Herbal medicines can treat anxiety and depression

In this article I want to go through natural ways to treat anxiety and depression. The first thing to get clear is understanding the causes of anxiety and depression, although we may think it is because certain events happen to us or even genetics, the truth is when we attach, we suffer. This is what the Buddha outlined in the Noble Eightfold Path, as he understood the causes of suffering he also understood the way to its cessation. This is what modern science is now confirming with many clinical studies on mindfulness (Hofmann et al., 2010). However, mindfulness isn’t for everybody so tools like cognitive behavioral therapy can be used (Butler et al., 2006). Additionally, herbal medicine and diet changes may prove very useful as I will now discuss.

Herbal medicines for depression and anxiety

Herbs can be very helpful for certain people and I have come to believe they are overly ignored in our society. I think depression and anxiety should be seldom dealt with pharmaceutical drugs, herbal medicines offer a gentler, healthier, and effective solution. Take St. John’s wort, we know this works for depression because it has been very well studied, and a recent meta-analysis concluded it was effective for mild to moderate depression (Ng et al., 2017). So why aren’t we using it in the NHS as they use in their primary health system in Germany? The answer is cultural stigma; we are conditioned to believe in pharmaceutical drugs over herbal medicines and our research system is highly dependent on pharmaceutical companies which are not interested in funding natural healing methods. Having worked with pharmaceutical companies quite a lot myself, I think they have their place and so do their drugs, especially in very serious cases of diseases. However, they are far over used in my view. There are natural and effective ways to treat depression and anxiety. Many of the herbs used to treat depression in herbalism, called the nervines, also have a anti-anxiety effect as well. Let’s now turn to examine some of these medicines in more detail.

stjohnswortwikicommons

St John’s wort is effective for mild to moderate depression, but St. John’s wort was not thought of as an anti-depressant traditionally (Castleman, 2001). It was used internally to treat neuropathic pain and anxiety. It’s use goes as far back as the ancient Greeks as a treatment for Sciatica. St. John’s wort is best in a fresh tincture form with a deep red colour to it. St. John’s wort does have a few contraindications, such as with SSRIs and also it generally decreases the effectiveness of pharmaceutical drugs taken at the same time. I would like to point out, while the commonly used medicinal herbs can have side effects and contra indications, the truth is they are generally far less dangerous than chemical drugs.

A more traditional Western herb for depression is motherwort. 17th century herbalist, Nicholas Culpeper wrote, ‘There is no better herb to take melancholy vapours from the heart … and make me a merry cheery soul’ (Castleman, 2001). Lemon balm is another herb used traditionally for depression, and the 11th century Arab physician, Avicenna, wrote, ‘Balm causeth the mind and heart to become merry’. David Hoffman in his book, ‘Holistic Herbal’, states that lemon balm is ‘an excellent carminative herb….(with) anti-depressive properties’ (Hoffman, 1988). David Winston recommends a combination of St. John’s wort and lemon balm for SAD because of their uplifting properties (Winston, 2007). Lemon balm is another herb best in a fresh tincture to increase its medicinal potency.

motherwort

A nervine herb that is held is very high regard in Western herbalism is American skullcap which is an old Native American remedy and it is a relaxing tonic for nerves in fresh (not dried) tincture. One study found a significant anxiety reducing effect versus placebo in a double blinded trial (Wolfson and Hoffmann, 2003). Milky oats is another effective nervine and nutritive tonic medicine for the nerves, which David Winston has called, ‘the greatest nervous system trophorestorative’ (Winston, 2007). This is a good option if stress and anxiety are your problems. The idea of these tonic herbs, quite different to pharmaceutical drugs, is to restore the nervous system into balance.

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Finally a good herb to consider including in a formula for anxiety, this time from traditional Indian medicine, is tulsi. Tulsi has been found to reduce stress in a large double blind placebo controlled study (Saxena et al., 2011) and has a rich history of traditional use in India. Tulsi is a rasayana herb in Ayurveda, otherwise known as a rejuvenator, and is thought to nourish a person towards health and long life (Winston, 2007). Since plants are more like food and they are so diverse, the idea of special tonic healing herbs makes intuitive sense to me.

