Herbal medicine used for anxiety and depression is becoming more common. One study of two hundred and sixty patients with depression showed that up to fifty per cent had tried some form of natural medicine.[1]
Another study from the USA found that forty per cent of people with moderate depression and anxiety had tried some form of natural medicine, including herbal medicine.[2]
Statistics from the Hong Kong mental health review report from 2017 put these numbers into context. The report demonstrated that one in seven people in Hong Kong would experience a typical mental health episode in their life.[3] Anxiety and depression are the most common in Hong Kong.[4]
Seventy-four per cent of mental health sufferers don’t seek professional help.[5]
Furthermore, a survey conducted in Iran articulated some common reasons why this is the case. These reasons include, but aren’t limited to, unwanted side effects from drugs, feeling unsatisfied with conventional treatments, and a suboptimal therapeutic relationship with their primary practitioner.[6]
And statistics like this have led me to write this article.
Herbal medicine has some great scope in treating anxiety and depression. However, it does have its limitations and can also interact with other medications you’re taking.
On reflection, I’ve seen the best results when psychiatrists and natural medicine practitioners work together. Especially when it comes to herbal medicine for anxiety and depression. Neither party is a specialist in the other’s field, so the pairing is patient-centred and effective. However, both parties are responsible for being aware of the other’s areas for things to work well.
This reluctance to seek professional help leads me to make this statement so you can get the best results.
The herbs mentioned in this article have some excellent preliminary research behind them. The effects in the studies very much reflect what I see clinically. But, and this is a big but, no matter how good they sound, please don’t cease your prescribed medication. This cessation can be discussed with your prescribing practitioner at the very least and can be dealt with appropriately.
A fair share of readers might see this as me protecting myself. However, it’s more about your protection. Many herbal medicines for anxiety and depression, including some of the ones discussed in this article, work on the same pathways as your prescribed pharmaceutical drugs. This shared pathway can make interactions between herbs and pharmacy quite intense!
I think I’ve made my point. Let’s get started by looking at one of the most popular and well-known herbs in Lavender.
Lavender has substantial results in helping generalised anxiety disorder.
You can find patented versions of herbs under different names in research studies. In the case of Lavender, the name of the patented form is Silexan.
One of the landmark studies that put Silexan on the map was a multicentre, double-blind, randomised (that’s almost the best you can get) study published in 2010. This study compared Silexan to a pharmaceutical drug for anxiety called lorazepam.
Compared over six weeks, the lavender preparation, Silexan, decreased anxiety scores on the well-known Hamilton Anxiety Rating Scale, similar to the lorazepam.[7]
The scores encompassed both somatic anxiety (seen as a more physical experience) and psychic anxiety (more “in your head”).[8] If you are new to these terms, somatic anxiety feels more physical. Symptoms include abdominal pain, indigestion, chest pain, fatigue, dizziness, insomnia and headache.[9] Psychic or cognitive anxiety is as it sounds. Symptoms are more mental, with negative anticipatory thoughts, depression, and attention deficits among some common presentations.[10]
These forms of anxiety improved with the Silaxen over the six weeks.
The most promising part of this study is the lack of side effects and safety of the Silaxen. As well as these positives, the lavender formulation was not sedating or habit-forming.[11] Two things that I know a lot of patients are concerned about—especially those in the financial hubs like Hong Kong, London and Singapore.
As with the next herb, St John’s Wort, Lavender, either as Silaxen or in its whole herb form, interacts with other sedatives. Especially pharmaceutical ones. So please consult your healthcare practitioner to make sure.
St John’s Wort can be very effective for mild to moderate depression.[12]
Interestingly, St John’s Wort has become more famous for its anti-viral role over the last five to ten years.[13]Especially in conditions such as Influenza A.[14]
Studies dating back to the late nineties through 2019 have shown positive results for St John’s Wort in mild to moderate depression but not so much for major depression.[15] A good example, I think, of one of the limitations of natural medicine in mental health.
A meta-analysis compared St John’s (most naturopaths I know shorten it to this, so welcome to the club!) and SSRI drugs (common antidepressants) in mild to moderate depression. They reviewed twenty-seven trials pooling just under four thousand people. The St John’s Wort preparations were comparable to the SSRIs, but no evidence was present for severe or major depression.[16]
It also seems that the potency of St John’s depends on the amount of one of the active ingredients in the herb, hyperforin. This study brings up an important note about using herbal medicine in therapeutic settings that I’ll bring up at the end of this article.
