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Use of Herbal Medicines Among C-L Populations

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TO THE EDITOR: I am writing to thank Drs. Crone and Wise for their excellent and timely review of herbal medications in consultation-liaison populations.¹ The article's table of potential drug interactions was particularly helpful, and Crone and Wise make the important point that we have little information about such interactions. I could find only two reported drug interactions between an herbal medication and a psychotropic, one between ginseng and phenelzine² (causing euphoria) and one between kava and alprazolam³ (leading to coma).

The use of such drugs is only likely to increase with the growing cultural diversity in the U.S. population. Perhaps even more important, the public's mounting interest in and access to medical information suggests that they will be even more able to learn about alternative or complementary medicines and then perhaps to try them. Needless to say, the information available to the public is of unpredictable scientific quality.⁴ Many of the drugs described in Crone and Wise's paper can be purchased over the Internet, often from overseas distributors. There is essentially no regulatory oversight for this activity because of jurisdictional problems, and drugs such as L-tryptophan, currently banned from U.S. distribution, remain available by this means. Consultation-liaison psychiatrists and their consultees should keep these issues in mind.

REFERENCES

1. Crone CC, Wise TN: Use of herbal medicines among consultation-liaison populations: a review of current information regarding risks, interactions, and efficacy. Psychosomatics 1998; 39:3–13[Abstract/Free Full Text]
2. Jones BD, Runikis AM: Interactions of ginseng with phenelzine. J Clin Psychopharmacol 1987; 7:201[Medline]
3. Almeida JC, Grimsley EW: Coma from the health food store: interaction between kava and alprazolam. Ann Intern Med 1996; 125:940–941[Free Full Text]
4. Silberg WM, Lundberg GD, Musacchio RA: Assessing, controlling, and assuring the quality of medical information on the Internet: caveat lector et viewor—let the reader and viewer beware. JAMA 1997; 277:1244–1245[Abstract/Free Full Text]

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