Herbal Medicines in Pediatric Neuropsychiatry

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Herbal components

There are many different chemical constituents in herbal plants that can have therapeutic as well as toxic effects. Herbal supplements may come prepared as tablets/capsules, powders, tinctures, syrups, and brewed teas for oral consumption.6 Other preparations for topical application include salves, ointments, and shampoos. Parts of the plant that may be used include the flower, leaves, stem, roots, seeds, and berries.6 Bioflavonoids, one of the major herbal components, include flavonoids that

Product quality assurance

Quality control of herbal supplements within the United States remains largely unregulated. There are no standard governmental regulations that ensure good manufacturing processes and product reliability. Standardization of herbal supplements is challenging because of the chemical complexity of botanicals, which may contain multiple active ingredients, and because of uncertainty about which ingredient is contributing to the therapeutic effect.8 Laboratory analysis of multiple brands of a herbal

Use within the general pediatric and adolescent population

Use of CAM therapy continues to gain in popularity, with numerous studies trying to quantify the numbers and types of individuals using CAM therapy. CAM therapy has been well documented in the adult population, and an increasing number of studies have sought to evaluate use within the pediatric population. Studies have been limited by small sample sizes and restriction to a locale or region and specific illnesses. In regards to specific illnesses, CAM use has been reported in patients with

Herbal supplements and neuropsychiatric disorders

It is not uncommon for patients to look to complementary therapy for the treatment of headaches, insomnia, depression, anxiety, and fatigue.25 Many supplements are promoted for treating these symptoms and patients may often self-treat before seeking professional treatment. As seen in the general population, a few surveys indicate that pediatric patients with neuropsychiatric disorders also turn to complementary therapy for treating a variety of ailments, including the primary neuropsychiatric

St John’s wort

St John’s wort is likely the most heavily researched supplement, with the major focus on the treatment of depression. Other indications in which St John’s wort has been proposed to be beneficial but that lack sufficient supporting evidence include anxiety, obsessive-compulsive disorder (OCD), and seasonal affective disorder (SAD).29 The primary active ingredients of St John’s wort include naphthodianthrones (eg, hypericin), phloroglucinols (eg, hyperforin), flavonoids (eg, quercetin),

Melatonin

Endogenous melatonin is secreted by the pineal gland, along with other organs, to maintain a normal circadian rhythm.38 Production is regulated via a complex pathway, with stimulation occurring during periods of darkness and peak serum levels occurring before bedtime.38 Because of its ability to regulate the circadian rhythm, melatonin has been evaluated for a variety of conditions, including jet lag, night-shift work, and neuropsychiatric disorders.38 Melatonin is also believed to have

Valerian

Valeriana officinalis is the most common species of the genus Valeriana that is used for medicinal properties.47 The root of the plant has been used for centuries for its purported benefits as an anxiolytic and sedative hypnotic. Valerian is also considered to have antispasmodic, anticonvulsant, and antidepressant effects.47 Volative oils and valepotriates may be the major components that contribute to the pharmacologic effects of valerian.47 Volative oils contain monoterpenes and

Kava

Kava originates from the South Pacific Islands and is derived from the roots, rhizomes, and root stems of the shrub Piper methysticum.57 In the South Pacific Islands it is used culturally as a social beverage as well as in ceremonial rituals.57, 58 It also has medicinal implications, which include treating anxiety, insomnia, premenstrual syndrome, and stress.49 Kava is comprised of kavalactones (also known as kavapyrones), which are considered the pharmacologically active components. A variety

DHA and EPA

Omega-3 fatty acids (DHA and EPA) have been evaluated in several pediatric diseases, including asthma, Crohn disease, and eczema as well as ADHD, ASD, dyslexia, and juvenile bipolar disorder (JBD).65, 66 Omega-3 fatty acids (also referred to as long-chain polyunsaturated fatty acids) can be derived from their precursor α-lineolic acid (ALA) within the human body, but this process is not efficient.65 ALA can be derived from plant sources, including green vegetables and some nuts, whereas omega-3

Herbal supplements for weight loss

A variety of herbal supplements exist for the treatment of obesity but no clinical trials have been performed in children or adolescents. Table 5 lists supplements and possible mechanisms of action. Many herbal supplements formerly contained ephedrine but because of its adverse effect profile, including sudden death, the FDA banned its use in 2004.74 Since then, Citrus aurantium has been substituted for ephedrine because of its stimulant properties (α-adrenergic agonist) and/or caffeine, which

Summary

Complementary medicine, including the use of herbal supplements, continues to grow even within the pediatric population. The ease of use associated with supplements, including access and self-administration, patients’ perceptions that herbals are safe, and consumer advertising, has led to an increased use in herbal supplements for prevention as well as treatment of chronic diseases. Parental use of CAM therapy is often associated with CAM use in pediatric patients, as noted in survey studies.

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