Brainy herbs: Facts Versus Fiction. 6th EASHTN Conference – 16, March, 2017

Brainy Herbs
Facts Vs. Fiction
Nilly Shams
Public Health and Nutrition Specialist
Certified Health Coach, Institute of Integrative Nutrition, USA
President of Egyptian and Health Coaching Association, ENHCA
CPHQ, NAHQ. USA
CBPPS, NPSF. USA
6th EASHTN Conference – 16, March, 2017

Road Map
 Frequently asked Questions about Herbal Medicine.
 Herbs Vs Pharmaceuticals.
 How to deal with the uncertainty of the Herbal Product?
 What is the role of Herbal Medicine in Mental Health?
 Why do Nutritionists need to know more about this role?
 The most commonly used herbal supplements for mental health.
 Take home messages.

Road Map
 Frequently asked Questions about Herbal Medicine.
 Herbs Vs Pharmaceuticals
 The most commonly used herbal supplements for mental health
 Take home messages

Psychiatr Quart 2002; 73:367–381
J Orthomol Med 2001; 16:155–156

Herbal medicines include a range of pharmacologically active compounds, in some
cases it is not well understood which ingredients are important for a therapeutic
effect.
The supporters of herbal medicine believe that isolated ingredients in the majority of
cases have weaker clinical effects than whole plant extract, a claim that would
obviously require proof in each case.
Herbal Medicine

 Is Generalization about efficacy of herbal medicine possible?
NO
- Each one needs systematic research including a variety of animal
studies and also randomized clinical trials due to different factors:
Herbal preparations
Regulatory control
Standardization of products.
Frequently asked Questions about
Herbal Medicine

Herbal Medicine
Are clinical trials of herbal medicines feasible?
Yes
- Clinical trials of herbal medicines are feasible much in the same way as
for other drugs.
- Numerous randomized clinical trials of herbal medicines have been
published and systematic review and meta-analyses of these studies
have been available.

Herbal Medicine

Neuropsychiatric Disease and Treatment 2013:9
Clinical trials of herbal medicines are feasible

Herbal Medicine
Why herbal medicine is still of interest in many diseases??
• only about two centuries ago, the major pharmacopoeias were
dominated by herbal drugs.
• Herbal medicine went into rapid decline when basic and clinical
pharmacology established themselves as leading branches of
medicine.
• Nevertheless, herbal medicine is still of interest in many diseases
in particular psychiatric and neurological disorders.

Herbal Medicine
Why herbal medicine is still of interest in many diseases??
• Patients are dissatisfied with conventional treatment
• Patients want to have control over their health care decision
• Patients see that herbal medicine is congruent with their philosophical values and
beliefs.

Danger
• Many people believe that herbal medicines have no toxicity problems or even
side effects.
• People are not aware of many possible interactions of herbal medicine with
concurrently prescribed medications
A Physicians' Guide to Herbal Medicine. 3rd ed. Berlin, Germany: Springer- Verlag; 1998

Road Map
 Frequently asked Questions about Herbal Medicine
 Herbs Vs Pharmaceuticals.

Herbs versus Pharmaceuticals
The most obvious difference is in the evaluation of the product itself.
active ingredient
known uncertain
pharmaceutical product Herbal Product

The most obvious difference is in the evaluation of the product itself
active ingredient
pharmaceutical product Herbal Product
Strict measures high quality Uncertainty ( non Standardized)
Quality criteria and standardization of phytopharmaceuticals: Can acceptable drug standards be achieved?
Drug Inf J 1998;32:101-10.

even in countries where the preparation of herbal products is strictly regulated,
there is no guarantee that the amount of active ingredients in different batches is
equal or even similar.
Gardner 326 Rev Psychiatr Neurosci 2002;27(5) Evidence-based decisions about herbal products J Psychiatry
Neurosci 2002;27(5) 327

Road Map
 The most commonly used herbal supplements for mental health

How to deal with the uncertainty of
the Herbal Product?
The widely recognized JAMA series Users’ Guides to the Medical
Literature describes how to handle a broad range of situations of
uncertainty including questions of:
• Effectiveness
• Harm (drug interactions, adverse effects)
• Prognosis
• Diagnosis
Users’ guides to the medical literature: A manual for evidence-based clinical practice. Chicago:
American Medical Association; 2002.

