Evidence-Based Reviews

Taking the spice route: Psychoactive properties of culinary spices

Current Psychiatry. 2014 April;13(4):21-32

References

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Saffron
Stigma of saffron (a member of the family Iridaceae) was found to be significantly more effective than placebo and equally as efficacious as fluoxetine and imipramine in treating depression. Saffron petal was found to be significantly more effective than placebo and as effective as fluoxetine and saffron stigma in a recent systematic review.^45-48

Asafetida
Asafetida (Ferula assa-foetida), when combined with valerian root, is used as a sedative to treat hyperactivity.² The active ingredients of asafetida are the resin, endogenous gum, essential oil, propenyl-isobutylsulfide, umbelliferone, and vanillin. Several of the volatile constituents produce a sedative effect.² Additive effects can occur between the hypotensive property of asafetida and dopamine receptor agonists such as bromocriptine mesylate. Use caution when combining asafetida in conjunction with a CNS depressant or a stimulant.²

Recommendations for treating spice-abusers
Patients may present to psychiatry services with psychological and physiological evidence of intoxication with culinary spices that may mimic 1) abuse of other substances, 2) primary psychiatric illness, and 3) primary medical illness. When you encounter a patient with a new psychiatric symptom, consider inquiring about the abuse of spices.

Patients might abuse more than 1 spice; a comprehensive screening approach might therefore be useful. Caution patients that ingesting these substance to excess can have harmful effects. Consider appropriate psychopharmacotherapy for underlying psychiatric symptoms to help patients who use spices maladaptively to self-medicate psychiatric symptoms.

Consider abuse of culinary spices in clinical presentations of psychiatric symptoms that do not seem adequate for a diagnosis of a primary anxiety, mood, or psychotic disorder, or in cases atypical psychiatric presentations that are—perhaps to your surprise—associated with negative toxicology studies for common, more familiar substances of abuse.

Physicians practicing in an environment where street drugs are difficult to obtain (eg, prisons) should consider monitoring for possible abuse of spices. Based on the available, albeit limited, literature, it appears that most culinary spice–associated intoxication can be managed:
• with an elevated level of clinical suspicion
• by ruling out other causes of intoxication
• using targeted, empirical psychopharmacotherapy to manage symptoms
• with supportive care that includes close psychiatric follow-up.

Consider comorbid abuse of other, more familiar substances of abuse in patients who misuse spices. As with inhalant abuse, the concept of “substance abuse” in clinical practice may need to be further expanded to include patients who abuse culinary spices. Patients could be screened for psychiatric illnesses known to increase the risk of substance abuse. These might include—but are not limited to:
• comorbid psychotic disorders
• mood disorders, particularly bipolar disorders
• trauma- and stressor-related disorders, particularly posttraumatic stress disorder
• personality disorders, particularly antisocial, borderline, and narcissistic personality disorders.

Pending the availability of population-based studies on abuse of culinary spices, the usual cautions regarding substance abuse seem to be appropriate when caring for these patients. Assessment for and management of comorbid psychiatric conditions is essential in the comprehensive psychiatric care of patients who abuse substances.

Last, general consideration of a 12-step recovery program appears warranted for these patients; the self-reflection and group support of such programs can be useful in helping patients control their use of these substances.

Bottom Line
Presentation of culinary spice intoxication can parallel that of other medical or psychiatric illnesses, or other drugs of abuse. Consideration and questioning for abuse of spices is necessary to ascertain the psychoactive effects of these substances when used surreptitiously. Management should follow substance abuse treatment protocols: inquiry into patterns of problematic use and readiness to change, assessment and management of psychiatric comorbidity, and referral to a recovery program.

Related Resources
• Srinivasan K. Role of spices beyond food flavoring: nutraceuticals with multiple health effects. Food Reviews International. 2005;21(2):167-188.
• Parthasarathi U, Hategan A, Bourgeois JA. Out of the cupboard and into the clinic: Nutmeg-induced mood disorder. Current Psychiatry. 2013;12(12):E1-E2.

Drug Brand Names
Bromocriptine mesylate • Parlodel Imipramine • Tofrani
Flunitrazepam • Rohypnol Iproniazid • Marsilid
Fluoxetine • Prozac Tranylcypromine • Parnate

Disclosures
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.

Taking the spice route: Psychoactive properties of culinary spices

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Out of the cupboard and into the clinic: Nutmeg-induced mood disorder