Low-Dose Herbs For Depression

Historically, several potentially toxic herbs have been used for depression. It is unlikely that modern practitioners will find much use for them as they are only indicated for the most serious cases of depression, where the better studied, more reliable synthetic drugs are more appropriate. Nevertheless, we briefly discuss these herbs, one of which still has a potential place in the treatment of people with depression.

Papaver somniferum (opium) is highly recommended by the late Dr. Weiss as the safest and most effective botanical for therapy-resistant, severe depression. Mu opioid receptor agonists like morphine induce euphoria. However, it is clear from Weiss’s description that opium is only palliative, and he says that symptoms will return unless the opium is used long term. Weiss states that opium is best for endogenous depression, particularly in perimenopausal women and in elderly patients with atherosclerosis causing cerebrovascular insufficiency. He recommends extremely small doses of whole plant extracts (5 doses of tincture three times per day titrated slowly up to 20 drops three times per day), which in his experience are not addictive. Perhaps even more controversial is his suggestion that the patient be misled as to the nature of the medicine (he suggests calling it “tincture thebaica,” an antiquated term), because once the patient knows it is opium, the fear of addiction may become a complicating factor. Morphine or other isolated opiates are not recommended for treatment of depression due to their much higher risk of addiction and adverse effects.

Opium tincture may rarely have a place in the treatment of people with depression unrelieved by any other intervention, natural or pharmaceutical. It is clearly not indicated for milder cases or in people who respond to other therapies. Tincture of opium (also known as laudanum or ladanum) and deodorized tincture of opium (opium combined with camphor, also known as paregoric) are schedule III drugs in the United States and can only be prescribed by physicians registered with the Drug Enforcement Agency (DEA). In contrast, morphine, codeine, and other isolated opium alkaloids are schedule II drugs and clearly much more addictive than the whole plant. Weiss recommends combining tincture thebaica with Rheum palmatum (rhubarb) root if constipation is a problem (and suggests this will usually pass in a few days) or Mentha x piperita (peppermint) and bitters if gastrointestinal upset is a problem. Opium should be avoided in people with compromised lung function or intestinal obstruction and is contraindicated in pregnancy and lactation.

Strychnine and brucine are two alkaloids found in such plants as Ignatia amara (St. Ignatius bean, ignatia) and Strychnos nuxvomica (ordeal bean). Strychnine and brucine act as glycine receptor antagonists, thereby blocking the normally inhibitory effects of the amino acid glycine on neurotransmission. As a result, the entire nervous system is indirectly stimulated by strychnine and brucine. If the dose of these agents is too high, a highly characteristic seizure and diaphragmatic paralysis results. Because of these potentially lethal effects, strychnine-containing herbs are no longer recommended for use, except perhaps in the form of homeopathic remedies. Advanced practitioners might consider using a single drop of ignatia mother tincture (1:10 weight:volume) per 5 ml dose of St. John’s wort tincture or an individualized tincture formula as an “activator” or “synergizer.”