Diet

Finally, diet is very important as it is for managing pretty much any health problem. There is increasing evidence the gut microbiome is related to mental health (Foster et al., 2013). So if the diet is made cleaner, i.e. by removing processed foods and refined sugars, reducing or eliminating grains and dairy, and eating more vegetables and fruits this will help.

Formulation notes

Anti-depressive pair

Fresh St. John’s wort tincture (1 part) (warming, drying)
Fresh lemon balm tincture (1 part) (cooling, drying)

This formula is more specifically for depression, but may be helpful for anxiety.

Dose: 10-60 drops, 2-3 times daily
Notes: This formula is contra indicated with SSRIs. St. John’s wort may decrease the effectiveness of pharmaceutical drugs.

Nervine tonic triplet formula

Fresh St. John’s wort tincture (1 part) (warming, drying)
Fresh skullcap tincture (1 part) (cooling, drying)
Fresh milky oats tincture (1 part) (warming, moistening)

This formula is for balancing the nervous system which includes treatment of anxiety and insomnia, but also may be useful for nerve pain and depression. The milky oats balances it’s energetic properties as it has a moistening effect to avoid long term constitutional drying out in pre-disposed individuals, e.g. dry skin.

Dose: 15-60 drops 2-3 times daily
Notes: This formula is contra indicated with SSRIs. St. John’s wort may decrease the effectiveness of pharmaceutical drugs. If on sedative medication be highly cautious regarding dose.

Summary

We need to research more into medicinal plants for depression and anxiety, however, in the current lack of knowledge I think we can rely on traditional knowledge from strong traditions which often proves correct. After all more than 80% of the total population in the developing world dependent on herbs and up to 50% the approved drugs during the last 30 years are from from natural products (Veeresham et al., 2012). I believe natural ways to treat depression and anxiety are the way forward in the majority cases, so if you are suffering from these problems I think there is cause for optimism.

References:

Bodhi, Bhikkhu. “The Noble Eightfold Path–The Way to the End of Suffering.” The Wheel Publication (1984).

Hofmann, Stefan G., et al. “The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review.” Journal of consulting and clinical psychology 78.2 (2010): 169.

Butler, Andrew C., et al. “The empirical status of cognitive-behavioral therapy: a review of meta-analyses.” Clinical psychology review 26.1 (2006): 17-31.

Ng, Qin Xiang, Nandini Venkatanarayanan, and Collin Yih Xian Ho. “Clinical use of Hypericum perforatum (St John’s wort) in depression: A meta-analysis.” Journal of Affective Disorders 210 (2017): 211-221.

Castleman, Michael. “The new healing herbs.” Bantam Book, New York (2001): 465-471.

Hoffman, David. Holistic herbal. Element Books, 1988.

Saxena, Ram Chandra, et al. “Efficacy of an extract of ocimum tenuiflorum (OciBest) in the management of general stress: A double-blind, placebo-controlled study.” Evidence-Based Complementary and Alternative Medicine 2012 (2011).

Winston, David, and Steven Maimes. Adaptogens: herbs for strength, stamina, and stress relief. Inner Traditions/Bear & Co, 2007.

Veeresham, Ciddi. “Natural products derived from plants as a source of drugs.” Journal of advanced pharmaceutical technology & research 3.4 (2012): 200.

Wolfson, P., and D. L. Hoffmann. “An investigation into the efficacy of Scutellaria lateriflora in healthy volunteers.” Alternative therapies in health and medicine 9.2 (2003): 74.

Brock, C., Whitehouse, J., Tewfik, I., & Towell, T. (2014). American Skullcap (Scutellaria lateriflora): A Randomised, Double‐Blind Placebo‐Controlled Crossover Study of its Effects on Mood in Healthy Volunteers. Phytotherapy Research, 28(5), 692-698.

