Psychosis related to ephedra-containing herbal supplement use

Ephedra, a psychoactive substance with stimulant properties, is found in many herbal products. Often perceived by the lay public as benign, the potential health-related dangers of using these products are beginning to be recognized. We review four cases associated with ephedra-containing herbal products and report three additional cases. Unlike the previously reported cases, the patients presented in this report developed persistent psychosis that required psychopharmaceutical management.