A critical note with St John’s Wort is that it interacts with many pharmaceutical medications.
This wide-ranging interaction is down to its effect on the liver, which can speed up the breakdown of drugs, making them less effective once they hit the bloodstream.
This interaction is significant with blood-thinning drugs that have narrow therapeutic windows. A narrow therapeutic window is a drug that relies on being at a specific dose entering into the bloodstream to work successfully.
As a rule, some key drugs that may be affected by St John’s Wort are immunosuppressants such as cyclosporine, anti-retroviral drugs such as indinavir and oral contraceptives.[17] Other commonly prescribed drugs such as blood thinners and medications used in surgery are also at risk of being affected by St John’s Wort.
When touching on St John’s, I will take this opportunity to remind you of our little statement earlier in this piece. Research into St John’s Wort is still where we are unsure of precisely what dose and what duration is necessary to achieve the results seen in these studies.
So please, if you want to try St John’s Wort whilst using other medication, especially pharmaceutical medication for mental health symptoms, consult your healthcare practitioner or someone who has professional training before making changes that could harm you.
Now for one of my most used and favourite herbs, Saffron!
So there is a fun story I’ll tell on the podcast episode about how I got onto this wonderful herb early in the piece. Thanks mainly to Professor Kerry Bone, who, via Iranian research[18] [19], found the potential of Saffron as an alternative to St John’s Wort, especially when other pharmaceutical medications for mental health are involved.
Since that night, yep, I’m making you listen to the podcast for the story; I’ve seen countless people walk into the clinic with those same heavy eyes. Aside from the mild to moderate depression potential, which I’ll get to, Saffron seems to positively affect the quality of people’s day. One study from 2020 showed that alongside the depression improvements, participants saw their social relationships improve alongside their resilience to daily stress,[20] a significant thing when looking at how intense the world seems to be as it heals from the pandemic.
This effect on stress is yet to be studied. Still, initial mechanism-based research in animals suggests that saffron supplementation can positively affect blood cortisol levels[21] , affecting sleep quality and anxiety.
Numerous small studies have shown Saffron’s potential for mild to moderate depression.
One particular meta-analysis (remember we like these because they pool studies together for a more precise result) found Saffron significantly more effective than placebo for mild to moderate depression.[22]
Another study that particularly caught my attention was a combined study using curcumin from turmeric and Saffron for anxiety and depression. This study looked at 123 people with major depressive disorder over 12 weeks and found that curcumin and Saffron assisted with symptoms of both anxiety and depression.[23]
Some nuances to consider when looking at herbal medicine for anxiety and depression.
If you live with anxiety or depression, a day can seem like a week. Because of this, when looking for treatments, the expectation is that they work quickly. Often, once things have gotten to the point where you ask for help, a quick solution becomes more than desirable. It’s necessary for your safety.
If you feel this is the case, it might be best to speak to your healthcare practitioner about using pharmacy first. Now, this may be disappointing if you’ve come to this page and read this article to the end just to find that the natural option might not be for you. But this is the nuance between mild to moderate and major depression we’re looking at in this article.
Mental health, especially anxiety and depression, is a very individual experience.
And this level of unique experience means that getting someone to help you make sense of where to start and how to measure your experience will be an essential step to success.
All this doesn’t mean that you can’t be successful, as we’ve seen in the research listed in this article, and I hope always you’ve found some reassurance that maybe there are some herbal medicine options for you to help your anxiety and depression.
Hope this helps x
References
[1] Liu X., Hollingworth S., Williams G., et al. Use of complementary and alternative medicines in people with depression and central obesity: findings from a Tai Chi and Qigong study. Journal of Traditional Chinese Medical Sciences. 2018;5(2):100–109. doi: 10.1016/j.jtcms.2017.09.006.
[2] Rhee TG, Evans RL, McAlpine DD, Johnson PJ. Racial/Ethnic Differences in the Use of Complementary and Alternative Medicine in US Adults With Moderate Mental Distress. J Prim Care Community Health. 2017;8(2):43-54. doi:10.1177/2150131916671229
[3] https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf, viewed 1st June 2022.