Foster, Jane A., and Karen-Anne McVey Neufeld. “Gut–brain axis: how the microbiome influences anxiety and depression.” Trends in neurosciences 36.5 (2013): 305-312.

Winston, David, and Steven Maimes. Adaptogens: herbs for strength, stamina, and stress relief. Inner Traditions/Bear & Co, 2007.

Herbal strategies to fight nerve pain

I found herbal medicine and began studying it when I realised it can work pretty well for my own problem, this was nerve pain. Your unlikely to get a miracle cure, but relief is possible and herbal medicine is generally gentler than drugs. I think herbal medicines are far under appreciated and have been neglected by mainstream medicine. There are many types of nerve pain and this article can only provide some general indications of what herbs may help, I also talk a little bit about diet which can be relevant.

Underlying causes, diet, and the immune system

I should first say, when approaching nerve pain, including disorders like peripheral neuropathy, small fiber neuropathy, fibromyalgia, sciatica, and carpal tunnel, the key is to always look for the underlying cause. For example, some people have a deficiency in B12 which is causing or aggravating their problem, others may have a trapped nerve and need physiotherapy or to see a chiropractor. Poor digestive health may be a contributor or underlying the nerve pain, so steps may be necessary to improve the health of the digestive system, the simplest way is changing the diet. Especially to remove refined sugars, processed foods, and excess carbohydrates. I should also say, B vitamins are key to the health of the nervous system (Watanabe et al., 1994), so the diet should include B vitamins through good quality meats (grass fed or wild) or a B complex could be tried. Remember vitamin B6 can be toxic in high doses so do research and be careful if taking this (Levine et al., 2002). Alpha lipoic acid, an anti-oxidant molecule, has been shown to improve certain kinds of neuropathic pain, therefore is worth considering (Ziegler et al., 1995).

Before we go into the nervine herbs, it is relevant to discuss immunomodulating herbs, immune dysregulation, and go further into diet. Certainly this has relevance in disorders like MS, however, in other neurological conditions inflammation and chronic nerve pain are actually intimately connected and we are increasingly appreciating chronic neuropathic pain as a neuroimmune disorder (Scholz and Woolfe, 2004). Although usual anti inflammatory drugs, like NSAIDs, are not effective at reducing neuroinflammation and neuropathic pain, herbs are more complex, and there is a huge range of different medicinal plants that have immune modulating activity.

Key tonic herbs for the immune system include reishi and ashwagandha, both also act on the nervous system to induce a state of calm (Groves, 2016). It is also important to change diet to remove pro-inflammatory foods and to eat more anti-inflammatory foods. A natural plant based Paleo type diet (removes grains, dairy, processed foods, and refined sugars) is a good option (Cordain, 2012). Although, I definitely prefer to avoid red meat as it is pro-inflammatory and pro-cancer and include legumes and chickpeas (Montonen et al., 2013). Small amounts of good quality seafood and white meat are sensible, but the emphasis is on vegetables and fruits. There is also evidence omega3 oils may be helpful in treating neuropathic pain. In one recent study, researchers found omega3 supplementation in mice helped assist in recovery from nerve injury (Gladman et al., 2012). It is best to find a good quality supplement with high strength EPA and DHA.

Many people with nerve pain also suffer with sleep issues. This is where good sleep habits can really help. Going to bed at the same time every day and getting up at the same time can help train the circadian clock (Roenneberg et al., 2007). Many of the nervine herbs mentioned below may improve sleep as they calm the nervous system. Getting good sleep will assist in the healing process. Also, some may find it useful to combine immunomodulating herbs with those that more specifically target the nervous system, induce a state of relaxation, may restore function, and also treat pain. These are the nervine tonic herbs, generally, the most important class of herbs for nerve pain.

