Herbal remedies and
supplements
This leaflet is for anyone who would like to
try complementary medicines for a mental health problem. It
covers:
What are complementary and alternative medicines
(CAMs)?
They are ways of treating illness that have
developed outside the mainstream of modern medicine. Many are
traditional remedies that have developed in different cultures over
the centuries. They include:
- herbal medicines
- foods
- nutritional supplements, such as vitamins and minerals
All these treatments can be used on
their own, or with conventional medicine.
CAMs and mental health
problems
Many CAMs have been used for mental health
problems but there is little good evidence to support their use.
Some of these treatments may work, but most have not been
thoroughly tested. The studies have often been too small to give a
clear answer. We know most about the treatments for depression,
anxiety and insomnia. Despite the lack of formal evidence, people
all over the world take CAMS and many report that they find them
helpful. Ultimately, whether taking CAMS is a good idea depends on
individual circumstances; if in doubt, ask for advice.
Who can I speak to about
CAMs?
Your doctor, pharmacist or nurse may be able
to help or suggest somebody who knows more.
How to use CAMs safely?
Do
- choose a qualified practitioner who is a member of a recognised
society
- ask about their qualification and experience
- ask about side effects
- if in doubt, ask your doctor, nurse or pharmacist
- tell professionals involved in your care, including your CAM
practitioner, about all your treatments and medications
- tell them if you are pregnant, plan to become pregnant or
breast-feed
- tell them about your physical health and allergies
- discuss your concerns about treatment
- seek medical advice if you experience unusual symptoms
- make special time for your treatment sessions
- find a reliable source for your information about
therapies
- stop conventional medicines without telling your doctor
- believe claims for “wonder cures”
- take high doses of supplements unless confirmed with an
experienced health professional
- combine many different remedies
- take complementary medicines without knowing what they
are for
- take somebody else’s complementary medicines
- give remedies to children without seeking specialist
advice
- take remedies from an unreliable source - this includes the
internet
- eat or drink raw plant material, such as flowers, fruits,
leaves, seeds or the root unless you are sure it is absolutely
safe. Many plants are poisonous and need to be processed before
they can be used safely
- prepare your own teas and extracts unless you are sure it is
safe
- smoke raw plant material
- pay large sums of money up front
- practice acupuncture or any other physical treatment on
yourself unless you have been trained
- blame yourself if a treatment does not work.
Herbal remedies and supplements
Herbal remedies come from plants. If possible,
choose a remedy which has been standardised, i.e. the contents are
approximately the same in each bottle or tablet you buy. Plant
remedies are not always safer than ordinary medicines. All of them
can have side effects and interact with other medicines.
Supplements include vitamins, minerals and
animal and plant products, such as cod liver oil. They can also
have side effects and interact with other medicines. Some people
take supplements like vitamin C in high doses. But, this can damage
the liver or kidneys. Many supplements have a recommended daily
intake (RDI), or allowance (RDA). Do not go beyond this dose
without talking to an experienced health professional.
Brain function and dementia
These are called cognitive enhancers and can
improve concentration. They include:
-
Ginkgo (ginkgo biloba)
-
Ginseng (panax ginseng)
-
Hydergine (Ergot) (claviceps purpurea)
-
Sage (Salvia officinalis, salvia lavandulaefolia)
Ginkgo
Ginkgo is a tree originating in China.
Extracts of its seeds and leaves are used to improve thinking in
healthy people, as well as people with dementia.
How does it
work?
We don't know. It may:
- act as an antioxidant to prevent cell damage;
- increase the blood flow in the brain or increase chemical
transmitters in the brain.
How good is it?
Research shows that Ginkgo may help in dementia. The same is true
of its use in healthy adults. However, more recently its
effectiveness has been put in doubt.
Side effects: It
may, rarely, cause bleeding into the brain and into the
eye or prolong bleeding time during surgery. About twenty such
cases have been reported and patients undergoing surgery may
consider avoiding gingko. Gingko should not be taken together with
blood thinning medications, such as aspirin and ibuprofen.
There is an increased risk of fits and lower fertilitty in men
and women has also been reported.
