Adverse Neuropsychiatric Reactions to Herbal and Over-the-Counter "Antidepressants."

Background: Many unregulated over-the-counteragents for the treatment of depression are now available topatients and consumers. The potential for adverseneuropsychiatric effects with these agents has not beensystematically studied in most cases.

Data Sources: The author performed a MEDLINEsearch on a variety of herbal and nonherbal over-the-counteragents said to be useful in the treatment of depression. The Physicians’Desk Reference for Herbal Medicines was also consulted.

Data Synthesis: Although many of the herbalagents said to have benefits in depression appear to be safe,serious neuropsychiatric side effects and interactions have beenreported for several over-the-counter”antidepressants.” There is reason to suspectunderreporting of those adverse events. Moreover, there is verylittle evidence from systematic studies regarding the potentialfor drug-drug or herb-drug interactions with theseover-the-counter agents. Vitamins and amino acids touted for thetreatment of depression are also not without risk.

Conclusion: Although some over-the-counterremedies for depression are probably safe and effective foras-yet unidentified subgroups of depressed individuals, moreresearch is required before these agents can be recommended forroutine use. Stricter U.S. Food and Drug Administration oversightof these agents is indicated.