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 Concern
- Lemon balm contains active compounds that can result in additive central nervous system (CNS) depression when combined with sedatives or anti-seizure medications, posing a significant risk to individuals with epilepsy 1
- Research has identified rosmarinic acid, ursolic acid, and oleanolic acid as active compounds in lemon balm that inhibit GABA transaminase (GABA-T), an enzyme targeted in the treatment of epilepsy and anxiety disorders 2
- While GABA-T inhibition might seem beneficial, unpredictable interactions with prescribed anti-seizure medications could disrupt carefully balanced seizure control 1, 3
Risks for Epilepsy Patients
- Fever, which can lower seizure threshold, combined with the CNS effects of lemon balm could further complicate seizure management 4
- Approximately one-third of patients with epilepsy use herbs or dietary supplements that have the potential to increase seizures (16%) or interact with hepatically metabolized drugs (19%) 5
- Many herbal products, including lemon balm, paradoxically can have both anticonvulsant and proconvulsant effects, making their use particularly risky in epilepsy 3
Medication Interactions
- Lemon balm may interact with anti-seizure medications at the level of the P450 hepatic enzyme system and the P-glycoprotein transport system, potentially altering drug levels 3
- Maintaining consistent therapeutic levels of prescribed anti-seizure medications is crucial for seizure control, especially during times of illness or fever 4
- The Society for Perioperative Assessment and Quality Improvement recommends holding lemon balm for at least 2 weeks before surgery due to its CNS depressant effects, highlighting its potential for significant drug interactions 1
Alternative Approaches
- For epilepsy patients seeking complementary approaches, it's important to note that pharmacotherapy with anti-seizure medications remains the initial treatment of choice for the vast majority of patients 1
- Some supplements like melatonin have been shown to be safer in certain contexts and may be better options for patients with epilepsy seeking complementary approaches 1
- Passionflower has demonstrated a reduction in anxiety with a better safety profile in some studies, though any supplement should be discussed with a healthcare provider before use 1
Clinical Recommendations
- Healthcare providers should routinely inquire about the use of dietary supplements, including lemon balm, in patients with epilepsy 5
- Patients should be educated about the potential risks of lemon balm and similar herbal products that could affect seizure control 1, 3
- Despite traditional use of lemon balm for various conditions including epilepsy in some cultures 6, current medical evidence suggests avoiding it due to potential risks 1