The nervine tonics

Two key herbs from the Western herbal materia medica, that may restore the nerves and reduce pain, are St. John’s wort and prickly ash. St. John’s wort was used by the ancient Greeks to treat sciatica (Castleman, 2001). It’s popular use as an antidepressant is only a recent development, traditionally it was used internally to heal nerves and topically for burns and wounds. There is some scientific support of it’s ability to treat neuropathic pain in experimental models (Galeotti et al., 2010). St. John’s wort is perhaps the most important herb for nerve pain in our materia medica and it is best obtained in fresh tincture form with a very deep red colour. Not using a fresh tincture in this case I believe is a mistake.

Prickly ash is a circulatory stimulant and analgesic, Matthew Wood reports good success in treating nerve pain using a combination of prickly ash and St. John’s wort mixed in equal parts, and taken 1-3 times daily in small doses (around 5-10 combined in drops) (Wood, 2009). Other tonics for nerve pain from the European and North American system, other than St. John’s wort and prickly ash, include wood betony, blue vervain, and American skullcap that can be considered for inclusion into a formula (Groves, 2016).  However, my preferred two, are St. John’s wort and ashwagandha.

Outside of the Western system, traditional regenerative herbs for renewing the nervous system from Ayurveda, known as the ‘medhya rasayana’ herbs, include gotu kola, calamus, and ashwagandha (Groves, 2016). Ashwagandha, is a very powerful herb and a versatile rasayana (restorative) tonic, recent science suggests it can encourage new growth of nerves when they are damaged (Nakayama et al., 2007). It is also calming, anti-inflammatory, and can be energising.

Other option is a mushroom called lion’s mane, it has started recently to be widely used as a nervine tonic by herbalists (Groves, 2016), and there is preliminary scientific evidence that it can regenerate nervous tissue and encourage release of nerve growth factor (Wong et al., 2011). However, it has no traditional use as a herb for nerve pain. Cannabidiol, one of 2 primary medicinal components of cannabis, has recently emerged as a popular option for nerve and inflammatory pain. Human studies strongly support the use of CBD/THC cannabis extracts for neuropathic pain (Nurmikko et al., 2007).

Formulation notes

It can be useful in herbalism to consider the constitution and energetics as well as the plant’s action, for example, gotu kola is a cooling herb that is less suited for the vata constitution (cold, dry). Formulating it with ashwagandha (warming) makes a compound better suited for vata.

The herbs I have mentioned above are all constitutionally drying. Although this may not be an issue with some people, if taking drying herbs long term it may be better to formulate them with moistening herbs such as hawthorn berry or fresh milky oat seed. Long term intake of sufficient quantities of drying herbs in a person prone to dryness may result in dry skin and constipation.

Nerve pain pair (from Matthew Wood)

Fresh St. John’s wort (1 part) (warming, drying)
Prickly ash (1 part) (warming, drying)

Dose approx: 10-40 drops 2-3 times daily

Note: This formula is contraindicated with SSRIs, during pregnancy, and breastfeeding. St. John’s wort may decrease the effectiveness of pharmaceutical drugs and can cause easy sun burning. I have found prickly ash can be pretty drying to the constitution compared with say American skullcap.

Nerve pain pair II

These two are a good combination for the nerve pain.

Fresh St. John’s wort (1 part) (warming, drying)
Fresh American skullcap (1 part) (cooling, drying)

Dose approx: 20-60 drops 2-3 times daily
Note: This formula is contraindicated with SSRIs. St. John’s wort may decrease the effectiveness of pharmaceutical drugs and can cause easy sun burning.

Nervous system restorative formula

This is what I think I have had the most success with. The fresh tincture of the American skullcap is very useful for sleep.

Fresh St. John’s wort (1 part) (warming, drying)
Fresh American skullcap (1 part) (cooling, drying)
Ashwagandha KSM-66 (2-4, 400mg capsules per day)

Dose approx: 20-90 drops 2-3 times daily
Note: This formula is contra indicated with SSRIs. If on sedative medication be highly cautious regarding dose. St. John’s wort may decrease the effectiveness of pharmaceutical drugs and can cause easy sun burning.

