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Complementary medicines in psychiatry: Review of effectiveness and safety

  • Ursula Werneke (a1), Trevor Turner (a2) and Stefan Priebe (a3)



The use of complementary medicines in those with mental health problems is well documented. However, their effectiveness is often not established and they may be less harmless than commonly assumed.


To review the complementary medicines routinely encountered in psychiatric practice, their effectiveness, potential adverse effects and interactions.


Electronic and manual literature search on the effectiveness and safety of psychotropic complementary medicines.


Potentially useful substances include ginkgo and hydergine as cognitive enhancers, passion flower and valerian as sedatives, St John's wort and sadenosylmethionine as antidepressants, and selenium and folate to complement antidepressants. The evidence is less conclusive for the use of omega-3 fatty acids as augmentation treatment in schizophrenia, melatonin for tardive dyskinesia and 18-methoxycoronaridine, an ibogaine derivative, for the treatment of cocaine and heroin addiction.


Systematic clinical trials are needed to test promising substances. Meanwhile, those wishing to take psychotropic complementary medicines require appropriate advice.

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Corresponding author

Dr Ursula Werneke, Division of Psychiatry, Homerton University Hospital, East Wing, Homerton Row, London E9 6SR, UK. E-mail:


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Ahlemeyer, B. & Krieglstein, J. (2003) Neuroprotective effects of Ginkgo biloba extract. Cellular and Molecular Life Sciences, 60, 17791792.
Akhondzadeh, S., Naghavi, H. R., Vazirian, M., et al (2001a) Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. Journal of Clinical Pharmacy and Therapeutics, 26, 363367.
Akhondzadeh, S., Kashani, L., Mobaseri, M., et al (2001b) Passionflower in the treatment of opiates withdrawal: a double-blind randomized controlled trial. Journal of Clinical Pharmacy and Therapeutics, 26, 369373.
Alderman, C. P. & Kiepfer, B. (2003) Complementary medicine use by psychiatry patients of an Australian hospital. Annals of Pharmacotherapy, 37, 17791784.
Amenta, F., Cavallotti, C., Franch, F., et al (1989) Muscarinic cholinergic receptors in the hippocampus of the aged rat: effects of long-term hydergine administration. Archives Internationales de Pharmacodynamie et de Thérapie, 297, 225234.
Benjamin, J., Muir, T., Briggs, K., et al (2001) A case of cerebral haemorrhage – can Ginkgo biloba be implicated? Postgraduate Medical Journal, 77, 112113.
Benton, D. (2002) Selenium intake, mood and other aspects of psychological functioning. Nutrition and Neurosciences, 5, 363374.
Benton, D. & Cook, R. (1991) Selenium supplementation improves mood in a double-blind crossover trial. Biological Psychiatry, 29, 10921098.
Birks, J., Grimley Evans, J. & Van Dongen, M. (2002) Gingko biloba for cognitive impairment and dementia. Cochrane Library, Issue 2. Oxford: Update Software.
Boerner, R. J., Sommer, H., Berger, W., et al (2003) Kava-Kava extract L1150 is as effective as opipramol and buspirone in generalised anxiety disorder – an 8-week randomized, double-blind multi-centre clinical trial in 129 out-patients. Phytomedicine, 10 (suppl.), 3849.
Bottiglieri, T., Laundy, M., Crellin, R., et al (2000) Homocysteine, folate, methylation, and monoamine metabolism in depression. Journal of Neurology, Neurosurgery and Psychiatry, 69, 228232.
Bowden, C. L. (2001) Novel treatments for bipolar disorder. Expert Opinion in Investigating Drugs, 10, 661671.
Bressa, G. M. (1994) S-adenosyl-1-methionine (SAMe) as antidepressant: meta-analysis of clinical studies. Acta Neurologica Scandinavica, 154 (suppl.), 714.
