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Generalized Anxiety Disorder and Valerian

Read more about Valerian.

Overview

The herb valerian is best known as a remedy for insomnia. However, because many drugs useful for insomnia also reduce anxiety, valerian has been proposed as an anxiety treatment as well.

Effect of Valerian on Generalized Anxiety Disorder

Our understanding of how valerian might function remains similarly incomplete. Several studies suggest that valerian affects GABA, a naturally occurring amino acid that appears to be related to the experience of anxiety.17-20 Conventional tranquilizers in the Valium family are known to bind to GABA receptors in the brain, and valerian may work similarly. However, there are some significant flaws in these hypotheses, and the reality is that we don't really know how valerian works (or if, indeed, it really does).21,22

Research Evidence on Valerian

In a double-blind, placebo-controlled study, 36 people with generalized anxiety disorder were given either valerian extract, valium, or placebo for a period of 4 weeks.16 The study failed to find statistically significant differences between the groups, presumably due to its small size. However, a careful analysis of the results hints, at least, that valerian was helpful.

In addition, a preliminary double-blind study found that valerian may produce calming effects in stressful situations.28 Again, though, this study was too small to provide definitive results. Another study evaluated the anxiety-relieving effects of a combination containing valerian and lemon balm taken in various doses; some benefits were seen with doses of 600 mg or 1200 mg three times daily, but the highest dose (1800 mg three times daily) actually appeared to increase anxiety symptoms during stressful situations. Furthermore, people taking the herbal treatment at any dose showed slightly decreased cognitive function as compared to those given placebo.

Side Effects and Warnings

#Safety Issues

Valerian is on the FDA's GRAS (generally recognized as safe) list and is approved for use as a food. In animals, it takes enormous doses of valerian to produce any serious adverse effects. ^[1] Valerian has shown an excellent safety profile in clinical trials. ^[2] In a suicide attempt, one young woman took approximately 20 g of valerian (20 to 40 times the recommended dose). Only mild symptoms developed, including stomach cramps, fatigue, chest tightness, tremors, and light-headedness. All of these resolved within 24 hours, after two treatments with activated charcoal. ^[3] The woman's lab tests—including tests of her liver function—remained normal. Keep in mind that this does not mean that you can safely exceed the recommended dose!

One report did find toxic results from herbal remedies containing valerian mixed with several other herbal ingredients, including skullcap . Four individuals who took these remedies later developed liver problems. ^[5] However, skullcap products are sometimes contaminated with the liver-toxic herb germander, and this could have been the explanation.

There have also been about 50 reported cases of overdose with a combination preparation called Sleep-Qik, which contains valerian as well as conventional medications. ^[6] Researchers specifically looked for liver injury, but found no evidence that it occurred.

There are some safety concerns about valepotriates, constituents of valerian, because in test tube studies they have been found to affect DNA and cause other toxic effects. However, valepotriates are not present to a significant extent in any commercial preparations. ^[7] Although no animal studies or controlled human trials have found evidence that valerian causes withdrawal symptoms when stopped, one case report is sometimes cited in support of the possibility that this might occur. ^[8] It concerns a 58-year-old man who developed delirium and rapid heartbeat after surgery. According to the patient's family, he had been taking high doses of valerian root extract (about 2.5 g to 10 g per day) for many years. His physicians decided that he was suffering from valerian withdrawal. However, considering the many other factors involved (such as multiple medications and general anesthesia), it isn't really possible to conclude that valerian caused his symptoms.

In clinical trials, use of valerian has not been associated with any significant side effects. A few people experience mild gastrointestinal distress, and there have been rare reports of people developing a paradoxical mild stimulant effect from valerian.

Valerian does not appear to impair driving ability or produce morning drowsiness when taken at night. ^[9] ^[10] ^[11] As noted above, most studies have failed to find any immediate sedative effect with valerian. However, one study reported finding mild impairment of attention for a couple of hours after taking valerian. ^[12] For this reason, it isn't a good idea to drive immediately after taking it.

There have been no reported drug interactions with valerian, and two studies found reasons to believe that valerian should not raise or lower the blood levels of too many medications. ^[13] Nonetheless, there are at least theoretical concerns that valerian might amplify the effects of sedative drugs. A 1995 study was somewhat reassuring on this score because it found no interaction between alcohol and valerian. ^[14] However, animal studies have found that valerian extracts may prolong the effects of some sedatives, ^[15] and there have been some worrisome case reports suggesting that the combination of valerian and alcohol can lead to excessive sedation in some people. ^[16] For this reason, we recommend that you do not combine valerian with central nervous system depressants except under doctor’s supervision.

Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease has not been established.

#Interactions You Should Know About

If you are taking sedative drugs such as benzodiazepines ; don't take valerian in addition to them, except under physician supervision.

References

  1. Andreatini R, Sartori VA, Seabra ML, et al. Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study. Phytother Res. 2002;16:650-654.
  1. Santos MS, Ferreira F, Cunha AP, et al. Synaptosomal GABA release as influenced by valerian root extract—involvement of the GABA carrier. Arch Int Pharmacodyn Ther. 1994;327:220-231.
  1. Santos MS, Ferreira F, Cunha AP, et al. An aqueous extract of valerian influences the transport of GABA in synaptosomes. Planta Med. 1994;60:278-279.
  1. Holzl J, Godau P. Receptor bindings studies with Valeriana officinalis on the benzodiazepine receptor. Planta Medica. 1989;55:642.
  1. Mennini T, Bernasconi P, Bombardelli E, et al. In vitro study on the interaction of extracts and pure compounds from Valeriana officinalis roots with GABA, benzodiazepine, and barbiturate receptors in rat brain. Fitoterapia. 1993;64:291-300.
  1. Santos MS, Ferreira F, Faro C, et al. The amount of GABA present in aqueous extracts of valerian is sufficient to account for [ 3H ] GABA release in synaptosomes. Planta Med. 1994;60:475-476.
  1. Cavadas C, Arajo I, Cotrim MD, et al. In vitro study on the interaction of Valeriana officinalis L. extracts and their amino acids on GABAa receptor in rat brain. Arzneimittelforschung. 1995;45:753-755.
  1. Kohnen R, Oswald WD. The effects of valerian, propranolol, and their combination on activation, performance and mood of healthy volunteers under social stress conditions. Pharmacopsychiatry. 1988;21:447-448.

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