[4] Lam LC, Wong CS, Wang MJ, et al. Prevalence, psychosocial correlates and service utilization of depressive and anxiety disorders in Hong Kong: the Hong Kong Mental Morbidity Survey (HKMMS). Soc Psychiatry Psychiatr Epidemiol. 2015;50(9):1379-1388. doi:10.1007/s00127-015-1014-5
[5] Lam LC, Wong CS, Wang MJ, et al. Prevalence, psychosocial correlates and service utilization of depressive and anxiety disorders in Hong Kong: the Hong Kong Mental Morbidity Survey (HKMMS). Soc Psychiatry Psychiatr Epidemiol. 2015;50(9):1379-1388. doi:10.1007/s00127-015-1014-5
[6] Kalantar Motamedi MH, Abouie A, Hafezi-Nejad N, et al. Prevalence and Costs of Complementary and Alternative Medicine among Traumatic Patients in Iran: A Nationwide Population-based Study. Iran J Public Health. 2018;47(10):1558-1566.
[7] Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2010;17(2):94-99. doi:10.1016/j.phymed.2009.10.006
[8] Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2010;17(2):94-99. doi:10.1016/j.phymed.2009.10.006
[9] Gelenberg AJ. Psychiatric and Somatic Markers of Anxiety: Identification and Pharmacologic Treatment. Prim Care Companion J Clin Psychiatry. 2000;2(2):49-54. doi:10.4088/pcc.v02n0204
[10] Chand SP, Marwaha R. Anxiety. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470361/
[11] Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2010;17(2):94-99. doi:10.1016/j.phymed.2009.10.006
[12] Linde K, Mulrow CD, Berner MM, Egger M. St John’s Wort for depression. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub2. Accessed 02 June 2022.
[13] Barnes J, Anderson LA, Phillipson JD. St John’s wort (Hypericum perforatum L.): a review of its chemistry, pharmacology and clinical properties. J Pharm Pharmacol. 2001;53(5):583-600. doi:10.1211/0022357011775910
[14] Pu, Xy., Liang, Jp., Wang, Xh. et al. Anti-influenza A virus effect of Hypericum perforatum L. extract. Virol. Sin. 24, 19 (2009). https://doi.org/10.1007/s12250-009-2983-x
[15] Apaydin, E.A., Maher, A.R., Shanman, R. et al. A systematic review of St. John’s wort for major depressive disorder. Syst Rev 5, 148 (2016). https://doi.org/10.1186/s13643-016-0325-2
[16] Ng QX, Venkatanarayanan N, Ho CY. Clinical use of Hypericum perforatum (St John’s wort) in depression: A meta-analysis. J Affect Disord. 2017;210:211-221. doi:10.1016/j.jad.2016.12.048
[17] Markowitz JS, DeVane CL. The emerging recognition of herb-drug interactions with a focus on St. John’s wort (Hypericum perforatum). Psychopharmacol Bull. 2001;35(1):53-64.
[18] Mollazadeh H, Emami SA, Hosseinzadeh H. Razi’s Al-Hawi and saffron (Crocus sativus): a review. Iran J Basic Med Sci. 2015;18(12):1153-1166.
[19] Hosseinzadeh H, Nassiri-Asl M. Avicenna’s (Ibn Sina) the Canon of Medicine and saffron (Crocus sativus): a review. Phytother Res. 2013;27(4):475-483. doi:10.1002/ptr.4784
[20] Jackson PA, Forster J, Khan J, et al. Effects of Saffron Extract Supplementation on Mood, Well-Being, and Response to a Psychosocial Stressor in Healthy Adults: A Randomized, Double-Blind, Parallel Group, Clinical Trial. Front Nutr. 2021;7:606124. Published 2021 Feb 1. doi:10.3389/fnut.2020.606124
[21] Hooshmandi Z, Rohani AH, Eidi A, Fatahi Z, Golmanesh L, Sahraei H. Reduction of metabolic and behavioral signs of acute stress in male Wistar rats by saffron water extract and its constituent safranal. Pharm Biol. 2011;49(9):947-954. doi:10.3109/13880209.2011.558103
[22] Tóth B, Hegyi P, Lantos T, et al. The Efficacy of Saffron in the Treatment of Mild to Moderate Depression: A Meta-analysis. Planta Med. 2019;85(1):24-31. doi:10.1055/a-0660-9565
[23] Lopresti AL, Drummond PD. Efficacy of curcumin, and a saffron/curcumin combination for the treatment of major depression: A randomised, double-blind, placebo-controlled study. J Affect Disord. 2017;207:188-196. doi:10.1016/j.jad.2016.09.047
