Vitex and suicidal depression
A 44 year-old woman with persistent premenstrual depression self-prescribed an extract of Vitex agnus-castus. The depression worsened for two consecutive cycles until she developed thoughts of suicide. After discontinuing the extract, her “normal” premenstrual depression returned. A 32 year old woman with premenstrual depression as a predominant PMS symptom took Vitex for three cycles with no relief of symptoms, and at that time began taking a pharmaceutical antidepressant. The initiation of the medication could be a measure of a worsening of the depression.
Most cases of premenstrual syndrome are conventionally attributed to an elevated estrogen:progesterone ratio,, and are frequently treated with progesterone, or with vitex, which may elevate progesterone secretion by the corpus luteum (Milewicz et al) An exception is “PMS-D” in which depression is the predominant complaint. This form is attributed to deficient estrogen, and may be induced or aggravated by progesterone, progestin, or anti-estrogen administration (Arpels; Crammer). Although some contemporary herbalists state that Vitex agnus-castus has an amphoteric effect on ovarian hormones, raising or lowering hormone levels depending on what is required, scientific evidence support only its action to decrease prolactin levels and elevate progesterone secretion from the corpus luteum, presumably through an effect in the higher regulatory centers. The widely observed efficacy of vitex in the treatment of most forms of PMS, in female infertility, and in menopause may be due to this progesterone-increasing effect. In the relatively rare PMS-D, when due to estrogen deficiency, further elevation of progesterone may exacerbate the depression, as in the cases above, with potentially lethal effects. It is our opinion that premenstrual depression as the dominant PMS symptom should be considered a contraindication for the persistent use of Vitex agnus-castus.
Arpels, J.C.. The female brain hypoestrogenic continuum from the premenstrual syndrome to menopause. A hypothesis and review of supporting data. J Reprod Med 1996 Sep;41(9):633-9
Crammer JL. Premenstrual depression, cortisol and oestradiol treatment. Psychol Med 1986 May;16(2):451-5Milewicz A, Gejdel E, Sworen H, Sienkiewicz K, Jedrzejak J, et al. “Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo-controlled double-blind study.” Arzneimittelforschung 1993 Jul;43(7):752-6 [Article in German]