Brown, B. G., Zhao, X. Q., Chait, A., et al (2001) Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. New England Journal of Medicine, 29, 15831592.
Brugha, T., Rampes, H. & Jenkins, R. (2004) Surely you take complementary and alternative medicines? Psychiatric Bulletin, 28, 3639.
Cardinali, D. P., Gvozdenovich, E., Kaplan, M. R., et al (2002) A double blind-placebo controlled study on melatonin efficacy to reduce anxiolytic benzodiazepine use in the elderly. Neuroendocrinology Letters, 23, 5560.
Carman, J. S., Post, R. M., Buswell, R., et al (1976) Negative effects of melatonin on depression. American Journal of Psychiatry, 133, 11811186.
Chatterjee, S. S., Nolder, M., Koch, E., et al (1998) Antidepressant activity of hypericum perforatum and hyperforin: the neglected possibility. Pharmacopsychiatry, 31 (suppl.), 715.
Chevallier, A. (1996) The Encyclopedia of Medicinal Plants. London: Dorling Kindersley.
Coffin, A. I. (1845) Botanic Guide to Health and Natural Pathology of Diseases. London: J. Caudwell.
Cohen, M. H. & Eisenberg, D. M. (2002) Potential physician malpractice liability associated with complementary and integrative medicinal therapies. Annals of Internal Medicine, 136, 596603.
Committee on Safety of Medicines & Medicines Control Agency (2000) Reminder: St John's wort (Hypericum perforatum) interactions. Current Problems in Pharmacovigilance, 26, 67.
Corrigan, J. J. Jr (1982) The effect of vitamin E on warfarin-induced vitamin K deficiency. Annals of the New York Academy of Sciences, 393, 361368.
Cott, J. M. (1997) In vitro receptor binding and enzyme inhibition by hypericum perforatum extract. Pharmacopsychiatry, 30 (suppl.), 108112.
De Vry, J., Maurel, S., Schreiber, R., et al (1999) Comparison of hypericum extracts with imipramine and fluoxetine in animal models of depression and alcoholism. European Neuropsychopharmacology, 9, 6168.
Delle Chiaie, R., Pancheri, P. & Scapicchio, P. (2002) Efficacy and tolerability of oral andintramuscular S-adenosyl-L-methionine 1, 4-butanedisulfonate (SAMe) in the treatment of major depression: comparison with imipramine in 2 multicenter studies. American Journal of Clinical Nutrition, 76 (suppl.), 1172S1176S.
Dhawan, K., Kumar, S. & Sharma, A. (2002a) Reversal of cannabinoids (delta9-THC) by the benzoflavone moiety from methanol extract of Passiflora incarnata Linnaeus in mice: a possible therapy for cannabinoid addiction. Journal of Pharmacy and Pharmacology, 54, 875881.
Dhawan, K., Kumar, S. & Sharma, A. (2002b) Nicotine reversal effects of the benzoflavone moiety from Passiflora incarnata Linneaus in mice. Addiction Biology, 7, 435441.
Dhawan, K., Dhawan, S. & Chhabra, S. (2003) Attenuation of benzodiazepine dependence in mice by a tri-substituted benzoflavone moiety of Passiflora incarnata Linneaus: a non-habit forming anxiolytic. Journal of Pharmacy and Pharmacological Science, 6, 215222.
Diaper, A. & Hindmarch, I. (2004) Adouble-blind, placebo-controlled investigation of the effects of two doses of a valerian preparation on the sleep, cognitive and psychomotor function of sleep-disturbed older adults. Phytotherapy Research, 18, 831836.
Dinh, L. D., Simmen, U., Bueter, K. B., et al (2001) Interaction of various Piper methysticum cultivars with CNS receptors in vitro. Planta Medica, 67, 306311.
Dorn, M. (2000) Efficacy and tolerability of Baldrian versus oxazepam in non-organic and non-psychiatric insomniacs: a randomised, double blind, clinical comparative study. Forschende Komplementarmedizin und Klassische Naturheilkunde, 7, 7984.
Dravid, A. R. (1983) Deficits in cholinergic enzymes and muscarinic receptors in the hippocampus and striatum of senescent rats: effectofchronic hydergine treatment. Archives Internationales Pharmacodynamie et de Therapie, 264, 195202.
Eisenberg, D. M., Kessler, R. C., Foster, C., et al (1993) Unconventional medicinein the United States. Prevalence, costs and pattern of use. New England Journal of Medicine, 328, 246252.
