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Herbals for sleep and anxiety


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I "borrowed" this text from a website with content updates for the textbook I'm using to teach my junior nursing students. Since several folks here have mentioned sleeping problems, here it is:


Black et al: Medical-Surgical Nursing, 6th edition

Content Updates

Herbal Alternatives for Sleep, Anxiety and Depression

James Higgy Lerner, RN, LAc

A number of herbs have been researched for their use as sleep aids, anxiolytics, and antidepressants. The following herbs have been found to be both safe and effective. Their effectiveness and the potential for interactions with pharmaceutical drugs of similar effect means it is important for nurses to be aware of their use by clients.

Valerian root. Valerian root (Valeriana officinalis) grows wild in America and Eurasia, and has been used for centuries for its calming and sleep-promoting properties. Two randomized, placebo-controlled studies demonstrated valerian's efficacy in improving sleep quality and shortening time to falling asleep, without residual sedation the next morning. German health officials have approved it for use as a mild sedative and sleep aid.6

No serious side effects have been reported from valerian although a small percentage of users may experience restlessness and palpitations. Since in vitro studies have demonstrated cytotoxic and mutagenic activity for valerian, although this has not been seen in vivo even at high doses, use by pregnant women is not recommended. Like sedatives in general, valerian should not be used with other sedatives, or in situations where alertness is required. Dosage is generally 300-500 mg of valerian root extract, one hour before bedtime.8

Kava root. Kava (Piper methysticum), also known as kava kava, is a south seas plant that has been used for over 3000 years for its calming effects. Modern research has borne out the usefulness of kava for the treatment of anxiety. One study, comparing kava to placebo, found it superior to placebo over the course of the 25 week trial. Only two of 52 kava treated clients reported side effects, both reporting upset stomach.9 Another study,10 compared kava to oxazepam or bromezepam, over a six week trial, in 164 clients with nonpsychotic anxiety, tension and agitation. Kava did as well in this trial in decreasing anxiety as the two benzodiazepine-type agents.

Overall, kava side effects, which can include liver damage and yellowing of the skin, are rare and seen primarily with chronic use. Since kava appears to have CNS depressing effects, caution must be exercised in terms of using it with other CNS depressants or when performing tasks such as driving. The benefits and relative safety of kava mean that it may be considered for treatment of nonpsychotic anxiety.2 Dosage recommendations of kava vary somewhat. Generally standardized extracts are currently used, with 140-210 mg kavalactones as a daily dose. 4

St. John's Wort. St. John's Wort (Hypericum perforatum) is a yellow-flowered herb, growing wild in much of the world. Its nervous system effects were described by Galen, the renowned ancient Greek physician. It is the most common antidepressant used in Germany, prescribed more commonly than pharmaceutical antidepressants. Its use has also grown in the United States.6

Numerous studies have evaluated St. John's Wort's effectiveness in the treatment of depression. A meta-analysis of prior studies done in 1996,3 found that St. John's Wort extracts were significantly superior to placebo, and as effective as low dose tricyclic antidepressants, with significantly fewer side effects (20% versus 53%). In Germany, besides its use as an antidepressant, St. John's Wort is also used for the treatment of anxiety and sleep disorders.5 One study1 found it useful in treatment of seasonal affective disorder as well.

Side effects from St. John's Wort are generally minimal. Fair-skinned individuals should be cautious with taking large doses, because it can cause photo-sensitivity. The dosage is 300 mg, three times daily, of an extract standardized to a hypericin content of 0.3%. Until the mechanism of St. John's Wort's antidepressant activity is better known, it should not be used with other antidepressants, nor should it be used during pregnancy, since it exhibits a uterotonic effect. Additionally, recent research has shown that St. John's Wort can cause drug interaction problems with a number of drugs, leading to suppressed activity of the pharmaceuticals. This can be a problem with certain protease inhibitors, immuno-suppressant drugs, birth control pills, cholesterol-lowering medications, seizure drugs, and blood thinners.7 Thus, great caution must be exercised if it is used at all for clients on any of these types of medications.6

James Higgy Lerner, RN, LAc

Private practice of acupuncture, traditional Oriental medicine and biofeedback

Chico, California


1. Kasper, S. (1997). Treatment of seasonal affective disorder (SAD) with hypericum extract. Pharmacopsychiat., 30 (Supplement): 89-93.

2. "Kava root and anxiety," (1998, December 1). In The Integrative Medicine Consult, 1: 2-3.

3. Linde, K., et al.(1996). St. John's Wort for depression: an overview and meta-analysis of randomised clinical trials. British Medical Journal, 313 : 253-258.

4. Lininger, S., et al. (1998). The natural pharmacy. Rocklin, CA: Prima Health.

5. Miller, L.G.(1998). Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Archives of Internal Medicine, 158: 2200-2211.

6. O'Hara, M.O., et al. (1998). A review of 12 commonly used medicinal herbs. Archives of Family Medicine, 7: 523-536.

7. "Risk of drug interactions with St. John's Wort," (Summer, 2000). Complementary and Alternative Medicine at the NIH, VII, (3): 10-11. National Center for Complementary and Alternative Medicine Clearinghouse.

8. Schultz, V., Hansel, R., Tyler, V.(1997). Rational phytotherapy: A physician's guide to herbal medicine. New York: Springer.

9. Volz, H.P., & Kieser, M.(1997). Kava-Kava extract WS 1490 versus placebo in anxiety disorders - a randomized placebo-controlled 25-week outpatient trial. Pharmacopsychiat., 30: 1-5.

10. Woekl, H., Kapoula, O., Lehrl, S. (1993). Treatment of anxiety patients. Kava special extract WS 1490 in anxiety patients is comparable to the benzodiazepine oxazepam, a double-blind study. Zeitschrift Allgemeinmed.,69: 271-277.

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Guest Karen C.

Does anyone have an opinion on melatonin? I've been taking it for a few years now to help with my sleep and I think it works wonders. Most melatonin comes in a 3 mg dose but my doc recommended 1 mg or less daily for folks my age (40's) - higher dose for older folks. I found some 1 mg pills at Costco once and you can find 3 mcg at some drugstores.

Just wondering.

Karen C.

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Thank you for the information. I may end up trying one of the herbs you mentioned. I seem be be having periods of depression and after what I saw with Johnny I'm terrified of most medications. What about the different herbs used for making tea? I have heard that some of them are very calming. I just can't remember the ones I heard about. I like tea and feel it would be the best way to test the effects without trying a large dose.

The information you give is very interesting and upsetting. I wanted to try something like that for Johnny when his anxiety got so bad. The advice from the doctors was don't take anything even in the form of tea. No herbs and no vitamins other than a multivitamin. Because of their advice we never tried anything. I feel it all goes along with the out dated and selfish approach of many doctors toward lung cancer. They consider anything that is not drugs as alternative treatment and denounce it. That is not only a shame but very harmful.

It amazes me that we are told by our doctors all of our lives that eating right, exercise and good habits will not only make us feel better but improve our health. Mention cancer and they do a complete turn around. They not only tell you that those things don't help but warn you against them. That is just one more thing that has led to a deep distrust of most doctors especially oncologists. I feel like they think they know everything even more than God. Hopefully some day they will be forced to see how wrong they are.

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I think the only concern about melatonin is that it is a hormone and it is not known if there can be problems with long term use.

Melatonin (at higher doses) is actually has been used in clinical trials for brain mets not sure of the outcome

http://www.sleeping-tips.com/natural_re ... sleep.html

I have used it (the time released type seem better for me)


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