• About Joy
• About Shame
• An Inspiration from War
• Are You Considering Therapy?
• Boundaries
• Depression In The Culture
• Depression: The Problem
• Depression: What To Do About It
• Fantasy And Reality: #1
• Fantasy And Reality: #2
• Feeling Like You Belong
• Finding Purpose
• Getting Enough Attention
• Growing Up Emotionally
• Handling Criticism
• How Much Change Is Possible?
• How To Play
• Life's Craziest Beliefs
• Living With Alcoholics
• Loneliness
• Motivation
• Natural Anger
• Natural Sadness
• Natural Scare
• Perfectionism
• Personal Freedom
• Problems With Anger
• Problems With Sadness
• Problems With Scare
• Quitting Addictions
• Self Love
• Shame: What You Can Do About It
• Stop Making Comparisons!
• Were You Loved As A Child?
• What To Tell A Therapist
• Who Needs Help?
• Who's Healthy?
• Why Are You Treated The Way You Are?

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next: I Often Feel Ashamed.

• About Change
• About Joy
• About Love
• About Shame
• An Inspiration from War
• Analyzing Your Dreams
• Angels, Infants, and Hope
• Bigotry
• Boundaries
• Can You Make Someone Change?
• Clear Communication: #1
• Clear Communication: #2
• Couples: Passive & Controlling Partners
• Depression In The Culture
• Depression: The Problem
• Depression: What To Do About It
• Discipline
• Employment
• Fantasy And Reality: #1
• Fantasy And Reality: #2
• Feeling Like You Belong
• Feeling Safe
• Finding Purpose
• Getting Enough Attention
• Growing Up Emotionally
• Handling Criticism
• How Happy Couples Stay That Way
• How Much Change Is Possible?
• How To Have A Lousy Sex Life
• How To Play
• How To Talk About Feelings
• How Are You Spending Your Life?
• Life's Craziest Beliefs
• Loneliness
• Mistakes Every Good Parent Makes
• Motivation
• My Wishes For Real People

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• Natural Anger
• Perfectionism
• Personal Freedom
• Powerful Ideas: #1
• Problems With Anger
• Relationship Analysis (online evaluation)
• Relationships
• Self Love
• Self-help Quiz #1
• Self-help Quiz #2
• Sexual Abuse In Childhood
• Shame: What You Can Do About It
• Should We Blame Our Parents?
• Stop Making Comparisons!
• Subconscious Life Scripts
• Taking Care Of Yourself
• The Three Stages of Relationships
• Were You Loved As A Child?
• What To Tell A Therapist
• Who Can You Trust?
• Who Is The Real You?
• Who's Healthy?
• Why Are You Treated The Way You Are?
• Why Do We Work So Hard?

next: I Want to Learn About Addiction

Study about postpartum relapse of bipolar disorder and effectiveness of lithium in preventing postpartum bipolar relapse.

For women with bipolar disorder, estimates of the risk for relapse during the postpartum period range from 20 to 50 percent. Despite growing support for the use of prophylactic treatment for women with bipolar disorder, the standard management of these patients typically does not include exposure to lithium during pregnancy because of the risk of teratogenicity. Cohen and associates performed a retrospective review to assess the impact of the use of mood stabilizers during pregnancy and the postpartum period in women with bipolar disorder.

The study included 27 women with bipolar disorder who were followed during pregnancy and the puerperium. All of the study patients had histories of recurrent manic-depressive illness, and 85 percent had a history of more than three episodes of mania or depression. Four had a history of puerperal psychosis, and seven had histories of nonpsychotic postpartum depression. Eighty-five percent of the patients had been treated with mood stabilizers before pregnancy. Within the first 48 hours postpartum, 14 of the 27 women received prophylactic mood stabilizers.

Of the women who received mood stabilizers, only one demonstrated evidence of recurrent affective instability during the first three months postpartum. Eight of the 13 women who did not receive prophylactic therapy experienced manic or depressive relapse within the first three months postpartum. Women who did not receive prophylactic treatment had an 8.6 times higher risk of relapse than women who received prophylaxis.

