Concerns about potential herb-drug interactions prevent many physicians from integrating plant extracts into psychiatric practice. However, most of the herbs that are useful in psychiatric patients have very few, if any, significant adverse effects.
Adaptogens are herbs whose roots, leaves, petals, stamen, and/or berries contain biologically active constituents that when extracted enhance the ability of organisms to resist numerous kinds of stressors—including physical activity, psychological stress, toxic exposures, excess heat or cold, infections, inflammation, hormonal changes, and malignancies. To qualify as an adaptogen, the extracts must be low in adverse effects and well tolerated by most people. More recently, these plant extracts are being redefined as metabolic regulators.
Arctic root, rose root, golden root (Rhodiola rosea). This ancient medicinal herb produces over a hundred bioactive compounds in its roots that act as antioxidants, antimicrobials, mitochondrial energy enhancers, antidepressants, selective estrogen receptor modulators, and more. Extensive research has shown that high-grade extracts can improve cellular repair and physical and intellectual performance, particularly under stress. Evidence supports the role of adaptogens in neuroendocrine regulation of the hypothalamic-pituitary-adrenal axis and in gene expression of key mediators of stress-induced signal transduction pathways, such as neuropeptide Y, nitric oxide, membrane-bound G protein signaling pathways, stress-activated protein kinase, and molecular chaperones such as heat shock protein 70.12 In addition, R rosea reduced extrapyramidal adverse effects of neuroleptics.
Siberian ginseng (Eleutherococcus senticosus or Acanthopanax senticosus). E senticosus, which grows in northern China and Siberia, improves fatigue, sleep, stamina, mood, and cognitive function with very few adverse effects. One study showed it augmented lithium, reduced conversion to mania, and increased remission rates after 6 weeks.13
Schisandra chinensis. Extracts from Schisandra roots and seeds are used to reduce stress, fatigue, bipolar depression, tension, anxiety, and weakness. Schisandra is also useful in reducing the adverse effects of other medications, such as antidepressants and antipsychotics. Adaptogen combinations such as ADAPT, with R rosea, E senticosus, and S chinensis, exert synergistic therapeutic effects.
Korean ginseng or Asian ginseng (Panax ginseng). P ginseng extracts increase blood flow, abstract thinking, reaction time, accuracy, and working memory at daily doses of 300 to 800 mg. However, methodological limitations have been found in studies of ginseng.14 Moreover, anxiety, insomnia, tachycardia, GI symptoms, headache, and reduced platelet aggregation have been reported with the use of ginseng.15
St John’s wort. High-quality St John’s wort extracts have been demonstrated to be effective in the treatment of mild to moderate depression and somatoform disorder, with possible benefits in seasonal affective disorder.16-18 However, St John’s wort has also been shown to induce cytochrome P-450 3A4, 2C9, and 1A2 isozymes and P-glycoproteins in humans.19 It can affect serum levels of many medications, including immune suppressants used to prevent organ rejection in transplant patients, digoxin, warfarin, oral contraceptives, theophylline, and protease inhibitors.
In addition, St John’s wort can cause phototoxicity, mania in bipolar patients, and serotonin syndrome, particularly in combination with prescription antidepressants. Therefore, it is incumbent on the physician to be knowledgeable about brand quality, inquire about the use of St John’s wort, check for potential herb-drug interactions, and inform the patient of potential risks.
Nutritional supplements, particularly the use of daily vitamins has become routine practice. Complementary and alternative medicine approaches, such as hypnosis and acupuncture have gradually gained acceptance in mainstream medical practice. Thousands of articles are published each year on complementary, alternative, and integrative treatments. Rather than being left behind, physicians can safely integrate these valuable treatments into their clinical work by identifying the most effective and best-documented treatments and by learning how to minimize the risks of adverse reactions.
Dr Gerbarg is Assistant Professor in Clinical Psychiatry, New York Medical College. She is a member of the American Psychiatric Association Task Force on Complementary and Integrative Medicine and an American Botanical Council Board Member. Dr Brown is Associate Professor in Clinical Psychiatry, Columbia University College of Physicians and Surgeons, New York. He is also a member of the American Psychiatric Association Task Force on Complementary and Integrative Medicine. Dr Brown and Dr Gerbarg coauthored Non-Drug Treatments for ADHD: New Options for Kids, Adults, and Clinicians (WW Norton and Company, Inc; 2012); The Healing Power of the Breath: Simple Techniques to Reduce Stress and Anxiety, Enhance Concentration, and Balance Your Emotions (Shambhala Publications, Inc; 2012); and over 40 articles and book chapters on complementary, alternative, and integrative treatments. They wrote How to Use Herbs, Nutrients, & Yoga in Mental Health (WW Norton and Company, Inc; 2009) with Dr Philip Muskin.
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