Valerian's therapeutic uses

• PRINCIPAL PROPOSED USE: Insomnia

• OTHER PROPOSED USES: Anxiety, nervous stomach, stress

DEFINITION: Natural plant product used to treat specific health conditions.

Overview

More than two hundred plant species belong to the genus Valeriana, but the one most commonly used as an herb is V. officinalis. The root is used for medicinal purposes.

Galen recommended valerian for insomnia in the second century. Beginning in the sixteenth century, this herb became popular as a sedative in Europe, and it later became popular in the US. Scientific studies on valerian in humans began in the 1970s, leading to its approval as a sleep aid by Germany’s Commission E in 1985. However, the scientific evidence showing that valerian really works remains incomplete.

As with most herbs, experts are unsure which ingredients in valerian are most important. Early research focused on a group of chemicals known as valepotriates, but they are no longer considered candidates. A constituent called valerenic acid has also been studied, but its role is far from clear. Another substance in valerian, called linarin, has also attracted research interest.

The understanding of how valerian might function remains similarly incomplete. Several studies suggest that valerian affects gamma-aminobutyric acid (GABA), a naturally occurring amino acid that appears to be related to the experience of anxiety. Conventional tranquilizers in the valium family are known to bind to GABA receptors in the brain, and valerian may work similarly. However, there are some significant flaws in these hypotheses, and the reality is that experts do not really know how valerian works or, indeed, whether it does work.

Therapeutic Dosages

For insomnia, the standard adult dosage of valerian is two to three grams of dried herb, 270 to 450 milligrams (mg) of aqueous valerian extract, or 300 to 600 mg of an ethanol extract, taken thirty to sixty minutes before bedtime. The same amount, or a reduced dose, can be taken twice daily for anxiety. The effects begin to be felt after one to two weeks of use, and it can be used safely for up to six weeks.

A tea can be made with two to three grams of dried valerian root and one cup of boiling water. Because of valerian’s unpleasant odor, European manufacturers have created odorless valerian products. However, these are not widely available in the US. Valerian is often mixed with passionflower (Passiflora incarnata) or other calming, pleasant-smelling herbs to mask its odor. Valerian is not recommended for children under three years old.

Therapeutic Uses

Valerian is commonly recommended as a mild treatment for occasional insomnia. However, evidence from the best positive study on valerian suggests that it is useful only when taken over an extended period for chronic sleep disorders. Overall, it is unclear whether valerian is effective for sleep.

Like other treatments used for insomnia, valerian has also been proposed as a treatment for anxiety, but there is no reliable evidence that it is effective. Finally, valerian is sometimes suggested as a treatment for a nervous stomach, menstrual cramps, headaches, migraines, and symptoms of menopause. However, there is no supporting scientific evidence for these uses.

Scientific Evidence

Insomnia. Overall, the evidence supporting valerian as a sleep aid remains substantially incomplete and contradictory. A systematic review concluded that valerian is probably not effective for treating insomnia. In a subsequent review of eighteen randomized trials, researchers found that people who took valerian reported an improvement in their sleep, but this finding was not supported by more objective measures of sleep quality.

However, there have been some positive results, both with valerian alone and with valerian combined with other herbs. The best positive study of valerian for insomnia followed 121 people for twenty-eight days. In this double-blind, placebo-controlled trial, half of the participants took 600 milligrams (mg) of alcohol-based valerian extract one hour before bedtime, while the other half took a placebo. Valerian did not work right away. For the first couple of weeks, valerian and a placebo were equally effective. However, by day twenty-eight, valerian pulled far ahead. Effectiveness was rated as good or very good by participant evaluation in 66 percent of the valerian group and 61 percent by doctor evaluation, whereas in the placebo group, effectiveness was rated by only 29 percent of participants and doctors.

Although positive, these results are confusing. In another large study, valerian was immediately more effective than the placebo, which is more in keeping with how the herb is typically used. This trial followed 128 subjects who had no sleeping problems. On nine nonconsecutive nights, each participant took one of three treatmentsvalerian, a combination of valerian and the herb hops (Humulus lupulus), or placebo. The results showed that on the nights they took valerian alone, participants fell asleep faster than when they were taking a placebo or the combination. In contradiction to this, other studies have failed to find any immediate mental-depressant effects with valerianmost substances that rapidly induce sleep also sedate the mind.

