H.C. George Wong, MD
The article in the March issue of BCMJ (“Self-report of use of traditional Chinese medicine by patients attending a cross-cultural psychiatry outpatient clinic,” 2007;49[2]:68-71) reported 20% of Chinese patients attending a cross-cultural psychiatry outpatient clinic in Vancouver had used traditional Chinese medicine (TCM). Many of those patients took the TCM products for somatic symptoms and not specifically for emotional symptoms.
Panax ginseng may cause manic-like symptoms when combined with monoamine oxidase inhibitors. [1]
St. John’s wort is self-medicated by Caucasians and individuals of various ethnocultural groups for depression. Clinical studies have demonstrated clinical efficiency for mild depression. [2] However, its use in moderate to severe depression is controversial.[3-6]
The production of hepatic cytochrome P450 3A4 enzyme, [7] and active efflux pump P-glycoprotein are increased by St. John’s wort. It affects the metabolism of 50% of all marketed medications and reduces their serum concentrations.
Many drugs metabolized by CYP 3A4 enzyme and reported to be affected by concurrent use of St. John’s wort include antidepressants (selective serotonin re-uptake inhibitor, tricyclic), HIV drugs, antihypertensives, anesthetics, warfarin, theophylline, digoxin, immunosuppressives, oral contraceptives, tamoxifen, sympathomietics, and others.
Acute onset of serotonin syndrome with hypertension, diaphoresis, agitation, dizziness, and weakness has been reported on two patients after 10-day use of St. John’s wort. The syndrome resolved following supportive care and discontinuation of St. John’s wort. [8]
In the article, the clinic psychiatrist advised the patients to discontinue the TCM. The authors cautioned the potential of toxic ingredients and potential interactions with Western psychotropic medications.
TCM and other herbal medicine can have adverse reaction and interaction with many different classes of Western medications. They should also be discontinued 2 weeks prior to elective surgeries because they may cause bleeding and have an effect on blood pressure and anesthetics. In addition, allergic reaction can occur,[9] and contaminant or adulterant may be present.[10]
—H.C. George Wong, MD
Vancouver
