MAPS: MAPS Antidepressant Effects of Salvia Divinorum

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Abstract found on the site for the Journal of Clinical
Psychopharmacology


Antidepressant Effects of the Herb Salvia Divinorum: A
Case Report

Karl R. Hanes, PhD

JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY 2001;21:634-635

Editors:

Case Report
Ms. G is a 26-year-old woman with a history of
depression that has shown no significant periods of
remission since adolescence and has been predominated
by feelings of worthlessness, lack of interest in
social activities, an absence of occupational
satisfaction, and inability to find "purpose and
meaning" in her life. After first seeking treatment
for her depression 5 years ago Ms. G was prescribed
sertraline, 50 mg daily, which she self-discontinued
after 3 months, reporting no significant benefits. Ms.
G then underwent a course of cognitive-behavioural
therapy for about 6 months, with some improvement but
no definitive resolution of her symptoms. Hamilton
Depression Rating Scale (HAM-D 1 ) scores during the
6-month period of cognitive-behavioural therapy were
consistently in the moderately depressed range (i.e.
19-21).

During a review consultation some 7 months after
discontinuing cognitive-behavioural therapy Ms. G
claimed to have found relief from her symptoms of
depression with use of the herb salvia divinorum
sourced through a mail-order herbal supplier. A HAM-D
score of 2 confirmed remission of her symptoms of
depression at this time. Ms. G claims that she
discovered its antidepressant effects accidentally
after smoking the herb and had later developed a
method of oral consumption which she claimed
maintained its antidepressant effects even after she
abstained from using it for up to a week.

Despite being cautioned against use of a herb whose
safety profile was unknown, she has continued to use a
preparation of salvia divinorum leaves taken as an
oral dose of 2-3 leaves (1/2 to 3/4 of a gram of leaf
material) three times per week (the leaves are chewed
and held in the mouth for 15-30 minutes). During this
period she has continued to show a total remission of
her symptoms of depression according to HAM-D scores
in the range of 0-2 and has maintained this
improvement for the last 6 months, showing no signs of
relapse and reporting only minimal side effects, such
as occasional lightheadedness for up to 1 hour after
using the herb.

Ms. G volunteered that she has also benefited from
occasional intoxicating oral doses of salvia
divinorum, consisting of from 8-16 leaves of the herb
(approximately 2 to 4 grams), claiming that this herb
had engendered a kind of "psychospiritual" awakening,
characterized by the discovery of the depth of her
sense of self, greater self-confidence, increased
feelings of intuitive wisdom and "connectedness to
nature."

Discussion
Salvia divinorum is a perennial herb of the Labiateae
(mint) family native to the Sierra Mazateca region of
Oaxaca, Mexico. 2-4 Its main constituents have been
identified as the neoclerodane diterpenes Salvinorin A
and B 5,6 while trace elements of several other
diterpenes have also been detected. 6 The plant has
been used in healing ceremonies by the Mazatec Indians
of Oaxaca for centuries and for the treatment of such
conditions as anaemia, headache, and rheumatism. 7 The
psychoactive effects of the main ingredient Salvinorin
A in humans were uncovered recently and it has enjoyed
some popularity since that time as a legal,
short-acting psychedelic, though its psychoactivity
varies considerably depending on dosage and method of
ingestion. 8

This unique case may be of interest to the psychiatric
and psychopharmacological communities in demonstrating
the possible therapeutic effects of the unique active
components of salvia divinorum in a case of
treatmentresistant depression. While the typical dose
used by this patient in maintenance management of her
depression, consisting of 2-3 leaves, is well below
that reported to cause significant intoxication when
taken orally, 8 one cannot discount the possibility
that some of the benefits derived from salvia
divinorum were due to the psychedelic qualities
associated with the larger doses of this herb used
occasionally by this patient.

While a discussion of these effects is outside the
scope of this paper, the value of psychedelic
compounds as research tools and their beneficial
effects in the amelioration of symptoms of psychiatric
conditions is well established. 9-11 Given that the
mechanisms of action of the constituents of salvia
divinorum remain unknown and the spectrum of
psychedelic effects of this herb appears to be unique,
8 it is not inconceivable that research using the
active ingredients from this herb may pinpoint a
unique mechanism of antidepressant action for these
compounds. This, in turn, could lead to methods for
the management of depression or of treatment-resistant
subtypes of this condition. This possibility is
further enhanced by the recent finding using the
screening procedure called Novascreen that Salvinorin
A did not show significant inhibition of reference
target compounds on any of the 42 known bioreceptors
tested. 8 We may be dealing with a highly novel agent
that has significant research and therapeutic
potential in fields such as psychopharmacology,
psychiatry and complementary disciplines such as
herbal medicine.



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