Scientific basis and practical use

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Many patients can benefit from herbs with a milder action, fewer side effects, and some health benefits beyond their antidepressant effects.

BOOK REVIEW

Herbal Treatment of Major Depression: Scientific Basis and Practical Use
by Scott D. Mendelson, MD, PhD; Boca Raton, Fla .: CRC Press; 2020
420 pages • $ 160.00 (hardcover)

Scott Mendelson, MD, PhD, wrote a landmark volume in the Clinical Pharmacognosy Series on Botanical Medicines for CRC Press. Why is this a landmark book? It thoughtfully reviews theories of the mechanisms of activity of antidepressants, including ketamine, and exposes the evidence for the activity of plants through these mechanisms. Most psychiatrists will be surprised to learn of the anti-inflammatory, antioxidant, anti-diabetic, and neuroplastic effects of these herbs.

Chapters in the book include relevant in vitro studies on the effects of 66 herbs, providing a foundation for understanding preclinical animal studies and human studies of depression. An additional chapter details Chinese herbal medicine. Another chapter covers specific plant chemical constituents, supported by data on their mechanisms of action. The final chapter explains how to choose herbs, combine herbs, treat co-morbidities, and increase conventional synthetic pharmaceuticals.

The evidence base for herbal treatments for depression is now growing rapidly. The availability of good research should help psychiatrists gain confidence and enthusiasm for prescribing herbs for depression. Those looking for options other than psychotropic drugs will have better choices. Researchers from pharmaceutical companies wishing to expand their consumer base may develop combination formulas or new herbal products based on the data in this volume. Botany researchers will also find it informative.

Many patients can benefit from herbs with a milder action, fewer side effects, and some health benefits beyond their antidepressant effects. Ethnopharmacologic differences include increased sensitivity to adverse drug reactions in some populations. For example, people of Asian descent may be more prone to the side effects of psychotropic drugs than Caucasians. Consumers who learn about herbal treatments can discuss this knowledge with their health care providers.

Another obstacle to the use of phytomedicines is the lack of insurance reimbursement. The direct cost must be weighed against the potential therapeutic benefits to the patient, in the context of the patient’s financial situation.

Dr. Mendelson succinctly discusses not only familiar herbs for depression, such as St. John’s Wort and Saffron, but also curcumin, lavender, hibiscus, lemon balm, chamomile and many other lesser known herbal medicines. It also offers some fascinating clinical pearls, like the use of milk thistle for obsessive-compulsive disorder (OCD). Evidence suggesting that St. John’s Wort may cause insulin resistance may be new to even experienced herbal prescribers.

When you find that your patient is taking unknown herbs for depression, this is the book to consult. Here you will find the well-researched and clinically relevant information you will need to assess and counsel your patient. It will also provide a solid foundation for your entry into the herbal prescribing arena to reduce side effects, minimize the use of synthetic drugs, increase other antidepressant treatments, and improve adherence. and patient outcomes.

Dr Brown is Associate Professor of Clinical Psychiatry at Columbia University Vagalos College of Medicine, New York.

Experts could read this book cover to cover, but for those who may not be familiar with biochemistry, the dense structure of scientific information makes it a heavy read. Most readers will find there an excellent reference book for researching a herb of interest.

Here and there, editing errors make the text less readable. Occasional problems are left out, such as the risk of St. John’s Wort causing severe phototoxic rashes. For this reason, clinicians should consult more than one source of information on herbal remedies, especially regarding side effects.

The clinical utility of the book could have been enhanced by providing guidance on identifying reliable and quality brands of herbal products. This is a challenge, especially because companies often change the source or content of their products. This is a difficult and controversial area, but for many herbal remedies, only a few companies manufacture and test their product properly. In addition, the lower look-alikes seem to benefit from the high-quality products.

However, these omissions are minor compared to the conceptual and practical advances that are represented in this book. Since two-thirds of psychiatric patients use alternative approaches, psychiatrists and other healthcare professionals need more information to help patients achieve their treatment goals. Herbal medicines may be more helpful than many psychiatrists realize. Overall, they cause fewer side effects and are more environmentally friendly (causing less pollution than synthetic psychotropic drugs).

I highly recommend this book to psychiatrists and other health professionals who deal with depression. In addition, plant protection researchers interested in the development of new treatments will find interesting ideas to pursue.


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