NADD Bulletin Volume IV Number 4 Article 3

Complete listing

Herbal Remedies Used In Psychiatric Practice

Ann R. Poindexter, M.D.

1.Black Cohosh (Cimicifuga racemosa): Used by North American aboriginal peoples as treatment for hot flashes, anxiety, and dysphoria (acute unhappiness) associated with menopause. Probably works on the gonadotropic system.

· EFFICACY: seems to work better than placebo and/or conjugated estrogen for treatment of physical and mental menopausal symptoms. Takes up to 2 weeks to work.

· POTENTIAL SIDE EFFECTS: gastric upset, throbbing headaches, dysphoria, and cardiovascular depression.

· POSSIBLE DRUG INTERACTIONS: sex hormone system

2.German Chamomile (Matricaria recutita): Used for treatment of g-i tract discomfort, peptic ulcer disease, mouth and skin irritation, pediatric colic and teething, and mild insomnia and anxiety. Contains flavonoid apigenin, which may attach to the benzodiazepine receptor and may also interact with the histamine system.

·EFFICACY: A mild hypnotic effect has been reported on mice and on humans, but no randomized or controlled clinical studies have been reported.

·POTENTIAL SIDE EFFECTS: rare, but usually are allergic in nature.

3.Evening Primrose (Oenothera biennis): Some authors have proposed its use in the treatment of schizophrenia, childhood hyperactivity, and dementia, apparently because of isolated reports of prostaglandin abnormalities in schizophrenia and AD/HD, but there is little scientific evidence or cultural tradition to support this recommendation.

·POTENTIAL SIDE EFFECTS: probably relatively safe, but should be used with caution in mania and epilepsy. Cases of primrose-oil exacerbation of epilepsy have been reported.

·POSSIBLE DRUG INTERACTIONS: phenothiazines, nonsteroidal anti-inflammatory drugs, corticosteroids, beta-blockers, and anticoagulants.

4.Ginkgo (Ginkgo biloba): One of the oldest deciduous tree species on earth, has been used for medicinal purposes a lot in Europe and has a minor role in traditional Chinese medicines. Indications have included dementia, “chronic cerebrovascular insufficiency,” and “cerebral trauma.”

·EFFICACY: Ginkgo extracts probably improve vascular perfusion and can decrease blood clotting by blocking platelet activating factor. Antioxidant properties of flavonoid components may explain its postulated neuroprotective and ischemia-reperfusion-protective effects. Review of controlled trials for cerebral problems indicated usually significant improvement in symptoms such as memory loss, trouble concentrating, fatigue, anxiety, and depressed mood. Studies looking at augmenting memory or treating memory loss have had conflicting results. Usually, some improvement is reported in people with moderate to severe memory impairment, but no significant improvement in those with mild to no memory impairment. Ginkgo has also been used to treat impotence, but no clear benefits have been reported. One study showed that ginkgo improved resistant depression when used as an augmenting agent with conventional antidepressants.

·POTENTIAL SIDE EFFECTS: relatively uncommon, but may include headache, g-i tract upset, and skin allergy to the Ginkgo fruit.

·POSSIBLE DRUG INTERACTIONS: anticoagulants. Caution should be exercised when taken where there is a risk of bleeding.

5.Hops (Humulus lupulus): Used by the brewing industry to produce beer, but the female flowers of the plant have a long medicinal history as a mild sedative. Currently used as a mild hypnotic agent.

·EFFICACY: No clinical studies are available concerning its use as a single agent to treat specific symptoms or illnesses, such as insomnia or anxiety disorders.

·POTENTIAL SIDE EFFECTS: allergy and disruption of menstrual cycles.

·POSSIBLE DRUG INTERACTIONS: sedative-hypnotic agents and alcohol.

6.Kava (Piper methysticum): Preparations from the root of kava have been used extensively by people in the South Pacific, both for medicinal and cultural purposes. Commonly believed to have anxiolytic, anticonvulsant, sedative, and muscle relaxant properties.

·EFFICACY: Kava has been reported to cause EEG changes similar to those of diazepam (Valium™). May bind at GABA sites. Standardized doses may be beneficial in management of anxiety and tension of nonpsychotic origin. Does not appear to adversely affect cognitive function, mental acuity, or coordination as compared with oxazepam (Serax™).

·POTENTIAL SIDE EFFECTS: Long-term use with higher doses may result in scaling of the skin on the extremities.

·POSSIBLE DRUG INTERACTIONS: May interact with benzodiazepine antianxiety drugs and/or alcohol.

7.Lemon Balm (Melissa officinalis) has a history of use as an antianxiety preparation.

·EFFICACY: One article has reported hypnotic and analgesic effects on mice, but no studies are available documenting these effects in people, although some people recommend its use. One study using a combination of lemon balm with valerian showed a sleep-promoting effect.

·POTENTIAL SIDE EFFECTS: None have been reported.

·POSSIBLE DRUG INTERACTIONS: May potentiate effects of other CNS depressants, including alcohol, and may interact with thyroid medications or thyroid disease.

8.Passion flower (Passiflora incarnata L.) is native to the Americas, and its leaves have been used as a sedative by native peoples such as the Aztecs. Current use is as a sedative-hypnotic.

·EFFICACY: Current use as a sedative-hypnotic is supported by results of some animal studies, but no studies on humans are available. One study, randomized, controlled, used a commercial preparation of Passion flower plus valerian, showed benefit in the treatment of adjustment disorder with anxious mood.

·POTENTIAL SIDE EFFECTS: Hypersensitivity vasculitis and some problems with altered consciousness have been reported. Can cause sedation, which may cause problems when driving or operating machinery.

·POSSIBLE DRUG INTERACTIONS: Have not been studied.

