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Herbal Supplements: Mental Health

Many vitamin and herbal supplements conceivably could have a positive impact on symptoms of anxiety and depression. Information about mental health conditions and related products is available and useful is the content in The Natural Pharmacy Health Encyclopedia co-hosted by iHerb.com.

Especially evident in mental health applications is the growing research evidence for the usefulness of St. John's wort (hypericum perforatum) and 5-HTP (5-Hydroxytryptophan) for relief of symptoms including mild to moderate depression and anxiety. The focus in the mental health section of the PJ-Herbal Clinic will be on those two supplements.


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St. John's wort
(hypericum perforatum)
5-HTP
(5-Hydroxytryptophan)
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St. John's wort

Research studies.  St. John's wort, probably the most widely publicized of the herbal supplements for mental health, has strong support in the research literature. An article by Dr. Michael Murray found more than two dozen studies in which the herb was used with depression symptoms with overall consensus of effectiveness in treating mild to moderate symptoms.

The only apparent controversy regarding the effectiveness of this supplement is in whether it is also effective in treatment of symptoms of major depression. A study completed in 2001 and widely quoted in the popular press concluded that the herb was not effective for treatment of major depression. The authors acknowledged difference in their findings from those in prior research but suggested that most of the other studies had significant flaws in the research designs. A panel convened to review the results, however, reconfirmed St. John's wort as safe and beneficial for mild to moderate depression, stress and anxiety. They emphasized caution in generalizing from subject pools limited to participants with major depressive disorders.

In context, as a researcher, I would further note that some controversy in interpretation of clinical studies is not unusual, and certainly not limited to studies with St. John's wort. In fact, while the authors in the JAMA article raised questions about the methodology in prior studies, some questions about their own research design were evident in an analysis of their study that I prepared for my students in a graduate research methods course.

Target Symptoms and Dosage.   Symptoms of depression and anxiety are the primary target symptoms for this herbal supplement. The standard dosage recommendation is 300 mg 3 times a day using an extract standardized to contain 0.3% hypericin. A few weeks of usage is typically required before a difference in symptoms will be evident.

Side Effects and Contraindications.  Even critics report that St. John's wort appears to be safe and well-tolerated by most of the population. That is certainly consistent with my personal experience with this supplement. A small percentage of individuals have reported mild stomach discomfort, a rash, feeling tired, feeling restless.

A primary caution involves possible interaction with prescribed psychotropics you are already taking. Consulting the prescribing physician is a crucial factor before either substituting or adding the St. John's wort supplement to current medication. Persons with bipolar disorder should be especially cautious with possibility that increased serotonin from the herbal supplement could trigger a manic episode.

Summary.  All things considered, St. John's wort appears a remarkably safe supplement for most adults with relatively small risk of unwanted side effects and remarkably high probability of some degree of symptom remission. At the time of this writing, no deaths due to St. John's wort toxicity have been reported which, unfortunately, is not the case for some synthetic antidepressants. While targeted for depression and anxiety symptoms, one could also reasonably anticipate that the supplement could be helpful for other problems in which an underlying depression or anxiety was contributing to the behavioral symptoms.


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5-HTP

Research studies.   5-HTP is an amino acid that appears to increase the cellís output of serotonin. It is derived from the seeds of a West African medicinal plan, the Griffonia simplicifolia. Although not as widely researched as St. John's wort, the available research with 5-HTP (5-Hydroxytryptophan) is quite promising. Comparable symptom relief was usually reported when compared to standard psychotropics but with fewer negative side effects. A summary of 5-HTP study outcomes is provided in the The Natural Pharmacy Health Encyclopedia, (click Herbs & Supplements, then scroll down to 5-HTP).

Target Symptoms and Dosage.   A particularly comprehensive online review of 5-HTP has been provided by Ray Sahelian, M.D.. Dr. Sahelian recommends starting on a very low dosage, 10 to 25 mg a couple of times a day before a meal and 25 mg at bedtime. He also recommends periodically alternating use of 5-HTP with other supplements or medications to avoid developing a tolerance. Dr. Michael Murray also provides a great deal of valuable information about this supplement and suggests starting 5-HTP at a low dosage, 50 mg, three times per day, and increasing to 100 mg if the response is inadequate.

Both Drs. Murray and Sahelian suggest that 5-HTP can be taken in conjunction with St. John's wort. If combined, low dosages of each would be recommended, perhaps 50-100 mg of 5-HTP and 150-300 mg of St. John's wort, three times daily.

Side Effects and Contraindications.  When used at appropriate dosage levels, side effects of 5-HTP appear to be minimal. The side effect most often reported is mild symptoms of nausea during the first few weeks of 5-HTP use.

A primary caution is to avoid use of 5-HTP with prescribed medications which increase serotonin levels (e.g. Prozac, Zoloft, Paxil, etc.) unless the use is being directly monitored by your physician. There would be risk of serotonin "overload". 5-HTP would probably not be a good choice for persons with bipolar disorder, whether or not other medications are being used, with risk of triggering a manic episode.

You will also want to be especially cautious in selection of your source for 5-HTP. The U.S. Food and Drug Administration found a dangerous contaminant known as "peak X" in some 5-HTP products.

Summary.  Considering all available information, the increased availability of serontonin with use of the 5-HTP supplement could have a positive effect on a variety of symptoms of distress. Like (or along with) St. John's wort, a reduction in symptoms of depression and anxiety could be anticipated, along with relief of other behavioral symptoms in which anxiety or depression was a contributing factor. Several studies suggest that 5-HTP may be especially helpful with appetite control.

A good rule of thumb for this (and probably all supplements) is to be extremely cautious in combining with prescribed medications. The prescribing physician should be involved in any decision about adding or substituting the 5-HTP supplement if you are now taking a prescribed psychotropic medication.


Statements made, or products recommended through this web site, have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.


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