title: Clinical applications of herbal medicines for anxiety and insomnia; targeting patients with bipolar disorder.
abstract: OBJECTIVE
  Patients with bipolar disorder frequently continue to experience residual anxiety and insomnia between mood episodes. In real-world practice, patients increasingly self-prescribe alternative medicines.
  
  
  METHODS
  We reviewed case reports, open-label, and placebo-controlled trials investigating the use of herbal medicines to treat anxiety and insomnia, and discussed their potential applications for bipolar disorder.
  
  
  RESULTS
  Eleven herbal medicines that have been studied in human subjects are included in this review. Mechanisms of action, efficacy, side effects, and drug-drug interactions are discussed. Based on currently available evidence, valerian seems to be the most promising candidate for insomnia and anxiety in bipolar disorder.
  
  
  CONCLUSIONS
  Adjunctive herbal medicines may have the potential to alleviate these symptoms and improve the outcomes of standard treatment, despite limited evidence. Physicians need to have a more in-depth understanding of the evidence of benefits, risks, and drug interactions of alternative treatments.
authors.affiliation: Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, USA School of Medicine, Sungkyunkwan University, Seoul, Korea.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Baek
authors.affiliation: Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, USA Department of Psychiatry, Harvard Medical School, Boston, USA anierenberg@partners.org.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.affiliation: Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, USA Department of Psychiatry, Harvard Medical School, Boston, USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Kinrys
mesh_terms: D001007:Anxiety / Q000188:drug therapy* / Q000209:etiology; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy*; D020843:Chamomile; D029001:Herbal Medicine / Q000379:methods; D006801:Humans; D031334:Melissa; D029598:Passiflora; D008517:Phytotherapy / Q000379:methods; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000209:etiology; D014632:Valerian
keywords: Herbal medicine; adjunctive treatment; anxiety; bipolar disorder; insomnia