9.Skullcap (Scutellaria) has a long history of medicinal use, with the roots being used in traditional Chinese medicine and other parts in western herbalism. Skullcap has been used both as a sedative and as an anticonvulsant.

·EFFICACY: Active ingredients and pharmacology are not well-documented. Existing studies may not necessarily be applicable to presently available preparations, since different species and parts of the plant are used.

·POTENTIAL SIDE EFFECTS: Giddiness, confusion, sedation, seizures, and perhaps bad effects on the liver.

·POSSIBLE DRUG INTERACTIONS: May interact with other CNS drugs.

10.St. John’s Wort (hypericum perforatum L) probably has a history going back to the time of the ancient Greek physicians such as Hippocrates, and its use has continued since. Modern usage has been as an antidepressant.

·EFFICACY: Evidence of benefit as an antidepressant is better than for any other herbal remedy. Active ingredients have been investigated, but the mechanism of action is still controversial. Evidence of efficacy for mild to moderate depression is good.

·POTENTIAL SIDE EFFECTS: Probably has less side effects than with conventional antidepressants, but may include sun sensitivity of skin, delayed hypersensitivity, g-i tract upset, dizziness, dry mouth, sedation, restlessness, and constipation.

·POSSIBLE DRUG INTERACTIONS: Potential for MAO inhibitor-like drug interactions cannot be excluded.

11.Valerian (Valeriana officalis L. and Valeriana species) has a rich history of world-wide use for a variety of indications, but particularly as a sedative.

·EFFICACY: Studies on mechanism of action have yielded contradictory findings. Animal studies show results similar to those of other hypnotic (sedative) agents such as benzodiazepine drugs, but reports on anticonvulsant activity are contradictory. Studies on humans show a mild sedative effect, but exact effects on EEG sleep patterns are inconsistent. No studies show that valerian is better than other sedatives or other treatments for insomnia.

·POTENTIAL SIDE EFFECTS: Some possible adverse liver effects have been reported.

·POSSIBLE DRUG INTERACTIONS: Sedative effects of valerian may potentiate the effects of other CNS depressants.

HERBAL REMEDIES WITH CNS EFFECTS

1.Capsicum (Capisicum annuum L), usually seen in the form of chili or cayenne pepper, has been used topically for pain relief in a number of parts of the world, and taken by mouth as a treatment for g-i tract complaints. Other uses have included as a treatment for improving circulation in people with heart trouble. No scientific studies have been done to check this out.

·POTENTIAL SIDE EFFECTS/POSSIBLE DRUG INTERACTIONS: When taken by mouth these products may increase secretion of catecholamines, so caution must be used if MAO inhibitors are also being used.

2.Chaste Tree (Vitex Agnus-castus L) has been used as a medicine in the Mediterranean and central Asia for thousands of years, primarily to treat symptoms of premenstrual syndrome, painful breasts, menopause, hyperprolactinemia, and menstrual irregularity. Mechanism of action is unclear, but probably involves the prolactin axis, and some affinity for dopamine receptors has been reported.

·POTENTIAL SIDE EFFECTS/POSSIBLE DRUG INTERACTIONS: Potential interaction with other dopaminergic drugs, such as antipsychotics and metoclopramide (Reglan™).

3.Siberian Ginseng (Eleuthrococcus senticosus Masim) is a member of the Araliaaceae family, and is not the same thing as “regular” ginseng, described below. This material is a native of northern China, Japan, Korea, and eastern Russia, and the roots have been used for hundreds of years to help fatigue and stress and to improve endurance.

·POTENTIAL SIDE EFFECTS/POSSIBLE DRUG INTERACTIONS: Should be used cautiously with sedative-hypnotic agents, since some studies report changes of barbiturate-induced sleeping time.

HERBAL REMEDIES THAT MAY CAUSE PSYCHIATRIC SYMPTOMS

1.Ginseng (P. ginseng CA Meyer and P. quinquefolius L), which may be confused with Siberian ginseng (see above), has a long list of indications, including treating stress and fatigue and improving endurance. Mechanism of action is unknown, but probably involves the hypothalamic-pituitary-adrenal axis, causing elevated corticotropin and corticosteroid levels.

·POTENTIAL SIDE EFFECTS: Insomnia, hypertension, diarrhea, restlessness, anxiety, and euphoria.

·POSSIBLE DRUG INTERACTIONS: Should be used with caution in people with hypertension and/or diabetes, and with other centrally acting medications. May potentiate the effects of MAO inhibitors, stimulants (including caffeine), and haloperidol (Haldol™).

2.Yohimbe (Pausinystalia yohimbe) is derived from the bark of the P. yohimbe tree. Yohimbe seems to act as an alpha2-adrenoceptor blocker, and the salt is used in the treatment of erectile dysfunction. The bark is supposed to have aphrodisiac properties, and is widely sold for this purpose.

·POTENTIAL SIDE EFFECTS: Anxiety, nervousness, palpitations, restlessness, and increased cortisol levels. May contribute to psychotic symptoms, mania, and seizures.

·POSSIBLE DRUG INTERACTIONS: Tricyclic antidepressants, alpha blockers, centrally acting sympathomimetics, MAO inhibitors, and antimuscarinic agents all can potentiate the action of yohimbine. (Note: Many commercial products containing yohimbe bark actually have little or no yohimbine.)

Reference:

Wong, A. H. C., Smith, M., & Boon, H. . (1998). Herbal remedies in psychiatric practice. Archives of General Psychiatry, 55, 1033-1044.

©2001, Poindexter, used with permission.

For further information:

Ann R. Poindexter, M.D.
1024 Clifton
Conway, AR 72032
e-mail: dapoin@cyberback.com