Herbal Remedies for OCD and Anxiety Disorders

St. John's Wort, Milk Thistle, N-Acetylcysteine and OCD

St. John's Wort herbal remedy
Can herbal remedies such as St. John's wort work for obsessive compulsive disorder (OCD)?. Steve Gorton/Dorling Kindersley/Getty Images

Alternative medicines such as herbal remedies have been growing in popularity in both Europe and North America. Many people with anxiety disorders such as obsessive compulsive disorder (OCD) have tried alternative therapies at one time or another. One of the most popular herbal remedies for anxiety is St. John’s Wort. What nutritional supplements have been studied for OCD specifically, and what have we learned?

St. John’s Wort as a Herbal Remedy for OCD?

Although the effectiveness of St. John’s Wort (Hypericum perforatum) in treating depression and other forms of mental illness is still a matter of some controversy, St. John’s Wort has been widely used (and in some cases, licensed) in Europe for decades to treat mood and anxiety disorders. In addition, in animal studies, hypericum, the chemical thought to be the key ingredient in St. John’s Wort, appears to affect the serotonin system. Disruptions in the serotonin system are thought to be important in the development of symptoms of OCD.

Given that antidepressant medications such as Paxil (paroxetine) and Anafranil (Clomipramine) that target the serotonin system are also effective in treating OCD, it has been suggested that St. John’s Wort could be an alternative therapy for reducing OCD symptoms. SSRIs are only around 40 to 60 percent effective in treating the symptoms of OCD, and in addition, can have significant adverse effects.

Is St. John’s Wort an Effective Treatment for OCD?

The evidence that St. John’s Wort is an effective treatment for OCD is limited. A case study using only one patient suggested that St. John’s Wort was effective in reducing symptoms. A second, larger study using 12 people with OCD found that St. John’s Wort produced a significant reduction in symptoms that was similar to what would be expected with treatment with a selective serotonin reuptake inhibitors or SSRIs.

Neither study, however, properly accounted for the placebo effect. In both cases, the people participating in the research studies were told up front they were going to be receiving St. John’s Wort in hopes of reducing their OCD symptoms. Simply knowing they were receiving a potentially beneficial treatment could have been enough to cause people to feel better.

Studies evaluating the effectiveness of medications should include placebo treatment group that receives a “sugar pill” that is inactive and could not possibly account for any reduction in symptoms or adverse-effects. By using a placebo treatment, it is possible to tell if the actual drug had an effect or not. It is also important that neither the researchers nor the study participants know who is receiving what treatment until the study is over as this could also bias the results. A medical study in which neither the patient or physicians know who is using the medication or supplement and who is receiving a placebo is called a double blind study.

At least one randomized-control trial looked at whether St. John’s Wort is effective in reducing OCD symptoms. In this study, 60 people randomly received either St. John’s Wort or a placebo. At the end of the study, the reduction in OCD symptoms among those who took St. John’s Wort was no different than those who received the placebo.

Milk Thistle (Silybum Marianum) and OCD

Milk thistle is an herbal remedy that has long been used in Iran. In 2010 a double blind placebo controlled study compared the effects of milk thistle to that of Prozac (fluoxetine) in treating OCD (600 mg of milk thistle vs 30 mg of Prozac daily.) It was found that there was no significant difference between mild thistle and Prozac with respect to control of OCD symptoms.

N-Acetylcysteine and OCD

N-Acetylcysteine is an amino acid which appears to moderate glutamine in the brain (it helps produce glutathoine.) A single study of a single person found that N-acetylcysteine augmented (made work better) the actions of the SSRI Luvox (fluvoxamine), resulting in a significant decrease in OCD with the combination in this patient.

Other Herbal Treatments and OCD

Since dysregulation of serotonergic and glutamatergic pathways in the brain appears to occur with OCD, other herbs which work in this pathway have also been considered for their possible benefits. Some of these include 5-hydroxytryptophan (5-HTP) and inositol.

Is an Herbal Remedy or Dietary Supplement Right for Me?

Currently, there is limited evidence that herbals like St. John’s Wort are beneficial in reducing the severity of OCD symptoms; however, more research is needed in this area.

Most herbal remedies are available at your local drugstore without a prescription. Indeed, most people take herbal remedies like St. John’s Wort without consulting a medical doctor or expert in alternative therapies such as a naturopathic physician. It's important to consider herbal supplements the same way in which you would a prescription medication. In addition to having side effects, many of these nutritional supplements can interfere (enhance or decrease) the actions of prescription medications.

Precautions and Side Effects

Although many consumers believe that herbals are safer and have less adverse effects than prescription medications do, herbals, like St. John’s Wort, are not regulated as closely as conventional medications and may cause unpleasant or even dangerous adverse-effects in some people. For example, Kava, an herbal medication used to reduce anxiety has been banned or restricted in some countries after suggestions that it may cause liver problems in some individuals.

Herbals can also interfere with prescription medications you may already be taking. For example, if you are currently taking an SSRI to treat OCD, it essential that you consult with your treating physician before taking St. John’s Wort as it could affect your body’s ability to metabolize these and other types of medication. It could lead to a problem known as serotonin syndrome.

If you are thinking about taking an herbal therapy to help with symptoms of OCD, be sure to consult with your physician or a registered expert in alternative therapies such as a naturopathic physician.

Other Complementary/Alternative or "Integrative" Therapies for OCD

When talking about "alternative" therapies, we sometimes forget that there are self-help and lifestyle interventions that may be effective as well. In other words, that there is more available than just pills and potions. Unfortunately there have been few clinical trials looking at these interventions for people with OCD and those that have been done are fairly poor quality. Yet, unlike prescription and herbal medications, these treatment rarely have significant side effects and may help with other areas of life, such as stress. Therapies that researchers have begun to look at include mindfulness meditation, acupuncture and yoga.

Sources:

Camfield, D., Sarris, J., and M. Berk. Nutraceuticals in the Treatment of Obsessive Compulsive Disorder (OCD): A Review of Mechanistic and Clinical Evidence. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2011. 35(4):887-95.

Kobak, K., Taylor, L., Bystritsky, A. et al. St John's Wort Versus Placebo in Obsessive-Compulsive Disorder: Results from a Double-Blind Study. International Clinical Psychopharmacology. 2005. 20(6):299-304.

Lafleur, D., Pittenger, C., Kelmendi, B. et al. N-Acetylcysteine Augmentation in Serotonin Reuptake Inhibitor Refractory Obsessive-Compulsive Disorder. Psychopharmacology. 2006. 184(2):254-6.

Sarris, J., Camfield, D., and M. Berk. Complementary Medicine, Self-Help, and Lifestyle Interventions for Obsessive Compulsive Disorder (OCD) and the OCD Spectrum: A Systematic Review. Journal of Affective Disorders. 2012. 138(3):213-21.

Sayyah, M., Boostani, J., Pakseresht S., and A. Malayeri. Comparison of Silybum marianum (L.) Gaertn. with fluoxetine in the treatment of Obsessive-Compulsive Disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2010. 34(2):362-5.

Taylor, L., and K. Kobak. An Open-Label Trial of St. John's Wort (Hypericum Perforatum) in Obsessive-Compulsive Disorder. The Journal of Clinical Psychiatry. 2000. 61(8):575-8.

Continue Reading