Valerian

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Health Goals: sleep anxiety stress

Research Overview

Clinical research on Valeriana officinalis (valerian) has focused most heavily on sleep-related outcomes, particularly insomnia and subjective sleep quality, with additional smaller studies in anxiety disorders and other symptom clusters (e.g., restless legs syndrome). The abstracts provided include multiple randomized, placebo-controlled trials and at least two meta-analyses/systematic reviews centered on insomnia, as well as pilot randomized trials in generalized anxiety disorder (valepotriates vs diazepam vs placebo) and obsessive-compulsive disorder (valerian extract vs placebo). There is also investigation in special populations where sleep disturbance is common (postmenopausal women; patients undergoing cancer treatment), reflecting a trend toward evaluating valerian as a lower-risk alternative or adjunct to conventional hypnotics.

The strongest evidence in this set supports a modest benefit of valerian for subjective sleep improvement in insomnia. Both the systematic review and meta-analysis report statistically significant effects when sleep quality is assessed dichotomously (improved vs not), while showing little or no clear benefit on quantitative measures such as sleep latency or continuous sleep-quality scales; this pattern suggests effects may be small, variable across preparations/doses, or more detectable via patient-reported global improvement than via specific sleep parameters. Individual trials also report improvements in sleep quality in postmenopausal women and potential benefit in a subgroup of restless legs syndrome patients with baseline daytime sleepiness. Across studies, tolerability appears generally favorable, though sedation/somnolence is a recurring signal (and was significantly more common in the OCD pilot trial), consistent with valerian’s known CNS-depressant properties.

Key gaps include the need for larger, well-powered randomized trials using standardized valerian preparations (and clear characterization of active constituents such as valepotriates), consistent dosing regimens, and validated outcomes that include objective sleep measures (e.g., actigraphy/polysomnography) alongside patient-reported endpoints. The evidence for psychiatric indications beyond sleep—such as generalized anxiety disorder and OCD—remains preliminary due to small sample sizes, mixed primary-outcome results, and limited replication. Additional research is also needed on long-term safety, interactions with sedatives/anxiolytics, and effectiveness in clinically relevant subgroups (e.g., those with prominent daytime sleepiness, comorbid anxiety, or cancer-related sleep disturbance), as well as on comparative effectiveness versus established behavioral and pharmacologic treatments.

1. What conditions has Valerian been studied for?

  • Obsessive-Compulsive Disorder (OCD): An 8-week pilot double-blind randomized trial compared valerian extract (765 mg/day) vs placebo.

  • Generalized Anxiety Disorder (GAD): A 4-week pilot double-blind trial compared valepotriates (a class of valerian constituents) vs diazepam vs placebo.

  • Restless Legs Syndrome (RLS): An 8-week triple-blind randomized placebo-controlled trial tested valerian 800 mg/day.

  • Insomnia / sleep disturbance (general): Two systematic reviews/meta-analyses summarized randomized placebo-controlled trials of valerian for sleep quality.

  • Insomnia in postmenopausal women: A 4-week triple-blind randomized controlled trial tested concentrated valerian extract 530 mg twice daily.

  • Sleep disturbance in people with cancer undergoing treatment: An 8-week randomized placebo-controlled trial tested valerian 450 mg at bedtime.

  • Menopausal hot flashes: An 8-week double-blind placebo-controlled trial tested valerian 255 mg three times daily.

  • Dysmenorrhea (menstrual pain): A double-blind randomized placebo-controlled trial tested valerian 255 mg three times daily for 3 days at menses onset, across two cycles.

  • Arthritis-related sleep disturbance: A small 5-night randomized placebo-controlled pilot tested valerian 600 mg nightly.

2. Does it work in treating those conditions? Summarize the evidence.

  • OCD: In a small 8-week pilot RCT (n=31), valerian extract (765 mg/day) showed a statistically significant benefit vs placebo at end of treatment (P=0.000). This suggests potential anti-obsessive/compulsive effects, but the study is small and described as preliminary.