Women who were taking lithium during pregnancy had their dosage reduced one week before the estimated date of delivery to minimize the potential for neonatal and maternal toxicity. Evidence of toxicity was not observed in the neonates of the women who continued to receive lithium throughout pregnancy and into delivery.

The finding of a high rate of relapse among the women who did not receive prophylactic lithium compared with those who continued their drug treatment suggests that, at least for women with bipolar disorder, treatment with lithium during the puerperium is of clinical benefit. The authors conclude that identification of women at risk for postpartum illness and appropriate use of treatment for selected diagnostic groups before, during and after pregnancy may prevent relapses of affective disorders and other sequelae of untreated postpartum depression. (Cohen LS, et al. Postpartum prophylaxis for women with bipolar disorder. Am J Psychiatry 1995;152:1641-5.)

Source: 1996 American Academy of Family Physicians
Adapted from the American Journal of Psychiatry 1995;152:1641-5 - Tips from Other Journals

next: Women and Bipolar Disorder
~ bipolar disorder library
~ all bipolar disorder articles

THE OPPOSITE OF SELF-CONFIDENCE is self-consciousness. To achieve self-confidence, then, all you need to do is get rid of your self-consciousness. But how? How do we get our attention off ourselves? Easy - by putting it somewhere else. And the easiest way to have your attention on something else is to have a purpose of some kind.

Let's see how this works. Let's say you're at a party and you're feeling self-conscious. The first question to ask is "Do you have some purpose for being at the party in the first place?" If you don't, a quick and easy way to stop feeling self-conscious would be to leave the party. But let's say you do have a purpose for being there.

Ask yourself, "What's my purpose here?" In other words, what do you want? What are you trying to accomplish? What are you after? Take a few moments and think about it. Would you like to make business contacts? Do you want to entertain people? Do you need information from somebody? Do you want to help bring people together? Do you want to meet someone? The question is: What is your aim or intention? If you don't have any purpose for being there, either go somewhere where you do have a purpose or make up some purpose. For example, during the course of the evening your purpose could be to find someone who knows where you can get a good math tutor for your child.

In a place I used to work, we had stretches of time with nothing to do, yet we had to be there. It left me with no purpose. So I made up purposes or made the situation serve other purposes of mine. Some of the employees spoke more Spanish than English, and I wanted to learn Spanish, so in the dead times, I'd teach them English and they'd teach me Spanish. Other times I needed new ideas for a project I was working on at home, and I asked my coworkers to help me, which they were glad to do.

Accomplish a goal. Make up a goal if you have to. Do you want to get rid of your self-consciousness? Put your attention on an aim. To have self-confidence, have a purpose. It's that simple.

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Relieve self-consciousness by focusing on a purpose.

Self-Help Stuff That Worksmakes a great gift. Order from any online bookstore. These are the most popular:

 

Here's an interesting twist on self-confidence. When you
judge people less, you feel more self-confidence,
almost as a side-effect. Check out how:
Here Comes the Judge

next: The Power of a Poker Face

Attitude
Feel good more often. And learn how to change your attitude even under the most difficult circumstances. The new book Self-Help Stuff That Works has three sections: Attitude, Work, and People.

Work
Find out how to enjoy your work more, be more productive, and make more money. Chapters from the Work section of Self-Help Stuff That Works can be reached from this page.

People
Our relationships are the most important things in our lives. You probably have good relationships already, but there is always more to learn. Links to fifteen chapters can be found here.

Online Bookstores
Most online bookstores now carry Adam Khan's new book, Self-Help Stuff That Works, including:

BarnesandNobre.com

Borders.com

Amazon.com

About the Author
Learn a little about the author of Self-Help Stuff That Works, Adam Khan.

What About News?
Find out the bad news about bad news and also find out what you can do about it.

Table of Contents
This is a clickable table of contents from the book Self-Help Stuff That Works. About half of the chapters from the book are here online.

Bite-Size
Check out some easily digestible nibbles of self-help stuff that works, to get you out of a bad mood or into a more effective state of mind in just a few minutes.

