Primary interest in lemon balm surrounds its effects on the central nervous system. One small study demonstrated decreased stress and agitation in patients with dementia and Alzheimer disease. Another small trial supports a potential cholesterol benefit. Lemon balm cream has shown some efficacy in herpes virus lesions in a few small placebo-controlled trials.
Crude lemon balm herb is typically dosed at 1.5 to 4.5 g/day. Doses of 600 to 1,600 mg extract have been studied in trials. A standardized preparation of lemon balm (80 mg) and valerian extract (160 mg) has been given 2 or 3 times/day as a sleep aid, and has also been studied in children. A 1% extract cream has been studied as a topical agent for treatment of herpes virus lesions.
Contraindications have not yet been identified.
Information regarding safety and efficacy in pregnancy and lactation is lacking.
None well documented.
Clinical trials generally report no adverse reactions.
Research reveals little or no information regarding toxicology with the use of this product.
Lemon balm is a low-growing perennial herb with ovate- or heart-shaped leaves that emit a lemon odor when bruised. The small yellow or white flowers are attractive to bees and other insects. It is indigenous to the Mediterranean region and western Asia, and widely naturalized in Europe, Asia, and North America. The leaves are harvested before flowering and used medicinally.1
Lemon balm has been used in herbal medicine since the times of Pliny (Roman, AD 23-79), Dioscorides (Greek, AD 40-90), Paracelsus (Austrian 1493-1541), and John Gerard (English, 1545-1612). The name Melissa corresponds to the Greek word for bee, while balm is a contraction of balsam. The plant has culinary and medicinal uses, with principal historical medicinal uses being carminative, diaphoretic, and antipyretic.2
Lemon balm leaves contain 0.2% to 0.3% of a lemon-scented essential oil similar to that of lemon grass. Major mono- and sesquiterpenes include geranial, neral, beta-caryophyllene, beta-caryophyllene oxide, linalool, citronellal, nerol, and geraniol.3, 4, 5 R(+)-methyl citronellate is characteristic of Melissa oil and distinguishes it from lemon grass oil.6, 7 Flavonoids, oleanane, and triterpenes have also been isolated from the plant.4, 8 Major nonvolatile constituents are caffeic acid and its di- and trimeric derivatives, including rosmarinic acid and melitric acids A and B.7, 9, 10
Uses and Pharmacology
Rosmarinic acid was found to inhibit the C3 and C5 convertase steps in the complement cascade.27, 28, 29 This action may play a role in the anti-inflammatory action of Melissa extract, because the action was observed in vitro and in vivo in rats with oral administration of the compound.
Lemon balm has antiviral activity against a variety of viruses, including herpes simplex virus (HSV) and HIV-1.11, 12 The activity has been attributed to caffeic acid and its di- and trimeric derivatives, as well as to tannins. A concentration-dependent inhibition of HSV-2 proliferation by lemon balm essential oil has been demonstrated, possibly due to the citral or citronellal components.13 Activity against bacteria and fungi has been evaluated with varying results.4, 8, 14 Activity against culex mosquito larvae has also been demonstrated.15
Placebo-controlled trials have shown symptomatic improvement for herpes virus lesions after application of a standardized lemon balm cream applied 2 to 4 times daily for 5 to 10 days.16, 17, 18
In vitro antioxidant activity has been described for lemon balm essential oil and its extracts.4, 10, 14, 30
Activity against human and mouse cancer cell lines has been demonstrated in vitro.5
In hyperlipidemic rats and mice, lemon balm extracts improved the lipid profile as well as liver enzyme markers (AST, ALT, alkaline phosphatase) and increased glutathione levels in the tissue.31, 32
A double-blind, randomized, placebo controlled trial (n=58) in borderline hyperlipidemic adults documented a significant improvement in low-density lipoprotein (LDL) cholesterol levels (P=0.022) as well as AST (P=0.009) with administration of M. officinalis leaf powder (500 mg 3 times daily for 2 months) compared to placebo. Baseline mean LDL dropped by 13.96 mg/dL with the intervention compared to a 1.17 mg/dL increase with placebo. Similarly, mean AST decreased 1.35 units/L with treatment and increased 2.23 units/L with placebo. No significant differences were found between groups in total cholesterol (TC), high-density lipoprotein (HDL), LDL:HDL, TC:HDL, fasting blood sugar, triglycerides, ALT, creatinine, body mass index, or physical activity. No serious adverse events were reported.41
The lyophilized hydroalcoholic extract, which does not contain the volatile oil components, exhibited sedative activity in several mouse models when given intraperitoneally.19 This extract was also active in an acetic acid writhing analgesia assay but not in a hot plate test. The volatile oil of the plant had much weaker activity or was inactive in the same assays.