  • GAD/anxiety (valepotriates): In a 4-week pilot trial (n=36; 12/group), the primary between-group comparison on total HAM-A was not significant. However, only diazepam and valepotriates significantly reduced the “psychic factor” of HAM-A, suggesting a possible signal for psychic symptoms. Authors explicitly note the small sample size likely limited power.

  • RLS: In an 8-week trial (n=37), both valerian and placebo groups improved on sleep and RLS severity overall. A nested analysis among participants who were sleepy at baseline (ESS ≥10) and received valerian (n=17) found significant pre–post improvements in sleepiness (P=.01) and RLS symptoms (P=.02), with correlated changes (P=.006). This suggests benefit may be more apparent in a symptomatic subgroup, but the overall parallel-group results appear mixed.

  • Insomnia/sleep quality (general evidence):

    • A systematic review of 16 RCTs (total 1093 patients) found a benefit on a dichotomous “sleep quality improved” outcome (RR 1.8, 95% CI 1.2–2.9), but noted substantial methodological problems and evidence of publication bias.

    • A meta-analysis of 18 RCTs found a modest benefit on a dichotomous sleep-quality improvement outcome (RR 1.37, 95% CI 1.05–1.78), but no meaningful benefit on quantitative sleep latency (mean difference 0.70 minutes, 95% CI −3.44 to 4.83) or quantified sleep quality scales (SMD −0.02, 95% CI −0.35 to 0.31). This suggests subjective improvement may occur, while objective/quantitative improvements are not consistently demonstrated.

  • Insomnia in postmenopausal women: In a 4-week triple-blind RCT (n=100), valerian extract significantly improved sleep quality vs placebo (P<0.001). Improvement was reported in 30% of the valerian group vs 4% of placebo (P<0.001).

  • Sleep in cancer patients on treatment: In an 8-week RCT (227 randomized; 119 evaluable for primary endpoint), valerian 450 mg at bedtime did not improve PSQI area-under-curve vs placebo (P=0.6957). Exploratory analyses suggested improvements in some fatigue endpoints and self-reported “less trouble with sleep” and “less drowsiness,” but these were secondary/exploratory findings.

  • Menopausal hot flashes: In an 8-week double-blind trial (n=68), valerian significantly reduced hot flash severity and frequency vs placebo (p<0.001 for multiple comparisons reported).

  • Dysmenorrhea: In a double-blind RCT (n=100), pain severity decreased in both groups, but the reduction was significantly greater with valerian (P<0.05 between groups). Systemic symptoms decreased without clear between-group differences except syncope (P<0.05).

  • Arthritis-related sleep disturbance: In a very small 5-night pilot (n=15), differences vs placebo were nonsignificant on diary and actigraphy outcomes; the study mainly supported feasibility rather than efficacy.

3. What health benefits does it have?

  • Sleep-related benefits (most studied): Evidence across trials and reviews suggests valerian may improve subjective sleep quality in some populations (e.g., postmenopausal insomnia trial with significant PSQI improvement; meta-analyses showing benefit on “improved vs not improved” sleep outcomes). However, quantitative/objective improvements (e.g., sleep latency minutes, standardized scales) are inconsistent.

  • Potential psychiatric symptom benefits:

    • OCD: Pilot evidence suggests improvement vs placebo after 8 weeks at 765 mg/day.

    • Anxiety (psychic symptoms): Valepotriates showed a possible signal for improving the “psychic factor” of anxiety in a small pilot study, though the primary outcome was negative.

  • RLS symptom management (possible subgroup effect): In participants with notable baseline sleepiness (ESS ≥10), valerian was associated with improvements in sleepiness and RLS symptom severity in pre–post analysis.

  • Menopause-related symptoms: One trial reported reductions in hot flash severity and frequency over 8 weeks.

  • Menstrual pain: One RCT suggests valerian can reduce dysmenorrhea pain more than placebo, consistent with the authors’ hypothesis of antispasmodic effects.

  • Fatigue (in oncology setting): In the cancer trial, valerian did not improve the primary sleep endpoint, but exploratory analyses suggested improvements in fatigue measures (BFI and POMS).

