KAVA ROOT (Piper methysticum)

Latin: Piper methysticum
English: Kava / Kava-Kava

WHAT IT DOES: Kava root is bitter, pungent and slightly astringent in taste and warming in action.  It tranquilizes the mind, calms anxiety and reduces skeletal and bladder muscle spasms and pain. Also used to help deepen sleep.

RATING: yellow, due to limitations in usage.

SAFETY ISSUES: Talk to your doctor about use during pregnancy or nursing.  Do not exceed recommended dosage.  Do not use when depressed, because Kava potentiates the effects of barbiturates, and benzodiazepines such as Xanax.  Do not use in patients with Parkinson’s Disease.  Extreme excess dosage over time may cause a reversible scaly rash.  A single case use of kava root with alprazolam resulted in a coma (Almeida and Grimsley, 1996). More on Kava safety.

• Pills containing standardized extract: 100-250 mg one to three times per day.  
Note: when standardized, extracts usually contain 30% kavalactones, also called kavapyrones

Kava root relaxes the central nervous system and can be used to treat conditions like irritable bladder syndrome, anger, anxiety, nervousness and insomnia.  It is a very effective treatment for irritable bladder because it numbs pain as well as relaxing spasms.  According to written accounts, inhabitants of the Pacific Islands have used kava root as a mild intoxicant since the1772-1775 voyages of Captain Cook.  Typically, they would chew the root, then cover it with water.  After it macerated for a while, they would strain it and drink the liquid (Felter and Lloyd, 1898).  They now have more sophisticated uses for it, such as drinking the tea before marriage counseling sessions to prevent chair throwing.  My experience with kava is that it induces a mild euphoria in the average person, but I suggest you keep quiet about it, as anything that provides too much pleasure is currently a source of great concern to our moral and political leaders.

Kava root may be a good substitute for some prescription medications for anxiety.  However, a qualified physician should supervise any changeover.  It is important to distinguish between anxiety and depression, as kava should usually only be used in cases of anxiety and irritability.  It may exacerbate depression.  

For clarification purposes, depression is when you want to lie in bed forever and hide from the world, and nothing matters.  Anxiety is when your mind races out of control with fears and quickly changing ideation.  I have seen many patients who were self-medicating with herbs, and did not seem to understand the differences between these conditions or the differences between kava root and St.  John’s wort. 

There are several combination products on the mass market that contain combinations of kava root and St.  John’s wort.  This may be of benefit for persons suffering from both anxiety and depression.  However, if it makes you too calm or makes you more anxious, you may not know whether to discontinue the herbs or double the dosage! Your best bet is to try each herb individually for a short period of time and determine which one is more effective for your condition.  Some people may benefit more from the combination.

Research Highlights

• Kava seems to work through a variety of biochemical mechanisms.  The mood-elevating actions may be due to the activation of the meso-limbic dopaminergic neurones (Baum et al., 1998).

•  In s clinical multi-center randomized double-blind controlled trial of 101 outpatients suffering from anxiety, kava extract demonstrated a clear superiority over placebo according to the Hamilton Anxiety Scale.  Adverse events were rare.  The researchers reported these results as support for the use of kava extract “as a treatment alternative to tricyclic antidepressants and benzodiazepines in anxiety disorders, with proven long-term efficacy and none of the tolerance problems associated with tricyclics and benzodiazepines.” (Voltz et al., 1997).

•  placebo-controlled randomized double-blind study tested the effect of a standardized kava extract on safety when taken with alcohol.  Twenty males and females participated in seven skill performance tests over several days.  The kava did not cause any negative additive effects.  However, the kava and alcohol group showed a “remarkable” advantage over the alcohol group on the concentration test (Herberg, 1993).

• In a controlled double-blind crossover study comparing the effects of oxazepam (a benzodiazepine anti-anxiety agent) and a kava root extract on recognition and memory tasks, subjects were asked to recognize and recall words.  Oxazepam caused a reduction in memory for both old and new words, while kava showed a slight increase in recognition rate (Munte et al., 1993)

Is Kava Hepatotoxic?