People have reported numerous incidents of serious psychiatric problems - including hallucinations, mania and severe Depression - that may have resulted from taking ephedra, new study findings report.

Nearly one-half of those incidents involved hospitalization. Some of these of patients also harmed themselves or others, and were brought up on criminal charges for their behavior.

Two-thirds of the people reporting psychiatric problems from ephedra, also known as ma huang, had pre-existing psychiatric conditions, or were using other medications or illegal drugs, according to the researchers, led by study author Margaret Maglione of the RAND Corporation, headquartered in Santa Monica, California.

The report likely underestimates the number of people who developed psychiatric problems from ephedra, Maglione and her team note, given that only an estimated 1 percent of reactions to supplements are typically reported.

Maglione cautioned that it’s still unclear whether ephedra caused these symptoms, but people should still be careful. “If your friend starts acting a bit strangely, it might be the ephedra supplements he’s taking,” she told Reuters Health.

Ephedra is a weight-loss supplement that has been linked to serious safety problems, such as an increased risk of heart attack and stroke. Recently the U.S. Food and Drug Administration (FDA) banned ephedra, the first time the agency has banned a supplement.

However, U.S. regulators allowed an exemption on the ephedra ban for practitioners of Chinese medicine who have been using the herb for thousands of years to treat ailments ranging from asthma to fevers.

Previous research involving people taking ephedra for weight loss or athletic performance found that users were almost four times more likely to exhibit psychiatric symptoms, including euphoria, agitation, dizziness and anxiety.

However, Maglione and her colleagues write in the American Journal of Psychiatry that this earlier research included too few patients to really detect rare, serious side effects.

In this study, Maglione and her team reviewed all 1,820 incidents of side effects from dietary supplements containing ephedra reported to the FDA as of September 30, 2001.

The researchers found 57 cases of serious psychiatric events, most commonly psychosis, severe Depression, mania or agitation, hallucinations, sleep disturbance and suicidal thoughts.

In 10 of the reported cases, patients harmed themselves or other people. Twenty-six cases ended in hospitalization, which was involuntary for at least 6 patients.

Most patients had pre-existing psychiatric problems such as Depression, eating disorder or bipolar disorder, or were taking other medications or illegal drugs.

Maglione explained that other drugs contain powerful ingredients that can interact with herbs or supplements, another reminder of the importance of consulting a doctor before starting any alternative therapies.

She added that it’s not clear how ephedra might cause psychiatric problems, although some research suggests that the supplement’s active ingredient, ephedrine, affects chemical messengers that influence brain processes.

SOURCE: American Journal of Psychiatry, January 2005.