Depression and Kava

Kava or kava-kava, is an ancient crop of the pepper family originally consumed throughout the western Pacific. As the use of this becomes increasingly popular in other parts of the world, it is important to note that kava refers to the plant itself, the beverage produced from its roots, and the manufactured extract being marketed in the western world Though there is controversy around the use of kava in any treatment regime, there are studies supporting its effectiveness. The extract produced and sold in the western world continues to be tested but is said to be potentially beneficial in the treatment of anxiety, depression and even some cancers.

More recently, the availability of kava in a supplement form for the treatment of anxiety has increased its popularity in the west.

Find other natural remedies for depression.

The active ingredients, kavalactones, are said to have sedating and relaxing effects that do not compromise mental clarity. The availability of kava in a supplement form for the treatment of anxiety has increased in popularity in the west.

Kavalactones being the active ingredient, pharmaceutical and herbal supplement companies extract these from the plant directly to use in pills. It is important to make sure kava powder and supplements come only from the kava plant’s roots as other parts (including the stems and peelings) can be harmful or cause toxicity.¹

When consumed throughout many Pacific Ocean cultures, traditionally the kava plant’s fresh or dried roots were chewed directly, were pounded and steeped as a tea, or ground into powder then mixed with water and consumed immediately. Kavalactones in the kava root are activated through each of these processes. Today, Kava root powder is the most common way to obtain kava as the powder form is easily exported.

Ingesting these kavalactones have been shown to have the physical effects of mild sedation and slight numbing of the gums and mouth, and cognitive effects of increased clarity, calmness, and cheerful mood.³Kava can also have muscle relaxant, anaesthetic, anticonvulsive and antianxiety properties which is thought to result from the increase in release of neurotransmitters due to these active kavalactones.⁴ Effects are said to vary widely depending on the strand of kava consumed, amount, and potency of the method of consumption.

Read more details about Kava.

One double-blind randomized placebo-controlled trial found that after just one dose of kava extract (300mg) subjects’ state of cheerfulness increased (as assessed by state-trait-cheerfulness-inventory).³

Anxiolytic and calming effects were the primary themes qualitatively reported by participants taking a kava supplement in yet another study. Additionally, quantitative data on the reduction of anxiety, increased ability to sleep and improved mood of the participants supports the effectiveness of the kava supplement.⁹

Another study found that kava produced muscle relaxant, anaesthetic, anxiolytic and anticonvulsive properties in animals.⁵

Mostly consumed in the west as an herbal supplement, it is usually recommended that the kava supplement be consumed 1-3 times daily; the amount would vary depending on the individual’s needs and other substances being taken, though most supplements available in the west come in pills of 150-300mg.

The Australian Therapeutic Goods Administration recommends taking no more than 250mg supplement of kava each day.²

Due to alleged allegations of toxicity, some countries have a ban on the sale of kava (including France, Switzerland and the Netherlands) and the Medicines Control Agency in the U.K. maintains that kava is not safe in any dose since “rare” (defined as 1/1000 or 1/10,000) cases of hepatotoxicity have been reported.⁷

Safety Issues

Until recently, kava had been considered a safe herb. Animal studies have shown that kava dosages of up to 4 times the normal amount cause no health problems, and 13 times the normal dosage causes only mild problems in rats. ¹ A study of 4,049 people who took a rather low dose of kava (70 mg of kavalactones daily) for 7 weeks found side effects in 1.5% of cases. These were mostly mild gastrointestinal complaints and allergic rashes. ² A 4-week study of 3,029 people given 240 mg of kavalactones daily showed a 2.3% incidence of basically the same side effects. ³ One review of the literature concluded that "the data support the safety of kava in treating anxiety at 280 mg kava lactones daily for 4 weeks." ⁴ However, a growing number of case reports have raised serious concerns about kava’s safety. These reports suggest that, occasionally, even normal doses of kava can cause severe liver injury. ^{5 6} Based on these reports, regulatory agencies have taken action in numerous countries banning or restricting sale of kava. However, case reports are notorious for failing to show cause and effect, and some well-regarded experts who have reviewed the literature feel that kava has not been shown to be unsafe. ⁷ In a report examining 26 alleged liver toxicity cases in kava users, consuming the herb at the recommended daily dose (less than 120 mg) and duration (less than 3 months) was clearly linked with only one case. ⁸ In all other cases, kava was either not implicated, was taken inappropriately, or was combined with another drug.

At present, if you wish to use this herb, we recommend that you seek physician supervision to monitor for liver inflammation. People with liver problems, who drink alcohol excessively, or who take medications that can harm the liver, are probably at increased risk of harm by kava.

There are other safety concerns as well. For example, kava should not be used by individuals who have had "acute dystonic reactions." These consist of spasms in the muscles of the neck and movements of the eyes, which are believed to be related to effects on dopamine. They are typically caused by antipsychotic drugs , which affect dopamine. Kava might trigger such reactions, too. ⁹ At ordinary doses, kava does not appear to produce mental cloudiness. ¹⁰ However, high doses cause inebriation ¹¹ and can lead to charges of driving under the influence of drugs.