Ernst, E. (2002) “Flower remedies”: a systematic review of the clinical evidence. Wiener Klinische Wochenschrift, 30, 963966.
Ernst, E. & Cassileth, B. R. (1999) Howuseful are unconventional cancer treatments? European Journal of Cancer, 35, 16081613.
Fava, M., Giannelli, A., Rapisarda, V., et al (1995) Rapidity of onset of the antidepressant effect of parenteral S-adenosyl-L-methionine. Psychiatry Research, 56, 295297.
Fisher, A. A., Purcell, P. & LeCouteur, D. G. (2000) Toxicity of Passiflora incarnata L. Journal of Clinical Toxicology, 38, 6366.
Food Standards Agency. Expert Group on Vitamins and Minerals (2003) Safe Upper Levels for Vitamins and Minerals.
Friedel, H. A., Goa, K. L. & Benfield, P. (1989) S-adenosyl-L-methionine. A review of its pharmacological properties and therapeutic potential in liver dysfunction and affective disorders in relation to its physiological role in cell metabolism. Drugs, 38, 389416.
Fugh-Berman, A. (2000) Herb—drug interactions. Lancet, 355, 134138.
Glick, S. D., Maisonneuve, I. M. & Dickinson, H. A. (2000) 18-MC reduces methamphetamine and nicotine self-administration in rats. Neuroreport, 11, 20132015.
Haag, M. (2003) Essential fatty acids and the brain. Canadian Journal of Psychiatry, 48, 195203.
Hamilton, M. (1967) Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278296.
Hawkes, W. C. & Hornbostel, L. (1996) Effects of dietary selenium on mood in healthy men living in a metabolic research unit. Biological Psychiatry, 39, 121128.
Herxheimer, A. & Petrie, K. J. (2003) Melatonin for the prevention and treatment of jet lag. Cochrane Library, issue 4. Oxford: Update Software.
Houghton, P. J. (1999) The scientific basis for the reputed activity of Valerian. Journal of Pharmacy and Pharmacology, 51, 505512.
Itil, T. M., Ahmed, I., Kunitz, A., et al (1998) The pharmacological effects of ginkgo biloba, a plant extract, on the brain of dementia patients in comparison with tacrine. Psychopharmacology Bulletin, 34, 391397.
Jaroszewski, J. W., Olafsdottir, E. S., Wellendorph, P., et al (2002) Cyanohydrin glycosides of Passiflora: distribution pattern, a saturated cyclopentane derivative from P. guatemalensis, and formation of pseudocyanogenic alpha-hydroxyamides as isolation artifacts. Phytochemistry, 59, 501511.
Joy, C. B., Mumby-Croft, R. & Joy, L. A. (2003) Polyunsaturated fatty acid supplementation for schizophrenia. Cochrane Library, issue 4. Oxford: Update Software.
Jussofie, A., Schmiz, A. & Hiemke, C. (1994) Kavapyrone enriched extract from Piper methysticum as modulator of the GABA binding site in different regions of rat brain. Psychopharmacology, 116, 469474.
Kanowski, S. & Hoerr, R. (2003) Ginkgo biloba extract EGb 761 in dementia: intent-to-treat analyses of a 24-week, multi-center, double-blind, placebo-controlled, randomized trial. Pharmacopsychiatry, 36, 297303.
Kessler, R. C., Soukup, J., Davis, R. B., et al (2001) The use of complementary and alternative therapies to treat anxiety and depression in the United States. American Journal of Psychiatry, 158, 289294.
Keung, W. M. (1993) Biochemical studies of a new class of alcohol dehydrogenase inhibitors from Radix puerariae. Alcoholism, Clinical and Experimental Research, 17, 12541260.
Klepser, T. B. & Klepser, M. E. (1999) Unsafe and potentially safe herbal therapies. American Journal of Health-System Pharmacy, 56, 125138.
Knaudt, P. R., Connor, K. M., Weisler, R. H., et al (2001) Alternative therapy use by psychiatric outpatients. Journal of Nervous and Mental Disease, 187, 692695.
Krasowski, M. D., McGehee, D. S. & Moss, J. (1997) Natural inhibitors of cholinesterases: implications for adverse drug reactions. Canadian Journal of Anaesthesia, 44, 525534.
