Adverse neuropsychiatric reactions to herbal and over-the-counter "antidepressants"

Background: Many unregulated over-the-counter agents for the treatment of d epression are now available to patients and consumers. The potential for ad verse neuropsychiatric effects with these agents has not been systematicall y studied in most cases. Data Sources: The author performed a MEDLINE search on a variety of herbal and nonherbal over-the-counter agents said to be useful in the treatment of depression. The Physicians' Desk Reference for Herbal Medicines was also c onsulted. Data Synthesis: Although many of the herbal agents said to have benefits in depression appear to be safe, serious neuropsychiatric side effects and in teractions have been reported for several over-the-counter "antidepressants ." There is reason to suspect underreporting of those adverse events. Moreo ver, there is very little evidence from systematic studies regarding the po tential for drug-drug or herb-drug interactions with these over-the-counter agents. Vitamins and amino acids touted for the treatment of depression ar e also not without risk. Conclusion: Although some over-the-counter remedies for depression are prob ably safe and effective fur as-yet unidentified subgroups of depressed indi viduals, more research is required before these agents can be recommended f or routine use. Stricter U.S. Food and Drug Administration oversight of the se agents is indicated.