Immediate Relief
Find out what the new discoveries from cognitive research tell us about old-style positive thinking.

Bonus Chapters
Here are some chapters from future as-yet-unpublished books.

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About the Book
Here is a description of Self-Help Stuff That Works and further links about the book.

Ever Feel Insecure?
Most people do at one time or another. There is definitely something you can do about it. Check out this linking page. It'll get you to a more specific category of insecurity, where you'll find out exactly what you can do about it.

Enjoy Work More
Good news from the frontiers of science about enjoying work.

Links
An extensive collection of links on self-help subjects can be found here. Mark this page as a resource you can use again and again. It is continually being updated.

More Money
If you would like to earn more money, or if you know of some young person who has that ambition, this is an excellent guide to how more money can be made.

Are Others Jerks?
Do you get miffed at people relatively often? Does it seem to you that the world is filled with stupid people? Does this ever make you feel stressed?

next: Getting More Specific

Seeking mental health treatment can be a big decision. But acknowledging your need is only the first step. You then have to decide what type of mental health professional to consult, and the choices are many - and sometimes confusing. What type of practitioner should you choose? A psychiatrist? Psychologist? Social worker? Does it matter? And what about their schooling, training and experience?

Ultimately, your choice comes down to two key factors: competence and comfort level, says Keith Kramlinger, M.D., a psychiatrist at Mayo Clinic, Rochester, Minn.

"You must feel a sense of comfort and have confidence in the person you're confiding in," Dr. Kramlinger says. "There are many good mental health professionals, but as in other fields, there are also some whose professional approaches are questionable. If you feel uncomfortable or pressured in any way, get a second opinion."

There are four major types of mental health professionals:

1. Psychiatrists
2. Psychologists
3. Social workers
4. Psychiatric nurses

Each state licenses these professionals - although criteria vary by state - and has certain requirements for maintaining and updating training and skills. In addition, each of these groups has a professional organization that establishes standards and ethics that its members must follow.

Here's a closer look at these major groups.

Psychiatrists

Psychiatrists are doctors who specialize in psychiatry, a branch of medicine devoted to the study, treatment and prevention of mental disorders. After earning their medical degree (M.D.) or osteopathic degree (D.O.), they must complete 4 years of residency training at a teaching hospital. The first year of residency is an internship to sharpen skills in general medicine and neurology. The last 3 years focus on psychiatry.

A psychiatrist can be certified by the American Board of Psychiatry and Neurology after passing oral and written exams. That certification process can occur 1 to 2 years after completion of training. Those who are then board certified are referred to as diplomats of the American Board of Psychiatry and Neurology. Some psychiatrists might have only a board eligible designation. That means they've completed the required psychiatry training at an accredited program but haven't yet completed the certification process.

Doctors don't have to be board certified in psychiatry to use the title of psychiatrist. However, certification is evidence of advanced training and experience.

Some psychiatrists seek additional specialty training after residency so they can specialize in certain areas, such as child and adolescent psychiatry, geriatrics or addictions. In addition, some limit their practice to one area, such as mood disorders or schizophrenia.

Because they're medical doctors, psychiatrists can prescribe medications as part of mental health treatment. They can also order laboratory tests, X-rays or other studies as part of your treatment. In addition, they're trained to provide psychotherapy of various kinds to individuals, couples, families and groups.

Psychologists

Psychologists are specialists in psychology, the branch of science that deals with the mind, mental processes and behaviors. They're trained to provide evaluation, assessment, testing and treatment of mental disorders. Psychologists often have training in abnormal psychology, statistics, psychological testing, psychological theory, research methods, psychotherapeutic techniques and psychosocial evaluation.

Education, training and state licensing criteria can vary widely. In some states, psychologists must hold a doctoral degree, for instance. That degree may be a doctor of philosophy (Ph.D.) in psychology, a doctor of education (Ed.D.) in psychology or a doctor of psychology (Psy.D.). Unlike psychiatrists, psychologists aren't medical doctors.