Lee, B. M., Lee, S. K. & Kim, H. S. (1998) Inhibition of oxidative DNA damage, 8-OHdG, and carbonyl contents in smokers treated with antioxidants (vitamin E, vitamin C, beta-carotene and red ginseng). Cancer Letters, 132, 219227.
Lehrl, S. (2004) Clinical efficacy of kava extract WS 1490 in sleep disturbances associated with anxiety disorders. Results of a multicenter, randomized, placebo-controlled, double-blind clinical trial. Journal of Affective Disorders, 78, 101110.
Le Poncin-Lafitte, M., Rapin, J. R., Duterte, D., et al (1985) Learning and cholinergic neurotransmission in old animals: the effect of Hydergine. Pharmacology, 16 (suppl), 5763.
Lewis, R., Wake, G., Court, G., et al (1999) Non-ginsenoside nicotinic activity in ginseng species. Phytotherapy Research, 13, 5964.
Liede, K. E., Haukka, J. K., Saxen, L. M., et al (1998) Increased tendency towards gingival bleeding caused by joint effect of alpha-tocopherol supplementation and acetylsalicylic acid. Annals of Medicine, 30, 542546.
Lin, R. C. & Li, T. K. (1998) Effects of isoflavones on alcohol pharmacokinetics and alcohol-drinking behavior in rats. American Journal of Clinical Nutrition, 68 (suppl.), 1512S1515S.
Linde, K., Ramirez, G., Mulrow, C. D., et al (1996) St John's wort for depression – an overview and metaanalysis of the randomised clinical trials. BMJ, 313, 253258.
Linde, K., Berner, M., Egger, M., et al (2005) St John's wort for depression. Meta-analysis of randomised controlled trials. British Journal of Psychiatry, 186, 99107.
Lohr, J. B., Kuczenski, R. & Niculescu, A. B. (2003) Oxidative mechanisms and tardive dyskinesia. CNS Drugs, 17, 4762.
Maclennan, K. M., Darlington, C. L. & Smith, P. F. (2002) The CNS effects of Ginkgo biloba extracts and ginkgolide B. Progress in Neurobiology, 67, 235257.
Macmahon, K. M. A., Broomfield, N. M. & Espie, C. A. (2005) A systematic review of the effectiveness of oral melatonin for adults (18 to 65 years. with delayed sleep phase syndrome and adults (18 to 65 years. with primary insomnia. Current Psychology Reviews, 1, 103113.
Maisonneuve, I. M. & Glick, S. D. (2003) Anti-addictive actions of an iboga alkaloid congener: a novel mechanism for a novel treatment. Pharmacology, Biochemistry and Behavior, 75, 607618.
Malamud, W., Barton, W. E., Fleming, A. M., et al (1957) The evaluation of the effects of derivatives of Rauwolfia in the treatment of schizophrenia. American Journal of Psychiatry, 114, 193200.
Marangell, L. B., Martinez, J. M., Zboyan, H. A., et al (2003) A double-blind, placebo-controlled study of the omega-3 fatty acid docosahexaenoic acid in the treatment of major depression. American Journal of Psychiatry, 160, 996998.
Markstein, R. (1985) Hydergine: interaction with the neurotransmitter systems in the central nervous system. Journal of Pharmacology, 16 (suppl.), 117.
Mash, D. C., Staley, J. K., Pablo, J. P., et al (1995) Properties of ibogaine and its principal metabolite (12-hydroxyibogamine) at the MK-801 binding site of the NMDA receptor complex. Neuroscience Letters, 192, 5356.
Mathews, J. M., Etheridge, A. S. & Black, S. R. (2002) Inhibition of human cytochrome P450 activities by kava extract and kavalactones. Drug Metabolism and Disposition, 30, 11531157.
Matthews, M. K. Jr (1998) Association of Ginkgo biloba with intracerebral hemorrhage. Neurology, 50, 19331934.
Matthews, S. C., Camacho, A., Lawson, K., et al (2003) Use of herbal medications among 200 psychiatric outpatients: prevalence, patterns of use, and potential dangers. General Hospital Psychiatry, 25, 2426.
Medical Economics (2000) PDR (Physicians’ Desk Reference) for Herbal Medicines (2nd edn). Montvale, NJ: Medical Economics Company.
Meseguer, E., Taboada, R., Sanchez, V., et al (2002) Life-threatening parkinsonism induced by kava-kava. Movement Disorders, 17, 195196.
Miller, L. G. (1989) Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Archives of Internal Medicine, 158, 22002211.