If you are not feeling like making a formula, a very good commerical pre prepared formula for nerve pain is the Herb Pharm ‘nervous system tonic’. It contains St. John’s wort and American skullcap plus a few other herbs.

Conclusions

The best approach to nerve pain is a holistic one that takes into account the underlying cause of the problem, if known, and other factors in ones lifestyle, like diet and associated digestive health. The path back from serious nerve problems, or to manage them, takes time, patience, and willingness to troubleshoot. Conventional medicine does not currently have good solutions for nerve pain, but I believe the answers are out there.

Further reading

https://www.americanherbalistsguild.com/sites/default/files/ahgchronicpaingroves_0.pdf

Note: If you are not fully comfortable with a DIY approach for your condition for any reason, please do not hesitate to contact a local professional herbalist for more tailored assistance. It is best to inform your doctor of any herbs you are planning to take especially if you have a pre-existing medical condition.

References:

Bibel, Barbara. “Body into Balance: An Herbal Guide to Holistic Self-Care.” (2016): 117-117.

Castleman, Michael. “The new healing herbs.” Bantam Book, New York (2001): 465-471.

Christopher, John R. Herbal home health care. Christopher Publications, 1976.

Cordain, Loren. AARP The Paleo Diet Revised: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat. John Wiley & Sons, 2012.

Galeotti, Nicoletta, et al. “St. John’s Wort reduces neuropathic pain through a hypericin-mediated inhibition of the protein kinase C γ and ɛ activity.” Biochemical pharmacology 79.9 (2010): 1327-1336.

Gladman, Stacy J., et al. “Improved outcome after peripheral nerve injury in mice with increased levels of endogenous omega-3 polyunsaturated fatty acids.” Journal of Neuroscience 32.2 (2012): 563-571.

Groves, Maria. Body into Balance. Storey Publishing, 2016.

Levine, S., and A. Saltzman. “Pyridoxine (vitamin B6) toxicity: enhancement by uremia in rats.” Food and chemical toxicology 40.10 (2002): 1449-1451.

Montonen, Jukka, et al. “Consumption of red meat and whole-grain bread in relation to biomarkers of obesity, inflammation, glucose metabolism and oxidative stress.” European journal of nutrition 52.1 (2013): 337-345.

Nakayama, Natsuki, and Chihiro Tohda. “Withanoside IV improves hindlimb function by facilitating axonal growth and increase in peripheral nervous system myelin level after spinal cord injury.” Neuroscience research 58.2 (2007): 176-182.

Nurmikko, Turo J., et al. “Sativex successfully treats neuropathic pain characterised by allodynia: a randomised, double-blind, placebo-controlled clinical trial.” Pain 133.1 (2007): 210-220.

Roenneberg, Till, C. Jairaj Kumar, and Martha Merrow. “The human circadian clock entrains to sun time.” Current Biology 17.2 (2007): R44.

Scholz, Joachim, and Clifford J. Woolf. “The neuropathic pain triad: neurons, immune cells and glia.” Nature neuroscience 10.11 (2007): 1361.

Watanabe, Tetsuya, et al. “Ultra-high dose methylcobalamin promotes nerve regeneration in experimental acrylamide neuropathy.” Journal of the neurological sciences 122.2 (1994): 140-143.

Winston, David, and Steven Maimes. Adaptogens: herbs for strength, stamina, and stress relief. Inner Traditions/Bear & Co, 2007.

Wong, Kah-Hui, et al. “Peripheral nerve regeneration following crush injury to rat peroneal nerve by aqueous extract of medicinal mushroom Hericium erinaceus (Bull.: Fr) Pers.(Aphyllophoromycetideae).” Evidence-based complementary and alternative medicine 2011 (2011).

Wood, Matthew. The Earthwise Herbal: A Complete Guide to New World Medicinal Plants. North Atlantic Books, 2009.

Ziegler, D., et al. “Treatment of symptomatic diabetic peripheral neuropathy with the anti-oxidant α-lipoic acid.” Diabetologia 38.12 (1995): 1425-1433.