Factors affecting activity level and effectiveness of a
herbal product
Differences in product formulation and
dosage preparation (e.g., teas,
tinctures, extracts, dried roots,
capsules)
Preparation process (e.g., variations in
the extraction procedure)
Standardized dose
Parts of the plant
Timing of the harvest
Drying
Storage conditions
Can acceptable drug standards be achieved? Drug Inf J 1998;32:101-10.
A study should fully describe
Genus
Species
Parts of the plant used
Name and manufacturer if a
commercial product was used
All tests conducted to identify the
product’s constituents

A set of guiding questions that leads the reader through the most important issues to
be considered when evaluating and applying research to an individual patient.
J Psychiatry Neurosci 2002;27(5) 327

Blinding
 Strong convictions (for and against) held by the public and
health care providers about herbal products
Subjectivity in rating clinical symptoms and level of
disability associated with mental disorders
blinding is imperative for an accurate and
unconfounded evaluation of the clinical effect of
hytopharmaceuticals.

Blinding
Nature of herbal products
Difficult to effectively Blind participants and researchers
Source of bias.
In a trial involving 2 groups, an accuracy rate approaching 50% indicates that
blinding worked.
Problems and designs. Arzneimittelforschung 1995; 45:88-92.

Current Interventions For
Mental Health Problems

Role of Herbal Medicine
in Mental Health
• Persons with mental health problems, who compared with the general population
report a much greater use of alternative treatments, including herbal and
homeopathic remedies.
• These remedies when used to treat psychiatric symptoms may produce changes in
mood, thinking, or behavior, and they may interact with a number of conventional
medications.
- J Clin Psychiatry 2000; 61:815–820.
- Alternative therapy use by psychiatric outpatients. J Nerv Ment Dis 1999; 187:692–695

Role of Herbal Medicine
in Mental Health
It has been reported that most patients with a mental disorder sought herbal
medicine treatment for somatic problems rather than for their mental and
emotional symptoms and the best example is somatic symptoms of depression.

Why should Nutritionists care??

Road Map

The most commonly used Herbal supplements
for mental health

St. John’s wort
(Hypericum perforatum L)
Efficacy of hypericum one of the hypothesized
active ingredients in St. John’s Wort in the
treatment of Depression has been supported
by more rigorous evidence than any other
herbal remedy
Herbal remedies in psychiatric practice. Arch Gen Psychiatry 1998; 55:1033–1044.

St. John’s wort
(Hypericum perforatum L)
Strength of recommendation (SOR) is level A for the evidence in support of St. John’s
Wort as an antidepressant.

Mechanism of action
The possible action of SJW stems in part from its hypericin and hypericin-like
constituents act on acetylcholinesterase by decreasing the
degradation rate of acetylcholine.
Sedative actions come from the hypericins, biflavones, and hyperforin. Other
reports demonstrate a serotonergic activity act as a weak serotonin-
reuptake inhibitor (SSRI) that leads to fewer side effects
St. John’s wort for depression: A systematic review. Arch Intern Med 2000; 160: 152–6.

Mechanism of action
The mechanisms for the antidepressant effects of St. John’s Wort are not fully
understood
 Suggested mechanisms:
- monoamine oxidase (MAO) inhibition,
- inhibition of serotonin receptor expression,
- serotonin reuptake inhibition,
- reduction of cytokine expression

Potential Uses
- Available evidence supports only its use for mild to moderate depression
- Severe depression
- Anxiety
- Sleep disorders
- A few randomized controlled studies show beneficial effects for treatment
of somatization disorder (similar to hypochondria) and seasonal affective
disorder
- It has also been tested (unsuccessfully) for use to relieve irritable bowel
syndrome

Potential Uses
 People with a history of good response to low-dose SSRIs but intolerable side
effects such as weight gain or sexual dysfunction, would be better candidates
for St. Johns wort.
the best candidates for St. John’s wort may be those with milder and more
acute forms of depression.
How to Use Herbs, Nutrients & Yoga in Mental Health CareW. W. Norton and Company, New York, 2009

Potential Uses
• Although many people use St. John’s wort as long-term treatment, there is little
evidence of long-term safety or efficacy.
• All of the clinical studies have been short (24-26 weeks at the most), and most
have been small.

