WESTPORT, CT (Reuters Health) Dec 13 - Several over-the-counter antidepressant agents have been known to cause serious neuropsychiatric side effects, according to a review by Dr. Ronald Pies.
"Severely depressed or suicidal individuals who self-medicate with herbal and over-the-counter agents may be risking their lives," he writes in the November 2000 issue of the Journal of Clinical Psychiatry.
Dr. Pies, of Tufts University School of Medicine in Boston, identified non-prescription agents for treatment of depression using the Physicians' Desk Reference for Herbal Medicines. He then conducted a MEDLINE search for human studies of these agents: dehydroepiandrosterone (DHEA), inositol, S-adenosylmethionine (SAMe), St. John's wort and 11 other herbs.
Dr. Pies' review of DHEA indicated "antidepressant effects in certain populations, such as patients with midlife-onset dysthymia and major depression." But he adds that "caution is warranted, given the risk of both mania and psychosis with this agent."
Inositol, too, "has the potential to provoke neuropsychiatric side effects," Dr. Pies writes. His review revealed some benefit from oral inositol treatment for patients with depression, panic attacks and obsessive-compulsive disorder, but found no benefit for patients with schizophrenia, Alzheimer's disease, autism or attention-deficit/hyperactivity disorder.
Dr. Pies found that SAMe "has not been studied systematically in well-defined samples of psychotic or bipolar depressed patients." A few cases of hypomanic or manic symptoms in bipolar patients have been reported, but the data are preliminary. There have been no controlled studies on long-term outcome with SAMe in unipolar depression, or formal studies of safety in patients taking this agent with prescription antidepressants.
Dr. Pies noted that St. John's wort has the potential to interact with standard, prescribed antidepressants. Neither the combined use of this herb with other psychotropic medications nor the effects of St. John's wort in bipolar or psychotically depressed populations is well studied, he added.
Dr. Pies' review of 11 additional herbs, including scarlet pimpernel, mugwort, corydalis, California poppy, lemon balm, basil, marjoram, and passionflower, revealed that "the potential for 'herb-drug' interactions between these remedies and prescribed medications remains almost completely unexplored."
Dr. Pies concludes that "large-scale, controlled studies are clearly needed, and greater 'oversight' responsibility on the part of the Food and Drug Administration now seems advisable."
J Clin Psychiatry