Drug interactions
with:
- blood thinning drugs such as aspirin, ibuprofen, warfarin
(increases bleeding time)
- trazodone, (one case of coma has been reported)
- antidepressants, (increase the risk of going high -
mania)
- anticonvulsants, reduces their
effectiveness.
Ginseng
Ginseng grows in many parts of the world.
Panax ginseng or Korean ginseng are most commonly used.
How does it
work?
We don't know. It may:
- thin the blood;
- prevent cell damage through antioxidant activity
How good is
it? It might improve cognitive performance, but
there is no evidence that it delays ageing.
Side effects:
agitation and mania; sleep problems; blood pressure changes;
changes in bleeding time so people with bleeding disorders such as
stroke and blood clots (thrombosis) should avoid it; it may
possibly stimulate some breast cancers.
Drug interactions
with:
- drugs used in diabetes, (lower blood sugar)
- blood thinning agents such as aspirin, ibuprofen and warfarin,
(changes in bleeding time)
- MAOI antidepressants (eg. Phenelzine), may lead to
agitation and sleep problems.
Hydergine
This comes from a fungus which lives on rye.
For hundreds of years it has caused epidemics of poisoning
(ergotism). This is caused by eating bread made from infected rye
flour.
How does it work? It
may affect the activity of brain transmitters.
How good is it? It
may improve memory in dementia.
Side effects: It can
cause fits; confusion, hallucinations and psychosis. Severe
poisoning can cause gangrene.
Drug interactions
with:
- antidepressants and some pain killers;
- drugs for dementia;
- drugs for migraine.
Sage
Sage
produces oils which are used in aromatherapy. It is used
to improve concentration and memory and has been suggested as a
treatment of depression and anxiety.
How does it work? It
may:
- increase some brain transmitters
- have antioxidant, anti-inflammatory and oestrogen effects
How good is it?
There is some evidence for improved memory in volunteers. One study
found that it improved mood, alertness, calmness and contentedness.
It may help concentration in people with dementia.
Side effects:
Although safe when used in amounts commonly found in
foods, some types when taken orally can cause
convulsions. Sage may also lower blood sugar. It should
not be used in pregnancy or breast feeding
Drug interactions
with:
- drugs for diabetes;
- drugs for epilepsy;
- sedatives.
Vitamin E (alpha-tocopherol)
Vitamin E is found in plant oils, nuts,
vegetables and to a lesser degree in meat and dairy products.
How does it
work? Antioxidant properties may prevent cell
damage.
How good is it? It
may improve behaviour in dementia, but there is no good evidence
that it improves memory or slows the progress of the disease.
Side effects: A
recent study found that a daily intake of more than 400IU (270 mg
of alpha-tocopherol) resulted in an increase of death from all
causes, and an increased risk of bleeding and stroke.
Drug interactions
with:
- drugs to thin the blood;
- anaesthetics and cocaine;
- drugs to lower cholesterol and some cancer
treatments.
Anxiety and sleep problems
Most of these treatments seem to work on
gamma-amino-butyric acid (GABA), a chemical in the brain linked to
anxiety. We do not know if these drugs can cause addiction. They
are less powerful than conventional sedatives or sleeping
tablets.
NOTE
- Kava (piper methysticum) has been withdrawn in the UK due to
concerns that it might cause liver damage. It should not be
used.
- Combinations of extracts may be less safe. There have been
concerns about liver damage from combinations of valerian and other
herbs.
Valerian
Valeriana officinalis is thought to be safe
and is available as a standard extract in the UK. Some other
species may cause liver problems
How does it work? it
seems to stimulate brain transmitters. It may also counteract the
effects of caffeine.
How good is it? The
evidence that it works is poor.
Side effects:
drowsiness or excitability. It may slow reaction time so you should
not drive or operate dangerous machinery after taking it. It may
cause liver damage, but this seems to be confined to some
formulations. You should not take it in pregnancy.
Drug interactions
with:
- sedatives
- alcohol
- the pill
- HIV medicines;
- cancer treatments
- epilepsy and anti fungal treatments
- blood thinning medicines.
Passion flower
Passion flower is used to treat anxiety; it
has also been suggested as a treatment in alcohol craving and
opiate withdrawal.
How does it work? It
probably acts on GABA.