Mischoulon, D. & Fava, M. (2002) Role of S-adenosyl-L-methionine in the treatment of depression: a review of the evidence. American Journal of Clinical Nutrition, 76 (suppl), 1158S1161S.
Morris, M., Fava, M. & Jaques, P. F. (2003) Depression and folate status in the US population. Psychotherapie Psychosomatik, 72, 8087.
Müller, W. E., Singer, A., Wonnemann, M., et al (1998) Hyperforin represents the neurotransmitter reuptake inhibiting constituent of hypericum extract. Pharmacopsychiatry, 31 (suppl), 1621.
Munoz-Hoyos, A., Sanchez-Forte, M., Molina-Carballo, A., et al (1998) Melatonin's role as an anticonvulsant and neuronal protector: experimental and clinical evidence. Journal of Child Neurology, 13, 501509.
Natural Medicines Comprehensive Database (2004a) Product search: Kava.
Natural Medicines Comprehensive Database (2004b) Product search: Iodine.
Natural Medicines Comprehensive Database (2004c) Product search: Selenium.
Natural Medicines Comprehensive Database (2004d) Product search: Folic acid.
Natural Medicines Comprehensive Database (2004e) Product search: Indian snakeroot.
Natural Medicines Comprehensive Database (2004f) Product search: Iboga.
Natural Medicines Comprehensive Database (2004g) Product search: Kudzu.
Neary, J. T. & Bu, Y. (1999) Hyperforin inhibits uptake of serotonin and norepinephrine in astrocytes. Brain Research, 816, 358363.
Nemets, B., Stahl, Z. & Belmaker, R. H. (2002) Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. American Journal of Psychiatry, 159, 477479.
Oken, B. S., Storzbach, D. M. & Kaye, J. A. (1998) The efficacy of ginkgo biloba on cognitive function in Alzheimer disease. Archives of Neurology, 55, 14091415.
Olde Rikkert, M. G. & Rigaud, A. S. (2001) Melatonin in elderly patients with insomnia. A systematic review. Gerontology and Geriatrics, 34, 491497.
Olin, J., Schneider, L., Novit, A., et al (2001) Hydergine for dementia. Cochrane Library issue 4. Oxford: Update Software.
Ondrizek, R. R., Chan, P. J., Patton, W. C., et al (1999) Inhibition of human sperm motility by specific herbs used in alternative medicine. Journal of Assisted Reproduction and Genetics, 16, 8791.
Overstreet, D. H., Keung, W. M., Rezvani, A. H., et al (2003a) Herbal remedies for alcoholism: promises and possible pitfalls. Alcoholism, Clinical and Experimental Research, 27, 177185.
Overstreet, D. H., Kralic, J. E., Morrow, A. L., et al (2003b) NPI- 031G (puerarin) reduces anxiogenic effects of alcohol withdrawal or benzodiazepine inverse or 5-HT(2C) agonists. Pharmacology, Biochemistry and Behavior, 75, 619625.
Pancheri, P., Scapicchio, P. & Chiaie, R. D. (2002) A double-blind, randomized parallel-group, efficacy and safety study of intramuscular S-adenosyl-L-methionine 1, 4-butanedisulphonate (SAMe) versus imipramine in patients with major depressive disorder. International Journal of Neuropsychopharmacology, 5, 287294.
Perovic, S. & Müller, W. E. (1995) Pharmacological profile of hypericin extract. Effect on serotonin reuptake by postsynaptic receptors. Arzneimittelforschung, 45, 11451148.
Pittler, M. H. & Ernst, E. (2003) Kava extract for treating anxiety. Cochrane Library issue 4. Oxford: Update Software.
Poyares, D. R., Guilleminault, C., Ohayon, M. M., et al (2002) Can valerian improve the sleep of insomniacs after benzodiazepine withdrawal? Progress in Neuropsychopharmacology and Biological Psychiatry, 26, 539545.
Rezvani, A. H., Overstreet, D. H., Yang, Y., et al (1997) Attenuation of alcohol consumption by a novel nontoxic ibogaine analogue (18-methoxycoronaridine) in alcohol-preferring rats. Pharmacology, Biochemistry and Behavior, 58, 615619.
Rezvani, A. H., Overstreet, D. H., Yang, Y., et al (1999) Attenuation of alcohol intake by extract of Hypericum perforatum (St. John's Wort) in two different strains of alcohol-preferring rats. Alcohol and Alcoholism, 34, 699705.
