Class I Evidence: Herbs with at least one properly designed, randomized controlled trial.
|Common/Chinese Names(Botanical Name)||Safety Rating||Drug Interactions||CONTRA & Warnings||MH Support|
|1*Borage (Echium amoenum) Supportive||Very safe||None Identified||None Identified||Weak|
Comments from MHs: This herb contains Pyrrolizidine alkaloids in the leaf and therefore increases the possibility of liver damage; the herbalists emphasize that this is not likely to occur but clinicians should be aware of this.
Recommended Dose: 1-3drops of tincture 1-3 times daily (Wood, 1993).
|1*Brahmi (Bacopa monniera) Anxiolytic||Very Safe||None Identified||None Identified||Weak|
Comments from MHs: None
Recommended Dose: 5-13 ml of 1:2 liquid extract per day; 35-90 ml of 1:2 liquid extract per week (Bone, 2003).
|1*Chamomile (Matricaria recutita) Anxiolytic||Very Safe||None Identified||None Identified||Very Strong|
Comments from MHs: In addition to noting this herb’s high level of safety, one herbalist noted that patients using it concurrently with heavy doses of anti-inflammatory medications or blood thinners should do so with care as this herb may increase these effects.
Recommended Dose: 3-6 ml of 1:2 high-grade liquid extract per day; 20-40 ml of 1:2 high-grade liquid extract per week (Bone, 2003).
|1*Ginkgo(Ginkgo biloba) Supportive||Generally Safe||MAOI’s such as: Zelapar,Marplan, Pernate, Eldepryl Emsam and Nardil.||Not for use in pregnancy, or if bipolar as it can cause mania. Not for long-term use and seeds should not be ingested.||Weak|
Comments from MHs: Ginkgo has a blood thinning effect and must be used with caution in patients on blood thinners such as Warfarin and Heparin (5). Because of this, Ginkgo is contraindicated in patients pre-and post-surgery (2). Also, Ginkgo may modify the CYP2D6 pathway and any medications metabolized by this pathway may be effected. A minority of MHs feel that Gingko has little relevance in treating depression; or that its use should be limited to the elderly suffering from depression. It is viewed primarily as a blood thinner and cerebral circulatory stimulant. It was also reported that Gingko can cause severe headaches in some people.
Additionally, although the seeds should not be consumed one herbalist noted that if the outer skin is removed it is considered food in Chinese medicine.
Recommended Dose: 3-4 ml of the standardized (2:1) liquid extract per day; 21-28 ml of the standardized (1:2) liquid extract per week (Bone, 2003).
|10+ *Kava (Piper methysticum)Anxiolytic||Generally Safe||Benzodiazepines such as: Prosom, Alprazolam,Intensol, Doral, Niravam, Diazepam Intensol, Xanax XR, Tranxene, Librium, Klonpin Wafer,Xanax, Serax, Valium,Klonopin, Dalmane,Diastat, Halcion, Ativan,Lorazepam Intensol,Restoril, Tranxene SD,Tranxene T-Tab, Versed,Onfi, Diastat Acu-Dialand Diastat Pediatric. Antidepressants such as:Paxel, Lexapro, Celexa,Prozac, Zoloft, Pexeva, Luvox CR, Sarafem,Brisdelle, Selfemra and Rapiflux.||Liver disease, pregnancy, and current or recovered alcoholics are contraindicated.||Strong|
Comments from MHs: This herb can affect CYP450 enzymes and the metabolism of drugs through these pathways. Precaution should be taken if used when patient is also taking multiple medications which can affect liver functioning or in patients with poor or declining kidney functioning (2). Kava can also interact with alcoholic beverages and can increase the likelihood of accidents and other issues related to the use of alcohol. In addition to those medications listed above, one herbalist reported that Kava interacts with Synthroid and Levoxyl. One herbalist reported that Kava can be used to help patients decrease their use of benzodiazepines if it is used cautiously and at the lowest doses possible; however, it was also noted that doing so can cause feelings of fatigue in the patient. It is recommended that Kava be used sparingly and not over long periods of time (2) as it was reported that frequent large doses can be habit forming and cause extreme apathy and scaly skin. It was also recommended that patients be educated on the use and interactions of Kava as to reduce the possibility of a nocebo effect.
