Patient Reviews
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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*Kava (Bacopa monniera) Anxiolytic Generally Safe Benzodiazepines such as:Prosom, Alprazolam,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. Antidepressants such as: Paxel, Lexapro, Celexa, Prozac, Zoloft, Pexeva, Luvox CR, Sarafem, Brisdelle, Selfemra and Rapiflux Liver disease,pregnancy, current or recovered alcoholics, and frequent alcohol use are contraindicated. Weak

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: The standard dose is 2 to 4 g as a decoction, up to three times daily (Gardner & McGuffin, 2013). 3.0-8.5 ml of 1:2 liquid extract per day; 20-60 ml of 1:2 liquid extract per week (Bone, 2003).


1 *Lavender(Lavandula spp.) Very Safe None Identified None Identified Very Strong

Comments from MHs: This herb is very safe but it may potentiate Benzodiazepines or drowsiness in sensitive patients.

Recommended Dose: 2.0-4.5 ml of 1:2 liquid extract per day; 15-30 ml of 1:2 liquid extract per week (Bone, 2003).


*Roseroot (Rhodiola rosea) 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).


*Roseroot (Rhodiola rosea) 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 exctract is used and as part of an adaptogenic (Yance, 2013).


8 Saffron (Crocus sativus) Generally Safe None Identified None Identified Weak

Comments from MHs:None.

Recommended Dose: 100-250 ml per day which equals approximately 1-5 strands (Pole, 2013).

Lo-Marzia, Zeosa, Zovia,

*St Johns wort(Hypericum perforatum) Generally Safe Induces CYP3A4, and inhibits CYP1A1,CYP1B1, and CYP2D6 enzymes.Hormonal Contraceptives such as: Elinest, Estrostep Fe, Gildess, Nordette, Tri- riphasil, Demulen, Emoquette, Syeda, Plan B, Ovcon 35 and Mon- Linyah, etc. Axiolytics such as: Seconal, Seconal Sodium, Mebaral, Nembutal Sodium, Luminal, Amytal Sodium, Butisol Sodium and Nembutal, Prosom, Alprazolam Intensol, Doral, Niravam, Diazepam Intensol, Xanax XR, Tranxene, Librium, Klonpin Wafer, Xanax, Unisom, Benadryl, Ambien, Lunesta, BuSpar, etc. Antidepressants such as: Paxel, Lexapro, Celexa, Prozac, Zoloft, Pexeva, Luvox CR, Sarafem, Brisdelle, Selfemra and Rapiflux. Beta-adrenergetic blockers such as: Kerlone, Tenormin, Toprol-XL, Lopressor, Metoprolol, Coreg, Indural, Levatol, Blocadren, etc. Bipolar can occur if taken in high doses,and not for use during phototherapy. or excessive sun exposure. Very Strong

Comments from MHs: St Johns wort (SJW) affects the CYP3A4 and CYP2C9 enzymes and careful consideration should be taken when combining SJW with drugs metabolized by these pathways (2). Major negative interactions this herb has are with organ anti-rejection drugs and conventional antivirals commonly used in patients with HIV/AIDS. One MH considers these the most clinically relevant interactions SJW has with other medications. Two MHs report that they do not believe SJW is contraindicated with conventional antidepressants (2) or anxiolytics (2) but should be used in combination when supervised by a trained clinician. The research supporting Hypericum interacting with contraceptives, antidepressants, and anxiolytics, and subsequently concluding that these interactions cause negative effects that are clinically significant should be viewed cautiously as the research is of poor quality (3). Numerous MHs report using SJW extensively in patients taking conventional antidepressants without their patients experiencing a negative interaction. One MH disagreed with the list of interactions listed above because it did not distinguish the difference between hyperforin and hypericin and how these chemical constituents metabolize differently. This MH stated that much of the current literature fails to appreciate the difference between hyperforin and hypericin thussubsequently leads to misleading interactions such as SJW uniformly interacting with contraceptives. Conversely, one MH stated that regardless of the poor evidence supporting SJW causing negative interactions, she avoids using the herb concurrently with these medications as a precaution against unwanted pregnancy and serotonin syndrome.

Recommended Dose: : 2-6 ml of 1:2 liquid extract per day; 2-6 ml of 1:2 high hypericin liquid extract per day; 15-40 ml of 1:2 liquid extract per week; 15-40 ml of 1:2 high hypericin 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.

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