Rezvani, A. H., Overstreet, D. H., Perfumi, M., et al (2003) Plant derivatives in the treatment of alcohol dependency. Pharmacology, Biochemistry and Behavior, 75, 593606.
Roberts, C. G. & Ladenson, P. W. (2004) Hypothyroidism. Lancet, 363, 793803.
Roder, C., Schaefer, M. & Leucht, S. (2004) Metaanalysis of effectiveness and tolerability of treatment of mild to moderate depression with St. John's Wort. Fortschritte der Neurologie Psychiatrie, 72, 330343.
Sano, M., Ernesto, C., Thomas, R. G., et al (1997) A controlled trial of selegeline, alpha-tocopherol or both as treatment for Alzheimers disease. New England Journal of Medicine, 336, 12161222.
Schelosky, L., Raffauf, C. & Jendroska, K. (1995) Kava and dopamine antagonism. Journal of Neurology, Neurosurgery and Psychiatry, 58, 639640.
Schmitz, M. & Jackel, M. (1998) Comparative study for assessing quality of life of patients with exogenous sleep disorders (temporary sleep onset and sleep interruption disorders) treated with ahops-valerian preparation and a benzodiazepine drug. Wiener Medizinische Wochenschrift, 148, 291298.
Schreiter-Gasser, U. & Gasser, T. (2001) A comparison of cholinesterase inhibitors and ginkgo extract in treatment of Alzheimer dementia. Fortschritte der Medizin Originalien, 119, 135136.
Shamir, E., Barak, Y., Plopsky, I., et al (2000) Is melatonin treatment effective for tardive dyskinesia? Journal of Clinical Psychiatry, 61, 556558.
Shamir, E., Barak, Y. & Shalman, I. (2001) Melatonin treatment for tardive dyskinesia: double-blind, placebo-controlled, crossover study. Archives of General Psychiatry, 58, 10491052.
Shebek, J. & Rindone, J. P. (2000) A pilot study exploring the effect of kudzu root on the drinking habits of patients with chronic alcoholism. Journal of Alternative and Complementary Medicine, 6, 4548.
Sheppard, S. G. (1994) A preliminary investigation of ibogaine: case reports and recommendations for further study. Journal of Substance Abuse and Treatment, 11, 379385.
Sher, L. (2001) Role of thyroid hormones in the effects of selenium on mood, behavior, and cognitive function. Medical Hypotheses, 57, 480483.
Singer, C., Tractenberg, R. E., Kaye, J., et al (2003) Alzheimer's Disease Cooperative Study. A multicenter, placebo-controlled trial of melatonin for sleep disturbance in Alzheimer's disease. Sleep, 26, 893901.
Soares, K. V. S. & McGrath, J. J. (2001) Vitamin E for neuroleptic-induced tardive dyskinesia. Cochrane Library issue 4. Oxford: Update Software.
Spinella, M. (2001) Psychotherapeutic herbs. In The Psychopharmacology of Herbal Medicine p. 278. Cambridge, MA: MIT Press.
Staley, J. K., Ouyang, Q. & Pablo, J. (1996) Pharmacological screen for activities of 12-hydroxyibogamine: a primary metabolite of the indole alkaloid ibogaine. Psychopharmacology, 127, 1018.
Stevinson, C. & Ernst, E. (2000) Valerian for insomnia: a systematic review of randomized clinical trials. Sleep Medicine, 1, 9199.
Stoll, A. L., Severus, W. E., Freeman, M. P., et al (1999) Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Archives of General Psychiatry, 56, 407412.
Su, K. P., Huang, S. Y., Chiu, C. C., et al (2003) Omega-3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial. European Neuropsychopharmacology, 13, 267271.
Szegedi, A., Kohnen, R., Dienel, A., et al (2005) Acute treatment of moderate to severe depression with hypericum extract WS5570 (St John's wort): randomised controlled double blind non-inferiority trial against paroxetine. BMJ, 330, 503506.
Tabet, N., Birks, J. & Grimley Evans, J. (2000) Vitamin E for Alzheimer's disease. Cochrane Library issue 4. Oxford: Update Software.
Tang, F., Nag, S., Shiu, S. Y., et al (2002) The effects of melatonin and Ginkgo biloba extract on memory loss and choline acetyltransferase activities in the brain of rats infused intracerebroventricularly with beta-amyloid. Life Sciences, 71, 26252631.