Some states require that psychologists have a period of supervised training after earning a doctorate, such as a supervised clinical internship in a hospital or other facility. They may also have to complete a year or more of postdoctoral supervised practice before practicing independently.

In some states, a master's degree (M.A. or M.S.) is sufficient to allow practice as a psychologist. But they may only be allowed to provide therapy under the supervision of a physician or a psychologist with a doctorate.

Traditionally, psychologists have been unable to prescribe medications because they're not medical doctors. However, in some cases, psychologists are now able to write prescriptions for certain medications.

There are different types of psychologists. Clinical psychologists, for instance, work with the diagnosis and treatment of mental disorders. Counseling psychologists focus mainly on adjustment issues or life challenges, such as choosing a career or coping with marital problems. And school psychologists work with the emotional or academic problems of students.

Social workers

Social workers help individuals, families and communities overcome a variety of social and health problems. There are many types of social workers, and the term can be broadly used. Their training and education can vary widely. Most, but not all, have a master's degree in social work.

Not all social workers can be licensed to provide mental health services. They must be clinical social workers with advanced training in psychotherapy. They must have a master of social work (M.S.W.) degree and meet certain training requirements as set by their state, including experience working under supervision to provide mental health and psychotherapy services.

But training alone isn't enough. In order to actually offer psychotherapy, clinical social workers must be licensed by their state, as with psychiatrists, psychologists and nurses. Once licensed, they're designated as a licensed clinical social worker (L.C.S.W.) or licensed independent clinical social worker (L.I.C.S.W). Licensing requirements vary by state.

Clinical social workers may provide therapy in private practice in psychiatric facilities, hospitals, community agencies or other places that offer mental health services. Others may work as case managers and coordinate psychiatric, medical and other services on your behalf. They often work with psychiatrists, psychologists, nurses and vocational therapists - job counselors - to help manage your overall care. Social workers can't prescribe medications or order medical tests as part of your treatment.

Psychiatric nurses

A psychiatric nurse is a licensed registered nurse (R.N.) who has additional training in mental health. They work with individuals, families or communities to evaluate mental health needs and assist other mental health professionals in treatment and referral.

A psychiatric nurse may have an associate arts, bachelor's, master's or doctoral degree. Much of a psychiatric nurse's specialty training takes place in a hospital. Their level of training and experience determines what services and care they can offer. Among the services they're trained to provide - under supervision of medical doctors - are mental health assessments, psychotherapy, help managing your medications, as well as other duties commonly performed by nurses, such as discharge planning, patient and family education, and medical care.

Advanced practice registered nurses (A.P.R.Ns.) have a master's degree in psychiatric-mental health nursing. There are two types of A.P.R.Ns.: clinical nurse specialists and nurse practitioners. In general, they can diagnose and treat mental illnesses, and in many states they're authorized to prescribe medications. They also may be qualified to practice independently, without the supervision of a doctor.

Other mental health providers

There are many other types of mental health providers.

Couples and family therapists may be psychiatrists, psychologists, social workers or nurses, or they may have other training. They diagnose and treat mental illness within the context of relationships. Those who are members of the American Association for Marriage and Family Therapy have at least a master's degree and 2 years of supervised practice with couples and families.

A pastoral counselor is a member of the clergy who integrates religious concepts with training in behavioral science. Licensing is not required, but counselors can seek certification with the American Association of Pastoral Counselors.

Who's right for you?

With the many types of mental health practitioners, deciding who to consult can be difficult.

If your symptoms are severe, you're having trouble coping in your daily life, or existing treatment isn't working well, consider contacting a psychiatrist or psychologist first, suggests Dr. Kramlinger. Their advanced level of training and experience may mean they're better skilled in treating complicated situations.

Need for psychiatric medication is also a consideration.

"If you have a condition that warrants treatment with medication as well as psychotherapy, you may be better off seeing a psychiatrist who specializes both in medical treatment and psychotherapy," Dr. Kramlinger advises. Or you can see both a psychotherapist and a psychiatrist. In addition, your family doctor can also work with your psychotherapist and prescribe needed medications.

