I have a client who has anxiety, depression, ADD, and is on the autism spectrum. He is taking bupropion and lurasidone. He wants an herbal formulation for the anxiety and another one for the depression. All of the herbs and formulations I came up with, including Mimosa Bark, all have potential contraindications. I am making him a flower essence formulation instead. His sister was in pharmaceutical industry in the past and didn’t understand why I was hesitant. Each herb I researched held a risk and I didn’t want to cause any harm. Obviously, herbs like St. John’s Wort were out, but even some of the more gentler herbs for this case came up as dangerous or risky. What do you do in circumstances like this? I find this to be one of the more frustrating aspects of being an herbalist. He’s unwilling to make any dietary changes. Thank you

David said: Flower essences are nice, but in my opinion will not touch these significant issues, Lurasidone is CI with herbs that effect CYP3A4 (SJW), but not most other nervine or anxiolytic herbs, Bupropion (Wellbutrin) is much less problematic than the Lurasidone. As for what do I do, I would create a protocol that I feel is safe and has a chance of being effective. I would go slowly and also work on other systems that affect mental health (i.e gut health, HPA axis, neuro-inflammation, etc). On the other hand if the patient is unwilling to change their diet, lifestyle and only wants an herbal magic bullet, I would not take them as a patient.