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Safe Supplements and for Mental Health J. Lake M.D.

Insomnia

Tier A supplements for

Although many natural supplements are widely used to treat insomnia only one— root extract—is substantiated by consistent findings of large well-designed research studies as both a safe and effective treatment of this condition.

Valerian (Valeriana officianalis)  Valeriana officianalis is an used to treat insomnia.  How it works: The active ingredients of V. officianalis affect in the causing mild sedation.  How much to take: A standardized extract of V. officianalis taken at a dose of 600mg to 900mg at bedtime improves the quality and duration of . V. officinialis may be as effective as some prescription sleep aids for the treatment of chronic insomnia.  Safe and effective treatment combinations: It is prudent to avoid taking V. officianalis in combination with other natural products or prescription medications (see below).  Adverse effects and warnings: Caution: V. officianalis should not be used in combination with prescription sleep aids or as this may result in severe sedation. Caution: V. officianalis may cause elevation in . Warning: some active ingredients of V. officianalis may cause birth defects and should be avoided in women who are pregnant or nursing.  Average duration of treatment needed to achieve beneficial results: Some persons experience sustained improvement in the quality and duration of sleep after taking standardized preparations of V. officianalis at the above dosages for 2 to 6 weeks.

Department Of Psychiatry, Oakland Medical Center

Tier B supplements for insomnia

The following supplements are widely used to treat insomnia and are supported by some evidence however they are not as strongly substantiated as Tier A supplements. L- and 5-Hydroxytroptophan (5-HTP)  L-tryptophan and 5-HTP are closely related amino acids that occur naturally in some foods.  How it works: L-tryptophan and 5-HTP are the building blocks of neurotransmitters (e.g. melatonin and ) involved in different aspects of normal brain function including sleep, attention and mood.  How much to take: There are no standard dosages of L-tryptophan or 5-HTP for insomnia. Taking L-tryptophan at doses up to 15gm, or taking 5-HTP at doses up to 300mg just before bedtime often decreases the severity of insomnia. The effective dose of 5-HTP for insomnia is much lower than L-tryptophan because 5- HTP more readily enters the brain and is one step closer to being used as a building block of serotonin.  Safe and effective treatment combinations: Many individuals with chronic insomnia are also depressed. L-tryptophan up to 2gm, or 5-HTP at doses up to 300mg may be safely combined with a sedating taken at bedtime. This combination may improve sleep and speed up the response to the antidepressant.  Adverse effects and warnings : L-tryptophan and 5-HTP are generally safe and have few minor adverse effects including dizziness, drowsiness and decreased appetite. Caution: L-tryptophan and 5-HTP interact with many drugs. You should consult with a physician or pharmacist before considering taking either substance. Note: Over two decades ago there were major safety concerns about the toxicity of L-tryptophan. Those concerns were rapidly resolved after the toxic effects were traced to a single contaminated batch.  Average duration of treatment needed to achieve beneficial results: Many persons with chronic insomnia experience rapid improvement in sleep after taking L-tryptophan or 5-HTP for several days at the above dosages.

Department Of Psychiatry, Oakland Medical Center

Melatonin  Melatonin is a that occurs naturally in the brain.

 How it works: Melatonin is secreted from the in the brain and regulates the sleep-wake cycle. Taking extra melatonin in addition to what the brain naturally produces may improve sleep quality and duration especially in persons who have sleep problems related to or . Melatonin is closely related to the serotonin which is very important in mood regulation.

 How much to take: Taking melatonin 0.3 to 6mg soon before bedtime improves the quality of sleep. Immediate-release melatonin decreases the time needed to fall asleep. Sustained-release preparations of melatonin increase the total amount of time spent sleeping.

 Safe and effective treatment combinations: Controlled-release melatonin (e.g. 2mg) may be safely combined with prescription sleep aids, is more effective than either approach alone and may permit a reduction in the dose of the sleep aid in some cases. Melatonin reduces the time needed to fall asleep and increases total sleep time compared to prescription sleep aids alone. Early morning bright light exposure therapy can be safely used in combination with melatonin for insomnia related to jet lag or shift work.

 Adverse effects and warnings: Melatonin taken at the above dosages is generally safe and there are few mild adverse effects including itching, headaches, and dizziness. Low doses (0.3mg) of melatonin cause no adverse effects. Some individuals who take melatonin at doses of 3mg or higher experience mild grogginess or a low body temperature the following day. Melatonin taken in the daytime may interfere with clear thinking and slow reaction time and should thus be taken only in the time just before one’s normal sleep schedule begins.

 Average duration of treatment needed to achieve beneficial results: Persons who take melatonin often experience rapid improvement in insomnia after finding the right dose and form (i.e. immediate versus delayed release) for their particular symptoms.

Department Of Psychiatry, Oakland Medical Center

Tier C herbal supplements for insomnia

The following herbal supplements are widely used to treat or self-treat insomnia. Limited or inconsistent research findings suggest that they have beneficial effects in some cases. However, the herbals in this tier are less substantiated than supplements in Tiers A and B. Therefore before trying one of the below herbals for insomnia it is prudent to first try another supplement supported by stronger evidence.

Different herbal medicines

 Ginkgo biloba, (St. John’s wort), Panax (Ginseng), and (Ashwagondha) are herbal medicines widely used in different World healing traditions to treat insomnia and other mental health problems.

 How the herbals work: Herbal medicines used to treat insomnia affect several neurotransmitters in the brain including serotonin, acetylcholine, GABA and others. G. biloba and W. somnifera enhance sleep quality and improve cognitive functioning in individuals diagnosed with mild . H. perforatum, widely used to treat depressed mood, improves overall sleep quality. Taking a standardized preparation of P. ginseng improves sleep quality and increases daytime alertness.

 How much to take: The dosages of different herbals used to treat insomnia depend on age, the severity of insomnia and other factors.

 Examples of safe and effective treatment combinations: Ginkgo biloba may be safely combined with sedating to improve sleep quality.

 Adverse effects and warnings: H. perforatum can cause dizziness, irritability, rash, headache and dizziness. P. ginseng can cause agitation, , headache and nervousness.G. biloba may cause upset , headaches or dizziness. G. biloba increases bleeding time and should be discontinued at least 2 weeks before surgery. Warning: G. biloba should not be taken in combination with aspirin, Coumadin or other drugs or natural products that interfere with bleeding.

Department Of Psychiatry, Oakland Medical Center

Warning: H. perforatum and P. ginseng interact with several medications resulting in potentially serious toxicities.  Average duration of treatment needed to achieve beneficial results: Some persons who take St. John’s wort, Ginkgo biloba or W. somnifera for several weeks experience improved sleep quality.

Department Of Psychiatry, Oakland Medical Center