Herbal Treatment of Major Depression: Scientific Basis and Practical Use

January 20, 2020

Many patients can benefit from herbs with gentler action, fewer adverse effects, and some health benefits beyond their antidepressant effects.

BOOK REVIEW

Herbal Treatment of Major Depression: Scientific Basis and Practical Use
by Scott D. Mendelson, MD, PhD; Boca Raton, FL: CRC Press; 2020
420 pages • $160.00 (hardcover)

Scott Mendelson, MD, PhD, has written a landmark volume in the Clinical Pharmacognosy series on Botanical Medicines for CRC Press. Why is this a landmark book? It thoughtfully reviews theories of the mechanisms of activity for antidepressants, including ketamine, and lays out the evidence for herbal activity through those mechanisms. Most psychiatrists will be surprised to learn about the anti-inflammatory, antioxidant, anti-diabetic, and neuroplastic effects of these herbs.

Book chapters include relevant in vitro studies of the effects of 66 herbs, providing a foundation for understanding preclinical animal studies and human studies of depression. An additional chapter goes into detail about Chinese Herbal Medicine. Another chapter covers specific plant chemical constituents supported by data on their mechanisms of action. The final chapter discusses how to choose herbs, combine herbs, address comorbidities, and augment conventional synthetic pharmaceuticals.

The evidence base for herbal treatments in depression is now growing rapidly. The availability of quality research should help psychiatrists gain confidence and enthusiasm for prescribing herbs for depression. Those who seek options beyond psychotropic medication will have better choices. Pharmaceutical company researchers wanting to expand their consumer base can develop combination formulas or new herbal products based on data in this volume. Botanical researchers will also find it informative.

Many patients can benefit from herbs with gentler action, fewer adverse effects, and some health benefits beyond their antidepressant effects. Ethnopharmacological differences include heightened sensitivity to adverse medication effects among certain populations. For example, people of Asian ethnicity can be more prone to adverse effects from psychotropics than Caucasians. Consumers who educate themselves about herbal treatments can discuss this knowledge with their healthcare providers.

Another barrier to the use of phytomedicinals is the lack of insurance reimbursement. The out-of-pocket cost must be weighed against the potential therapeutic benefits to the patient, in the context of the patient’s financial situation.

Dr Mendelson succinctly discusses not only familiar herbs for depression, such as St John’s wort and saffron, but also curcumin, lavender, hibiscus, lemon balm, chamomile, and many other lesser known phytomedicinals. He also offers some fascinating clinical pearls, such as the use of milk thistle for obsessive-compulsive disorder (OCD). Data suggesting that St John’s Wort could cause insulin resistance may be news to even experienced herbal prescribers.

When you find that your patient is taking unfamiliar herbs for depression, this is the book to reach for. Here you will find the well-documented, clinically relevant information you will need to evaluate and advise your patient. This will also provide a sound basis for your entry into the realm of herbal prescribing to reduce adverse reactions, minimize the use of synthetic medications, augment other antidepressant treatments, and improve patient compliance and outcomes.

Dr Brown is Associate Professor of Clinical Psychiatry at Columbia University Vagalos College of Medicine, New York.

Experts might read this book straight through, but for those who may not be conversant in biochemistry, the dense structure of the scientific information makes it a heavy read. Most readers will find it an excellent reference book for looking up an herb of interest.

Here and there, editing errors make the text less easy to read. Occasional issues are left out, such as the risk of St John’s Wort causing serious phototoxic rash. For this reason, clinicians should consult more than one source for herbal information, particularly regarding adverse effects.

The clinical utility of the book could have been enhanced by providing some guidance regarding identification of reliable, quality herbal product brands. This is challenging, particularly because companies often change the source or content of their products. This is a difficult and controversial area, but for many herbals, only a few companies manufacture and test their product properly. Furthermore, inferior look-alikes appear to ride on the coattails of high-quality products.

However, these omissions are minor compared to the conceptual and practical steps forward that are represented in this book. Since two thirds of psychiatric patients use alternative approaches, psychiatrists and other health professionals need more information to help patients attain their treatment goals. Phytomedicines can be more helpful than many psychiatrists realize. Overall, they cause fewer adverse effects and are more eco-friendly (causing less pollution than synthetic psychotropics).

I highly recommend this book for psychiatrists and other health professionals treating depression. Furthermore, phytopharmaceutical researchers interested in developing new treatments will find valuable ideas to pursue.