context: Managing the symptoms of fibromyalgia or related ailments is not easy. So, many patients turn to complementary health approaches to pain relief and sleep problems. They may use Chinese herbs or over-the-counter supplements such as 5- HTP, melatonin, and SAM-e. Because so many people -- not just those with fibromyalgia -- are using complementary health therapies, Congress formed the National Center for Complementary and Integrative Health ( NCCIH). It is part of the National Institutes of Health ( NIH), and it helps appraise complementary health treatments, including supplements, and define their effectiveness. This organization is now creating safe guidelines to help people choose appropriate complementary health approaches that may help their symptoms without making them ill. Some preliminary studies indicate that some medicinal herbs and natural supplements may help treat symptoms of fibromyalgia. Other studies of herbs and natural supplements, though, are less positive. If you want to take a natural approach to treating fibromyalgia, it's important to learn as much as you can about the therapies you consider. The herbs and natural supplements described in this article are just some of the complementary health approaches that may have an impact on fibromyalgia. 5- HTP (5- Hydroxytryptophan) is a building block of serotonin. Serotonin is a powerful brain chemical, and serotonin levels are thought to play a significant role in fibromyalgia pain. Serotonin levels are also associated with depression and sleep. For those with fibromyalgia, 5- HTP may help to increase deep sleep and reduce pain. In one study published in the Alternative Medicine Review, researchers reported that supplementation with 5- HTP may improve symptoms of depression, anxiety, insomnia, and fibromyalgia pain. However, there are some contradictory studies that show no benefit with 5- HTP. 5- HTP is usually well tolerated. L-tryptophan and possibly 5- HTP was associated with a serious condition called eosinophilia-myalgia syndrome. Some experts believe that a contaminant in these supplements led to the condition, which causes flu-like symptoms, severe muscle pain, and burning rashes. Melatonin is a natural hormone that's available as an over-the-counter supplement. It is sometimes used to induce drowsiness and improve sleep patterns. Some preliminary findings show that melatonin may be effective in treating fibromyalgia pain. Most patients with fibromyalgia have sleep problems and fatigue, and it's thought that melatonin may help relieve these symptoms. Melatonin is generally regarded as safe with few to no side effects. Due to the risk of daytime sleepiness, though, anyone taking melatonin should use caution when driving. There's no specific evidence that St. John's wort is helpful in treating fibromyalgia. However, this herb is often used in treating depression, and depression is commonly associated with fibromyalgia. There are several studies that show St. John's wort is more effective than placebo and as effective as older antidepressants called tricyclics in the short-term treatment of mild or moderate depression. Other studies show St. John's wort is as effective as selective SSRI antidepressants such as Prozac or Zoloft in treating depression. St John's wort is usually well tolerated. The most common side effects are stomach upset, skin reactions, and fatigue. St. John's wort should not be mixed with antidepressants or any other supplement unless your doctor says it's OK because the combinations can cause illness. It's not known exactly how SAM-e works in the body. Some feel this natural supplement increases levels of serotonin and dopamine, two brain neurotransmitters. Although some researchers believe that SAM-e may alter mood and increase restful sleep, current studies do not appear to show any benefit of SAM-e over placebo in reducing the number of tender points or in alleviating depression with fibromyalgia. Additional study is needed to confirm these findings. The studies are limited, but it's thought that L-carnitine may give some relief from fatigue in people with fibromyalgia. Some researchers have also concluded that while more studies are warranted, L-carnitine may provide support for the muscular system of patients with fibromyalgia. Probiotics are dietary supplements that contain potentially beneficial bacteria or yeasts. They may assist with the breakdown and proper absorption of food and help improve digestion. Some of the ways probiotics are used include: treating diarrhea preventing and treating infections of the female genital tract treating irritable bowel syndrome Side effects of taking probiotics are usually mild and include gas or bloating. There are other herbs and natural supplements that people say have helped manage fibromyalgia symptoms. They include echinacea, black cohosh, cayenne, lavender, milk thistle, and B vitamins. Nevertheless, there are no definitive studies on the efficacy of these natural therapies. Before taking any herb or supplement for fibromyalgia, talk to your doctor or pharmacist about possible side effects or herb-drug interactions. Herbal therapies are not recommended for pregnant women, children, the elderly, or those with weakened immune systems. In addition, some herbs have sedative or blood-thinning qualities, which may dangerously interact with anti-inflammatory painkillers or other pain medications. Others may cause stomach upset if taken in large doses.