How good is
it? Very few studies have been
conducted, One trial found it to be as good as conventional
tranquillisers.
Side effects:
isolated reports of severe toxicity even at normal doses. It can
cause dizziness, confusion, heart problems, and inflammation of
blood vessels. Some species may contain cyanides, so toxicity may
depend on the preparation.
Drug interactions
with:
- warfarin, a blood thinner.
German chamomile
Chamomile is a mild sedative. It is also used to
treat stomach upsets and mucosal irritations. Traditionally the
flowers are prepared as a tea.
How does it work?
Acts on GABA.
How good is it?
We don’t know.
Side-effects:
May increase bleeding time; may stimulate
breast cancer cell growth in oestrogen sensitive cancers.
Drug interactions
with:
Hops
Dried hops have been used to treat anxiety and
sleep problems.
How does it work? We
don't know.
How good is it? One
study showed that a valerian-hops combination helped sleep.
Side effects: none
reported.
Drug interactions
with: increases sedation when used with:
- sedatives;
- sleeping tablets;
- other herbs;
- alcohol.
Oats
People use this to lower cholesterol and for stomach upsets such
as irritable bowel syndrome. It has also been used to treat anxiety
and 
tiredness. It has even been suggested for use in alcohol
and nicotine addiction.
How does
it work? We don’t know.
How good is it? We
don’t know.
Side effects: none
known.
Drug interactions
with: none known.
Starflower (borage)
Starflower oil is used for rheumatoid arthritis,
premenstrual syndrome (PMS) and sedation.
How does
it work? We do not know.
How good is it? We
do not know.
Side effects: some
extracts can cause liver problems or possibly cancer. It should not
be used in pregnancy; it may increase epileptic fits.
Drug interactions
with:
- blood thinning drugs such as: aspirin, ibuprofen,
warfarin.
Lemon balm
Lemon balm is a herb of the mint family. It is used
for anxiety, sleep problems, heavy periods and period pain. It is
also used to treat agitation in dementia. Lemon balm is used as tea
or extract. The oil is also used in aromatherapy.
How does it work? it
may work on brain transmitters.
How good is it? Some
evidence of calming in dementia. No research on its use in anxiety
and insomnia. In combination with valerian and hops it can improve
sleep.
Side effects: very
few
Drug interactions
with: increases sedation when used with:
- sedatives;
- herbs;
- alcohol.
Lavender
Lavender is also a member of the mint family.
Drops of lavender oil or seeds put onto pillows have been used to
aid sleep. It is used in aromatherapy and as an extract or tea.
How does it work? We
don't know.
How good is it? May
act as a mild sedative when used in aromatherapy.
Side effects: skin
irritation.
Drug interactions
with: increased sedation when used with:
- sedatives;
- herbs;
- alcohol.
Bach flower remedies
This is an extract from a combination of
flowers which is used to treat anxiety, panic and trauma.
How does it
work? We don’t know.
How good is it? No
good evidence.
Side
effects: We don’t know.
Drug interactions
with: We don’t know.
Melatonin
Melatonin is a hormone made by the pineal
gland in the base of the brain. It controls our body clock. Sleep
medicines derived from it are being developed.
How does it work? By
regulating the body clock.
How good is it? It
may improve sleep quality in older adults.
Side effects:
sleepiness and low mood.
Drug interactions
with:
Increases sedation when used with:
Depression and bipolar disorder
Remedies include:
In bipolar disorder (manic depression) adding
omega-3 fatty acids may reduce the chance of relapse. Some people
buy natural lithium, but we do not recommend this because the doses
offered in the tablets are much lower than in prescription
preparations. Also, lithium at any dose should be closely
monitored.
Most treatments for depression are
supplements, which are building blocks in the production of
serotonin. This is a chemical in the brain that seems to be
involved in depression
L-tryptophan, is one of these building blocks
but it has not yet been cleared as safe.
St John's wort
St John’s wort gets its name from St John’s
day on the 24th June. This is when the plant starts to flower. For
a long time it was thought that the red dye, hypericin, which is
produced when the plant is crushed, was responsible for its action.
Research now suggests that another ingredient, hyperforin, may
produce the antidepressant effect. St John’s wort has also been
suggested as a treatment of anxiety, addiction and premenstrual
stress.
