From The June 2001 Issue of Nutrition Science News

Valerian-Lemon Balm An Effective Combo

By Richard N. Podell, M.D.

Irregular sleeping patterns—difficulty falling asleep, interrupted sleep, and trouble staying asleep through the night—are among Americans' most common health complaints. While prescription drugs can help an occasional sleepless night, ongoing use of these drugs for chronic insomnia can lead to other health problems.

Natural dietary supplements such as valerian root (Valeriana officinalis), lemon balm (Melissa officinalis), passion flower (Passiflora incarnata), lavender oil (Lavandula angustifolia), the hormone melatonin, and the amino acid 5-hydroxy-tryptophan promote restful sleep naturally.

Rationale Phytotherapy, a leading German-language textbook on herbal medicine, reports the results of numerous European double-blind studies. Published valerian studies suggest that the herb is far more effective after two- to four-week treatments than it is when taken intermittently. Researchers conclude that in addition to promoting healthy sleep patterns, it also enhances daytime mood.

In another study, Eurvegal Forte, a proprietary brand of valerian root with lemon balm (320 mg valerian, 160 mg lemon balm twice/day) was tested against placebo on 68 patients with mild but chronic insomnia.¹ All subjects received placebo for a seven-day run-in period. In the subsequent two-week phase, subjects were randomized to either Eurvegal Forte or placebo. All patients received placebo for a seven-day washout period.

Standardized questionnaires and diaries measured the quality and duration of patients' sleep and daytime well-being. Compared with the initial run-in placebo phase, sleep quality improved during the two-week treatment phase—for both the valerian/lemon balm and placebo groups, demonstrating an important placebo effect. However, two different standardized sleep-quality questionnaires showed greater improvement with valerian/lemon balm compared with placebo.

The time it took subjects to fall asleep decreased from 53.4 minutes during the run-in phase to 36.9 minutes during active treatment. The placebo subjects also improved—from 52.7 minutes during the run-in phase to 47.1 minutes during active treatment.

Subjective daytime well-being improved for both groups during the treatment period, and those taking Eurvegal Forte reported superior daytime well-being (p=0.001). A separate measure of combined day- and nighttime satisfaction, using the Clinical Global Impression scale, also showed improved results (p=0.05).

During the post-treatment washout period, valerian/lemon balm's positive effect decreased, although there was positive carryover. Subjects who had taken the valerian/lemon balm averaged 41.5 minutes to fall asleep, compared with 46.8 minutes post-placebo. Daytime anxiety decreased after using valerian/lemon balm compared with placebo, with no indication of withdrawal or rebound symptoms.

Six adverse events were reported during the study's two-week therapy phase, five in the herbal treatment group. However, two of the events—one case of bronchitis and one food-induced episode of vomiting—were deemed unrelated to the study. It is uncertain whether the herbs caused the other three events—one headache, one stomachache, and one episode of leg cramps.

Some people taking valerian twice a day may feel sedated, but this has not proven to be a problem when instead they use valerian at 600 mg only at night. Although valerian seems safe for a month's use, there are no studies on potential side effects over a longer duration, or on issues around habituation, tolerance, or withdrawal symptoms. And while a few people are sensitive to these herbs, there are remarkably few adverse reports.

Richard N. Podell, M.D., M.P.H., is director of the Podell Medical Center in New Providence, N.J.

Bibliography

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Schulz V, et al. Rational phytotherapy: a physician's guide to herbal medicine. New York: Springer; 4th ed. 2000.

References

1. Dressing H, et al. Improvement of sleep quality with a high-dose valerian/lemon balm preparation: a placebo-controlled double-blind study. Psychopharmakotherapie 1996;3:123-30. (Translated from German in HNR. 1999 Spring;6:32-40.)