Questions & Answers on Psychiatric Medications

Tadao Ogura, M.D.


Can I Take Natural Remedies Instead of Medication?

There has been a growing backlash against all things "artificial" and a general assumption that all things that are "natural" are good. People want "all-natural" food and drinks, and that may be OK. However, when people start wanting "all-natural" healthcare, that is not necessarily a good thing.

First of all, let me challenge the assumption that all things "natural" are "safe." I will remind you that Cyanide is an "all natural" substance, yet it is also one of the most dangerous poisons known to man. In reality, so-called "natural" or "herbal remedies" today are not regulated by the Food and Drug Administration, which is why you should see a disclaimer on all the packaging, stating that the "claims" have not been approved by the FDA.

In fact, if you see claims without the disclaimer, you should think twice about taking the supplements, because they are not even following U.S. labeling requirements. When Consumer Reports magazine studied some of the more popular brands of herbal remedies, they found a wide disparity of concentration of the "active ingredients" from one manufacturer to another, and even from one batch to another of the same brand. Furthermore, there is some question about the quality of the herbs used as the source itself. Where are they grown? How are they grown? How are they harvested? Do we know? Has anyone bothered to find out?

I have studied herbal medicine in Japan, and I found it difficult to get good sources of supply for quality herbs in Japan even forty years ago! Now that there is such a huge demand for "herbal supplements," I can only imagine what they must be doing to meet the demand --quality herbs are hard to grow and harvest! In other words, when you take these so-called "natural remedies," you are taking unregulated substances with unknown quality of ingredients from sources that may or may not be reliable. As a physician, I cannot recommend a treatment based on such questionable quality control.

I am not saying that the entire herbal supplement industry has poor quality control. What I am saying is that I do not and cannot know what the level of quality control is. Therefore, as a physician, I cannot rely on unknown quality products to develop a treatment plan. I often avoid using "generic" products for the first year or so after they come to the market because their quality has not been "tested by time." Some of my patients have complained that they did not do well on generic products and requested to return to "brand name" medications. When FDA-approved "generic" medications are not quite trust-worthy, how can you trust an unregulated substance?

In contrast, what you may consider to be "artificial" or "synthetic" medications have been tested on thousands of patients and scrutinized before being approved by the FDA and are regulated by that organization. It means that suppliers and manufacturers have to go through rigorous safety checks, and doctors are required to report any problems or undue side effects to the FDA.

Although there is no guarantee that all these "FDA-approved" medications are 100% safe and effective for 100% of people either, they are much, much safer and far more effective than uncontrolled, unchecked "natural remedies." Through continuous monitoring and scrutiny by thousands of physicians, these "artificial" or "synthetic" medications are more reliable as well.

Having studied "Oriental Medicine," I have knowledge and experience in "herbal medicine" and can honestly say that there are some benefits, but there are also many limitations. But in ancient times, they had an excuse. Oriental Medicine doctors simply did not have the advantage of modern science, so they had no choice but to resort to trial-and-error methods with whatever was available, all of which happened to be natural substances.

They tried everything: metals and ores including mercury and sulfur, barks and juices of trees, roots of plants and trees, flowers and leaves, gall-bladders of tigers and bears, deer horns, and even mud. Can you imagine how many lives must have been sacrificed before they finally figured out which substances worked and which ones did not?

Slowly, ancient doctors learned to use a combination of ingredients, commonly, five or more. This "cocktail technique" allowed ancient doctors to minimize the negative effects and maximize the benefits of each ingredient and enabled them to use much lower dosages of each ingredient than when each was used singly. By the way, this cocktail technique was recently applied to the treatment of AIDS and revolutionized the treatment outcome for this disorder.

But the real issue about "natural" vs. "artificial" medications is that many people seem to naively associate "natural" with "nature" and "artificial" with "fake." "Nature" is associated with "Mother Nature" or even with "God." Therefore, "Natural" must be "Good" and "Artificial" must be "Bad." These beliefs have prevailed for centuries and have become "natural" beliefs.

Your body, however, really does not know nor care whether what it ingests is from "nature" or is "artificial" as long as it works well for it (including the brain). When you take herbal remedies, it is broken down into its chemical components in the body, and only the "active ingredients" actually "do the job" and the other ingredients theoretically just pass through.

Recently, however, these so-called "inactive ingredients" were found to cause serious complications as well. Therefore, you cannot assume that you are "safe" with "natural" remedies - you may find you that you will have a bad "side effect" to even an "inactive ingredient" of the herbal remedy.

What About St. John's Wort? Isn't That Safer?

One herbal remedy often mentioned as an alternative to psychiatric medications is St. John's wort, which has allegedly been used for centuries in many folk remedies. It is sold as a nutritional supplement in the U.S. and is promoted as a "natural" way to improve mood, and even as a "treatment" for mild to moderate depression. Recently, however, the National Institute of Health has officially determined that St. John's wort is ineffective for the treatment of major depressive disorders.

Other studies also have found that St. John's wort adversely interacts with an antiviral medication for HIV infection called indinavir. Another study in Switzerland found two cases of interaction between St. John's wort and cyclosporine, a medication used to prevent rejection of organ transplants. Still more research has suggested the herbal extract may interfere with the effectiveness of birth control pills and medications for heart disease (such as Coumadin), depression, seizures, and certain cancers. Thus, the FDA has issued an alert to physicians warning them of these potential adverse interactions and advising them to alert their patients.

There is evidence that people with Bipolar I Disorder who take St. John's wort may switch into mania, especially if they are not on any mood-stabilizing medications. Therefore, if you are considering taking this supplement, or are already taking it, always inform your doctor.

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