HERBAL THERAPIES FOR ANXIETY AND DEPRESSION

ANXIETY AND DEPRESSION – A MATERIA MEDICA REVIEW
© Jillian Stansbury

By numerous accounts, a large percentage of the US population is using anti-depressant and anxiolytic medications. This may say a lot about the condition of the human heart and soul. A 2005 survey done by Kaiser Permanente reported that the use of anti-depressants by youth, mostly SSRIs , doubled in the decade between 1994 and 2003. There is growing concern and controversy regarding the use of such medications in children, with many physicians pointing out that the potential side effects have not been firmly established. There is obviously an enormous need for safe, nourishing and tonifying ways to soothe and strengthen the psyche. This article aims to remind readers of valuable herbal therapies to treat anxiety and depression.

Hypericum, of Course
Hypericum is the most well-known and well-researched herb and is indeed effective for both anxiety and depression in my clinical experience. Most readers will be aware that Hypericum has been shown to increase levels of dopamine, serotonin, and noradrenaline in the synapses. Research suggests that Hypericum has multiple mechanisms of affecting these catecholamines including effects on the monoamine oxidase enzymes in a manner that increases the turnover of serotonin and dopamine, inhibitory effects on the reuptake of neurotransmitters in the synapses, and overall stimulatory effects promoting dopaminergic transmission over other neurotransmission.
Hypericum is also well noted to promote cytochrome enzymes and p-glycoprotein transporters in the liver and intestines , and blood brain barrier , thereby theoretically affect drug metabolism. These enzyme systems and transporter proteins can be both promoted and inhibited by various herbs and their compounds. While there are numerous published articles hypothesizing the details of potential drug interactions between Hypericum and with pharmaceuticals, I have not seen any adverse interactions with my own patients, though I would avoiding using Hypericum for anyone managed on a drug with a narrow therapeutic window, such as warfarin and anti-arrhythmics. I have often pondered if an overlooked antidepressant mechanism of Hypericum is assisting the liver in removing a myriad of substances from the body. When you search the published literature it is hard to find actual cases of Hypericum and drug failure or serious complications. There is a published case of a schizophrenic patient who worsened after adding Hypericum, and as stated belos, herbs are rather unpredictable in psychoses and this case may be a poor response to the herb itself rather than a drug interaction. There are however studies suggesting Hypericum has increased the toxicity of various toxins or drugs in rats , increased the excretion of some drugs dramatically . The most commonly stated potential concerns are regarding the use of Hypericum with birth control pills, cardiovascular anti-arrhythmics, and immunosuprressive drugs. ,

Support the HPA drive Stress and Cortisol Responses with Adaptogens
Adaptogens are practically a “must have” ingredient in formulas for both ends of the mood spectrum – from lethargic, dark melancholy, to manic anxious insomnia. I choose Panax, Rhodiola, Bacopa, Eleutherococcus or Glycyrrhiza amongst other adaptogens and include them in herbal formulas for mood disorders. These versatile adaptogenic herbs are so widely used, researched and discussed by Naturopathic physicians that I will not go into the research here, assuming this is common knowledge.

If In Doubt, Treat the Liver – Alteratives for Depression and Anxiety
I also think depression and anxiety can be a state of toxicity of the body that has leaked in to
contaminate the mind. The spiritual and healing traditions that I have been studying in the Andes and Amazon for some years now, emphasis purification by diet, herb, ceremony, smoke and make offerings to the earth in order to rid ourselves of heavy energy in order to achieve both mental and physical health. Liver herbs and alteratives can be very valuable supportive herbs in formulas for anxiety and depression to help the liver to “smooth the chi”. Curcuma is an excellent liver remedy and while not commonly regarded to have nervine properties, recent studies report the bright yellow flavonoid, curcumin to increase dopamine and serotonin levels in the brain. Schizandra is another plant whose spicy fruits are dried and used as a traditional liver medicine in China. Schizandra is reported to reduce stress related elevations in cortisol and neurotransmitters levels in animal studies and researchers suggested a reduction in HPA activation. Thus, these liver herbs might be especially chosen, but any and all alteratives might be used as complementary herbs in formulas for emotional disturbance. When a patient has concomitant digestive difficulty, skin lesions, and a coated tongue, such alteratives might be featured more prominently in formulas, and/or the main anti-depressant or anti-anxiety formula complemented with a separate alterative tea or lipotropic type of encapsulation.

Herbs in Bi-Polar and Schizophrenic Disorders
I have learned from personal experience that some of the most powerful herbal anxiolytics, Kava (Piper methysticum) and Valerian (Valeriana officianalis and stichensis) can promote depression in some patients prone to biochemical depression and those with manic-depressive disorder, even if they do help insomnia and anxiety for a time. For patients with bipolar disorder, it is best to choose the more subtle tonifying nervines such as Matricaria, Avena, and Tilia. Herbs may also affect patients with schizophrenia and other psychoses in unpredictable ways due to the abnormal brain chemistry. It is best to use only a single herb at a time and make your formulas increasingly complex over time once it has been determined that a patient tolerates and responds well to an herb. Drop dosages of herbs and homeopathics are sometimes a more suitable initial approach for patients with psychoses.