How does it work?
Increases serotonin in the brain.
How good is it?
Shown to be effective in many trials.
Side-effects: People
taking St John’s wort may burn more easily in the sun; if in doubt
use sun screen.It may cause mania in people with bipolar disorder.
Drug interactions
with:
- antidepressants;
- strong painkillers;
- oral contraceptives (the pill), reduces its
effectiveness;
- some cancer drugs.
Can also reduce the effect of:
- some epilepsy drugs, such as carbamazepine;
- digoxin
- warfarin;
- HIV drugs;
- some cancer drugs.
There is also a risk of organ rejection in
people taking St John's wort who undergo transplant surgery.
S-Adenosyl-methionine
S-adenosyl-methionine (SAME) is another
building block of serotonin. It is not often used in the UK, but is
popular in Europe and the US. It is also popular with HIV sufferers
because it has few side effects. It is often given as an
injection
How does it work? It
helps to produce serotonin and other neurotransmitters.
How good is it? Two
trials show that SAME has a good antidepressant effect.
Side effects: may
cause mania in people with bipolar disorder.
Drug interactions
with:
- antidepressants;
- strong painkillers.
Folic acid
Folic acid is used by women who want to
become pregnant or are pregnant to prevent spina bifida, a
malformation of the baby’s spine. In some countries folic acid is
added to the flour.
How does it work? It
is another building block of serotonin and other
neurotransmitters.
How good is it? It
may increase the effect of some antidepressants.
Side effects: Large
doses can cause agitation, sleep problems, confusion and fits.
Drug interactions
with:
- some anti-cancer drugs;
- some antibiotics.
Selenium
Selenium is an important trace element. It is
found in vegetables, meat, fish and Brazil nuts. Brazil nuts can
vary in selenium content, but sometimes the concentration is so
high that the US National Institutes of Health advise that Brazil
nuts should be only eaten occasionally. The Food Standards Agency
recommends a safe upper level of 0.45 mg per day. Some formulations
exceed this dose.
How does it work?
Selenium is an antioxidant and may prevent cell damage. It also
helps produce thyroid hormone.
How good is it? We
don’t know.
Side effects: can
lead to nausea, vomiting, nail changes, irritability, weight loss,
depression, confusion, liver and skin changes.
Drug interactions
with:
- drugs to lower cholesterol;
- vitamin preparations.
Omega-3 fatty acids
Omega-3 acids are mainly derived from fish –
They are used to prevent heart and joint disease. They are also
used in depression. Omega-3 fatty acids have two main components:
docosahexaonic acid (DHA) and eicosapentaonic acid (EPA). The pills
are often large and some people find them hard to swallow. Avoid
preparations which have added vitamin A. This could cause vitamin A
poisoning.
How does it
work? We dont know
How good is it?
They may be worth taking with antidepressants. They may
help prevent relapse in bipolar disorder. There is not enough
evidence to recommend them as an alternative to antidepressants or
mood stabilisers.
Side effects:
unknown
Drug interactions
with:
Psychosis
Choices are limited. Rauwolfia, a plant
originating from India, has been used, but is not as good as
anti-psychotic medicines. Reserpine, a drug developed from
Rauwolfia, can cause depression and is no longer used in the
UK.
Omega-3s may be tried with anti-psychotic
treatment. But, there is no good evidence that they help. Many
anti-psychotics can cause weight gain and lead to a higher risk of
heart and blood pressure problems. Omega-3s may reduce these
changes, but success is not guaranteed.
Movement disorders
Many older anti-psychotics could cause
abnormal movements, known as tardive dyskinesia. If this occurs,
the dose of the anti-psychotic can be lowered, or an alternative
antipsychotic given.
Two complementary remedies may help -
vitamin E and
melatonin.
Vitamin E, may prevent the movements getting
worse. However, the potential benefits need to be offset against
long-term use, particularly if high doses of vitamin E are
considered.
Melatonin has also been tried, but the
research is inconclusive.
Addictions
The choice is limited. Valerian has been
suggested to improve sleep in people withdrawing from drugs like
Valium. But no good research has been done. Passion flower was
effective when combined with clonidine in one small study, and St
John’s wort may reduce alcohol craving.
