bit for marketing terms. I think we're really talking about absorption of curcumin, you know? And even that as you say, it's with… you're sort of harping on about something once perhaps because the horse has already bolted. It might actually be healing it at the gut level, which is a very good point to investigate. I think that's really good. 
 
Adrian: Yeah, I think that's the next area really. And it was interesting one of the studies that I did, looking at curcumin, and I looked at some of the biomarkers and one of them was a marker that may be associated with leaky gut and so the theory… And having a… elevated levels of this this biomarker, was associated increased efficacy from curcumin. So, potentially, people with kind of leaky gut, may benefit… particularly be beneficial from curcumin. 
 
I mean, yeah, there's other things within the curcumin too that I think beneficial. I mean, I chose the BCM initially because of the bioavailability research that I was certainly intrigued by that. But yeah, it also contains turmeric oil and things like that, which are used to enhance bioavailability or its absorption. I think turmeric also has, you know, your antimicrobial function and things like that, which may be beneficial too. 
 
Andrew: Ahh. So you might be again working on the microbiota sway? 
 
Adrian: Mm-hmm. Potentially. 
 
Andrew: I think one of the things, you know, whenever I hear about these newfangled, better ways of absorbing a food component. I always try and go back to "Well, where did this research actually start? With food. So, why don't we look at food? How about we do that first? 
 
And I've often told people who I've given curcumins to, is that always make sure your tongue is yellow at some stage during the day, preferably not from a texta. 
 
Adrian: Well, you know, maybe there's turmeric textas going around, that might be a good way to do it?
 
Andrew: There you go. Increased bioavailability. 

One of the things I was interested in was the inclusion of saffron. And this has been a bit of a favorite herb of Jerome Sarris, in his research. But I like the earlier work referring back to this guy...I think it was an Iranian, called Akhondzadeh, Shahin Akhondzadeh. And then there was work done by Heather Hausenblas. Really interesting. Not just for depression but for anxiety and other things, insomnia. So why did you choose to do the both? And I've got to ask then, which did you find was the major player? Could you tease apart an effect of each or both? Were they important to have together? 
 
Adrian: Well, initially I chose both because...I mean, I had already done a study just on curcumin on its own. So I then wanted to replicate it and I, you know, I thought maybe if we combine the two together that might increase the efficacy. And you know, obviously we know that, you know, incorporating herbs and spices in a diet is important for health and you wouldn't just have one herb or one spice every day you'd want to combine it. 

So, I used the combination. I did, I had four conditions in the studies. One condition was the placebo. Then there was two conditions which varying doses of the curcumin or the BCM. And then there was one condition which combined the two, the BCM and the saffron.  
 
Now, what I found was that the three active conditions were more effective than the placebo. But there was no difference between the three groups in terms of efficacy so the low-dose curcumin was just as effective as the high dose, and the combined ingredients were just as effective as the others.  
 
Andrew: Right. 
 
Adrian: Saying that, the study was flawed. In that when comparing active treatment conditions, you really do need quite large sample sizes. And so, you know, if the actives were effective by 30% and the combined was effective by 40%, it would only give a 10% improvement. And to identify through statistical analyses you need quite large sample sizes. So we didn't have that. So, now... 
 
Andrew: But, that's your next one. That's your next trial.  
 
Adrian: That's the next one. That's the next one.  
 
And the other one that I didn't have was I didn't have saffron on it's own compared to curcumin. And that would have been nice to see too. 
 
Andrew: Yeah. Yeah. I think this is the...look, it's the thing that dogs so much of integrative medicine research. And that is the numbers. You know, how do you get even a number to treat when you haven't even got a decent sample size? 

But having said that, I think the thing must be acknowledged that it's really hard to patent an egg. Admittedly, we're using a patented-type form of curcumin, but it's very hard to get research paid for that will include those massive numbers that we see in the pharmacological trials. 
 
Adrian: And yeah, and that's the problem. I think that… I mean, I've been fortunate enough and where... And this is, I suppose one of the criticisms too, is that I've been funded by the company. The studies were funded by the company that you know, BCM, the company that owns BCM. 

Now, saying that you know, they're an extremely ethical company and basically they provided the funds and we at Murdoch University have independently run the study. But people still criticise the study saying, well, look, it's industry-funded. Well, the response to that is, "Well, where else am I going to get the money?" 
 
Andrew: That's exactly right. 
 
I mean, I think, it's really interesting when you get people at the Friends of Science; they want to see the evidence of any nutritional intervention but they refuse any research investigations into that because you can't get it from government so you've got to get it from enterprise so therefore, it's skewed and therefore, it's of no use. So it's that you're done either waytreally, aren't you?  
 
Adrian: Yeah. 
 
