melissa officinalis is a medical and aromatic plant that is used for its hypnotic , sedative , and spasmolytic effects . this report presents a case study of30-year - old patient who was admitted to an emergency department with restlessness , tremor , distractibility , and sweating following a discontinuation of melissa officinalis consumption . in this case , withdrawal symptoms may be related to the dependence effect caused by long - term use of melissa officinalis . although melissa officinalis , a plant , is preferred by many patients as an alternative to pharmaceutical drugs , patients should be made aware that it may have a risk of dependency and can lead to withdrawal symptoms . herbal medicine is widely used as both an alternative and complement to pharmaceutical drug therapy . herbal teas have long been consumed for their presumed anxiolytic , hypnotic , and sedative effects in order to treat several different psychiatric disorders ( 1 ) . melissa officinalis l. ( lemon balm ) is a medical and aromatic plant and is a member of the lamiaceae family ( 2 ) . in some countries , melissa tea made from the leaves of lemon balm is used as an alternative therapy to treat migraine , insomnia , and stomach ailments , as well as to strengthen the heart and improve memory ( 3 ) . moreover , melissa officinalis is used for its anxiolytic , hypnotic , sedative , and spasmolytic effects by people practicing traditional medicine ( 4 ) . melissa officinalis has cholinergic receptor - binding properties and can modulate both mood and cognitive performance in young , healthy people ( 5 ) . the herb may , however , potentiates the effects of other central nervous system depressants , such as alcohol ( 6 ) . safety of consumption of melissa officinalis during pregnancy and lactation has not been established ( 7 ) . although several reports have been published on melissa officinalis , there is no reported information , to our knowledge , regarding dependency and withdrawal effects of this herb . here we report a case which presents probable dependency and withdrawal symptoms after the abrupt discontinuation of melissa officinalis consumption . a 30-year - old married male , a university graduate , applied to the emergency department with complaints of restlessness , tremor , distractibility , and sweating that had lasted approximately 24 hours . his medical history revealed that he was in the stressful period and had been suffering from anxiety symptoms for three months . he had purchased melissa tea ( including melissa officinalis ) from an herbalist two months prior in order to help treat his anxiety symptoms . he drank it regularly at night without combining it with another plant - based tea . he stated that he felt relief from anxiety after drinking the tea and felt restless and irritable when he did not consume the tea . further , over the course of two months , the amount of tea he consumed increased from one cup per day to four cups per day . his symptoms began 24 hours before being admitted to the emergency department , and he did not drink any tea for the two days prior . on psychiatric examination , he exhibited open conscious , normal orientation , anxious mood , internal restlessness , irritability , and reported decreased sleep , appetite , and concentration . the patient had no history of major medical or mental illness and had no documented alcohol or drug use . his family history was unremarkable . in his physical and neurological examination there were nt any pathological findings except a postural tremor in both of the patient s hands . his heart rate was 95bpm , his blood pressure 120/80 mm / hg , and his ecg was unremarkable . multiple tests of complete blood counts , serum electrolytes , hepatic and renal function , thyroid hormone , and urine were all normal . according to the naranjo causality scale ( 8) ( the score was 6 ) the adverse effects were likely due to melissa officinalis withdrawal . the patient was diagnosed as a case of  other substance withdrawal ( melissa officinalis - related )  . he maintained regular follow - up care for six months and exhibited no symptoms of withdrawal in control examinations . in this case , there was a clear relationship between the start of the patient s withdrawal symptoms and the discontinuation of melissa officinalis consumption . to our knowledge , this is the first reported case of withdrawal symptoms and probable dependency effects related to melissa officinalis . in this case , the patient s gradual increase of tea intake is considered to have built up his tolerance for melissa officinalis . the patient stated that he used melissa tea longer than he had initially planned to . however , he was not diagnosed as dependence on melissa officinalis because such a diagnosis would require use for a 12-month period , according to dsm - iv . as a result , his symptoms were diagnosed as melissa officinalis - related withdrawal . it has been suggested that the active components include flavonoids , monoterpenoid aldehydes , and polyphenolic compounds such as rosmarinic acid ( 4 ) and monoterpene glycosides ( 9 ) . melissa officinalis inhibits the activity of acetylcholinesterase and gaba - transaminase enzymes , which increase the cholinergic and gabaergic influences , respectively ( 10 ) . these mechanisms may be related to the sedative , anxiolytic , hypnotic , and cognitive effects of melissa officinalis . one study , which tested a combination product containing melissa officinalis and valeriana officinalis , showed the herbs have a positive effect on quality of sleep . in the same study , the positive effects of melissa officinalis were shown to be equal to 0.125 mg of triazolam ( 11 ) . the melissa - valeriana combination was used in a placebo - controlled trial and was found to significantly improve quality of sleep during a 30-day treatment of 600 mg / day(12 ) . another study , which tested four weeks of melissa officinalis essential oil aromatherapy on patients suffering from severe dementia , demonstrated a significant reduction in social withdrawal and agitation and an increase in constructive activities ( 13 ) . the effects of melissa officinalis were also shown to help improve anxiety , depression , neuroprotectivity , and cognition in many animal studies ( 14 ) . furthermore , melissa officinalis has been shown to modulate mood and cognitive performance in healthy young volunteers , who reported no side effects or symptoms of toxicity ( 15 ) . although melissa officinalis is preferred by many people as an alternative to pharmaceutical drugs , it should be noted and explained to patients that the herb may have a dependency risk and can lead to withdrawal symptoms when consumption is abruptly discontinued .
introduction : melissa officinalis is a medical and aromatic plant that is used for its hypnotic , sedative , and spasmolytic effects . 
 this report presents a case study of30-year - old patient who was admitted to an emergency department with restlessness , tremor , distractibility , and sweating following a discontinuation of melissa officinalis consumption.case report : in this case , withdrawal symptoms may be related to the dependence effect caused by long - term use of melissa officinalis . 
 although melissa officinalis , a plant , is preferred by many patients as an alternative to pharmaceutical drugs , patients should be made aware that it may have a risk of dependency and can lead to withdrawal symptoms .