Rhodiola rosea
The use of medicinal herbs had been widespread across many cultures since ancient times. A recent university student survey83 found that most herb use was self-prescribed (60%) and undisclosed to health providers (75%), 34% of users took herbs to treat a mood disorder, 13% of herb users were taking concurrent prescription medication, and those who took both herbs and prescription medications had higher depression and anxiety scores than other herb users. Detailed patient interviews are necessary to prevent adverse herb-drug interactions.82
Rhodiola rosea, recommended in many conditions, including irregular menopause,83,84 has also been reported to be effective in the treatment of mild-to-moderate depression.85 One trial used a standardized extract of Rhodiola rosea (SHR-5, Swedish Herbal Institute, Sweden) at doses of 340 mg and 680 mg daily for six weeks with no reports of side effects.85 A systematic review has also supported the antidepressant effects of Rhodiola rosea.86 Its mechanism of action in major depression is thought to be via beta-endorphins, tryptophan, and serotonin in the brain.57,88 Rosiridin is the bioactive ingredient of Rhodiola rosea, which is reported to inhibit monoamine oxidases A and B and may also be useful in dementia.83
Having no addictive potential, Rhodiola rosea is a mild stimulant, so should be taken in the morning to avoid sleep problems. It may induce temporary vivid dreams and mild nausea. It also binds with the estrogen receptor, so women with a personal or family history of estrogen-sensitive breast cancer should exercise caution in using Rhodiola rosea, although this issue needs further study.88 Products containing 3% rosavins and 1% salidrosides were found to be effective in a randomized controlled trial, and may be used to enhance the clinical effectiveness of Rhodiola rosea.57 Panossian et al provide detailed information on its traditional use, chemical composition, pharmacology, side effect profile, and clinical efficacy.84