Insurance coverage of mental health services is often a complicating issue. Contact your insurance company to find out its policy on mental health services, including how many visits will be covered in a certain time period. Some insurance plans authorize more visits to a nurse, social worker or psychologist than to a psychiatrist, whose fees are usually higher.

Finding a therapist

Finding a therapist who best suits your needs can take some legwork. If it seems like more time and energy than you can muster - especially if you're facing depression or another serious mental illness - consider enlisting help from your primary care doctor, family or friends. Don't hesitate to ask a lot of questions of a potential therapist, either during an initial phone call or at your first visit.

Here are some steps to take when choosing a therapist:

• Get a referral or recommendation from others, such as a trusted doctor, friends, family, clergy, your insurance provider, a professional association, your company's employee assistance program, community hot lines, your school district or local social services agencies.
• Consider whether you have preferences regarding gender, age, religion or other personal issues.
• Ask potential therapists about their education, training, licensure and years in practice. Licensing requirements can vary widely by state.
• Find out office hours, fees and accepted insurance providers.
• Double-check credentials by contacting your state's licensing boards.
• Discuss - on the phone before your first visit, if possible - their treatment approach and philosophy to make sure it agrees with your style and needs.
• Find out if they specialize. Therapists often specialize in certain disorders or age groups. Some, for instance, work only with adolescents. Others specialize in eating disorders or divorce issues.

If you don't feel comfortable after the first visit, or even several visits, talk about your concerns at your next session. And consider changing therapists.

Overview of antidepressants as a treatment for depression and whether antidepressants work in treating depression.

What are they?

Antidepressants are drugs designed to treat depression. They can only be prescribed by a doctor. There are several different classes of antidepressants. The main ones are the tricyclics, the monoamine oxidase inhibitors ('MAOIs' for short), the selective serotonin reuptake inhibitors ('SSRIs'), the serotonin and noradrenaline reuptake inhibitors ('SNRIs'), and the reversible inhibitors of monoamine oxidase A ('RIMAs'). Each of these general classes includes a number of different drugs. The tricyclics and the MAOIs are older classes of antidepressants, with the MAOIs seldom used these days. The SSRIs, SNRIs and RIMAs have been developed more recently and have come increasingly prescribed.

How do they work?

Antidepressants work by changing the level of neurotransmitters (chemical messengers) in the brain. Several neurotransmitters are thought to be in low supply in depression, including noradrenaline (sometimes called norepinephrine) and serotonin. Tricyclics mainly increase the level of noradrenaline in the brain. The SSRIs work by increasing the supply of serotonin only. The SNRIs and RIMAs increase the supply of both serotonin and noradrenaline in the brain.

Are they effective?

There are a very large number of studies showing that antidepressants work better than placebos (dummy pills) for adults. Tricyclic antidepressants, SSRIs and RIMAs work equally well. The best effects come from combining an antidepressant with a psychological therapy.

Tricyclics do not appear to work for children and have only limited effects on adolescents. There is some evidence that the SSRI fluoxetine is effective in children and adolescents. However, other SSRIs are not advised in children and adolescents because of safety concerns.

Are there any disadvantages?

Antidepressant drugs can have side effects. These tend to be more common for tricyclics than for SSRIs or RIMAs. Contrary to what many people believe, antidepressants are not at all addictive. Antidepressant drugs can take two to four weeks to have an effect. It is important not to give up on them too early. Several SSRI antidepressants (paroxetine, sertraline, citalopram, venlafaxine) may be unsafe for use by children and adolescents because they can produce an increase in suicidal thoughts.

Where do you get them?

Antidepressants can be prescribed by a GP or specialist doctor.

Recommendation

Antidepressants are one of the best treatments available for depressed adults, but caution is advised for children and adolescents. For adults, antidepressants can be combined with psychotherapy for even better results.

Key references

Mulrow CD, Williams JW, Trivedi M et al. Treatment of depression - newer pharmacotherapies. Psychopharmacology Bulletin 1998; 34: 409-610.

Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Combined pharmacotherapy and psychological treatment for depression: a systematic review. Archives of General Psychiatry 2004; 61: 714-719.

