Valerian: a safe and effective herb for sleep problems

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Valerian: a safe and effective herb for sleep problems By Kerry

Bone, Townsend Letter for Doctors and Patients

Recent publications appear to have answered several important

questions for valerian root:

* Does valerian impair cognitive function or cause excessive

sedation?

* How does its efficacy compare to benzodiazepine drugs?

* Is valerian safe and effective for children?

In an Australian study, nine healthy volunteers received single

doses of either valerian root (1000mg or 500mg), the drug triazolam

(0.25mg) or placebo in a double-blind, placebo-controlled, crossover

trial. (1) Results confirmed that while triazolam had a detrimental

effect on cognitive processes, the valerian was without effect.

Another study compared even higher doses of valerian (600, 1200 and

1800mg of a 5:1 extract) with 10mg diazepam and placebo in a

clinical trial of similar design. (2) Again an impairment of

performance occurred for the benzodiazepine drug whereas the

valerian had no impact on any parameters tested. A third study found

that valerian (400mg and 800mg) was not different from placebo on

any measure used of psychomotor performance or sedation. (3)

Patients aged 18 to 73 years and diagnosed with non-organic insomnia

were treated in a multicentre, double-blind, randomized parallel

group comparison with either 600 mg/day of valerian extract (5:1) or

10 mg/day oxazepam taken for 6 weeks. (4) A total of 202 outpatients

with a mean duration of insomnia of 3.5 months at baseline were

included. Sleep quality after 6 weeks showed that valerian extract

was at least as efficacious as treatment with oxazepam. Both

treatments markedly increased sleep quality compared with baseline

(p<0.01). Adverse events occurred in 29 patients (28.4%) receiving

valerian extract and 36 patients (36.0%) under oxazepam, and were

all rated mild to moderate. No serious adverse reactions were

reported in either group. Most patients assessed their respective

treatment as very good (82.8% in the valerian group, 73.4% in the

oxazepam group).

Another smaller trial of similar design compared the effect of the

same dose of valerian with 10mg oxazepam over 4 weeks in 75 patients

with non-organic insomnia. (5) The study showed no differences

between the efficacy of valerian and oxazepam.

The efficacy and tolerability of a valerian extract preparation were

investigated in an open, observational study on children aged to 6

to 12 years. (6) An average daily dosage of 2 tablets (range 1 to 4)

tablets containing 300mg of 5:1 extract was administered to 130

children suffering from nervous sleep disturbances and/or nervous

tension over a period of 4 weeks. Therapeutic efficacy was estimated

by parents and physicians as good to very good in 95% of cases. A

side effect (tiredness in the morning) was reported in only one

case, which disappeared after dose adjustment.

Commentary

Unlike the benzodiazepine drugs, valerian clearly does not cause

sedation or impairment of functioning in healthy volunteers. But

this could be attributed to valerian having no activity on the

nervous system (as detractors of phytotherapy would no doubt

assert). Hence, it is pertinent that a well-designed trial found

valerian to be just as effective as a benzodiazepine drug in the

alleviation of non-organic insomnia. (Non-organic insomnia is

characterized by a chronic, psychological impairment of the ability

to initiate or maintain sleep which leads to a preoccupation with

insomnia and impairment of functioning during the day.) The open

trial in children also provides proof of safety here, but its

efficacy should now be established in a randomized, controlled trial.