The Debate
 Evidence of efficacy in mild to moderate depression has been reported in a
meta-analysis of 23 randomized trials with a total of 1757 outpatients, in which
extracts of St. John’s Wort
- Tested alone (20 of 23 trials)
- in combination with other herbs (3 of 23)
- tested against placebo (15 trials)
- tested against antidepressant drugs (8 trials).
An overview and meta-analysis of randomized clinical trials. BMJ 1996; 313:253–258

The Debate
The Mayo Clinic states that,
“St. John’s wort is effective in treating mild to moderate depression and is relatively
safe.It has been shown to be as effective as some prescription antidepressants and
with fewer side effects. Its drawback and the reason that Mayo gave it a yellow light
instead of a green is that it interacts with many medications and has caused serious
side effects.”
The Mayo Clinic Guide to Alternative Medicine 2011 (Time Home Entertainment, Inc., New York 2010)

The Debate
The National Center for Complementary and Alternative Medicine addressed St.
John’s wort in its October, 2012 Clinical Digest:
current evidence for using St. John’s wort for depression is not conclusive, and the herb
can have serious side effects. It is also important to note that in the United States, the
Food and Drug Administration has not approved its use as an over-the-counter or
prescription medicine for depression.
http://nccam.nih.gov/health/providers/digest/depression-science?nav=cd

Major Risks
The risks of serotonin syndrome in people already taking medication for
depression such as fluoxetine (Prozac) are significant.
Serotonin syndrome
a condition defined by tremor, muscle rigidity, fever or drop in body temperature,
confusion, increased blood pressure and heart rate, and coma.
Using St. John’s wort with MAOIs as isocarboxazid (Marplan)may also increase
the risk of severely increased blood pressure.

Major Risks
the risk of triggering cycling (speeding up the depression/mania cycle) in people
with bipolar illness is severe.

DOSAGE
Typical dose for mild to moderate depression:
900 mg per day standardized to contain 0.3% hypericin or hyperforin
and split in three dosages.
In the absence of a standardized formulation, dosages can only be
considered as approximations

Kava-kava
Alleviate anxiety symptoms
Has euphoric and muscle relaxant properties
 its effect on arousal and alertness appears to be
minimal.
 It is commonly used in Europe and North America
for its anxiolytic effects.
A randomized placebo controlled 25-week outpatient trial. Pharmacopsychiat 1997; 30:1

Efficacy
 Seven sources confirm the beneficial uses:
- Treatment of generalized anxiety
- Mild intoxicant and analgesic
- Depression
- Stress
- tension
- agitation
- agoraphobia, specific other phobias
- generalized anxiety disorder
- adjustment disorder
- menopausal symptoms
- and insomnia
The Cochrane Library, Issue 4, 2003. Chichester, UK: John Wiley & Sons, Ltd.
systematic review and meta-analysis. J Clin Psychopharmacol 2000; 20:84–90.

Efficacy
 gives an A rating for the use of kava for
anxiety, it affirms the studies finding the
efficacy of kava to be similar to
benzodiazepine drugs such as diazepam
(Valium) or the anxiolytic drug buspirone
(Buspar).
concerns about potential liver toxicity
are emphasized.
rates use of kava for insomnia and
stress, C

Efficacy
- benefits are “modest”
- There is no proof that kava is effective for treatment of severe anxiety
- No published studies have yet tested kava’s efficacy for panic disorders
But

Mechanisms of action
Kavapyrones are the major constituents of this herb and are responsible for its
pharmacologic activity.
The mechanisms of their anxiolytic effect are still unclear.
Theories
- influencing gammaaminobutyric acid (GABA) receptor binding
- kavapyrones are a reversible inhibitor of human platelet MAO
- inhibition of voltage-gated ion channels
Neuroscience 1997;91:345–351
Planta Med 1998; 64:504–506.