Andrew: So where to now with your research? What is your next on the agenda?  
 
Adrian: Well, at the moment I'm doing a study looking at saffron on it's own, for teenagers. We will finish recruiting in the next week or two. So that study is looking at saffron in teenagers aged between the age of 12 and 16 suffering from low mood or anxiety. And I want to really look at the effects of saffron in that population. And I think that's, you know, children and teenagers is an area that's quite neglected in relation to research in general, but also particularly, you know, in natural ingredients and supplements and things like that. So, that's one that I'm about to do and hopefully, we'll have the data published by the end of the year. So that should be interesting. 

The other one that I've just got to manage time to do really is, I want to look at… I'm very much into, you know, while we've talked about supplements, I mean, the reality is that in my practice I never ever have somebody come in and I say, "Here, use some saffron. See you later." Or "Here's some curcumin. See you later." It really is an integrative approach. And that's the thing I really want to highlight is the benefits, the potential benefits of integrating changes in diet, exercise, sleep. And many of the listeners are already aware of that that. That, you know, if you combined all those factors then you're going to get the most beneficial effect. And there is the danger of just using supplements much like pharmaceutical drugs.  
 
You know, obviously, many people go see their doctor and they're placed on an antidepressant and that's the only intervention. And that's the danger for many people too. With like, you know, they could just take saffron and think that by taking saffron, all their worries are going to go. 
 
So saying all that, in a long-winded way, is that basically, what I would like to do, is actually compare an integrative approach. Where it would be, you know, maybe a six-session treatment looking at diet, sleep… you know, one session looks at diet, one session looks at sleep, and one session is cognitive behavior therapy, and all those different factors. And comparing that to the cognitive behavior therapy on its own. So does the integrative approach, same amount of sessions, six sessions for both. Comparing the two groups. And does the integrated approach work as well or better than just as a CBT-only treatment? 
 
Andrew: Yes. So then you can tease out the bang for buck. Because that's another one of my concerns is the cost. How do you find the acceptance of the costs, when you employ an integrative approach including supplements? Especially, I guess, for those people who might be depressed for a long period of time and might have issues with work, with you know, maintaining work. How does it fit in? 
 
Adrian: That's a… you know, I think one of the major criticisms I have with, you know, nutritional medicine and so forth is the cost. And obviously, for many people, yeah, many practitioners talk about doing all of these fancy tests, which cost hundreds of dollars for people. And for many people, they just can't do that. 

So I think that what it really needs to be, is that integrative approach needs to be very personalised. And for many people, they cannot afford hundreds of dollars of supplements every month. They cannot afford to do the testing that's required to determine, kind of, gut function and things like that. 
 
So when I'm seeing an individual coming into our practice, I'm assessing the individual. I'm looking at the barriers to intervention. I'm looking at their motivation to change, because obviously, many people who particularly come and see me may not be interested, they're coming to see a psychologist, and when I talk about diet you know, they may not be open to making changes in that. 

So to me, it's really been going, "Okay, how about if we look at making small changes in several different areas rather than just targeting one?" So if we can gain some sleep hygiene work, so they're sleeping half an hour more. If we can improve their diets by reducing soft drink consumption, or drinking water consumption? Yeah, it's not the ideal diet, but it's better than what it was. And not everybody needs to go on a gluten-free diet to feel better. The reality is that, you know, many people don't need to go on a gluten-free diet to feel better. And if we aim for this perfect diet, then many people are going to fail.  
 
And maybe then also, you know, giving them a couple of supplements. Whether it's just a fish oil initially, or B-complex. Or it's just a saffron or a curcumin supplementation. And that might be dependent upon what finances they have available to them and also what they're willing to take. So we really need to look at the individual, then target changes in multiple areas and yes, as a said, people don't have to walk out with hundreds of dollars of supplements at the end of the consultation. 
 
Andrew: Yeah. I do like that point because I've always stuck to the idiom that these are SUPPlements not MAINaments. The main, should be diet. You know, expecting a supplement to take the place of an unhealthy diet will not give you any good results. 
 
What was it… I think it was to Professor Tim Noakes said, "You can't outrun an unhealthy diet." Is that what... something like that…
 
Adrian: Yes. 
 
Andrew: With regards to your research though, we tend to sort of brush over… we tend to sort of want the glowing results and the nice things that happen to people who take supplements. What about adverse interactions? Particularly with regards to antidepressants or other medications they might be on. Did you find any issues here? 
 
Adrian: I… with the curcumin studies that I've done many people....I think from memory, I can't remember specifically, but about 50% of people were on antidepressants, so I didn't exclude people on antidepressants. So what I wanted to do was I wanted to use quite a representative sample of people attending...completing the study. So there wasn't any adverse… it was quite well tolerated, the curcumin antidepressant combination was quite well tolerated so that wasn't really any issues for me. The main issue was around, you know, your digestive problems that sometimes people experience... 
 
