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Many Herbs can carry serious Psychiatric Risks. (Mania, Psychosis, Delirium).

BOSTON -- Herbs and forensic psychiatry may seem like unlikely bedfellows, but the use of certain "natural" preparations can have serious psychiatric sequelae, which could bring them into the courts, Capt. Matthew Faubion, MC, USAF, said at the annual meeting of the American Academy of Psychiatry and the Law.

Issues involving products such as St. John's wort, ma huang, and dehydroepiandrosterone (DHEA) could surface regarding such legal questions as competence to stand trial, criminal responsibility and mitigation.

The effects of ma huang, in fact, were cited in a recent Texas homicide case, noted Dr. Faubion of Wilford Hall Medical Center, Lackland Air Force Base, Tex.

More than one in three adults reportedly used an alternative medication during a recent 12-month period. Although "natural" is often equated with "safe"--a substantial part of the appeal of such products--some herbs and similar preparations are associated with significant risks, including psychiatric problems.

St. John's wort, widely used as an antidepressant, clearly has effects on the central nervous system, including a 50% increase in 5-HT1A and 5-HT2A receptors after 6 months of treatment. Like prescription antidepressants, it appears to carry a risk of precipitating mania--perhaps exacerbated by the fact that it is usually taken without medical evaluation or supervision, Dr. Faubion said.

A literature review found seven cases of mania in patients who were taking St. John's wort. These include individuals with previously stable bipolar disorder, longstanding depression, or a family history of bipolar disorder.

One 20-year-old man became irritable, anxious, and psychotic after he took the standard dose of the herb for several days. While the patient himself had no prior psychiatric history an uncle was bipolar. Symptoms resolved with lithium.

DHEA, an adrenocortical hormone made by primates, is the precursor of a number of estrogens and androgens. Enthusiasts say it can burn fat; build muscle mass; increase libido; and prevent heart disease, memory loss, cancer, and diabetes, among other things.

Dr. Faubion observed that corticosteroids have well-documented effects on mood (more than half of patients on prednisone report psychiatric symptoms) and that DHEA also leads, in some users, to extremely high levels of testosterone.

He described one case report of a 51-year-old male physician who was hospitalized for agitation, irritability and delusions. He had been taking DHEA for 3 weeks "to boost energy."

The patient, who had no personal or family psychiatric history, was treated with haloperidol and divalproex and maintained on divalproex after discharge.

The herbal preparation ma huang, an extract of ephedra, is widely taken to increase energy and enhance athletic performance. Among the reported psychiatric complications of its use are affective disturbances and psychosis similar to reactions seen in patients who misuse asthma medications containing ephedrine, the active ingredient of ephedra.

Ephedrine structurally resembles amphetamine, has similar stimulant properties, and appears to induce a similar psychosis: paranoia with a clear sensorium, Dr. Faubion said.

A 20-year-old Marine without prior psychiatric history was evacuated from the Persian Gulf for "acute psychosis and agitation" after he destroyed a TV in an attempt to rescue individuals he believed were held captive therein. Several months earlier, he had initiated a regimen of ma huang supplements, DHEA, and heavy amounts of caffeine.
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Article Details
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Author:Sherman, Carl
Publication:Clinical Psychiatry News
Article Type:Brief Article
Geographic Code:1USA
Date:Jan 1, 2002
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