In a series of trials investigating the effects of lemon balm extract on laboratory-induced stress, a dose-dependent effect was demonstrated for single doses of Melissa officinalis.2, 20, 21 Cholinergic receptor-binding properties have also been demonstrated.20 With 600 mg of extract, increased calmness and decreased alertness were demonstrated compared with placebo. With 300 mg, no modulation of stress was found, but speed and accuracy of mathematical processing increased.21 At the highest dosage of 1,600 mg, a paradoxically negative effect on mood resulted, with reduced alertness.20 Lemon balm 80 mg combined with valerian 160 mg taken for 1 month significantly improved sleep quality compared with baseline (P = 0.001) and placebo (P = 0.0001) in women experiencing sleep disruption/disorders subsequent to natural menopause. The placebo group in this randomized trial (n = 100) also experienced a significant improvement in sleep scores compared with baseline (P = 0.0001). No adverse events were reported.40
In patients with mild to moderate Alzheimer disease, 60 drops of lemon balm extract (citral 500 mcg/mL) increased cognitive function and decreased agitation over placebo.22, 23, 24 Essential oil of lemon balm applied to the faces of patients with dementia decreased agitation compared with placebo.25, 26
The contractility of rat ileum was reduced with essential oil of lemon balm and its citral extract.33 Babies with colic given a combination preparation containing lemon balm extract as well as 2 other extracts showed improved symptoms.34
Crude lemon balm herb typically is dosed at 1.5 to 4.5 g/day. Doses of 600 to 1,600 mg have been studied in trials. A standardized preparation of lemon balm 80 mg and valerian extract 160 mg, Euvegal Forte, has been given 2 or 3 times/day as a sleep aid, and has also been studied in children.35, 36, 37 A 1% extract cream has been studied as a topical agent for herpes.17
Pregnancy / Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.
None well documented. A small trial evaluated the cardiac effects of lemon balm and reported possible cardiac muscarinic receptor stimulation or calcium channel-dependent blockage.38 Potentiation of pharmacologic agents may be possible.
Most clinical trials report no adverse reactions.2, 20, 37
Melissa extract was not found to be genotoxic in a screen of several medicinal plants.39
1. Melissa officinalis L. USDA, NRCS. 2008. The PLANTS Database (http://plants.usda.gov, 8 September 2008). National Plant Data Center, Baton Rouge, LA 70874-4490.2. Kennedy DO, Wake G, Savelev S, et al. Modulation of mood and cognitive performance following acute administration of single doses of Melissa officinalis (Lemon balm) with human CNS nicotinic and muscarinic receptor-binding properties. Neuropsychopharmacology. 2003;28(10):1871-1881.128887753. Adzet T, Ponz R, Wolf E, Schulte E. Content and Composition of M. officinalis Oil in Relation to Leaf Position and Harvest Time1. Planta Med. 1992;58(6):562-564.172265234. Mimica-Dukic N, Bozin B, Sokovic M, Simin N. Antimicrobial and antioxidant activities of Melissa officinalis L. (Lamiaceae) essential oil. J Agric Food Chem. 2004;52(9):2485-2489.151131455. de Sousa AC, Alviano DS, Blank AF, Alves PB, Alviano CS, Gattass CR. Melissa officinalis L. essential oil: antitumoral and antioxidant activities. J Pharm Pharmacol. 