Jerome Sarris1,2, Wolfgang Marx3, Melanie M Ashton3, Chee H Ng2, Nicole Galvao-Coelho1,4,5, Zahra Ayati1,6, Zhang-Jin Zhang7,8, Siegfried Kasper9, Arun Ravindran10, Brian H Harvey11, Adrian Lopresti12,13, David Mischoulon14, Jay Amsterdam15, Lakshmi N Yatham16, Michael Berk3,17,18. 1. Western Sydney University, NICM Health Research Institute, Westmead, Australia. 2. The Professorial Unit, The Melbourne Clinic; Department of Psychiatry, University of Melbourne, Melbourne, Australia. 3. Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia. 4. Postgraduate Program in Psychobiology and Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. 5. National Institute of Science and Technology in Translational Medicine, Brazil. 6. Division of Psychology and Mental Health, Department of Traditional Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. 7. School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. 8. Department of Chinese Medicine, The University of Hong Kong Shenzhen Hospital (HKU-SZH), Shenzhen, China. 9. Center for Brain Research, Medical University of Vienna, Spitalgasse, Wien, Austria. 10. University of Toronto and Centre for Addiction and Mental Health, Toronto, Ontario, Canada. 11. Division of Pharmacology, Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North West University, Potchefstroom, South Africa. 12. College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia. 13. Clinical Research Australia, Perth, Australia. 14. Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 15. Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 16. University of British Columbia, Vancouver, Canada. 17. Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Melbourne, Australia. 18. Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia.
Abstract
OBJECTIVES: Plant-based medicines have had a long-standing history of use in psychiatric disorders. Highly quantified and standardized extracts or isolates may be termed "phytoceuticals," in a similar way that medicinal nutrients are termed as "nutraceuticals." Over the past 2 decades, several meta-analyses have examined the data for a range of plant-based medicines in the treatment of psychiatric disorders. The aim of this international project is to provide a "meta-review" of this top-tier evidence. METHODS: We identified, synthesized, and appraised all available up to date meta-analyses... of randomized controlled trials (RCTs) reporting on the efficacy and effectiveness of individual phytoceuticals across all major psychiatric disorders. RESULTS: Our systematic search identified 9 relevant meta-analyses of RCTs, with primary analyses including outcome data from 5,927 individuals. Supportive meta-analytic evidence was found for St John's wort for major depressive disorder (MDD); curcumin and saffron for MDD or depression symptoms, and ginkgo for total and negative symptoms in schizophrenia. Kava was not effective in treating diagnosed anxiety disorders. We also provide details on 22 traditional Chinese herbal medicine formulas' meta-analyses (primarily for depression studies), all of which revealed highly significant and large effect sizes. Their methodology, reporting, and potential publication bias were, however, of marked concern. The same caveat was noted for the curcumin, ginkgo, and saffron meta-analyses, which may also have significant publication bias. CONCLUSIONS: More rigorous international studies are required to validate the efficacy of these phytoceuticals before treatment recommendations can be made. In conclusion, the breadth of data tentatively supports several phytoceuticals which may be effective for mental disorders alongside pharmaceutical, psychological therapies, and standard lifestyle recommendations.
OBJECTIVES: Plant-based medicines have had a long-standing history of use in psychiatric disorders. Highly quantified and standardized extracts or isolates may be termed "phytoceuticals," in a similar way that medicinal nutrients are termed as "nutraceuticals." Over the past 2 decades, several meta-analyses have examined the data for a range of plant-based medicines in the treatment of psychiatric disorders. The aim of this international project is to provide a "meta-review" of this top-tier evidence. METHODS: We identified, synthesized, and appraised all available up to date meta-analyses... of randomized controlled trials (RCTs) reporting on the efficacy and effectiveness of individual phytoceuticals across all major psychiatric disorders. RESULTS: Our systematic search identified 9 relevant meta-analyses of RCTs, with primary analyses including outcome data from 5,927 individuals. Supportive meta-analytic evidence was found for St John's wort for major depressive disorder (MDD); curcumin and saffron for MDD or depression symptoms, and ginkgo for total and negative symptoms in schizophrenia. Kava was not effective in treating diagnosed anxiety disorders. We also provide details on 22 traditional Chinese herbal medicine formulas' meta-analyses (primarily for depression studies), all of which revealed highly significant and large effect sizes. Their methodology, reporting, and potential publication bias were, however, of marked concern. The same caveat was noted for the curcumin, ginkgo, and saffron meta-analyses, which may also have significant publication bias. CONCLUSIONS: More rigorous international studies are required to validate the efficacy of these phytoceuticals before treatment recommendations can be made. In conclusion, the breadth of data tentatively supports several phytoceuticals which may be effective for mental disorders alongside pharmaceutical, psychological therapies, and standard lifestyle recommendations.
Authors: Wolfgang Marx; Melissa Lane; Tetyana Rocks; Anu Ruusunen; Amy Loughman; Adrian Lopresti; Skye Marshall; Michael Berk; Felice Jacka; Olivia M Dean Journal: Nutr Rev Date: 2019-05-28 Impact factor: 7.110
Authors: S I Gavrilova; U W Preuss; J W M Wong; R Hoerr; R Kaschel; N Bachinskaya Journal: Int J Geriatr Psychiatry Date: 2014-03-16 Impact factor: 3.485
Authors: Arun V Ravindran; Lynda G Balneaves; Guy Faulkner; Abigail Ortiz; Diane McIntosh; Rachel L Morehouse; Lakshmi Ravindran; Lakshmi N Yatham; Sidney H Kennedy; Raymond W Lam; Glenda M MacQueen; Roumen V Milev; Sagar V Parikh Journal: Can J Psychiatry Date: 2016-08-02 Impact factor: 4.356