Williams JW, Mulrow CD, Chiquette E, Noel PH, Aguilar C, Cornell J. A systematic review of newer pharmacotherapies for depression in adults: Evidence report summary. Annals of Internal Medicine 2000; 132: 743-756.

Whittington CJ, Kendall T, Fonagy P, Cottrell D, Cotgrove A, Boddington E. Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet 2004; 363: 1341-1345.

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back to: Alternative Treatments for Depression

How do you heal a life? This short essay suggests ten ways to heal your life.

Life Letters

To a student/ teacher,

The BIRTHQUAKE workshop is over, the conference room empty. I am preparing to leave when you approach me. You look stressed, in a hurry, and you speak rapidly. In high speed you tell me that you have enjoyed the workshop, and that you are wondering if I have a simple formula written for healing lives (preferably in one page or less I suspect.) I pause for a moment, attempt to concentrate on your request. You continue talking, speaking in fast-forward motion, and I find myself distracted by your impatient movements and no-nonsense face. The little girl in me who needs to please wants to give you what you've asked for - and right away! Yet there's far too little time to say all that I'd like to; and besides, you're too busy talking anyway. All of the sudden I am overcome by an urge to embrace you. And then, before I think, I act. My arms reach out and you immediately move into them. I rock you gently as if you were a small child, and you begin to weep. There are no anxious words now, nor any pearls of wisdom. There is just the silence and our communion. It is not enough, never perhaps enough, but it holds us...

I catch movement from the corner of my eye. It's your companion. He comes into the room quietly, but he seems agitated, inpatient. I let you go, and you turn to him, smile tremulously, and tell him that you'll be right with him. You are embarrassed now, I sadly note. I'm not sure what to offer that you can take away with you. What will render comfort and guidance, but require only seconds to deliver? Then I remember a handout I have stuffed inside my briefcase. I quickly forage around, locate it, and pass it over to you. I feel a bit apologetic. It's a very modest offering. Yet, it's a beginning.

It was published by the New York People with AIDS Coalition and is entitled: "Ten Ways to Heal Your Life." Do you remember it? It made the following recommendations (I've paraphrased them):

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1. Engage in activities that offer a sense of fulfillment, purpose and joy. Pursue that which validates your value as a unique person. Acknowledge that you are the creator of your own life, and thus make your creation as positive as possible.

2. Take loving care of yourself.

3. Learn to let go of those emotions that lead to negativity in your life such as envy, jealousy, anger, resentment, shame and fear. Don't hold onto your feelings, express them appropriately, and then let them go. Forgive yourself.

4. Hold onto images of what you truly desire to have in your life. When negative images arise; refocus on those images that inspire feelings of peace and joy.

5. Make love the primary expression and purpose of your life.

6. Attempt to heal the wounds of yesterday's relationships when possible, and foster loving, supportive relationships today.

7. Contribute to your community; serve others through activities that you value and enjoy.

8. Commit yourself to health and well being. Draw upon the support and wisdom of others, but don't forget your own inner voice.

9. Accept everything in your life as an opportunity to grow and to learn. Foster a sense of gratitude.

10. Always maintain your sense of humor. Tears and laughter are both healing.

I've found the above suggestions to be helpful. I hope that they were useful to you as well. You requested that day long ago, or so I thought then, a simple answer to a complicated question. Lately, I've begun to wonder if maybe that's part of the problem with we seekers. We've journeyed in the name of progress too far from the very basics. You see, I've discovered on my endless quest for wisdom that what you know is not quite as important as what you practice. And so, my dear companion, in your search for the answers to life's pain and the secrets to healing - don't forget the fundamentals. Live them while you go...

Sincerely, A Fellow Traveler...

next:Life Letters: On Losing Perspective

Licorice is a herbal remedy used to relieve respiratory ailments, skin diseases and stomach problems. Learn about the usage, dosage, side-effects of Licorice.

