Reed & Trigwell (Psychiatric Bulletin, October 2006, 30, 365-368) raise important issues about treatments recommended by health shops for symptoms of depression. The use of herbal medication, as alternative or complementary medicine, is equally relevant in low- and middle-income countries. The practice of Ayurvedic medicine and the use of herbal remedies are deeply rooted in Eastern cultures. It is common to see patients using herbal medications alongside Western medicine. This certainly does not differ in patients with psychiatric illnesses. Herbal remedies are sought for symptoms of depression, phobias and other psychiatric disorders. Advertisements that offer a herbal remedy for any sexual problem are abundant in the newspapers. Memory boosters are also much sought after.

Most people obtain these herbal remedies from small shops in villages and towns. Some obtain them from the village ‘medicine man’. Herbal remedies are also sold in larger shops with minimum regard to the legislation in place. A survey carried out in the out-patient psychiatry clinic at the North Colombo teaching hospital found that 25.5% of psychiatric patients had used herbal medication at some point. A longer duration of psychiatric illness was related to the greater use of herbal medication. A majority of patients who used herbal remedies were not aware that there can be harmful interactions with other medications. This can have disastrous consequences when herbal medication is used in a complementary role.

Use of herbal remedies as alternative medication may also contribute to a delay in seeking treatment. Patients may prefer to use herbal remedies, which are less stigmatising than psychotropic medication. This may result in a delay in treatment which may have negative effects on prognosis.