TABLE 1.
Natural and Herbal Remedies: Indications, Doses, and Adverse Effectsa
| Remedy | Indications | Dosing | Adverse Effects/Interactions |
|---|---|---|---|
| Ginkgo biloba | Dementia (Alzheimer’s and vascular); antidepressant-induced sexual dysfunction | 120–240 mg/day, BID–TID | Mild GI upset, headache, irritability, dizziness, possible bleeding in individuals with bleeding disorders or who take anticoagulants |
| Melatonin | Insomnia (particularly if secondary to circadian disturbance); safe in children and elderly individuals | 0.1–10.0 mg/day | Sedation, confusion, inhibition of fertility, decreased sex drive, hypothermia, retinal damage, immunosuppression |
| Omega-3 fatty acids (EPA and DHA) | Depression (including perinatal depression); bipolar disorder; psychotic disorders; borderline personality disorder; attention-deficit disorders; safe in children and elderly individuals | 1,000–2,000 mg/day (some studies administered up to 10 g/day) | GI upset; cycling to mania in patients with bipolar disorder; no adverse interactions |
| S-adenosyl methionine (SAMe) | Depression (including with comorbid medical conditions such as Parkinson’s disease, osteoarthritis and fibromyalgia, sexual dysfunction, neurocognitive disorders, psychotic disorders, and liver disease) | 200–3,200 mg/day (sometimes higher) | Mania in bipolar patients; GI upset, insomnia, anorexia, dry mouth, sweating, dizziness, and nervousness; no adverse interactions |
| St. John’s wort (Hypericum perforatum L.) | Depression, menopausal symptoms | 300–1,800 mg/day, BID–TID | Dry mouth, dizziness, constipation, phototoxicity, serotonin syndrome when combined with SSRIs; adverse interactions with warfarin, cyclosporin, oral contraceptives, theophylline, fenprocoumon, digoxin, camptosar, indinavir, zolpidem, irinotecam, and olanzapine; mania in patients with bipolar disorder |
| Valerian (Valeriana officinalis) | Insomnia; possibly OCD; safe in children, elderly individuals, and menopausal women | 450–600 mg before bedtime | Blurry vision, dystonias, hepatotoxicity, headaches; some concern about malformations if used during pregnancy |
a
BID, twice daily; TID, three times daily; GI, gastrointestinal; EPA, eicosapentaenoic acid; DHA, docosahexaenoic acid; SSRI, selective serotonin reuptake inhibitor; OCD, obsessive-compulsive disorder.