Major Risk
Kava is generally safe for short-term
Use of kava is not recommended to exceed three months
in rare cases cause catastrophic damage to the liver.
its use is very controversial, and the sources are split on whether it should ever
be recommended.
More research pinpointing risk factors could modify these recommendations,
since liver toxicity appears to be extremely rare

Major Risk
Kava is banned in Germany, Canada and Switzerland.
The FDA cautions:
Based on the 2002 FDA warning, kava is one of 12 supplements that Consumer
Reports advises that you should avoid.

Major Risk
Taking kava with other sedatives, or muscle relaxants can result in additive effects
up to and including coma.
Kava may have chemical properties similar to monoamine oxidase inhibitors
(MAOIs), and may be additive to the effects of MAOI antidepressants, such as
isocarboxazid (Marplan)
Kava should never be used with MAOIs

Major Risk
Kava has modest benefits in short-term studies of mild anxiety but considering
the risks of intoxication, the risk of abuse, and rarely severe adverse effects, the
authors do not recommend kava, until more compelling data on safety and
efficacy become available. Thus, adequate data are not available to show safety
and efficacy.
Weil, A., Spontaneous Happiness (Little, Brown and Company, New York 2011), at 117.

Dosage
no consensus on the optimal daily dose, and lack of a standardized extract makes
comparison impossible
Dosages suggestions range from 150 to 600 mg per day
 The more serious toxic reactions have been associated with high doses or
prolonged use of kava ( should not exceed 3 months ) and use of kava without
physician supervision
Mischoulon and Rosenbaum, op. cit., at 123-124

Valerian
Valerian (Valerian officinalis) is a root extract.
Valerian root preparations are used for their
sedative, anxiolytic, and antidepressant properties.
the best known herbal sedative.
The herb, a GABA agonist, is commonly used in the
treatment of sleeplessness and the management of
anxiety associated with muscle tension.
Arch Gen Psychiatry 1998; 55:1033–1044.

Efficacy
Valerian may be helpful for sleep disorders, but there is not enough evidence from
well-designed studies to confirm this.
Three of the eight sources discussing valerian decline to recommend its use for sleep
disorders, citing inadequate evidence.
A 2007 meta-analysis concluded that no rigorous studies had found any significant
effect of valerian on sleep.
In the sleep laboratory, the effects of valerian were not significantly different from
those of placebo.

Efficacy
Valerian may not be ideal for acute treatment of insomnia,
but some evidence and analysis suggests that it may be
effective in the promotion of natural sleep after several
weeks of use (2–4 weeks).
Since it appears relatively safe as long as drug interactions
are avoided, valerian may be a CAM support to help with
sleep even if it can’t cure chronic insomnia.
There is not enough scientific evidence to determine
whether valerian works for anxiety or for other conditions,
such as headaches, depression and sedation.
a Systematic Review and Meta-analysis,” American Journal of Medicine, 119(12):1005-1012 (2006)
(2013) (“Brown et al. II”)

Efficacy
SOR=C for the evidence in support of valerian as a somnolent and as anxiolytic
Further research is necessary to assess the effect of valerian in insomnia and anxiety
Phytother Res 2002; 16:650–654

Mechanisms of action
Valerian’s constituents include sesquiterpenes of the volatile oil (including valeric
acid), iridoids (valepotriates), alkaloids, furanofuran lignans, and free amino acids
such as GABA, tyrosine, arginine, and glutamine.
 The precise mechanisms of action are still unclear, though it has been suggested
that all of the active constituents act synergistically to produce a clinical response.
Research has also demonstrated modulation of GABA neurotransmission and
receptor function
Pharm Pharmacol 1999; 51:505–512
Am Fam Physician 2003; 67:1755–1758.