Furthermore, the best-designed studies have generally failed to find valerian more helpful. One of these was a four-week study in which 135 people were given valerian, and 135 were given a placebo. Another was a two-week study of 405 people that found “modest benefits at most.”

A six-week, double-blind study of 202 people with insomnia compared valerian extract (600 mg at bedtime) with the standard drug oxazepam (10 mg at bedtime) and found equal efficacy. Equivalent benefits were also seen in a similar study of seventy-five people. However, the absence of a placebo group in these two studies decreases the reliability of the results. A study of 184 people tested a standardized combination of valerian and hops with mixed results. Researchers tested quite a few aspects of sleep, such as time to fall asleep, length of sleep, and number of awakenings, and found evidence of benefit in only a few. This use of “multiple outcome measures” makes the results somewhat unreliable. A much smaller study also found evidence that a combination of hops and valerian extract is more effective as a sleep aid than the placebo. The results of this trial also hint that hops plus valerian is more effective than valerian alone, but this possible finding did not reach statistical significance.

A double-blind comparative study that enrolled forty-six patients compared the effects of the standard drug bromazepam to a mixture of valerian and hops with either treatment taken half an hour before bedtime. The results suggest that the two treatments were equally effective. One study found that this valerian-hops combination can antagonize the arousal produced by caffeine.

A combination of valerian and lemon balm (Melissa officianalis) has also been tried for insomnia. A rather poorly designed thirty-day, double-blind, placebo-controlled study of ninety-eight individuals without insomnia found marginal evidence that a valerian-lemon balm combination improved sleep quality compared with the placebo. However, a double-blind crossover study of twenty people with insomnia compared the benefits of the sleeping drug Halcion (0.125 mg triazolam) against a placebo and a combination of valerian and lemon balm and failed to find the herb effective. The drug, however, did prove effective. In addition, valerian has shown some promise for helping people sleep better after discontinuing conventional sleeping pills in the benzodiazepine family.

Anxiety and stress. In a double-blind, placebo-controlled study, thirty-six people with generalized anxiety disorder were given either valerian extract, Valium, or a placebo for a period of four weeks. The study failed to find statistically significant differences between the groups, presumably due to its small size.

Valerian has also been tested for possible benefits during stressful circumstances. Two preliminary double-blind studies found weak evidence that valerian may produce calming effects in induced stressful situations. Another study evaluated the impact of a combination of valerian and lemon balm in various doses. Some benefits were seen with doses of 600 mg or 1200 mg three times daily, but the highest dose, 1,800 mg three times daily, appeared to increase anxiety symptoms during a stressful situation. Furthermore, people taking the herbal treatment at any dose showed slightly decreased cognitive function compared to the placebo.

In an analysis of sixty studies evaluating valerian's efficacy in treating sleep problems, anxiety, and associated disorders, researchers concluded that the variation in study results may be due to the variation in herb quality and herb extract potency. Using the whole root to standardize quality and quantity in participant intake and supplementing valerian with herbs like hops and lemon balm is likely the best practice. The study also found valerian safe for participants aged seven to eighty.

Safety Issues

Valerian is on the US Food and Drug Administration’s (FDA) Generally Recognized As Safe (GRAS) list and is approved for use as a food. In animals, enormous doses of valerian are required to produce any serious adverse effects. Valerian has shown an excellent safety profile in clinical trials.

In a suicide attempt, one young woman took approximately twenty grams of valerian, twenty to forty times the recommended dose. Only mild symptoms developed, including stomach cramps, fatigue, chest tightness, tremors, and light-headedness. All these symptoms were resolved within twenty-four hours after two treatments with activated charcoal. The woman’s laboratory tests, including tests of her liver function, remained normal. However, this does not mean that people can safely exceed the recommended dose.

One report did find toxic results from herbal remedies containing valerian mixed with several other herbal ingredients, including skullcap (Scutellaria lateriflora), melatonin, kava (Piper methysticum), and St. John's wort. Four individuals who took these remedies later developed liver problems. However, skullcap products are sometimes contaminated with the liver-toxic herb germander, and this could have been the explanation. There have also been about fifty reported cases of overdose with a combination preparation called Sleep-Qik, which contains valerian as well as conventional medications. Researchers specifically looked for liver injury, but they found no evidence that it occurred.