Recommended Dose: 3.0-8.5 ml of 1:2 liquid extract per day; 20-60 ml of 1:2 liquid extract per week (Bone, 2003). Extracts providing quantified levels of kava lactones are recommended. Ideally, aqueous ethanol extracts should contain not less than 20 mg/ml of kava lactones (Gardner & McGuffin, 2013).
|4*Lemonbalm (Melissa officinalis) Anxiolytic||Very Safe||None Identified||None Identified||Very Strong|
Comments from MHs: None.
Recommended Dose: 3-6 ml of 1:2 liquid extract per day; 20-40 ml of 1:2 liquid extract per week (Bone, 2003).
|*Mimosa (Albizia julibrissin) Anxiolytic||Generally Safe||None Identified||None Identified||Weak|
Comments from MHs:None.
Recommended Dose: 40-80 drops of 1:5 tincture, up to three times a day (Winston & Maimes, 2007).
|1+*Passionflower (Passiflora spp.)Anxiolytic||Generally Safe||None Identified||None Identified||Very Strong|
Comments from MHs: This herb is also a sedative and one should be mindful of using it with other sleep medications.
Recommended Dose: : 3-6 ml of 1:2 liquid extract per day; 20-40 ml of 1:2 liquid extract per week (Bone, 2003).
|1Roseroot (Rhodiola rosea)Supportive||Generally Safe||MAOI’s such as: Zelapar,Marplan, Pernate,Eldepryl, Emsam and Nardil.||None Identified||Weak|
Comments from MHs: This herb can cause insomnia in a significance number people, heart palpitation in some people, and can provoke mania in people who have bipolar disorder. Additionally, if this herb is used for its energizing effects—instead of the patient getting the requisite sleep needed to be well—it can support behaviors that lead to exhaustion.
Recommended Dose: : : 2 to 5 ml daily if 1:1 extract is used and as part of a formula (Yance, 2013).
|1*Valerian(Valeriana spp.)Anxiolytic||Generally Safe||Acetaminophen,Estrodial, Morphine,Testosterone, and Benzodiazepines such as:Prosom, Alprazolam Intensol, Doral, Niravam, Diazepam Intensol, Xanax XR, Tranxene, Librium, Klonpin Wafer, Xanax, Serax, Valium, Klonopin, Dalmane,Diastat, Halcion, Ativan, Lorazepam Intensol, Restoril, Tranxene SD, Tranxene T-Tab, Versed, Onfi, Diastat Acu-Dial and Diastat Pediatric. Barbiturates and in general other sedatives.||None Identified||Very Strong|
Comments from MHs: This herb has an additive effect with benzodiazepines and has been used in combination in cases of insomnia with no negative effects reported. MHs report that Valerian can be used to help patients decrease their use of benzodiazepines as well, but warn that this combination will likely cause drowsiness during the day and should be done cautiously.
It was reported that large doses can cause significant grogginess upon waking from sleep and should not be mixed with alcoholic beverages. Some patients also have reported dark and disturbing dreams when using Valerian. Additionally, a small number of patients using Valerian become hyperactive instead of sedated.
Recommended Dose: 2-6 ml of 1:2 liquid extract per day; 15-40 ml of 1:2 liquid extract per week (Bone, 2003).
Note: Superscript Anxiety following name of herb = Primary action of the herb. Subscript1 prior to the name of the herb indicates the number of RCTs indicating significant positive results in treating or complementing the treatment of anxiety. *= indicates herbs with pharmacological, in vivo, or in vitro evidence. Parenthesis surrounding a number, such as (3), indicates the number of master herbalists contributing the statement preceding it.