Adverse Effects
Mild side effects
- Gastrointestinal effects
- Headaches
- Dizziness
- Excitability
- Uneasiness
- Unsteadiness
- Low body temperature
- Tiredness the morning after its use
- A “hangover” from large doses
Pharmacopsychiatry 2000; 33:47–53.

Adverse Effects
Valerian Withdrawal may occur if the consumer stops using the
drug suddenly after long-term high-dose use, entailing confusion
and rapid heartbeat.
Valerian is classified by the FDA as "generally regarded as safe
Long-term use may result in insomnia.
Slight reductions in concentration and ability to perform
complicated thinking may occur for few hours after taking valerian.
Use caution if driving or operating heavy machinery

DRUG INTERACTIONS
Valerian may increase the amount of drowsiness brought on by other drugs or herbs.
Valerian not be taken with alcohol, tranquilizers or barbiturates.
Valerian interacts with anesthetics and so must be discontinued before surgery.

DOSAGE
 Natural Standard:
400 to 900 mg per day of aqueous or aqueous-ethanol extract,
corresponding to 1.5 to 3 g of the drug, taken 30 to 60 minutes before
going to bed.
 Mischoulon and Rosenbaum:
450 and 600 mg per day, presumably in pill or capsule form,
approximately two hours before bedtime.
 Tea form : 1.5 to 3 g of the roots steeped for 5 to 10 minutes in 150
mm of boiling water. (Not studied)
 Doses of 300-1,800 mg per day have been taken by mouth in
capsule form.

Ginkgo
An ancient Chinese herbal remedy that has been
shown to have significant neuroprotective effects,
confirmed by all sources.
Ginkgo is believed to be helpful in the treatment of
memory impairment caused by dementia.
Used to treat stress, fatigue, chronic cerebrovascular
insufficiency, and cerebral trauma, and to improve
endurance.
Arch Gen Psychiatry 1998; 55:1033–1044

Mechanism of action
 Partially understood
contain several Bioactive compounds:
- Flavonoids
- Terpenoids (ginkgolide, bilbobide),
- Organic acids.
Main effects appear to be related to its antioxidant properties, which require the
synergistic action of the principal constituents. These compounds act as free
radical scavengers.
JAMA 1997; 278:1327–1332.
Brain Res 1994; 635:125–129.

Efficacy
The researchers found that the use of GBE led to significant improvements in blood
and oxygen flow.
GBE has the ability to normalize the acetylcholine receptors in the hippocampus
area of the brain (the area most affected by Alzheimer disease) in aged animals.
GBE has also demonstrated the ability to increase cholinergic activity and to
provide improvements in other aspects of the Alzheimer disease
Paris: Elsevier; 1991.
Lancet 1992; 340: 1136-9

Efficacy
The most effective form of GBE is one that is standardized to a concentration of 24
percent Ginkgo flavoglycosides.
A study compared the effectiveness of the most common Alzheimer’s drugs, such
as donepezil and rivastigmine, to that of a Ginkgo extract called Egb 761.
The researchers determined that EGb761 was as effective as any of these
commonly prescribed drugs are in treating the symptoms of Alzheimer’s patients.
EGb 761 is the most commonly sold form of Gingko in Europe.
JAMA 1997; 278: 1327-32.
Phytomedicine 2003; l4 Suppl 10: 74-9

Efficacy
A study compared the effectiveness of the most common Alzheimer’s drugs, such
as donepezil and rivastigmine, to that of a Ginkgo extract called Egb 761.
The researchers determined that EGb761 was as effective as any of these
commonly prescribed drugs are in treating the symptoms of Alzheimer’s patients.
EGb 761 is the most commonly sold form of Gingko in Europe.
JAMA 1997; 278: 1327-32.
Phytomedicine 2003; l4 Suppl 10: 74-9

The Debate
Two recent major studies and a Cochrane review cast doubt on the validity of the
prior, smaller and shorter studies, and determined that in the aggregate the data
do not support the use of ginkgo in the prevention of Alzheimer’s disease.
The recent evidence is mostly negative, though the studies are still inconsistent.
Ginkgo has a mild effect in protecting against mild cognitive impairment/dementia,
it probably does not prevent it.
All sources except one remain optimistic for some ongoing neuroprotective role for
Ginkgo.