One study suggests that kava does not amplify the effects of alcohol. ¹² However, there is a case report indicating that kava can increase the effects of certain sedative drugs. ¹³ For this reason, kava probably should not be combined with any drugs that depress mental function. Kava should also not be combined with antipsychotic drugs or drugs used for Parkinson's disease , due to the potential for increased problems with movement. ¹⁴ The German Commission E monograph warns against the use of kava during pregnancy and nursing. Safety in young children and individuals with kidney disease has not been established.

Interactions You Should Know About

If you are taking:

• Medications for insomnia or anxiety such as benzodiazepines : Do not take kava in addition to them.
• Antipsychotic drugs : Kava might increase the risk of a particular side effect consisting of sudden abnormal movements, called a dystonic reaction.
• Levodopa for Parkinson's disease: Kava might reduce its effectiveness.
• Medications that can irritate the liver: Avoid kava. Numerous medications have this potential. Ask your physician to see if this concern applies to you.

Some research has shown the supplementing of kava to be effective in the treatment of certain cancers especially ovarian cancer and leukemia.⁸

Traditionally, chewing the kava plant directly was used to treat throat pain as kava coats the throat and creates a numbing effect similar to the popular Chloraseptic spray used in the west.

1. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. 3rd ed. Berlin, Germany: Springer-Verlag; 1998:68.
2. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. 3rd ed. Berlin, Germany: Springer-Verlag; 1998:71.
3. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. 3rd ed. Berlin, Germany: Springer-Verlag; 1998:71.
4. Connor KM, Davidson JR, Churchill LE. Adverse-effect profile of kava. CNS Spectr. 6(10):848, 850-3.
5. Escher M, Desmeules J, Giostra E, Mentha G. Hepatitis associated with Kava, a herbal remedy for anxiety. BMJ. 322(7279):139.
6. Strahl S, Ehret V, Dahm HH, et al. Necrotizing hepatitis after taking herbal remedies [translated from German]. Dtsch Med Wochenschr. 1998;123:1410-1414.
7. Schulze J, Raasch W, Siegers CP. Related Articles, Links Abstract Toxicity of kava pyrones, drug safety and precautions—a case study. Phytomedicine. 2003;10(suppl 4):68-73. Review.
8. Teschke R, Schwarzenboeck A, Hennermann KH. Kava hepatotoxicity: a clinical survey and critical analysis of 26 suspected cases. Eur J Gastroenterol Hepatol. 20(12):1182-93.
9. Schelosky L, Raffauf C, Jendroska K, et al. Kava and dopamine antagonism [letter]. J Neurol Neurosurg Psychiatry. 1995;58:639-640.
10. Munte TF, Heinze HJ, Matzke M, et al. Effects of oxazepam and an extract of kava roots ( Piper methysticum ) on event-related potentials in a word recognition task. Neuropsychobiology. 1993;27:46-53.
11. Cairney S, Maruff P, Clough AR, Collie A, Currie J, Currie BJ. Saccade and cognitive impairment associated with kava intoxication. Hum Psychopharmacol. 18(7):525-33.
12. Herberg KW. Effect of Kava-Special Extract WS 1490 combined with ethyl alcohol on safety-relevant performance parameters [in German, English abstract]. Blutalkohol. 1993;30:96-105.
13. Almeida JC, Grimsley EW. Coma from the health food store: interaction between kava and alprazolam [letter]. Ann Intern Med. 1996;125:940-941.
14. Schelosky L, Raffauf C, Jendroska K, et al. Kava and dopamine antagonism [letter]. J Neurol Neurosurg Psychiatry. 1995;58:639-640.

1 Lim, S.T.S., Dragull, K., Tang, C.S., Bittenbender, H.C., Efird, J.T. & Nerurkar, P.V (2007). Effects of Kava Alkaloid, Pipermethystine, and Kavalactones on Oxidative Stress and Cytochrome P450 in F-344 Rats. Toxicological Sciences 97(1), 214-221: doi: 10.1093/toxsci/kfm035.

2 Kava fact sheet. Therapeutic Goods Administration, Government of Australia. April 2005.

3 Thompson, R., Ruch, W. & Hasenohrl, R.U. (2004). Enhanced cognitive performance and cheerful mood by standardized extracts of Piper methysticum (Kava-kava). Human Psychopharmacology: Clinical and Experimental 19(4), 243-250.

4 Cairney, S., Maruff, P. &, Clough, A.R. (2002). The neurobehavioural effects of kava. Australian and New Zealand Journal of Psychiatry 36(5), 657-662.

5 United States Centers for Disease Control and Prevention (2002). Hepatic Toxicity Possibly Associated with Kava-Containing Products--United States , Germany and Switzerland 1999-2002. Morbidity & Mortality Weekly Report 51(47), 1065-1067. Retrieved on June 23, 2010 from:[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5147a1.htm][1]

6 Center for Food Safety and Applied Nutrition (2002). Kava-Containing Dietary SUpplements May Be Associated with Severe Liver Injury. United States Food and Drug Administration. Retrieved on June 23, 2010 from:[http://web.archive.org/web/20080325210855/www.cfsan.fda.gov/~dms/addskava.html][2]

7 Richardson, W.n. & Henderson, L. (2007). The safety of kava-a regulatory perspective. British Journal of Clinical Pharmacology 64(4), 418-420. PMCID: PMC2048547