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Over 40 million Americans have been diagnosed with anxiety disorders from panic attacks, posttraumatic stress disorder (PTSD), phobias, and obsessive-compulsive disorder (OCD). Psychotherapy and drugs are the usual treatment, but for many patients, alternatives are personally being chosen. Some work and some donít. One exception is kava, generally taken as a tea. Kava, useful for relaxation without mental or physical side effects, is found in the root of a South American plant. Kava has been shown more effective against anxiety than a placebo in controlled studies. However, patients with liver problems, or who are taking barbiturates, Xanax, or alcohol, should not take kava. Studies of kava use for longer than 4 months have not been done and while the herb is banned in several countries, it is still available in the United States. Check to see that your patients are using preparations which come from the root of the plant, not the stem or leaves.
Another herb, Inositol (part of vitamin B complex), has been effective against panic attacks in 2 controlled studies, though its efficacy against OCD is not clear. Other herbs commonly taken by patients have not proved effective. These are St. John’s Wort, Valerian, and 5-HTP. Patients taking St. John’s Wort need to be alert to contraindications against taking cyclosporine, birth control pills, antidepressants, warfarin, and digoxin. While 5-HTP has had some positive effect on depression, anxiety, and insomnia in some patients, the prescribed drug clomipramine (Anafranil) is a consistently better solution.
Since herbal medicines are not regulated, talk with your patients about what they are actually taking. Be sure they check for reliable brands through independent sources such as consumerlab.com or through the Alternative Medicine Foundation at the Web site amfoundation.org.
(Source: Harvard Women’s Health Watch, December 2007)
