Can valerian root be used as an anxiolytic and antidepressant?

Valerian Root for Anxiety and Depression: Evidence-Based Assessment

Valerian root is not recommended as an anxiolytic or antidepressant due to insufficient evidence supporting its efficacy for these conditions. 1, 2, 3

Efficacy for Anxiety

• The evidence regarding valerian's efficacy for anxiety disorders is insufficient to support its use 3
• A Cochrane systematic review found only one small RCT (36 patients) comparing valerian with diazepam and placebo for generalized anxiety disorder, which showed no significant differences between valerian and placebo in anxiety scores 3
• While laboratory studies in rats have shown potential anxiolytic effects 4, these findings have not been adequately replicated in human clinical trials

Efficacy for Depression

• There is a notable lack of high-quality evidence supporting valerian's use as an antidepressant
• One open-label study examined the combination of St. John's wort with valerian for depression comorbid with anxiety, but this study design prevents drawing conclusions about valerian's independent antidepressant effects 5

Safety Profile

• Valerian is generally well-tolerated with infrequent and benign side effects 2
• According to perioperative guidelines, valerian can be continued during the perioperative period as it appears to be a safe supplement that may protect against cognitive dysfunction 1
• Common side effects may include vivid dreams (16% in one study) 6

Clinical Applications and Considerations

• For insomnia, the American Academy of Sleep Medicine suggests that clinicians not use valerian as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults 1
• This recommendation is based on trials of variable dosages of valerian and valerian-hops combination showing limited efficacy 1
• In one study examining sleep latency, valerian showed only a 9-minute greater reduction compared to placebo (95% CI: 0 to 18 min reduction) 1

Alternative Evidence-Based Options

• For anxiety disorders, evidence-based pharmacological treatments include SSRIs, SNRIs, and benzodiazepines 1
• For depression, SSRIs, psychotherapy, or a combination approach is supported by stronger evidence 1
• If patients are seeking natural alternatives:
  • Omega-3 fatty acids (particularly EPA at doses of 1-2g daily) have stronger evidence as an adjunctive treatment for depression 7
  • Ashwagandha (250-600mg daily) has some evidence for anxiety management 7

Common Pitfalls and Caveats

• Despite widespread popular use and perception of valerian as an effective remedy for anxiety and insomnia, clinical evidence does not support these claims
• The quality of available studies on valerian is generally poor, with methodological limitations including small sample sizes, inadequate standardization of preparations, and variable dosing 2
• Patients often self-medicate with valerian without informing healthcare providers, which may lead to potential herb-drug interactions
• While valerian appears safe, its efficacy for anxiety and depression has not been established through rigorous clinical trials

In conclusion, healthcare providers should not recommend valerian root for the treatment of anxiety or depression due to insufficient evidence of efficacy, despite its favorable safety profile.