Psych Meds and Herbal Remedies: How Are They Compatible? l

With the prevalence of psychiatric medications today, these represent a major issue for people who use or consider using herbal remedies. This issue — interactions of prescription medications with herbal medicines — has drawn much concern of late.

One of the “grandfathers” of psychopharmacology, Dr. Frank Ayd, has written on this topic for the Psychiatric Times (“Evaluating Interactions Between Herbal and Psychoactive Medications,” December 2000; 45-47). Though he has written for an audience of psychiatrists and other clinicians, his review offers a good starting point for the public — with a little translation!

Dr. Ayd notes that throughout the world, over 80 percent of people use herbal medicines; only 33 percent of Americans use these — still a large proportion of the population.

He discusses some herbals widely used in this country: Ephedra sinica (Ephedra); Ginkgo biloba (Ginkgo); Panax ginseng and its American relative, Panax quinquefolius (Ginseng); Paillinia cupano (Guarana); Humulus lupulus (Hops); Piper methysticum (Kava-kava); Myristica fragrans (Nutmeg); Hypericum perforatum (St. John’s Wort); Valeriana officalis (Valerian); and Pausinystalia yohimbe (Yohimbine). As he warns us in advance, data on interactions with these herbals is quite limited, so that we must rely on minimal information for our current assessment of risk.

Ephedra is a stimulant. It can also be used to suppress appetite and to increase the size of lung air passages (for example, in asthma). Any other stimulant taken with it — even caffeine — may result in excessive stimulation. It also risks dangerous rises of blood pressure if combined with the type of antidepressants called monoamine oxidase inhibitors (MAOIs), such as Nardil (phenelzine) and Parnate (tranylcypromine). Ephedra may come under other guises, such as the preparation called mahuang.

Ginkgo has especially common usage in this country, for problems with memory or circulation. It has also been used for dementia (such as Alzheimer’s disease), dizziness and ringing in the ears. The relatively common side effect of sexual dysfunction on newer specific serotonin reuptake inhibitors (SSRIs) like Prozac, Paxil, Zoloft, Luvox and Celexa, may benefit from ginkgo. There is scarcely any evidence bearing on its safety or lack thereof in such combinations, though bleeding inside the head has been reported in association with ginkgo use alone and in combination with caffeine.

Ginseng, Dr. Ayd notes, comes from various world sources, predominantly American vs. Siberian, which contain different ingredients. It is used as a stimulant, aphrodisiac and enhancer of endurance and stress resistance. It increases the elimination of alcohol from the body and therefore may reduce alcohol effects. When combined with antidepressants, it may cause excessive mood-elevating effects, termed mania; it may cause particular problems when combined with the MAOI antidepressants. It may also increase the effects of stimulants like caffeine.

Guarana, used as a stimulant, may interfere with elimination of lithium and thereby raise lithium blood levels, risking lithium toxicity.

Hops, used as a sleeping aid and anti-anxiety herbal, can increase the effects of other sleeping pills and sedative anti-anxiety medications, while decreasing the effects of antidepressants.

Kava-kava, another herbal anti-anxiety agent, might increase alcohol effects, though there is conflicting evidence on this point. One instance of coma occurred from combining kava-kava with the anti-anxiety medication Xanax (alprazolam), and there is concern for similar increase in sedative effects of combining kava-kava with other benzodiazepine anti-anxiety medications (such as Ativan, Valium, Klonopin, etc.). It may also cause over-sedation in combination with Tagamet (cimetidine) and may increase symptoms of Parkinson’s syndrome being treated with L-dopa (Sinemet).

to be continued…

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