The Debate
While citing all of the recent negative data, Brown et al still summarize that
ginkgo, “has shown potential in ameliorating the effects of a variety of
symptoms and disorders.”
The Mayo Clinic is counted as a negative: it relies on the 2008 NCCAM-funded
study and the 2009 Cochran Collaboration meta-analysis to conclude
that:"Ginkgo doesn't reduce the risk of Alzheimer's or other dementias."
Mayo, like Brown et al., remains optimistic for an ongoing neuro-protective
role.
Psychiatric Clinics of North America, copyright Elsevier, Inc., Philadelphia (2013) (“Brown et al. II”) at 82.
The Mayo Clinic Guide to Alternative Medicine 2011

The Debate
Mayo gives ginkgo a yellow “caution” light.
“Although ginkgo is one of the best studied herbs, there is no convincing evidence
that it has any effect on memory or other mental functions in healthy older people
that is, it doesn't sharpen an already clear mind, help prevent what is considered
normal age-related memory loss, or delay or prevent dementia.”
The Mayo Clinic Guide to Alternative Medicine 2011
Berkeley (University of California) Wellness Reports – Dietary Supplements (2010 edition)

The Debate
THE 2012 GuidAge Study, complementing the NCCAM-FUNDED GINKGO
EVALUATION OF MEMORY (GEM) STUDY of the standardized ginkgo product,
EGb 761, found it INEFFECTIVE in lowering the overall incidence of dementia
and Alzheimer's disease in older people with normal cognition.
A Randomised Placebo-controlled Trial, The Lancet Neurology: 11(10):851-859 (2012).

Conclusion
Until a scientific and popular consensus emerges, ginkgo will continue to be
used as a neuro-protective CAM treatment for incipient dementia, in preventing
and treating memory impairment, lack of concentration, and cerebral-vascular
insufficiency, as well as age-related and dementia-related cognitive weaknesses.
Because of Ginkgo low cost and benign risk profile :there is no reason to stop
using it.

Potential Uses
Brown, et al. recommend the use of ginkgo for protection against the neural
damage caused by antipsychotics.
WHO and Germany list EGb 761 for the treatment of depression.
The Natural Standard states that “good” evidence demonstrates ginkgo's
efficacy in the treatment of "cerebral insufficiency" “B” category.
Brown, et al. recommend the use of ginkgo as an adjuctive treatment for
attention deficit and hyperactivity disorder (ADHD).
Brown et al. and Mischoulon and Rosenbaum recommend use of ginkgo as
adjunctive therapy (with antipsychotics) for schizophrenia

Adverse effects
Ginkgo, "has an excellent safety record; and except for the assumed possible risk of
hemorrhage in patients taking anticoagulants, having bleeding disorders, or about
to undergo surgery, EGb 761 appears to be very safe."
Relatively uncommon
- Headaches
- Gastrointestinal tract upset, nausea, vomiting
- Skin Allergy
Mischoulon and Rosenbaum, op. cit. at 186
Houghton P. Ginkgo. Pharm J 1994; 253:121–122.

Adverse effects
Caution is advisable if ginkgo is used with psychotropic drugs, especially antidepressants.
Ginkgo has anticoagulant effects, may suppress platelet aggregation, and in rare cases
has been associated with serious bleeding problems, and thus suggests that people with
clotting disorders who are receiving any anticoagulant therapy, such as warfarin
(Coumadin), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil)
or have scheduled surgery or dental procedures, should use caution if using ginkgo.

DOSAGE
Study dosage is standardized at between 40 and 240 mg per day of EGb 761.
Berkeley Wellness cautions that commonly available products may be different
than the preparations used in clinical studies.
EGb 761 is the only preparation of ginkgo that should be used.

Ginseng
 Derived from the root of Panax ginseng, both Chinese ginseng (Pginseng CA
Meyer) and North American ginseng (P quinquefolius L) are associated with
the treatment of:
- mood and anxiety disorders
- reduce stress
- fatigue and to improve endurance
Manic episode and ginseng: Report of a possible case. J Clin Psychopharmacol 1995; 15:447–448.

