The Professional Counselor | Volume 12, Issue 2 109 for St. John’s wort to negatively interact with MAOIs (LaFrance et al., 2000; Sidhu & Marwaha, 2021). In addition, due to cytochrome P450 induction, it also impacts the effectiveness of commonly used medications such as warfarin (used to treat blood clots), ciclosporin (an immunosuppressant), digoxin (for arrythmias and heart failure), some anticonvulsants, oral contraceptives, and other drugs (Barnes et al., 2001; Chrubasik-Hausmann et al., 2019; Sharma et al., 2021). It has been noted that consumers continue to take St. John’s wort in combination with other drugs despite warnings, and it is important that clients receive further education on this topic (Chrubasik-Hausmann et al., 2019). Valerian Valerian root has been used as a sedative and hypnotic since antiquity (Perry et al., 2006). In Europe, valerian is widely used for the treatment of anxiety and sleep disorders (Shinjyo et al., 2020). It is considered to be effective in the treatment of anxiety, certain sleep disorders, some seizure disorders, possibly OCD, cognitive problems, and menstrual and menopausal symptoms (LaFrance et al., 2000; Shinjyo et al., 2020). The medicinal parts of the plant consist of the underground segments and roots and can be ingested as a juice, tea, dried herb, extract, or tincture (Gruenwald et al. 2007). Valerian is thought to enhance GABA transmission and prevent enzymatic breakdown of GABA in the brain (Mulyawan et al., 2020; K. Savage et al., 2018). No noteworthy adverse side effects seem to occur when it is taken at an appropriate dose (LaFrance et al., 2000; Shinjyo et al., 2020). Effective doses can range from 450mg–1410mg per day for whole herb preparations, and 300mg–600mg per day for valerian extract (Shinjyo et al., 2020). The non–habit-forming properties and limited potential for side effects may be beneficial for some clients (Al-Attraqchi et al., 2020). However, if valerian is combined with hepatoxic drugs, it may increase the risk of hepatoxicity and could lead to liver damage. Also, taking valerian in combination with other sedating drugs or alcohol may result in additive or synergistic effects, resulting in amplification of sedation or intoxication greater than their combined effect; when taken with loperamide (anti-diarrhea drug), it may also cause delirium (Gruenwald et al., 2007). Kava Kava is a medicinal plant belonging to the pepper family with origins in the South Pacific. Traditionally, it has been used as a relaxant. Kava ingested in larger quantities can cause intoxication (Sarris, 2018). Kava is considered to be a hypnotic and a sedative, and it also has analgesic properties (Gruenwald et al., 2007). Hypnotics are drugs that tend to be sleep inducing, whereas sedatives tend to have calming, anxiety-reducing effects (Perry et al., 2006). The medicinally active part of the plant are the rhizomes or creeping rootstalks (Gruenwald et al., 2007). Traditionally, kava beverages were made from the rhizomes; however, in the United States it is mainly available as dry-filled capsule preparations and less commonly as a tincture (Liu et al., 2018). It acts on GABA and has been found to be effective in the treatment of anxiety and insomnia (Gruenwald et al., 2007; LaFrance et al., 2000; Perry et al., 2006; Sarris, 2018). It also has muscle-relaxing, anticonvulsive, and antispasmodic effects (Gruenwald et al., 2007). It is comparable to diazepam in its effectiveness when used to treat anxiety, but it can cause elevation of liver enzymes, which may be an indication of inflammation or even damage to liver cells (Gruenwald et al., 2007; Pantano et al., 2016). When combined with benzodiazepines, kava can cause disorientation and lethargy due to an additive effect in which both substances bind to similar neuron receptors (Surana et al., 2021; Tallarida, 2007). It is important to note that in the 1990s, Germany approved the use of kava to treat anxiety-related disorders. In 2001, it was banned in Germany and across the European Union because of concerns over liver toxicity. The FDA issued a consumer advisory warning pertaining to the use of kava
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