Herbal medicines, other than St. John's wort, in the treatment of depression: a systematic review
OBJECTIVE: To evaluate herbal medicines, other than St. John's wort, in the treatment of depression. DATA SOURCES/SEARCH METHODS: A computer-based search of Medline, Cinahl, AMED, ALT Health Watch, Psych Articles, Psych Info, Current Contents databases, Cochrane Controlled Trials Register, and Cochrane Database of Systematic Reviews, was performed. Researchers were contacted, and bibliographies of relevant papers and previous meta-analysis were hand searched for additional references. REVIEW METHODS: Trials were included in the review if they were prospective human trials assessing herbal medicines, other than St. John's wort, in the treatment of mild-to-moderate depression and utilized validated instruments to assess participant eligibility and clinical endpoints. RESULTS: Nine trials were identified that met all eligibility requirements. Three studies investigated saffron stigma, two investigated saffron petal, and one compared saffron stigma to the petal. Individual trials investigating lavender, Echium, and Rhodiola were also located. DISCUSSION: Results of the trials are discussed. Saffron stigma was found to be significantly more effective than placebo and equally as efficacious as fluoxetine and imipramine. Saffron petal was significantly more effective than placebo and was found to be equally efficacious compared to fluoxetine and saffron stigma. Lavender was found to be less effective than imipramine, but the combination of lavender and imipramine was significantly more effective than imipramine alone. When compared to placebo, Echium was found to significantly decrease depression scores at week 4, but not week 6. Rhodiola was also found to significantly improve depressive symptoms when compared to placebo. CONCLUSION: A number of herbal medicines show promise in the management of mild-to-moderate depression.
(Altem Med Rev 2010;16(1):40-49)
Key Words: depression, antidepressant, dysphoria, review, crocus, saffron, lavandula, lavender, echium, rhodiola, sad, mood, nervine, anxiolytic, SSRI, imipramine, MAOI, TCA, tricyclics, monoamine, serotonin, endurance, fatigue, adaptogen
Depression is one of the top five most prevalent diseases worldwide. (1) By 2020 it is expected to be the second-leading cause of disability globally. (2) Depression typically presents as lowered mood, difficulty in thinking, loss of interest, and physical complaints such as headache, disturbed sleep, loss of energy, and change in sex drive. (3,4) It incurs substantial personal, economic, and social costs for both the individuals afflicted and those close to them. (5) In Australia, 40 percent of women and 30 percent of men are estimated to experience one or more episodes of major depression during their lifetime. (1,6) The prevalence of major depression is reported as 7.5 percent in Australia, 8 percent in Canada, and 5.4-8.9 percent in the United States. (2,6)
While there are many potential precipitating factors, it is currently believed that depression is primarily the result of biochemical alterations in the brain. (3,6) Pharmaceutical treatments, including selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants (TCA), and monoamine oxidase inhibitors (MAOI), cause alterations in brain chemistry through neurotransmitter amplification and regulation and have been shown to be effective in the treatment of depression. (4) Yet, a number of adverse reactions occur with pharmaceutical antidepressant administration, including anticholinergic effects, gastrointestinal effects including nausea and constipation, orthostatic hypotension, arrhythmias, weight gain,...