The Spectrum of Poisons & Remedies
Imagine a spectrum in front of you: on the very far left, you can see lots of different food – it’s all calorie-dense, but not particularly nutritious. A little further in, you see lots of produce and multi-colored, nutritious medicinal foods. (Skip the center for now – we’ll get to that in a minute!) On the right, you see lots of pills, tablets, injections, and different kinds of chemical therapies.
The idea here is that we’re looking at a spectrum of healing substances and poisonous substances. This ranges from food to drugs – both can be therapeutic, but if taken inappropriately, both can be poisonous.
If we look in the middle of the spectrum, this is where things get interesting – and it’s where you’ll see a lot of herbs and plants. The herbs closer to the food-like side work primarily by nourishing the body. They have a gentle action, take a longer time to work, and have a low risk of side-effects. As you come closer to the center, you’ll find herbs that are still gentle but have a more noticeable effect and a slightly higher risk of toxicity. To the right, you’ll find herbs with more of a drug-like effect – even though they have complex constituents – and are much stronger, which come with a much more precise dosing need to prevent toxicity.
This serves to orient us to the range of options when it comes to herbs, drugs, and lifestyle practices to support wellness – there’s no good or bad dichotomy when it comes to supporting your health, and there are advantages and disadvantages to each option. The real art is to match your needs to the right combination of therapeutics available on this spectrum. We often need help in doing this, and often from different people!
Key Questions about Herbs and Psychiatric Medication
Does St. John’s Wort really work as an antidepressant?
Antidepressants come in many different forms, and work in different ways. Depending on the form in which your depression presents, some classes of antidepressants might be totally ineffective while others might work well. One of the things that is so powerful about herbs like St. John’s Wort, we’re dealing with an entirely different way of looking at what your needs are and how to match herbs and therapeutics accordingly.
St. John’s Wort is not an herbal antidepressant (contrary to how the media has portrayed it!) St. John’s Wort is a very complex plant, and while it can be very effective for people with a certain kind of depression, for other types of depression it won’t help. The most amazing thing with St. John’s Wort is its ability to soothe and nourish the nervous system – it has an astonishing ability to calm down nerves involved in chronic pain. (People with chronic pain often have depression symptoms, for obvious and not-so-obvious reasons.) St. John’s Wort is useful when looking at symptoms of depression that involve the nerves and a lack of sunshine and light in someone’s life. It has many different uses and subtleties, and it also has more potential interactions with medication than many other popular herbs.
Are there interactions between herbs and drugs?
The best way to know this is to work with your prescribing physician and your herbalist to make sure that everyone is on the same page and is double-checking the data about interactions. The available data on herb-drug interactions really varies: some data sets are purely speculative, while others are very clear and well-understood. It’s very important that you have someone who can help you sort through all the information. It’s important to check everything with Medline yourself so you can be sure that there’s no interaction; if you see something that concerns you, you can raise it with your physician and herbalist.
The best way to avoid having negative interactions is to be sure that you don’t take a pharmaceutical medication and an herb to treat the same thing. Doubling up on your anti-depressants by taking a medication in addition to an herb that helps with depression can lead to what’s known as a synergistic effect – and when this happens, the combined effect is more than either the medication or herb would have on their own. This amplification can be dangerous, so don’t use herbs and drugs concurrently to treat the same issue.
The second thing to remember is that it’s important to think about the way the herb or drug is metabolized by the body. St. John’s Wort, for example, can actually have an impact on the way the liver metabolizes the way drugs and hormones move through the body. So, if you’re taking an herb that makes medications move through the body more quickly, it’ll affect the dosing requirements on those other medications.
On the other side of the coin, when it comes to psychiatric medications in particular, people often feel like they don’t want to need the medication, or they feel hesitant about having to deal with the side effects of psychiatric medications. This is where herb-drug interactions can work really well: the anti-seizure and anti-psychotic medications used to treat bipolar disorder, etc., can cause side effects like tremors and weight gain – and in cases like this, herbs can help mitigate those side effects so that people can stay on the medications they need.
What it comes down to is this: What does each person need, and how can we use all the resources at our disposal to make sure they get the help they need – and to ensure that the treatment is sustainable?
The Advantages and Disadvantages of Both Herbs and Pharmaceuticals in Mental Health Care:
Advantages of using pharmaceuticals:
- The number one advantage of medication is that, for people who have health care coverage, pharmaceuticals are backed by a great deal of research.
- Those taking medications have access to a broad network of support from trained psychiatrists, and usually there are a lot of practitioners and places readily available for pursuing this kind of help.
- It’s also often easier to find the right dose and manage in a predictable way.
Disadvantages of using pharmaceuticals:
- Medications can cause unwanted side effects, like the tremors and weight gain mentioned above.
- For those who don’t have health insurance, pursuing treatment with pharmaceuticals can be extremely expensive, and it’s often cost-prohibitive.
- Some medications carry the risk of addiction or dependence.
- Some medications don’t have a selective ability to dampen the intensity of peoples’ negative emotions without also dampening their positive emotions, leading to an across-the-board dulling effect.
Advantages of using herbs:
- For people who don’t have health insurance, herbal preparations are affordable and accessible.
- Herbs often have many fewer side effects than drugs do – if anything, they tend to have side-benefits.
- Most (but not all) herbs don’t carry a risk for dependence or withdrawal.
Disadvantages of using herbs:
- When dealing with severe mental health challenges, herbs won’t be enough to manage these conditions. More acute conditions require greater intervention than herbs can offer.
- Even though herbs are regulated, that regulation is not as strict as it is for pharmaceuticals. There are a lot of unscrupulous companies that take advantage of these loopholes – or, sometimes, other companies that don’t have the resources to create and sell a high-quality product. As a result, there are some diluted, ineffective products on the shelves. As a consumer, you need to really know where you’re getting your plants from, in what form, at what dose, and what’s really in the bottle. The idea that “what’s on the label is in the bottle” isn’t often true for herbs, so you need to have trustworthy sources.
What’s “Natural,” and How Does it Stack Up?
“Natural” is sometimes used as a foil to stand in for the stigma attached to using medication – and that stigma can lead to people preferring to pursue a “natural” treatment such as herbs instead of pharmaceuticals.
With this in mind, it’s important to value the plants for what they’re really good for. This involves honoring the real gifts they offer in terms of being effective yet gentle, their affordability, and the way they can offer multiple benefits while positively affecting different body systems.
But at the same time, let’s think more deeply than simply playing into the false dichotomy of “natural vs. artificial.” If we take a breath and look beyond this dichotomy, we can look at the real merits – and drawbacks – of both plants and medications. Each type of treatment has an important role to play in helping people become their best self, and the nuances of both medicine and people are far more complex than marketing campaigns on either side of the “natural vs. artificial” divide would have us believe! The most important element of this is ensuring that people get the types of support – which can be herbs, medication, or a combination thereof – that are most effective in addressing each person’s unique needs.