The use of herbal medicinals has grown tremendously in the last several years. Unfortunately, there is little knowledge about the safety of these products. There have been several reports of psychiatric side effects associated with the use of herbal medicinals. Manic symptoms have been reported with the use of St. John's wort, yohimbe, ginseng, and ma huang or its synthetically produced alkaloids. Ma huang or its alkaloids have also been associated with psychotic symptoms. Worsening anxiety and panic attacks have been reported with yohimbe. Recommendations for the use of these phytomedicinals and for future research are included.
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