Herbs for mental illness: Effectiveness and interaction with conventional medicines

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Applied Evidence

Herbs for mental illness: Effectiveness and interaction with conventional medicines

J Fam Pract. 2005 September;54(9):789-800

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References

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One of the most frequent scenarios encountered by the naturopath is the patient who is taking a psychotropic medication and wants to explore natural solutions to reduce the drug’s unpleasant side effects or to enhance general well being. Sharing information is the key to a healthy treatment regimen for such individuals (TABLES 3 AND 4). The patient should inform both the physician and naturopath about health care decisions, the naturopath must encourage the patient to be candid with the physician about proposed treatments, and the physician can be helpful by communicating to the naturopath the extent of the patient’s disorder.

FAST TRACK

Several well-referenced Internet sites describe the actions/costs of herbal products

Professionally, one must consider before asking a patient to discontinue one agent or the other whether the alternative treatment might be improving the patient’s condition or reducing negative side effects caused by the psychotropic medication. On one hand, withdrawing the drug can destabilize the patient’s condition, which may not be rapidly amenable to a botanical or nutritional treatment. Alternatively, to supplement an antidepressant, benzodiazepine, or antipsychotic regimen by adding an herbal preparation could lead to unpredictable interactions and unpleasant or even dangerous symptoms. For many cases of mild depression or mild anxiety disorder, natural therapies can be sufficient treatment. However, for more complicated cases, where little is known about the consequences of using alternative treatments, involvement by a clinician with more specialized training is recommended.

TABLE 3
Recommendations for clinicians

Ask your patients if they are using natural health products or seeing a natural health practitioner. Recognize that they may be covertly self-medicating with herbal or alternative treatments. Better-studied alternative treatments should be substituted.
Create an environment where patients are not reluctant to disclose the use of natural health care.
If the patient is seeing a naturopathic doctor, obtain contact information so that the specifics of the therapy can be requested.
Communicate directly with the naturopathic clinician about changes in treatment choices that are taking place in the ongoing care of the patient. This may often include sending consultation letters and other information to all individuals involved in the treatment of the patient.
Acquire good reference materials on natural health products. Suggestions: Natural Alternatives to Prozac by Michael T. Murray, ND, and The Textbook of Natural Medicine by Joseph Pizzorno, ND and Michael T. Murray, ND.
Never underestimate the potential risk of possible chemical interactions between medications.
Make contact with a community naturopathic doctor who can answer questions about specific natural health products.

TABLE 4
Internet resources about herbal products

The Natural Pharmacist ($) www.tnp.com
Evidence-based content developed and reviewed byphysicians and pharmacologists; sections on herbs and supplements, health conditions, and drug interactions; information referenced
Natural Medicines Comprehensive Database ($) www.naturaldatabase.com
Well-referenced, comprehensive database
Complementary and Alternative Therapies (Bandolier) www.jr2.ox.ac.uk/bandolier/booth/booths/altmed.html Evidence-based content; abstracts of systematic reviews, meta-analyses, or other studies about herbal therapies
National Center for Complementary and Alternative Medicine www.nlm.nih.gov/nccam/camonpubmed.html
Access to PubMed’s CAM database
HerbMed www.herbmed.org
Access to scientific evidence about the use of herbs for health $ = paid subscription required; all websites accessed April 5, 2005. Table adapted from Gardener.¹⁰²

CORRESPONDING AUTHOR
Martin A. Katzman, BSc, MD, FRCPC, Stress, Trauma, Anxiety, Rehabilitation Treatment (S.T.A.R.T.) Clinic for Mood & Anxiety Disorders, 790 Bay Street, Toronto, Ontario, Canada M5G 1N8. E-mail: mkatzman@startclinic.ca