Botanical Name:Glycyrrhiza glabra
Common Names:Spanish licorice, sweet root 

• Overview
• Plant Description
• What's It Made Of?
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Licorice (Glycyrrhiza glabra) is a flavorful herb that has been used in food and medicinal remedies for thousands of years. Also known as "sweet root," licorice root contains a compound that is roughly 50 times sweeter than sugar. Licorice root has been used in both Eastern and Western medicine to treat a variety of illnesses ranging from the common cold to liver disease. This herb has long been valued as a demulcent (soothing, coating agent) and continues to be used by professional herbalists today to relieve respiratory ailments (such as allergies, bronchitis, colds, sore throats, and tuberculosis), stomach problems (including, possibly, heartburn from reflux or some other cause and gastritis), inflammatory disorders, skin diseases, and liver problems.

Licorice root is often used to prevent and treat stomach ulcers. In fact, healthcare practitioners in Europe and Japan often prescribe a synthetic form of licorice for stomach ulcers. Although this drug is not available in the United States, many herbalists prescribe combination herbal remedies containing licorice for people with this painful health condition.

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Animal studies and early trials in humans support the value of licorice for stomach ulcers. One animal study recently found that aspirin coated with licorice reduced the number of ulcers in rats by 50 percent. (High doses of aspirin often cause ulcers in rats). Earlier studies in humans have found that preparations containing glycyrrhizin (an active compound in licorice) may be as effective as leading anti-ulcer medications in relieving pain associated with stomach ulcers and preventing the ulcers from recurring. In one study, licorice root fluid extract was used to treat 100 patients with stomach ulcers (of which 86 had not improved from conventional medication) for 6 weeks. Ninety percent of patients improved; ulcers totally disappeared in 22 of these patients.

Active compounds in licorice root are also used to help prevent and treat chronic hepatitis (liver inflammation). In one study of Japanese patients with hepatitis C, those who received intravenous treatment with glycyrrhizin, cysteine, and glycine for an average of 10 years were significantly less likely to develop liver cancer and cirrhosis (progressive liver failure) than those who received placebo. In a second study of 57 patients with hepatitis C, glycyrrhizin (in doses ranging from 80 to 240 mg/day) significantly improved liver function after only one month. These effects diminished after glycyrrhizin treatment was discontinued, however.

Emerging studies are beginning to suggest that licorice may also play a role in the treatment of heart disease. In one recent study, people with high cholesterol experienced a significant reduction in total cholesterol, LDL ("bad") cholesterol, and trigylceride levels after taking licorice root extracts for one month. The extract also reduced systolic blood pressure by 10 percent. These measures returned to their previous, elevated levels when the participants stopped taking the licorice supplements. Earlier studies in mice produced similar results. Licorice root extract reduced the risk of atherosclerosis in these animals.

Preliminary studies also suggest that licorice may play a role in the treatment of human immunodeficiency virus (HIV) and Japanese encephalitis. One early study of only 3 people with HIV suggested that intravenous glycyrrhizin may prevent replication of HIV, but larger studies have yet to duplicate these findings. A laboratory study found that glycyrrhizin inhibited the growth of Japanese encephalitis virus in test tubes, but further studies in humans are needed to confirm these preliminary findings. Experimental studies also suggest that active compounds in licorice may have estrogen-like effects. It is not clear at this time whether such effects are helpful or harmful to people with breast cancer.

Despite these promising findings, there is ongoing debate in the scientific community regarding the value and side effects of licorice products. People who regularly consume large amounts of licorice (more than 20 g/day) may inadvertently raise blood levels of the hormone aldosterone, which can cause serious side effects including headache, high blood pressure, and heart problems. Further studies are needed.

Plant Description

Licorice grows wild in some parts of Europe and Asia. A perennial that grows 3 to 7 feet high, licorice has an extensive branching root system. The roots are straight pieces of wrinkled, fibrous wood, which are long and cylindrical and grow horizontally underground. Licorice roots are brown on the outside and yellow on the inside. Licorice products are made from the roots and underground stems of the plant.

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What's It Made Of?