2004;56(5):677-681.151423476. Holst J, Lindblad B, Bergqvist D, Garre K, Nielsen H, Hedner U, et al. Protamine neutralization of intravenous and subcutaneous low-molecular-weight heparin (tinzaparin, Logiparin). An experimental investigation in healthy volunteers. Blood Coagul Fibrinolysis. 1994;5(5):795-803.78656877. Fecka I, Turek S. Determination of water-soluble polyphenolic compounds in commercial herbal teas from Lamiaceae: peppermint, melissa, and sage. J Agric Food Chem. 2007;55(26):10908-10917.180521028. Mencherini T, Picerno P, Scesa C, Aquino R. Triterpene, antioxidant, and antimicrobial compounds from Melissa officinalis. J Nat Prod. 2007;70(12):1889-1894.180048169. Agata I, et al. Meltric acids A and B, new trimeric caffeic acid derivatives from Melissa officinalis. Chem Pharm Bull. 1993;41(9):1608.10. Safra J, Pospísilová M, Honegr J, Spilková J. Determination of selected antioxidants in Melissae herba by isotachophoresis and capillary zone electrophoresis in the column-coupling configuration. J Chromatogr A. 2007;1171(1-2):124-132.1792061111. Kucera LS, Herrmann EC Jr. Antiviral substances in plants of the mint family (labiatae). I. Tannin of Melissa officinalis. Proc Soc Exp Biol Med. 1967;124(3):865-869.429027712. Herrmann EC Jr, Kucera LS. Antiviral substances in plants of the mint family (labiatae). II. Nontannin polyphenol of Melissa officinalis. Proc Soc Exp Biol Med. 1967;124(3):869-874.429045213. Allahverdiyev A, Duran N, Ozguven M, Koltas S. Antiviral activity of the volatile oils of Melissa officinalis L. against Herpes simplex virus type-2. Phytomedicine. 2004;11(7-8):657-661.1563618114. López V, Akerreta S, Casanova E, García-Mina JM, Cavero RY, Calvo MI. In vitro antioxidant and anti-rhizopus activities of Lamiaceae herbal extracts. Plant Foods Hum Nutr. 2007;62(4):151-155.1791264315. Cetin H, Cinbilgel I, Yanikoglu A, Gokceoglu M. Larvicidal activity of some Labiatae (Lamiaceae) plant extracts from Turkey. Phytother Res. 2006;20(12):1088-1090.1700920416. Wöbling RH, Leonhardt K. Local therapy of herpes simplex with dried extract from Melissa officinalis. Phytomedicine. 1994, 1:125-131.17. Koytchev R, Alken RG, Dundarov S. Balm mint extract (Lo-701) for topical treatment of recurring herpes labialis. Phytomedicine. 1999;6(4):225-230.1058944018. Gaby AR. Natural remedies for Herpes simplex. Altern Med Rev. 2006;11(2):93-101.1681345919. Soulimani R, Fleurentin J, Mortier F, Misslin R, Derrieu G, Pelt JM. Neurotropic action of the hydroalcoholic extract of Melissa officinalis in the mouse. Planta Med. 1991;57(2):105-109.189149020. Kennedy DO, Little W, Haskell CF, Scholey AB. Anxiolytic effects of a combination of Melissa officinalis and Valeriana officinalis during laboratory induced stress. Phytother Res. 2006;20(2):96-102.21. Kennedy DO, Little W, Scholey AB. Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm). Psychosom Med. 2004;66(4):607-613.1527211022. Akhondzadeh S, Noroozian M, Mohammadi M, Ohadinia S, Jamshidi AH, Khani M. Melissa officinalis extract in the treatment of patients with mild to moderate Alzheimer's disease: a double blind, randomised, placebo controlled trial. J Neurol Neurosurg Psychiatry. 2003;74(7):863-866.1281076823. Dos Santos-Neto LL, de Vilhena Toledo MA, Medeiros-Souza P, de Souza GA. The use of herbal medicine in Alzheimer's disease-a systematic review. Evid Based Complement Alternat Med. 2006;3(4):441-445.1717310724. Izzo AA, Capasso F. Herbal medicines to treat Alzheimer's disease. Trends Pharmacol Sci. 2007;28(2):47-48.1721801725. Ballard CG, O'Brien JT, Reichelt K, Perry EK. Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa. J Clin Psychiatry. 2002;63(7):553-558.1214390926. Block KI, Gyllenhaal C, Mead MN. Safety and efficacy of herbal sedatives in cancer care. Integr Cancer Ther. 2004;3(2):128-148.1516549927. Rampart M, Beetens JR, Bult H, Herman AG, Parnham MJ, Winkelmann J. Complement-dependent stimulation of prostacyclin biosynthesis: inhibition by rosmarinic acid. Biochem Pharmacol. 1986;35(8):1397-1400.351615628. Englberger W, Hadding U, Etschenberg E, et al. Rosmarinic acid: a new inhibitor of complement C3-convertase with anti-inflammatory activity. Int J Immunopharmacol. 1988;10(6):729-737.319830729. Peake PW, Pussell BA, Martyn P, Timmermans V, Charlesworth JA. The inhibitory effect of rosmarinic acid on complement involves the C5 convertase. Int J Immunopharmacol. 1991;13(7):853-857.176135130. Marongiu B, Porcedda S, Piras A, Rosa A, Deiana M, Dessì MA. Antioxidant activity of supercritical extract of Melissa officinalis subsp. officinalis and Melissa officinalis subsp. inodora. Phytother Res. 2004;18(10):789-792.1555139731. Bolkent S, Yanardag R, Karabulut-Bulan O, Yesilyaprak B. Protective role of Melissa officinalis L. extract on liver of hyperlipidemic rats: a morphological and biochemical study. J Ethnopharmacol. 2005;99(3):391-398.32. Lee J, Chae K, Ha J, et al. Regulation of obesity and lipid disorders by herbal extracts from Morus alba, Melissa officinalis, and Artemisia capillaris in high-fat diet-induced obese mice. J Ethnopharmacol. 2008;115(2):263-270.33. Sadraei H, Ghannadi A, Malekshahi K. Relaxant effect of essential oil of Melissa officinalis and citral on rat ileum contractions. Fitoterapia. 2003;74(5):445-452.1283735934. Savino F, Cresi F, Castagno E, Silvestro L, Oggero R. A randomized double-blind placebo-controlled trial of a standardized extract of Matricariae recutita, Foeniculum vulgare and Melissa officinalis (ColiMil) in the treatment of breastfed colicky infants. Phytother Res. 2005;19(4):335-340.1604173135. Dressing H, Kohler S, Muller WE. Improvement of sleep quality with a high-dose valerian/lemon-balm preparation. A placebo-controlled double-blind study. Psychopharmakotherapie. 1996;3:123-130.36. Cerny A, et al. Tolerability and efficacy of valerian/lemon balm in healthy volunteers (a double-blind, placebo-controlled, multicentre study). Fitoterapia. 1999;70:221-228.37. Müller SF, Klement S. A combination of valerian and lemon balm is effective in the treatment of restlessness and dyssomnia in children. Phytomedicine. 2006;13(6):383-387.1648769238. Gazola R, Machado D, Ruggiero C, Singi G, Macedo Alexandre M. Lippia alba, Melissa officinalis and Cymbopogon citratus: effects of the aqueous extracts on the isolated hearts of rats. Pharmacol Res. 2004;50(5):477-480.1545876739. Ramos Ruiz A, De la Torre RA, Alonso N, Villaescusa A, Betancourt J, Vizoso A. Screening of medicinal plants for induction of somatic segregation activity in Aspergillus nidulans. J Ethnopharmacol. 1996;5;52(3):123-127.877145240. Taavoni S, Nazem egbatani N, Haghani H. Valerian/lemon balm use for sleep disorders during menopause. Complement Ther Clin Pract. 2013;19(4):193-196.2419997241. Jandaghi P, Noroozi M, Ardalani H, Alipour M. Lemon balm: a promising herbal therapy for patients with borderline hyperlipidemia – a randomized double-blind placebo-controlled clinical trial. Complement Ther Med. 2016;26:136-140.27261994
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