Herbal Medicine (Kami-shoyo-san) in the Treatment of Premenstrual Dysphoric Disorder

Japanese herbal medicines are widely used in Japan as
adjunctive strategies with modern medicines. More than
one hundred herbal preparations have been approved for
use in clinical practice by the Japanese Ministry of Health
and Welfare. Kami-shoyo-san (TJ-24), which is composed
of ten herbs (bupleuri radix, paeoniae radix, atractylodis
lanceae rhizoma, angelicae radix, hoelen, gardeniae fructus,
moutan cortex, glycyrrhizae radix, zingiberis rhizoma,
and menthae herba) , is one of these preparations
and has been used to treat irregularity of menstruation
and anxiety involved with a menstrual cycle.1 Although
patients of premenstrual dysphoric disorder (PMDD) are
usually treated by SSRIs,2 these drugs were apt to cause
adverse events, including gastrointestinal symptoms. Because
of these adverse events, some patients cannot be
treated with SSRIs. In this letter, we report six women
with PMDD diagnosed by the research criteria of DSM-IV,
who were treated successfully with TJ-24 as an alternative
treatment.
Methods
Six untreated women with PMDD diagnosed by the
research criteria of DSM-IV whose ages ranged from 29
to 48 years old, were treated with TJ-24 at a daily dose
of 7.5 g (2.5 g three times daily, orally) for six menstrual
cycles. None of the patients were suicidal, and all asked
to receive herbal therapy rather than SSRIs. Therefore,
we prescribed TJ-24, paying attention to the change in
their mental status. None had any medical complications.
They did not take any other herbals or medications
to treat PMDD during the investigation period.
Results
Their rating scores of CGI (Clinical Global Impressions
Scale), GAF (Global Assessment of Functioning Scale),
Hamilton Depression (HAM-D) and Anxiety (HAM-A)
Rating Scales at the late luteal phase, before the treatment
of TJ-24 and six menstrual cycles after the administration
of TJ-24, are shown in Table 1. Six menstrual cycles after
the administration of TJ-24, at the late luteal phase, CGI
scores (4.3  0.5 to 2.7  0.5), HAM-D scores (18.0  3.2
to 6.0  3.7), and HAM-A scores (21.8  6.1 to 8.3  4.6)
decreased, and GAF scores improved (59.0  5.6 to 77.0
6.7). All of the patients did not fulfill the research criteria
for PMDD, and their severity of depression and anxiety
at the late luteal phase remitted. No adverse events occurred
with TJ-24 administration in any patient.
Discussion
The exact mechanism underlying this effect is unknown,
though bupleuri radix of TJ-24 is shown to have
inhibitory effects on central nervous system.1 In summary,
our results suggest that a herbal medicine, Kamishoyo-
san, may be effective for PMDD, without adverse
events. Further studies are needed to confirm our results.
KAZUO YAMADA, MD, PHD*
SHIGENOBU KANBA, MD, PHD†
*Department of Neuropsychiatry
Keio University School of Medicine
35 Shinanomachi
Shinjuku-ku
Tokyo 160–8582, Japan
†Department of Neuropsychiatry
Yamanashi Medical University
Yamanashi, Japan
References
1. Kanba S, Yamada K, Mizushima H, et al. Use of herbal medicine
for treating psychiatric disorders in Japan. In: Kanba S, Richelson
E, eds. Herbal medicine for neuropsychiatric diseases. New York,
NY: Seiwa Shoten/Brunner-Mazel, 1999:3–13.
2. Yonkers KA: Antidepressants in the treatment of premenstrual
dysphoric disorder. J Clin Psychiatry 1997;58(suppl 14):4–10.
DOI: 10.1097/01.jcp.0000024581.36017.4d