Andrew: Burping, bloating, and cramping. Which you can get from water. 
 
Adrian: Yes. Yes. It's interesting that I've got… at the moment, even the teenage study, yeah, I think at the moment it's probably placebo getting more side effects than the... Well, I don't know. But all I know is that the two groups, there's two different groups. I don't know which is which. But it seems as though the two are experiencing some digestive issues from both conditions. 
 
Andrew: Right. I know this is sort of skipping back to a previous point but it just came up in my mind. When you're looking at recruiting, Adrian. When you're looking at recruiting your subjects for the trials and you're based in a university, how does that recruitment take place? 
 
Adrian: We, I mean, I've been using a lot of kind of, social media to recruit. So I haven't been using University samples, which often is the case in many studies. But as with the advent of social media, you can promote the study to a wide range of individuals and that's where I've probably get the most of my participants. 
 
Andrew: Okay. So now, back to the present. When you're speaking about, you know, a significant portion of these participants being on medications. What about the responsibilities and perhaps even red flags when you're treating people, depressed patients who might be on medications? How do you refer back to their psychiatrist to say "Hey listen, they're part of this trial." Or indeed, how do you defer and say, "I've gotta hands off here because there's something going on here that you know I think it's serious you need to handle something." What do you do there on medical perspective? 
 
Adrian: Well, I mean, in the study you're trying to use a less complicated group of individuals from a health perspective. And also even with regard to your medication. So, many people who are on multiple medications you're not going to include them in a study, because it just complicates things from that perspective. 

And then also people presenting with serious mental health disturbances or suicidal ideations or things like that you won't include in the study. Because you can't work...well, you can't kind of monitor those individuals very well. So, not so much of an issue with regards to the studies because they'll be excluded. I mean, but obviously, within our practice, you know, if we're working with individuals on medications it's extremely important for us to be able to liaise with their general practitioner or psychiatrist if they're seeing one. 
 
Andrew: So, for the future, you know, I noted that you've also done some research into sage and it's cognitive enhancive and may be protective effects. You know, when you're looking at depressed people who can't think straight, as part of this inflammatory process have you got any thoughts about including sage in further trials or is that done and dusted? How did it work? 
 
Adrian: Well, mean, I wrote a review paper on sage. I actually haven't done any personal studies on the effects of sage.  
 
Andrew: Forgive me. 
 
Adrian: Yeah, I looked particularly at just reviewing the evidence in terms of its efficacy on cognitive function. And the results were really quite positive. Unfortunately, it's kind of slowed down. Some of the research around sage has slowed down and that's something that I certainly would like to look at some stage but it all depends on time and funding I suppose. 

So, I think, certainly sage, as an adjunct to antidepressant medications whether they be natural or pharmaceutical might be a really interesting thing to look at. Because we know that cognitive deficit is a common symptom with people with depression. 
 
Andrew: Yeah. And I guess just as a wrap-up question. When you're talking about negative thoughts that are included in this feeling of depression, this feeling of non-worth, of guilt of, you know, a lack of self-esteem. And it's often sort of said that you know, "negativity breeds negativity." So, for those people who are already in that mindset, they don't see the light in the tunnel, how hard do you find it to tweak them, to turn them towards, you know, a point in the tunnel where there is light? It may be distant, but there is a glimmer of light. How do you find that? What sort of tricks do you employ, I guess, to to show people, "Hey, there's another direction"?  
 
Adrian: It can be very difficult. I think that, you know, certainly, yeah, the characteristic of depression is that demotivation, so getting many people with depression to change can be very difficult. And that's where really, you know, it's about... again, I'm going to harp on it, but just working with the individual and just personalising the treatment. Developing a good rapport with them, providing information about why are we doing what we're doing, and then asking them you know, "What changes can they make? Here's the list of possibilities that we can work on. There's dietary changes, there's exercise, there's sleep, there's the supplements, there's psychological techniques. And you know, which ones are you ready to work on and how much change are you willing to make in that particular area?" 

So it's really you know, assessing their motivation and then assessing their barriers to change. You know, if they are lacking in energy, getting them to exercise is going to be very difficult. So maybe we'll work on energy first. If a big issue for them is around... I suppose the thing too is that for many, I suspect, many naturopaths are listening to these podcasts, is also assessing like, is the naturopathic approach or the dietary changes, should you be working on that first? Or are there other factors that maybe you need to work on first. Or maybe you need to refer on. And you know, maybe they do need some psychological therapy, maybe they need some assistance around stress management, maybe they need to increase their social networks. And that's the one you may need to work on first. 
 