Efficacy
A systematic review of 16 double-blind randomized controlled trials found that
ginseng did not improve cognitive function or psychomotor and physical
performance.
The efficacy of ginseng. A systematic review of randomised clinical trials. Eur J Clin Pharmacol 1999; 55:567–575.

Efficacy
Another review reported conflicting results from several studies:
• 1 double-blind randomized controlled trial of postmenopausal women who
received either a placebo or ginseng for 16 weeks revealed the superiority of
ginseng on measures of psychological well-being.
• Another double-blind randomized controlled trial, however, failed to find an
effect of ginseng on positive affect, negative affect, or total mood disturbance in
83 healthy adults who took the herb for 8 weeks.
- Am Fam Physician 2003; 68:1539–1542
- A double-blind, placebo-controlled trial. Swedish Alternative Medicine Group. Int J Clin Pharmacol Res 1999; 19:89–99.

Efficacy
At best, SOR=B for the evidence in support of ginseng, but only at best in relation
to psychological wellbeing.
Results of a double-blind, placebo-controlled, randomized clinical trial. J Am Diet Assoc 2001; 101:655–
660.

Mechanism of Action
The key active components of Panax ginseng
are ginsenosides, a group of steroidal
saponins that target a multitude of tissues to
produce pharmacologic responses.
 The overall pharmacology of ginseng is
complex due to the ability of ginsenosides to
initiate multiple actions in the same tissue.
Biochem Pharmacol 1999; 58:1685–1693

Adverse Reaction
- insomnia
- hypertension
- diarrhea
- restlessness
- anxiety
- euphoria
- There is at least 1 report of ginseng-induced mania, which occurred within 4 to 10
days of a patient’s interrupting a lithium and amitriptyline treatment.
Manic episode and ginseng: Report of a possible case. J Clin Psychopharmacol 1995; 15:447–448

Evening primrose
 Evening primrose (Oenothera biennis L) is a plant native
to North America.
 The oil pressed from its seed is marketed as a nutritional
supplement, and it has been used to treat many
disorders, including
- Premenstrual syndrome (PMS)
- Premenstrual dysphoric disorder (PMDD)
both which are marked by affective disturbances.
- Journal of Nursing and Midwifery Sciences 2015: 2(1): 20-26

Efficacy
A systematic review of the efficacy of evening primrose oil in the treatment of
PMS revealed few clinical trials of adequate methodology.
The authors found only 2 well-controlled studies, both which failed to show
beneficial effects for the herb.
At best, SOR=C for the evidence in support of evening primrose.
Controlled Clinical Trials 1996; 17:60–68

Efficacy
Gamma linolenic acid, a precursor of prostaglandin E and several other active
substances, is the main constituent responsible for the therapeutic effects of
evening primrose.
BMJ 1994; 309:824–825

Adverse Effects
Generally safe
Has occasionally exacerbated the symptoms of epilepsy.
 Other adverse effects:
- Nausea
- Softening of the stool
- Headache.
BMJ 1994; 309:824–825

Feverfew and Migraine
There is significant comorbidity of migraine with mood and
anxiety disorders.
Three out of four double blind, placebo-controlled trials
found that feverfew reduces the frequency and severity of
migraines and the associated nausea and vomiting.
the Canadian Regulatory Commission will only certify
whole leaf extract of feverfew as an effective medication.
Altern Med Rev 2001; 6: 488-94

Feverfew and Migraine
Caution:
- Feverfew can affect bleeding time and should not be used with warfarin.
- Feverfew should be discontinued 2–3 weeks prior to surgery.
Altern Med Rev 2001; 6: 488-94.

Lavendula angustifolium (lavender)
Lavender is used principally as an aromatic essential oil for relaxation.
In a single-blind randomized control trial, 80 women who took daily baths
with lavender oil experienced improved mood, reduced aggression, and a
more positive outlook.
Altern Complement Med. 2005;11(4):631-637.

