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Ask the Mental Health Expert Archives 2001-2004

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Q. I was wondering if the drug Serenity was as good as it claims to be. Do you know if it has any harmful side effects? Will it interact with other psychopharmacological drugs? I have been unable to locate information about it. Have you heard about it?

It's supposed to be an herbal medication for bipolar disorder and depression. It's also purported to be better than Lithium. I find that hard to believe, but am interested in natural/herbal treatments.

A. There are a number of products available over-the-counter that go by the name Serenity or some variant. For example, a product called Herbal Serenity is touted as useful for anxiety or depression; it contains St. John's Wort (SJW), a widely-used herbal remedy.

The literature on SJW is mixed, but generally points to some benefits in mild-to-moderate, unipolar depression (not in bipolar disorder, which SJW may sometimes worsen by provoking manic reactions--for details, see my paper, Adverse neuropsychiatric reactions to herbal and over-the-counter antidepressants. J Clin Psychiatry 2000;61:815-820.).

Another product marketed under the name Serenity describes itself as follows: "Serenity an exclusive, proprietary amalgamation in tablet form which includes the following uncommon botanicals, extracts, flower-top essences and essential oils: Radix Salviae, Sensitive Mimosa Bark, Arillus Euphoriae, Shizandra, Frutcus Mori, Caulis Polygoni, Zizyohus, Tang Kuei, Cedar Seed, Sweetflag Rhizome, Cuscutae, Amber, Radix Scutellariae, Evodia, Longan, Arisaema, Cistanches, Radix Polygalae, Red Sage Root and Eucommia."

The claim for this product states, "Serenity is not a high. It is not a low. It is not an upper. It is not a downer?Serenity promotes a serene, well-integrated status of self which in turn offers thoroughfare toward a more blissful, peaceful and euphoric lifetime of experiences." [http://www.zengardenbotanicals.com/serenity.htm]. I am not aware of any controlled research backing up these claims in any clinical population.

Finally, the product you may have in mind--also called Serenity--is apparently a form of lithium that is said to have advantages over the usual prescribed formulations of lithium. Some details of this product (lithium orotate) are available on the website www.findserenitynow.com. The product is touted as "?an all-natural, highly effective and completely safe mood stabilizer?" My literature search revealed only one published study of lithium orotate in humans.

This study (H.E. Sartori, Alcohol. 1986 Mar-Apr;3(2):97-100) evaluated 42 alcoholic patients (33 males and 9 females) who were treated with lithium orotate during an alcohol rehabilitation program in a private clinical setting for at least six months. Lithium orotate was given, 150 mg daily, along with several other mineral preparations or nutrients (e.g., calcium orotate, magnesium orotate, bromelaine, and essential phospholipids).

The authors concluded: "Lithium orotate proved useful as the main pharmacologic agent for the treatment of alcoholism. Ten of the patients had no relapse for over three and up to 10 years, 13 patients remained without relapse for 1 to 3 years, and the remaining 12 had relapses between 6 to 12 months. Lithium orotate therapy was safe and the adverse side effects noted were minor, i.e., eight patients developed muscle weakness, loss of appetite or mild apathy. For these patients, the symptoms subsided when the daily dose was given 4 to 5 times weekly."

I am unaware of any published, controlled studies of this formulation in patients with bipolar disorder. Hence, any claims as to its usefulness as a mood stabilizer must be viewed as highly suspect, notwithstanding the testimonials provided on the website. I say: caveat emptor!

December 2003

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