Taylor, M. J., Carney, S., Geddes, J., et al (2004) Folate for depressive disorders. Cochrane Library, issue 1. Oxford: Update Software.
Teufel-Mayer, R. & Gleitz, J. (1997) Effect of long term administration of hypericin extracts on the affinity and density of the central serotonergic 5HT1A and 5HT2Areceptors. Pharmacopsychiatry, 30 (suppl. 2), 113116.
Thiele, B., Brink, I. & Ploch, M. (1994) Modulation of cytokine expression by hypericin extract. Journal of Geriatric Psychiatry and Neurology, 7 (suppl. 1), S60S62.
Tian, J. Z., Zhu, A. H. & Zhong, J. (2003) Afollow-up study on arandomized, single-blind control of King's Brain pills in treatment of memory disorder in elderly people with MCI in a Beijing community. Zhongguo Zhong Yao Za Zhi, 28, 987991.
Unutzer, J., Klap, R., Sturm, R., et al (2000) Mental disorders and the use of alternative medicine: results from a national survey. American Journal of Psychiatry, 157, 18511857.
van Dongen, M., van Rossum, E., Kessels, A., et al (2003) Ginkgo for elderly people with dementia and age-associated memory impairment: a randomized clinical trial. Clinical Epidemiology, 56, 367376.
Viola, H., Wasowski, C. & Levi de Stein, M. (1995) Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptors-ligand with anxiolytic effects. Planta Medica, 61, 213216.
Vogeler, B. K., Pittler, M. H. & Ernst, E. (1999) The efficacy of ginseng. A systematic review of randomized controlled trials. European Journal of Clinical Pharmacology, 55, 567575.
Wang, J. L., Patten, S. B. & Russell, M. L. (2001) Alternative medicine use by individuals with major depression. Canadian Journal of Psychiatry, 46, 528533.
Watanabe, H., Kakihana, M., Ohtsuka, S., et al (1997) Randomized, double-blind, placebo-controlled study of supplemental vitamin E on attenuation of the development of nitrate tolerance. Circulation, 96, 25452550.
Werneke, U. (2003) Alternative nutrition therapies in cancer – the evidence. Clinical Nutrition Update, 8, 68.
Werneke, U., Earl, J., Seydel, C., et al (2004a) Potential health risks of complementary alternative medicines in cancer patients. British Journal of Cancer, 90, 408413.
Werneke, U., Horn, O. & Taylor, D. (2004b) How effective is St John's wort? The evidence revisited. Journal of Clinical Psychiatry, 65, 611617.
Wettstein, A. (2000) Cholinesterase inhibitors and gingko extracts – are they comparable in the treatment of dementia? Comparison of published placebo-controlled efficacy studies of at least six months. Phytomedicine, 6, 393401.
Whiskey, E., Werneke, U. & Taylor, D. (2001) A systematic review of hypericum perforatum in depression. International Clinical Psychopharmacology, 16, 239252.
Williams, J. W., Mulrow, C. D. & Chiquette, E. (2000) A systematic review of newer pharmacotherapies for depression in adults. Annals of Internal Medicine, 132, 743756.
Wolfman, C., Viola, H., Paladini, A., et al (1994) Possible anxiolytic effects of chrysin, acentral benzodiazepine receptor ligand isolated from Passiflora coerulea. Pharmacology, Biochemistry and Behavior, 47, 14.
Wolkowitz, O. M. (1993) Rational polypharmacy in schizophrenia. Annals of Clinical Psychiatry, 5, 7990.
Zhang, X. Y., Zhou, D. F., Cao, L. Y., et al (2004) The effect of vitamin E treatment on tardive dyskinesia and blood superoxide dismutase: a double-blind placebo-controlled trial. Clinical Psychopharmacology, 24, 8386.
Ziegler, G., Ploch, M. & Miettinen-Baumann, A. (2002) Efficacy and tolerability of valerian extract L1156 compared with oxazepam in the treatment of non-organic insomnia – a randomized, double-blind, comparative clinical study. European Journal of Medical Research, 25, 480486.
Zimmerman, R. A. & Thomspon, I. M. Jr (2002) Prevalence of complementary medicine in urologic practice. A review of recent studies with emphasis on use among prostate cancer patients. Urology Clinics of North America, 29, 19.

