Herbal Remedies for OCD and Anxiety Disorders

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

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, especially as treatments for anxiety disorders such as obsessive-compulsive disorder (OCD). What nutritional supplements have been studied for OCD, specifically, and what has been learned? Find out more, below.

St. John’s Wort 

Although the effectiveness of St. John’s Wort (Hypericum perforatum) in treating depression and other forms of mental illness is controversial, St.

John’s Wort has been widely used (and in some cases, licensed) in Europe for decades to treat mood and anxiety disorders.

In animal studies, hypericum—the chemical that's 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. 

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, slightly larger study using 12 people with OCD found that St. John’s Wort produced a significant reduction in symptoms that were similar to what would be expected with treatment with a selective serotonin reuptake inhibitors (SSRI) antidepressant medication.

Neither study, however, properly accounted for the placebo effect. In both cases, the people participating in the research studies were told up front that they were going to be receiving St. John’s Wort in the hopes of reducing their OCD symptoms. Simply knowing that 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 a placebo treatment group that receives a “sugar pill” that is inactive and could not possibly account for any reduction in symptoms. 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 to avoid bias. A medical study in which neither the patient nor the 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-controlled trial looked at whether St. John’s Wort was 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 it was in those who received the placebo. Results like this lead to questions about the effectiveness of St. John's Wort as a treatment for OCD.

Milk Thistle (Silybum Marianum) 

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 the antidepressant Prozac (fluoxetine) in treating OCD (600 milligrams of milk thistle vs 30 milligrams of Prozac daily).

It was found that there was no significant difference between milk thistle and Prozac with respect to control of OCD symptoms.

N-Acetylcysteine 

N-Acetylcysteine is an amino acid that moderates glutamine in the brain (it helps produce glutathione.) A single study of a single person found that N-acetylcysteine augmented (improved) the actions of the SSRI Luvox (fluvoxamine), resulting in a significant decrease in OCD symptoms.

5-HTP and Inositol

Since the dysregulation of serotonergic and glutamatergic pathways in the brain appears to occur with OCD, other herbs that work in this pathway have also been considered for their possible benefits.

Some of these include 5-hydroxytryptophan (5-HTP) and inositol.

Is a Dietary Supplement Right for You?

Currently, there is limited evidence that herbal remedies like those mentioned above are beneficial in reducing the severity of OCD symptoms; however, more research is needed in this area.

Most herbal remedies are available at drugstores without a prescription. However, it's important to talk to your doctor before taking any supplement. In addition to having side effects, many of these nutritional supplements can interfere (enhance or decrease) the actions of prescription medications.

Side Effects of Herbal Remedies

Although many consumers believe that herbals are safer and have fewer adverse effects than prescription medications do, herbals like St. John’s Wort are not regulated as closely as conventional medications are and they may cause unpleasant or even dangerous side effects in some people. For example, Kava, an herbal medication that's 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 that you may already be taking. For example, if you are currently taking a SSRI to treat OCD, it essential that you consult your treating physician before taking St. John’s Wort as it could affect your body’s ability to metabolize it. This could lead to a problem known as serotonin syndrome.

Other Complementary/Alternative/Integrative Therapies

Don't forget: Beyond supplements, lifestyle interventions such as mindfulness meditationacupuncture, and yoga.may be effective as well. Unfortunately, there have been few clinical trials looking at these interventions for people with OCD and those that have been done are of fairly poor quality. Yet, unlike prescription drugs and herbal medications, lifestyle interventions rarely have significant side effects and may also help reduce stress. 

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.

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.

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