Adverse Neuropsychiatric Reactions to Herbal and Over-the-Counter "Antidepressants."
J Clin Psychiatry 2000;61(11):815-820
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Background: Many unregulated over-the-counter
agents for the treatment of depression are now available to
patients and consumers. The potential for adverse
neuropsychiatric effects with these agents has not been
systematically studied in most cases.
Data Sources: The author performed a MEDLINE
search on a variety of herbal and nonherbal over-the-counter
agents said to be useful in the treatment of depression. The Physicians'
Desk Reference for Herbal Medicines was also consulted.
Data Synthesis: Although many of the herbal
agents said to have benefits in depression appear to be safe,
serious neuropsychiatric side effects and interactions have been
reported for several over-the-counter
"antidepressants." There is reason to suspect
underreporting of those adverse events. Moreover, there is very
little evidence from systematic studies regarding the potential
for drug-drug or herb-drug interactions with these
over-the-counter agents. Vitamins and amino acids touted for the
treatment of depression are also not without risk.
Conclusion: Although some over-the-counter
remedies for depression are probably safe and effective for
as-yet unidentified subgroups of depressed individuals, more
research is required before these agents can be recommended for
routine use. Stricter U.S. Food and Drug Administration oversight
of these agents is indicated.