Occasionally it may be necessary to temporarily boost the energy of someone who is feeling depressed. The German Commission E has approved the use of Cola nitida (kola nut) as an adjunct therapy in depression, and Camellia sinensis (tea), Coffea arabica (coffee), and Ilex paraguayensis (yerba mate) may be useful stimulants due to their caffeine content. However, this is rarely an effective long-term therapy, and entirely fails to address the underlying causes of depression. Certainly, botanical stimulants should not be part of a standard regimen for depression, and it is in fact often recommended that the nearly ubiquitous stimulant caffeine be removed from the diet to stop masking symptoms and allow the person to deal with the real issues of depression.
Instead, we recommend using adaptogens to provide stimulation. These do not contain caffeine and do not appear to have the suppressive effect of the caffeine alkaloid. Instead, they tend to stimulate the entire nervous system. On rare occasions, this may manifest as insomnia, agitation, or mild anxiety but usually adaptogens increase the person’s sense of well-being and energy without negatively affecting mood. That said, there is a case report of a woman, taking clomipramin and haloperidol, who added Asian ginseng to her regimen and became manic. Lorazepam was substituted for the clomipramin and Asian ginseng and her mania dissipated (she otherwise suffered from major depressive disorder). The clomipramin was subsequently reintroduced without sequelae. More typical are the results of a phase III clinical trial of Rhodiola rosea L. In a six-week study, patients took either 340 or 680mg/day of rhodiola or placebo. Rhodiola reduced overall depression and insomnia while increasing emotional stability compared to placebo.
In an animal model of depression, many plants were shown to have an antidepressant effect, such as Eleutherococcus senticosus (eleuthero, Siberian ginseng) root, Schisandra chinensis (schisandra), rhodiola, Echinacea purpurea (purple coneflower), and Syringa vulgaris (lilac). Eleuthero had the most pronounced effect, one comparable to amitriptyline. Rhodiola was a close second followed by echinacea. Interestingly, Melissa officinalis (lemon balm) did not have a positive effect in this study. Many people suffering from depression will find that adaptogens alleviate their symptoms, and where the depression is caused by a poor ability to cope with stress, their use may address the underlying cause of depression. In other patients, their effect will be mostly palliative. Depression that accompanies diseases characterized by immune compromise such as cancer is a strong indication for all these herbs. For more information on adaptogens, see chapter 3.
Peganum harmala (Syrian rue) seed and root is a less well-known stimulant. Though originally from northern India and southern Russia, it has since become naturalized in the western United States. It is completely unrelated to Ruta graveolens (rue). Syrian rue contains the indole alkaloids harmaline and harmine among others. These are a classic inhibitor of monoamine oxidase (MAO) in vitro. Herbalist Michael Moore of Bisbee, Arizona, put the indications for Syrian rue best when he wrote, “The seeds… are a useful antidepressant and mood elevator for folks with mopey dragass depressions, not the nervous, peripatetic, manic depression. People who sit in front of the television all day (whether or not they turn it on) and don’t want to go out or be visited usually find that Syrian rue and a noisy friend can shake them out of their malaise.” The generally safe dose is 1-1.5 ml (approximately 40 drops) of tincture three times per day. Syrian rue should only be used in the short term (a few days to weeks). It should not be taken with tyramine-containing foods (particularly aged cheeses, fermented foods, and wine). Syrian rue will tend to slow and strengthen the pulse while lowering blood pressure. If blood pressure becomes excessively low (to the point of causing dizziness) or if hallucinations occur, Syrian rue use should be discontinued.
The more famous harmine alkaloid-containing plant is Banisteriopsis caapi (ayahuasca), the hallucinogenic vine from South America. This use suggests that native peoples were taking advantage of monoamine oxidase inhibitors long before they were discovered by pharmaceutical science. Unlike ayahuasca, Syrian rue is only hallucinogenic at high, nearly toxic doses, far greater than usual clinical doses. Interestingly, Syrian rue was traditionally used as a vermifuge and amebicidal agent long before it was brought to the New World, and it has shown antimicrobial activity in vitro.