Other Remedies include:
Kudzu
Kudzu, or 'Japanese arroweed' flowers have a
pleasant fragrance. They have been used for many medical purposes
including menopausal problems. It has also been used for alcohol
problems.
How does it work? It
may reduce anxiety caused by alcohol withdrawal.
How good is it? One
study showed reduction in alcohol use in heavy drinkers. Another
study failed to show any effect on craving.
Side effects: none
reported.
Drug interactions
with:
- blood thinning drugs
- oral contraceptives (the pill)
- drugs for diabetes.
Iboga
Iboga is a West African shrub producing
ibogaine. This causes hallucinations and has been used widely for
religious rites. It became famous as a treatment for opiate
addiction in the 60s. However, it can have serious,
life-threatening side effects. Until these safety concerns are
clarified it cannot be recommended.
How does it work? It
probably affects several chemical transmitters in the brain.
How good is it? It may help
in withdrawal and in staying away from drugs.
Side-effects:
Between 1990 and 2006, twelve deaths after ibogaine use have been
reported. Thus the risk of death may be as high as 1
in 300 treatments. It is not known how many deaths have
occurred, but gone unreported due to the 'underground nature'
of ibogaine treatment.
Drug interactions
with:
- drugs which affect the same neurotransmitters.
Finding a practitioner
Finding a well-trained practitioner can be
difficult. You can also always ask your general practitioner (GP)
or mental health professional.
It may be useful to consult with your local
drug information service, and to find a health professional with
special expertise in this area, or use services recommended by your
GP or hospital. There are professional herbalists who belong to the
National Institute of Medical
Herbalists. They are trained and often work in a
private setting. Most are not medically qualified.
Useful websites
MedlinePlus: This is a
website run by the US National Institute of Health. The homepage
has a search option allowing you to type in different keywords so
you can retrieve the information you want. Typing the keyword
“alternative medicine” or “drug information” will direct you to the
relevant sites.
World Health
Organisation: This website contains information on how
complementary and alternative medicine is practised all over the
world. It has an alphabetical list of topics. Try “acupuncture” or
“plants medicinal”.
The Food and Mood Community Interest
Company (previously the Food and Mood Project): This
web-based user-led social enterprise founded with a Mind Millennium
Award in 1998 sells dietary self-help resources for individuals and
groups, including a DIY Food and Mood Workshop pack and The Food
and Mood Handbook.
Food Standards Agency: This
UK website can be difficult to navigate because of the sheer wealth
of information. From the home page, click on the “nutrition” button
on the menu. From there you can navigate further. Alternatively,
type “recommended daily intake” into the search engine on the
homepage.
The Prince of Wales Foundation for
Integrated Health: A UK website providing information
on the integration between complementary and conventional
healthcare. The Foundation is currently producing national
guidelines on the use of complementary healthcare within the
National Health Service to be published in 2007. Click on
“publications” in the menu to see available reports, for instance
the “Complementary health care guide for patients”, which can be
downloaded free of charge.
National Centre for complementary
alternative medicines / National Institute of Health:
This US website provides comprehensive information on complementary
medicines. It is easy to surf. Of particular interest is the
clinical trial register which gives an overview of American
research. This needs to be complemented with information from other
clinical trial databases, for instance the Cochrane collaboration .
Click on “news and events” for important safety updates.
Natural Medicines Comprehensive
Database: A subscription-only website with extremely
detailed and comprehensive information on all types of natural
medicines. It is cross-referenced with the scientific literature,
and contains features such as a natural product effectiveness
and drug interaction checker. It also allows condition-specific
searches and offers tutorials on specific topics. Patient hand-outs
can be downloaded.
Quackwatch: A nonprofit
corporation whose purpose is to combat health-related frauds,
myths, fads, fallacies, and misconduct. This website can be helpful
when unusual treatments are suggested, particularly if a lot of
money is to be paid in advance. Some people may find the website
too provocative and sceptical - click onto the “cheers and jeers”
section to get a flavour of the site.
References
Click here for the
full list of References.
This leaflet was produced by the Royal College of
Psychiatrists' Public Education Editorial Board.
© July 2007 Royal College of Psychiatrists. This leaflet
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