Neuroendocrine Herbs in the Treatment of Anxiety and Depression
Another category of herbs that I find helpful in herbal formulas for anxiety and depression are the reproductive hormone balancing herbs. Of course stabilizing reproductive hormones can improve emotional challenges occurring with PMS, menopause and other emotional symptoms related to hormone fluctuations, but some of the primary reproductive herbs used in the US, Vitex agnus-castus, and Actea (Cimicifuga )racemosa have been shown to affect brain neurotransmitters. In fact, because dopamine acts as a regulator of the pituitary hormones, FSH and FH, these herbs exert an effect on the reproductive system via neuroendocrine effects, rather than any significant agonist effects at hormone receptors as is the case with soy isoflavones and similar legume herbs such as Medicago, Glycrrhiza or Pueraria. Dopamine may also lower pituitary LH and thereby reduce testosterone production and is the proposed mechanism whereby Vitex may reduce anger and irritability, teenage acne, and traditionally the sexual frustrations of monks, earning the plant the common name of Chaste Tree Berry. A flavonoid glycoside from Vitex agnus castus, vitexin, has been shown to increase catecholamine levels in the synaptic cleft, as well as interact more directly with serotonin, noradrenaline, and dopaminergic receptors , particularly D2 receptors activity. Vitex also appears to act as an agonist of mu-opiate receptors.
Traditional literature emphasizes Actae for mood disorders characterized by agitation and even panic, especially when accompanied by muscle tension and tension headaches. I have found Actae to be a very helpful herb for fibromyalgia, in addition to menopausal and hormonal imbalances. Compounds in Actae have been shown to competitively bind to dopamine D2 and various serotonin receptors. There are a number of clinical trials involving Actae/Cimicifuga’s effect on female reproductive and menopausal symptoms .
Actae has been reported to have dopaminergic and serotonergic activities in animal and tissue models. The most strongly serotonergic compounds in the plant include cimicifugic acids A, B, and F, fukinolic acid, ferulic acid, isoferulic acid, and guanidine alkaloids cimipronidine and dopargine, which are molecularly close to dopamine itself. Vitex and Actae need not be reserved for women only because of their popular use for “female complaints”, as they most certainly can be used for depression and anxiety states in men.

Nepeta cataria Review
There are some 250 species in the Nepeta genus, a member of the Lamiacea family noted for its many nourishing and non-toxic plants. So safe in fact is Nepeta cataria (Catnip) that it is long standing remedy for irritability and restless sleep in babies and toddlers. Nepeta is most wellknown for its profound effects on the nervous systems of cats, but effects the nervous systems of humans as well, albeit in gentler ways. Maude Greive in her classic A Modern Herbal speaks of Nepeta under the heading of Catnep and reports that the fresh juice is more effective than the tea for nervous headaches, restlessness, colic, anxiety, hysteria and sleep disturbances including nightmares.
Despite Nepeta being a household staple at one time, there has been very little research on the plant. A terpene named nepetalactone is found in the volatile oil fraction of the plant and in known to act as an attractant to cats. The lascivious behavior displayed by some cats under the influence of catnip, may be due to the fact that sexual responses involve dopamine, the pleasure neurotransmitter, and Nepeta promotes dopamine. Like Valeriana, Nepeta contains iridoid glycosides which likely contribute to the anxiolytic and sedative effects , and several mouse studies report increased sleep , and anti-anxiety effects. The iridoid glycosides in Valerian are thought be calming via GABAnergic effects. Although the scientific research on Nepeta is very scant, the traditional literature is robust and clinical herbalists report general efficacy as a nervine. The flavor is bland enough to use Nepeta as tea for young children, or as Mrs. Greive suggests, fresh juice if you care to make this yourself.

Rauwolfia serptentina
Lastly, Rauwolfia deserves a mention as an extremely useful plant for anxiety states and even psychotic agitation. Rauwolfia serpentina is native to the tropical forests of India, Ceylon, Burma, and Malaysia where it has been a traditional remedy for snake bites, hence the common name, Indian Snake Root. Other traditional uses in India include using the root for abdominal pain and colic in children, skeletal muscle pain and tension, insomnia and even insanity and psychological disturbances. It is known that Gandhi regularly drank Rauwolfia tea as a calmative agent.
Rauwolfia was introduced into the European herbal armamentarium as early as 300 years ago as an anxiolytic agent. Rauwolfia contains numerous powerful alkaloids including resperpine, one of the first drugs introduced into neuropharmacology in the 1930s. Research into its mechanisms of action ushered in the era of neuropharmacology as reserpine’s effect on dopamine and neurotransmitters were explored.
Like Valerian and Kava, Rauwolfia is best for agitated, manic, and anxious states rather than depression as it is known to promote depression in some sensitive individuals. Animal studies have shown that very small amounts of reserpine will trigger the release of serotonin yet reserpine is noted to deplete dopamine and serotonin stores with longterm use. , While a small reduction in these catecholamines is very useful for those with acute anxiety and panic disorder, some susceptible individuals may become depressed when serotonin and dopamine levels decline. Avoid using Rauwolfia in patients with lethargy, impotence, and deep dark depression. Because many psychotic conditions involve abnormal elevations in catecholamine and indolamine neurotransmittors, or abnormal metabolism of theses neurotransmittors, Rauwolfia may be a helpful therapy to reduce levels, particularly serotonin and dopamine.
Reserpine may also partially block adrenaline receptors helping to reduce stress symptoms, panic, and acute tension. Whole Rauwolfia is generally thought to overall promote parasympathetic nervous activity, allowing it to dominate over the sympathetic nervous system therefore useful in treating anxiety and hypertension. Consider Rauwolfia in formulas for panic, insomnia, stress and muscle tension, anxiety related hypertension, and mania and psychosis.



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