Supplements/All-Natural Treatments

Note: these treatments are listed alphabetically rather than in order of preference

Borage (Echium amoenum)

Indications and Efficacy

Borage (Echium amoenum), is a dried flower used traditionally in the Persian culture as an anxiolytic and thymoleptic. The seed oil form of borage is generally the only version available in nutritional stores. At this time, we are unaware of any commercially available pill versions of borage with the flower extract. The flower and leaves, however, have been used to treat many conditions including fever, cough, depression, Attention Deficit Hyperactivity Disorder, and OCD. Documentation of borage use dates back to the Roman period of 300 BC.

The exact mechanism of borage in psychiatric illnesses is not clearly understood. The following use of borage in OCD is based upon use of the flower extract. The seed oil has not been studied.

Obsessive Compulsive Disorder. Borage (125mg capsules taken 1 capsule in the morning, 1 in the afternoon and 2 in the evening; capsules contained an aqueous extract made from borage flowers) was found to be effective in reducing obsessive and compulsive symptoms in 44 adult subjects randomly assigned to receive either borage extract or a matching placebo over a six-week period. In addition to reducing OCD symptoms, patients taking borage also benefited in terms of anxiety and depressive symptoms.

Initiation and Ongoing Treatment

The target dose of borage is not well established. Dosing between 375-500mg per day is a reasonable target.

Borage is available in oil form. For the flower extract (should a form be available), it should be prescribed at a maximum dose of 500mg per day. Pills should be given in 125mg per pill form.

TABLE 10.2 Possibly Helpful Alternative Treatments by Condition






Body Dysmorphic Disorder



Excoriation (Skin Picking) Disorder







Exercise, hypnosis, yoga

Hoarding Disorder

Illness Anxiety Disorder (Hypochondriasis)



Obsessive compulsive disorder

Borage, glycine, inositol, milk thistle, «-acetylcysteine, valerian root

Acupuncture, exercise, hypnosis, yoga

Tic disorders (Including Tourette’s Syndrome)




An example of a possible dose titration schedule for the flower extract is:

  • 125mg by mouth in the morning (between 0800-0900)
  • 125mg by mouth in the afternoon (between 1300-1500)
  • 250mg by mouth at night (between 2100-2300)

Given the potential for liver damage with prolonged doses of borage, it should ideally only be prescribed for a maximum of one year, and monitoring of liver function via blood tests should be considered.

Risks and Side Effects

The most common side effects reported with borage treatment include headache and mild skin irritation (if the seed oil is used). The use of borage over a long period of time can irritate the liver, potentially causing liver damage and cancers. Patients should be advised to visit an emergency room for symptoms suggestive of anaphylactoid reactions.

Contraindications/Special Considerations

Pregnancy/breast-feeding. Borage may contain pyrrolizidine alkaloids which can cause liver damage, cancer, and birth defects as they may pass into the breast milk of the mother. As such, treatment with borage is contraindicated in this population.

Liver disease/hepatitis. Pyrrolizidine alkaloids may worsen liver conditions. Since borage may contain pyrrolizidine alkaloids, it is contraindicated for individuals with liver disease or hepatitis.

Bleeding disorders/surgical interventions. Borage seed oil might prolong bleeding time and increase the risk of bruising. As such, patients should be instructed to stop taking seed oil borage at least three weeks before a scheduled surgery in order to prevent potential complications from excess bleeding both pre- and post-surgery. Patients with a bleeding disorder should not take any version of borage.

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