Glycyrrhizin, one of the main active ingredients in licorice, is believed to contribute to the herb's many healing properties. Laboratory studies have shown that glycyrrhizin reduces inflammation, promotes secretion of mucous (usually through coughing), soothes irritation, and stimulates the activity of the adrenal glands. The roots also contain coumarins, flavonoids, volatile oils, and plant sterols.

Available Forms

Licorice products are made from peeled and unpeeled dried root. There are powdered and finely cut root preparations, as well as dried and liquid extracts. Some licorice root extracts do not contain the compounds that stimulate the adrenal glands. These extracts are known as deglycyrrhizinated licorice (DGL), and do not seem to harm the adrenal glands or have the undesired side effects of other forms of licorice. DGL may be better for stomach or duodenal ulcers.Scientific studies show that DGL reduces inflammation and is as effective as some prescription drugs for gastric ulcers. In fact, DGL may offer protection against ulcer formation when taken with aspirin. In addition, it may enhance the effectiveness of antiulcer medications such as cimetidine.

How to Take It

Pediatric

For sore throat treatment in older children, a piece of licorice root may be chewed or licorice tea may be used. The appropriate dose of tea for a child should be determined by adjusting the recommended adult dose to account for the child's weight. Most herbal dosages for adults are calculated on the basis of a 150 lb (70 kg) adult. Therefore, if the child weighs 50 lb (20-25 kg), the appropriate dose of licorice for this child would be 1/3 of the adult dosage.

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Adult

Licorice can be taken in the following forms:

• Dried root: 1 to 5 g as an infusion or decoction three times per day
• Licorice 1:5 tincture: 2 to 5 mL three times per day
• DGL extract: 0.4 to 1.6 g three times per day for peptic ulcer
• DGL extract 4:1: in chewable tablet form 300 to 400 mg 20 minutes before meals for peptic ulcer

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and that can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, preferably under the supervision of a practitioner knowledgeable in the field of botanical medicine.

High doses of licorice (more than 20 g/day) may cause serious side effects. Too much glycyrrhizin causes a condition called pseudoaldosteronism, which can cause an individual to become overly sensitive to a hormone in the adrenal cortex. This condition can lead to headaches, fatigue, high blood pressure, and even heart attacks. It may also cause water retention, which can lead to leg swelling and other problems. An overdose of glycyrrhizin can lead to harmful conditions such as high blood pressure and even heart attack.

Although the most dangerous effects generally only occur with high doses of licorice or glycyrrhizin, side effects may occur even with average amounts of licorice. Some people experience muscle pain and/or numbness in the arms and legs. Too much licorice can also cause weight gain. These problems can probably be avoided if dosages are kept within the recommended guidelines. It is safest, though, to have use of licorice monitored by your health care provider.

People with high blood pressure, obesity, diabetes, or kidney, heart, or liver conditions should avoid licorice. This herb should also not be used by pregnant or breastfeeding women or by men with decreased libido or other sexual dysfunctions. Use of any licorice product is not recommended for longer than four to six weeks.

Possible Interactions

If you are currently being treated with any of the following medications, you should not use licorice without first talking to your healthcare provider:

Ace-inhibitors and diuretics
If you are taking angiotensin-converting enzyme (ACE) inhibitors or diuretics (except potassium-sparing diuretics) to regulate blood pressure, do not use licorice products. Licorice could interfere with the effectiveness of these medications or could worsen possible side effects.

Aspirin
Animal studies suggest that licorice may reduce stomach irritation as well as the risk of stomach ulcers associated with aspirin.

Digoxin
Because licorice may dangerously increase the risk of toxic effects from digoxin, this herb should not be taken with this medication.

Corticosteroids
Licorice may increase the effects of corticosteroid medications. You should consult with your doctor before using licorice with any corticosteroids.

Insulin
Licorice may enhance some of the adverse effects of insulin.

Laxatives
Licorice may cause substantial potassium loss in people taking stimulant laxatives.

Oral contraceptives
There have been reports of women developing high blood pressure and low potassium levels when they took licorice while on oral contraceptives. Therefore, you should avoid licorice if you are taking birth control medications.

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Supporting Research

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