There are some safety concerns about valepotriates, constituents of valerian because, in test-tube studies, they have been found to affect deoxyribonucleic acid (DNA) and cause other toxic effects. However, valepotriates are not present to a significant extent in any commercial preparations.

Although animal studies or controlled human trials have not found evidence that valerian causes withdrawal symptoms when stopped, one case report is sometimes cited in support of the possibility that this might occur. It concerns a fifty-eight-year-old man who developed delirium and rapid heartbeat after surgery. According to the patient’s family, he had been taking high doses of valerian root extract, about 2.5 to 10 g per day, for many years. His physicians decided that he was suffering from valerian withdrawal. However, considering the many other factors involved, such as multiple medications and general anesthesia, it is not possible to conclude that valerian caused his symptoms.

In clinical trials, the use of valerian has not been associated with any significant side effects. A few people experience mild gastrointestinal distress, and there have been rare reports of people developing a paradoxical mild stimulant effect from valerian.

Valerian does not appear to impair driving ability or produce morning drowsiness when taken at night. As noted above, most studies failed to find any immediate sedative effect with valerian. However, one study reported mild impairment of attention for a couple of hours after taking valerian, so it is best to avoid driving.

There have been no reported drug interactions with valerian, and two studies found some evidence that valerian should not raise or lower the blood levels of most medications. Nonetheless, there is some potential that valerian could amplify the effects of sedative drugs. A 1995 study was somewhat reassuring on this score because it found no interaction between alcohol and valerian. However, animal studies have found that valerian extracts may prolong the effects of some sedatives, and some worrisome case reports suggest that combining valerian and alcohol can lead to excessive sedation in some people. Experts recommend that people not combine valerian with central nervous system depressants except under a doctor’s supervision.

Safety among young children, pregnant or nursing women, and those with severe liver or kidney disease has not been established. People who are taking sedative drugs, such as benzodiazepines, antidepressants, sleep medication, narcotic pain relievers, or muscle relaxants, should not take valerian in addition to them except under physician supervision.

Bibliography

Bagheri-Nesami M., et al. "Effect of Acupressure with Valerian Oil 2.5% on the Quality and Quantity of Sleep in Patients with Acute Coronary Syndrome in a Cardiac Intensive Sare Unit." Journal of Traditional and Complementary Medicine, vol. 5, no. 4, 2015, pp. 241-47.

Fernández-San-Martín, M. I., et al. “Effectiveness of Valerian on Insomnia.” Sleep Medicine, vol. 11, no. 6, 2010, pp. 505-11.

Johnson, Jon. "Can Valerian Root Help You Relax and Sleep Better?" Medical News Today, 25 July 2024, www.medicalnewstoday.com/articles/valerian-root. Accessed 20 Sept. 2024.

Kennedy, D. O., et al. “Anxiolytic Effects of a Combination of Melissa officinalis and Valeriana officinalis During Laboratory Induced Stress.” Phytotherapy Research, vol. 20, 2006, pp. 96-102.

Koetter, U., et al. “A randomized, Double Blind, Placebo-Controlled, Prospective Clinical Study to Demonstrate Clinical Efficacy of a Fixed Valerian Hops Extract Combination (Ze 91019) in Patients Suffering from Non-organic Sleep Disorder.” Phytotherapy Research, vol. 21, no. 9, 2007, pp. 847-51.

Oxman, A. D., et al. “A Televised, Web-Based Randomised Trial of an Herbal Remedy (Valerian) for Insomnia.” PLoS One, vol. 2, no. 10, 2007, pp. e1040.

Shinjyo, Noriko, et al. “Valerian Root in Treating Sleep Problems and Associated Disorders-A Systematic Review and Meta-Analysis.” Journal of Evidence-based Integrative Medicine, vol. 25, 2020, doi:10.1177/2515690X20967323.

Taibi, D. M., et al. “A Randomized Clinical Trial of Valerian Fails to Improve Self-Reported, Polysomnographic, and Actigraphic Sleep in Older Women with Insomnia.” Sleep Medicine, vol. 10, no. 3, 2009, pp. 319-28.

"Valerian." Icahn School of Medicine at Mount Sinai, www.mountsinai.org/health-library/herb/valerian. Accessed 20 Sept. 2024.

"Valerian." National Center for Complimentary and Integrative Health, Oct. 2020, www.nccih.nih.gov/health/valerian. Accessed 20 Sept. 2024.