So whether you have the skills to do that yourself or refer on, I'm a big believer in working with several other disciplines, and I think it's a multi-disciplinary approach where we respect each other's skills and strengths, and we work together as a team to help the individual. 
 
Andrew: I said the last question but, of course, I've now got another question. When you're talking about inter-referral. How do you dialogue with a psychiatrist, who, you know, let's face it, they're going to be at the top of the pecking order with regards to intervention. I guess, you know, that's an air of responsibility and indeed litigation that they've got to cover. How do you dialogue and inter-refer with psychiatrists in particular, indeed other professions, and how do you find the inter-referral back? Do you find that happens, or do they tend to sort of say you hands off? Are they unwilling to acknowledge that there mayf be a dietary or a place for supplements? 
 
Adrian: There's going to be... I mean, there is a selection of psychiatrists who just really aren't willing to look at that. To consider diet or supplements as an intervention. And for those people, their eyes are closed and they're just not willing to do to acknowledge the role that it has. But saying that, I think for the majority of psychiatrists, that they are, you know, aware of the importance of diet are willing to acknowledge that.  
 
The issue though is, you know, is how much... And I suppose this is the thing I want people to consider is how much do they liaise with doctors and psychiatrists? I must admit I have never ever received a letter or a phone call really from a naturopath contacting me and saying, "Hey, this is what I'm doing." And so, I've never received that phone call, so I'm not saying it's not happening, but I've never received that phone call. So I really challenge people to ask themselves, "Do they liaise? Do they pick up the phone? Do they send that letter just providing an update to the psychiatrist or doctor just providing them with some information about the intervention that's been offered and the formulation and so forth?  
 
And I think with that information… and sometimes what I've done is I've included.. if I've included saffron as part of their regimen...I might include a copy of the paper. So I send a letter and I've included the copy of the paper. My paper for example, on saffron on review. And whether they do anything with that, I don't know? But at least you're showing them that, you know, "I'm not just doing things that are based in my opinion. There is a research component for a lot of the work that I'm doing." And I think that makes them a lot more open. 
 
I now get psychiatrists emailing me saying, "Hey, you know, what recommendations do you have? I've got somebody with PTSD? Are there any supplements you might recommend in conjunction with the work I'm doing?"  
 
So, it does happen. It takes time but you do need to put some effort into liaising and developing a relationship with them. 
 
Andrew: Dr Adrian Lopresti, I thank you so much for joining us on FX Medicine today. Not just taking us through the exciting things with regards to, you know, some interventions with regards to curcumin and saffron. But I think, very importantly and responsibly, the care that you take with your patients in personalising their approach. And lastly, I wish you well in your future endeavors. Showing what results these interventions have in your patients. I really thank you for your previous and future work. Thanks very much. 
 
Adrian: Thanks Andrew, for having me. 
 
Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.

Additional Resources

Dr Adrian Lopresti
Total Body Psychology
Murdoch University: Dr Lopresti's Research
Professor Gordon Parker
Prof Shahin Akhondzadeh
Murdoch University: Spice a potential treatment for adolescent depression

Research explored in todays podcast

Lopresti A, Jacka F. Diet and Bipolar Disorder: A Review of Its Relationship and Potential Therapeutic Mechanisms of Action. J Altern Complement Med 2015 Dec 1; 21(12):733-729

Lopresti A, Maes M, Meddens M, et al. Curcumin and major depression: A randomised, double-blind, placebo-controlled trial investigating the potential of peripheral biomarkers to predict treatment response and antidepressant mechanisms of change. J Euro Neuropsychopharm 2015 Jan; 25(1):38-50

Lopresti A, Maker G, Hood S, et al. A review of peripheral biomarkers in major depression: The potential of inflammatory and oxidative stress biomarkers. Prog Neuropsychopharmacol Biol Psychiatry. 2014 Jan 3;48:102-11

Lopresti AL, Maes M, Maker GL, et al. Curcumin for the treatment of major depression: a randomised, double-blind, placebo controlled study. J Affect Disord. 2014;167:368-75​

Lopresti AL, Drummond PD. Efficacy of curcumin, and a saffron/curcumin combination for the treatment of major depression: A randomised, double-blind, placebo-controlled study. J Affect Disord. 2017 Jan 1;207:188-196

Hausenblas HA, Saha D, Dubyak P, et al. Saffron (Crocus sativus L.) and major depressive disorder: a meta-analysis of randomized clinical trials. J Integr Med. 2013;11(6):377-383

Lopresti A. Salvia (Sage): A Review of its Potential Cognitive-Enhancing and Protective Effects. Drugs R D. 2017 Mar; 17(1): 53–64



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