Is lemon balm safe for individuals with epilepsy (seizure disorder)?

Lemon Balm and Epilepsy: Safety Concerns

Lemon balm should be avoided in individuals with epilepsy due to its potential to cause additive CNS depression and possibly worsen seizure control. 1

Mechanism of Action and Concerns

• Lemon balm (Melissa officinalis) contains active compounds that can result in additive central nervous system (CNS) depression when combined with sedatives or alcohol 1
• It contains rosmarinic acid and triterpenoids (ursolic acid and oleanolic acid) that inhibit GABA transaminase (GABA-T), an enzyme targeted in epilepsy therapy 2
• While GABA-T inhibition might theoretically help with seizures, the unpredictable nature of herbal supplements and potential drug interactions make lemon balm risky for epilepsy patients 3

Evidence from Guidelines

• The Society for Perioperative Assessment and Quality Improvement (SPAQI) recommends holding lemon balm for at least 2 weeks before surgery due to its CNS depressant effects 1
• This recommendation places lemon balm in the same category as other supplements with known CNS depressant properties that could potentially complicate medication management 1
• Many herbal supplements used by epilepsy patients have paradoxical effects - they may have both anticonvulsant and proconvulsant properties depending on dosage, preparation, and individual factors 3

Drug Interactions and Risks

• Approximately one-third of epilepsy patients who use herbs or dietary supplements take products that could potentially increase seizures (16%) or interact with hepatically metabolized drugs (19%) 4
• Herb-drug interactions can occur at the level of the P450 hepatic enzyme system and the P-glycoprotein transport system, potentially affecting antiepileptic drug levels 3
• The unpredictable nature of these interactions poses significant risks for patients with epilepsy, where maintaining consistent therapeutic drug levels is crucial 4, 3

Historical Use and Modern Caution

• Despite historical use of lemon balm for epilepsy by empirical physicians in some regions 5, modern evidence does not support this practice
• The majority of epilepsy patients use dietary supplements for general health promotion rather than specifically for their epilepsy 4
• Pharmacotherapy with anti-seizure medications remains the initial treatment of choice for the vast majority of patients with epilepsy 1

Recommendations for Patients with Epilepsy

• Patients with epilepsy should avoid lemon balm due to potential CNS depression effects and possible interference with anti-seizure medications 1, 3
• Patients should always disclose all supplement use to their healthcare providers, as many have potential interactions with anti-seizure medications 4, 3
• Maintaining consistent therapeutic levels of prescribed anti-seizure medications is crucial for seizure control, especially during times of illness or fever which can lower seizure threshold 6

Alternative Approaches

• For patients seeking complementary approaches, some supplements like melatonin have been shown to be safe in the perioperative period and may be safer options 1
• Passionflower has been studied in the perioperative setting and demonstrated a reduction in anxiety with a good safety profile 1
• Always consult with a neurologist or epileptologist before starting any supplement when diagnosed with epilepsy 4, 3