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Complementary medicines in psychiatry: Review of effectiveness and safety

  • Ursula Werneke (a1), Trevor Turner (a2) and Stefan Priebe (a3)


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Complementary medicines in psychiatry: Review of effectiveness and safety

  • Ursula Werneke (a1), Trevor Turner (a2) and Stefan Priebe (a3)
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Incomplete review of complementary medicines

Dr.Zaffar Ul Hassan, Staff Grade Psychiatrist
27 April 2006

I was disappointed to see the narrow concept of complimentary medicine in the paper by Werneke et al (2006), as its contents did not justify the chosen topic and it merely discussed a few herbal remedies. According to the definition by the National Centre for Complementary and Alternative Medicine (2002) complementary medicine is used together with conventional medicine while alternative medicine is used in place of conventional medicine. In the first place the paper failed to explain whether the herbal preparations were used in addition to conventional medicine or on its own.Secondly, the authors also failed to mention other known complementary therapies including the use of yoga, tai chi, relaxation exercises, music,spiritual healing, naturopathy and homeopathy for psychiatric ailments practised in various parts of the world. In this context I would like to point out that there are several papers indicating that acupuncture can also work in relieving depression, anxiety and Seasonal Affective Disorder(SAD). According to the monoamine hypothesis for affective disorders functional impairment of the monoamine systems in CNS is the cause of depression. Pharmacological manipulations of the monoaminergic neuronal system using tricyclics and monoamine oxidase inhibitors produces therapeutic effects. Based on animal experiments, Hans (1986) presented a paper to show that acupuncture or electro acupuncture (EA) is capable of accelerating the synthesis and release of serotonin (5-HT) and norepinepherine (NE) in the CNS. His clinical data indicated that electroacupuncture was at least as effective and with a higher therapeutic index than tricyclic amitriptylinein treating the depressive patients. Another study by Luo et al from the Beijing Institute of Mental Health in 1997 showed that acupuncture was as effective as amitriptyline in the treatment of depression (Kua and Tan -2005). Further studies have shown that different kinds of neuropeptides are released by different frequencies. For example, in EA Low frequency of 2 Hz accelerates the release of enkephalin, beta-endorphin and endomorphin, while high frequency of 100 Hz selectively increases the release of dynorphin. (Han, 2004). ). Practitioners of this art have also used it to relieve headache, insomnia and chronic pain, which may be a contributing factor in depressive illness. Acupuncture has also been used with violent persons and victims of national disasters, chronic fatigue syndrome and insomnia (Ackerman, 1999). In traditional chinese medicine there is also an emphasis on exercise as part of a healthy lifestyle to restore the yin-yang balance. Tai-chi or king-fu is encouraged as a form of exercise during the recuperation phase of physical and mental illness (Kua and Tan,2005).

Declaration of interest

Z.H is the Founder President of the Association for the Promotion of Acupuncture in Pakistan (A.P.A) Regd; taught acupuncture treatment to medical doctors at The Pakistan College of Acupuncture Sciences and was involved in arranging acupuncture seminars and conferences.


Ursula Werneke, Trevor Turner, and Stefan Priebe (2006), Complementary medicines in psychiatry: Review of effectiveness and safety,British Journal of Psychiatry 188:109-121

National Centre for Complementary and Alternative Medicine (2002): What is complimentary and Alternative Medicine (CAM) Retrieved on March, 6, 2006 from

Han JS (1986) Electro acupuncture: an alternative to antidepressants for treating affective disease, International Journal of Neuroscience, March;29: 79-92 Available on PubMed. Accessed on 01/03/2006

Kua, EH and Tan, CH (2005) Traditional Chinese medicine in psychiatric practice in Singapore, International Psychiatry, 7-9 Issue 8, April

Hans, JS (2004) Neuroscience Letters 361: 258-261, Issues 1-3 , 6th.May, Available from on 24/04/2006)

Ackerman, John M(1999) Acupuncture in Psychiatry Psychiatr Serv 50: 117 January. Available from American Psychaitric Association’s web page:
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Conflict of interest: None Declared

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