108 The Professional Counselor | Volume 12, Issue 2 The WHO defines herbal medicines as consisting of “herbs, herbal materials, herbal preparations, and finished herbal products” (Disch et al. 2017, p. 7). The U.S. Food and Drug Administration (FDA) considers herbal products to be botanicals, which include plant parts, fungi, and algae (FDA, 2015). Many herbal remedies contain compounds that are pharmaceutically active. These compounds can exert an effect on the body or the central nervous system (Sarris, 2018). It has been estimated that about 40% of modern pharmaceuticals originated from naturally occurring treatments (Balick & Cox, 2021). However, in accordance with U.S. laws, herbal remedies or herbaceuticals cannot be marketed as drugs. The FDA is only able to regulate herbaceuticals as dietary supplements. In general, oversight seems marginal in comparison to prescription drugs. For example, manufacturers do not have to seek FDA approval before selling herbal remedies as is required for prescription drugs, and claims made by manufacturers pertaining to dietary supplements are not evaluated by the FDA (A. C. Brown, 2017). Herbal remedies and dietary supplements do not undergo rigorous research and development in the same manner as pharmaceuticals. The FDA is currently only able to monitor those herbal remedies and dietary supplements (and their corresponding ingredients) after they are sold and adverse reactions have been reported, making possible adulteration one of the most worrisome safety concerns pertaining to herbal remedies and dietary supplements (A. C. Brown, 2017). Research has shown that many herbaceuticals are contaminated and are augmented with unlabeled fillers (Crighton et al., 2019; Newmaster et al., 2013). Herbaceuticals can be contaminated by dust and pollen; microbes; parasites; fungi; pesticides; and heavy metals such as lead, arsenic, mercury, and cadmium (de Sousa Lima et al., 2020; Posadzki et al., 2013,: P. Singh et al., 2008). Also, product substitution is a common problem; however, the lack of more effective FDA oversight does not limit herbaceutical popularity or use (Newmaster et al., 2013). Ravven et al. (2011) estimated that one-quarter to one-third of all herbal remedies in the United States are purchased with the intent to treat mental health conditions, especially anxiety and depression. CAMs such as herbal remedies and dietary supplements can create problems when they interact with medication prescribed by a physician. It is also important to note that many herbal remedies are not harmless; some can cause significant toxic side effects. Counselors must be familiar with the benefits and risks of the more widely used remedies, including St. John’s wort, valerian, kava, ginkgo, and cannabidiol. St. John’s Wort St. John’s wort has been found to be effective in the treatment of mild to moderate depression (Apaydin et al., 2016). There are some indications that it is comparable in effectiveness to tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) while also offering greater tolerability (Zirak et al., 2019). A meta-analysis including 27 studies and 3,808 participants confirmed that St. John’s wort seems to be as effective as SSRIs and tricyclic antidepressants when used in the treatment of depression (Q. X. Ng et al., 2017). St. John’s wort was found to be associated with significantly lower discontinuation rates when compared to prescribed antidepressants, may cause fewer side effects than prescription antidepressants, and might be beneficial for clients who struggle with tolerating the side effects of commonly prescribed antidepressants (Q. X. Ng et al., 2017; Zirak et al., 2019). St. John’s wort is also considered a low-cost alternative to prescription antidepressants (Zirak et al., 2019). It is most frequently taken orally as either a whole herb formulation or as an extract, and can also be prepared as an herbal tea (Kladar et al., 2020). Despite all the benefits it offers, taking St. John’s wort is not without risks. It acts as an SSRI and can lead to serotonin syndrome if combined with other SSRIs (Apaydin et al., 2016). In addition to affecting serotonin levels, St. John’s wort also impacts the neurotransmitters dopamine, norepinephrine, GABA, and glutamate (Brahmachari, 2018). A main side effect is photosensitivity. It is also possible
RkJQdWJsaXNoZXIy NDU5MTM1