Lavendula angustifolium (lavender)
The combination of lavender (60 drops/day of a lavandula tincture) and
imipramine (100 mg/day) was found to be more effective in the treatment of
depression than either treatment alone, according to a double blind randomized
control trial.
The findings of this study suggested that taking a moderate amount of lavender
might help reduce the amount of tricyclic antidepressants needed to treat
depression, leading to fewer side effects.
Prog Neuropsychopharmacol Biol Psychiatry. 2003;27(1):123-127

Crocus Sativus (Saffron)
The world’s most expensive spice and apart from its
traditional value as a food additive, recent studies
indicate its potential as an anti-cancer agent and
memory enhancer.
Saffron is used for depression in Persian traditional
medicine.
The clinical findings suggest that saffron is a safe and
effective antidepressant.
Exp Biol Med 2002; 227: 20-5.
Iran J Psychiatry 1:1, Winter 2006
Phytotherapy Res 2005; 19: 25-9

Rosemary Oil
Rosmarinus officinalis leaf has been traditionally indicated for depressive states
with general debility and chronic circulatory weakness, particularly in the elderly.
 Rosemary leaf can also stimulate the mind, memory and the senses.
Rosemary oil is regarded as a great tonic for the central nervous system,
strengthening mental clarity and improving memory.
Beaconsfield, 1988.
Bath, 1981.
Int J Neurosci 1998; 96: 217

Chamomile (M. recutita)
Two systematic reviews found evidence for herbal supplements containing
chamomilenin the treatment of Anxiety.
Research on this herb is limited.
Low in side effects.
A member of the ragweed family so it can trigger allergic reactions.
Eur Neuropsychopharmacol 2011;21(12):841–60.
Can J Physiol Pharmacol 2007;85(9):933–42.
J Clin Psychopharmacol 2009;29(4):378–82.

Royal Jelly
RJ has a stimulating, activating effects on the central nervous system, CNS and also on
the vegetative NS
RJ has been traditionally known to:
- Improve memory
- Prevent senility
- Increase energy,
- Reduce anxiety
- Calm hyperactive subjects.
Ed Fiat Lux, 2005

Royal Jelly
FURUKAWA, S (2008) Foods and Food Ingredients J.Jpn 213
Annales pharmaceutiques francaises 15 (6): 383-393.
 Recent investigations clarified a relationship between the neurogenesis in the
dentate gyrus of the hippocampus and the symptoms of depression, expecting
efficient use of royal jelly to activate neurogenesis.
 Reduction of neuronal death and an increase of neurogenesis in Alzheimer's
disease and Parkinson's diseases may be also supported by royal jelly, although
a detailed animal experiment is necessary

Take Home messages
 Physicians need to understand the biochemical and evidential bases for the
use of herbs to diagnose and treat patients safely and effectively to:
• Avoid interactions with standard medications,
• Provide patients with the benefits of alternative treatments.
• Integrate the findings for decision making.
 The Clinician should take a careful history of the patient’s use of herbs and
other supplements.
 Natural is not necessarily safe: Attention should be paid to quality of product,
dosage, and potential adverse effects, including interactions.

Take Home messages
 St. John’s wort (Hypericum perforatum) for mild to moderate depression.
 Support for evening primrose is primarily Anecdotal.
 The risk of serious side effects with kava far outweighs its mild anxiolytic effect.
 Data confirming valerian’s effects as a somnolent and anxiolytic are minimal.
 Ginkgo has shown promise in improving cognitive function in dementia, and its
side effects are few and uncommon

Take Home messages
 SOR=B for the evidence in support of ginseng but only at best in relation to
psychological wellbeing.
 Royal gel and mental health is a rich area to investigate.
 Feverfew, lavender oil, Saffron, Rosemary Oil, Chamomile needs further
research for proving their effect on mental health.

Brainy herbs: Facts Versus Fiction. 6th EASHTN Conference – 16, March, 2017

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Brainy herbs: Facts Versus Fiction. 6th EASHTN Conference – 16, March, 2017