4. Does it have any downsides or side effects?

  • Sedation/somnolence: In the OCD pilot RCT, somnolence was the only side effect that differed significantly between valerian and placebo (P=0.02). This is consistent with valerian’s commonly described sedative properties.

  • Laboratory changes/toxicity signals: In the cancer trial, there were no significant differences in toxicities between valerian and placebo by self-report or CTCAE, except mild alkaline phosphatase increases that were slightly more common in the placebo group (i.e., not clearly attributable to valerian in that study).

  • Inconsistent efficacy / risk of relying on it when stronger therapy is needed: Multiple studies show mixed or negative primary outcomes (e.g., cancer sleep trial; anxiety trial primary endpoint; arthritis sleep pilot), and meta-analytic findings suggest benefits may be mainly subjective. A practical downside is that valerian may not provide adequate symptom control for everyone.

  • Evidence limitations that affect safety conclusions: Reviews noted methodological problems and variability in dose/preparation/duration across trials, which makes it harder to generalize both efficacy and safety. The abstracts provided do not detail rare adverse events or long-term safety beyond 8 weeks.

5. Is it beneficial or harmful for any genetic variations (pharmacogenomics)?

The provided abstracts do not report pharmacogenomic analyses (e.g., outcomes stratified by genetic variants in GABA receptors, CYP enzymes, or transporters), and they do not identify any genetic subgroups with increased benefit or harm.

  • What can be said from these abstracts: No evidence is presented that specific genetic variants modify valerian’s efficacy or side-effect risk.

  • Key limitation: Even though valerian is discussed as having effects on GABA pathways, none of the trials summarized included genotype-based analyses, so pharmacogenomic conclusions cannot be drawn from this set of evidence.

References

  1. Extract of valerian root (Valeriana officinalis L.) vs. placebo in treatment of obsessive-compulsive disorder: a randomized double-blind study
    Siroos Pakseresht, Hatam Boostani, Mehdi Sayyah (2011)
  2. Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study
    Roberto Andreatini, Vânia A Sartori, Maria L V Seabra, José Roberto Leite (2002)
  3. Does valerian improve sleepiness and symptom severity in people with restless legs syndrome?
    Norma G Cuellar, Sarah J Ratcliffe (2009)
  4. Valerian for sleep: a systematic review and meta-analysis
    Stephen Bent, Amy Padula, Dan Moore, Michael Patterson, Wolf Mehling (2006)
  5. Effectiveness of Valerian on insomnia: a meta-analysis of randomized placebo-controlled trials
    Maria Isabel Fernández-San-Martín, Roser Masa-Font, Laura Palacios-Soler, Pilar Sancho-Gómez, Cristina Calbó-Caldentey (2010)
  6. Effect of valerian on sleep quality in postmenopausal women: a randomized placebo-controlled clinical trial
    Simin Taavoni, Neda Ekbatani, Maryam Kashaniyan, Hamid Haghani (2011)
  7. The use of Valeriana officinalis (Valerian) in improving sleep in patients who are undergoing treatment for cancer: a phase III randomized, placebo-controlled, double-blind study (NCCTG Trial, N01C5)
    Debra L Barton, Pamela J Atherton, Brent A Bauer, Dennis F Moore Jr, Bassam I Mattar (2011)
  8. The effects of valerian root on hot flashes in menopausal women
    Parvaneh Mirabi, Faraz Mojab (2013)
  9. Effects of valerian on the severity and systemic manifestations of dysmenorrhea
    Parvaneh Mirabi, Mahrokh Dolatian, Faraze Mojab, Hamid Alavi Majd (2011)
  10. A feasibility study of valerian extract for sleep disturbance in person with arthritis
    Diana M Taibi, Cheryl Bourguignon, Ann Gill Taylor (2009)
  11. The effect of Valerian root extract on the severity of pre menstrual syndrome symptoms
    Zahra Behboodi Moghadam, Elham Rezaei, Roghaieh Shirood Gholami, Masomeh Kheirkhah, Hamid Haghani (2016)


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