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Shang W, Guo L, Liu Y, Li Y, Wei Q, Guo K, Yang M, Wei L, Xu Z, Niu J, Li X, Yang K. PROTOCOL: Non-pharmacological interventions for older people with a diagnosis of depression: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1354. [PMID: 37771463 PMCID: PMC10523358 DOI: 10.1002/cl2.1354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
This is the protocol for an evidence and gap map. The objectives are as follows: To map available randomized control trials, economic evaluations, and systematic reviews that assess the effectiveness and cost-effectiveness of non-pharmacological interventions for older people with a diagnosis of depression and identify any existing gaps in the evidence that can inform future research.
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Affiliation(s)
- Wenru Shang
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- Collaborative Innovation Center of First Hospital of Lanzhou UniversityLanzhouChina
- School of Public Health, Evidence‐Based Social Science Research CenterLanzhou UniversityLanzhouChina
| | - Liping Guo
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
| | - Yujia Liu
- Gansu University of Traditional Chinese MedicineLanzhouChina
| | - Yanfei Li
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- School of Public Health, Evidence‐Based Social Science Research CenterLanzhou UniversityLanzhouChina
| | - Qian Wei
- Key Laboratory of Public Health Safety, Ministry of Education, School of Public HealthFudan UniversityShanghaiChina
| | - Ke Guo
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- School of Public Health, Evidence‐Based Social Science Research CenterLanzhou UniversityLanzhouChina
| | - Minyan Yang
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- School of Public Health, Evidence‐Based Social Science Research CenterLanzhou UniversityLanzhouChina
| | - Lili Wei
- Gansu University of Traditional Chinese MedicineLanzhouChina
| | - Zheng Xu
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
| | - Junqiang Niu
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- Collaborative Innovation Center of First Hospital of Lanzhou UniversityLanzhouChina
- Lanzhou University First Affiliated HospitalLanzhouChina
| | - Xiuxia Li
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- Collaborative Innovation Center of First Hospital of Lanzhou UniversityLanzhouChina
- School of Public Health, Evidence‐Based Social Science Research CenterLanzhou UniversityLanzhouChina
| | - Kehu Yang
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- Collaborative Innovation Center of First Hospital of Lanzhou UniversityLanzhouChina
- School of Public Health, Evidence‐Based Social Science Research CenterLanzhou UniversityLanzhouChina
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Zepeda RC, Juárez-Portilla C, Molina-Jiménez T. St. John's Wort usage in treating of perinatal depression. Front Behav Neurosci 2023; 16:1066459. [PMID: 36688122 PMCID: PMC9851381 DOI: 10.3389/fnbeh.2022.1066459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Rossana C. Zepeda
- Laboratorio de Biomedicina Integral y Salud, Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Claudia Juárez-Portilla
- Laboratorio de Biomedicina Integral y Salud, Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Tania Molina-Jiménez
- Facultad de Química Farmacéutica Biológica, Universidad Veracruzana, Xalapa, Veracruz, Mexico,*Correspondence: Tania Molina-Jiménez ✉
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Cui J, Li M, Wei Y, Li H, He X, Yang Q, Li Z, Duan J, Wu Z, Chen Q, Chen B, Li G, Ming X, Xiong L, Qin D. Inhalation Aromatherapy via Brain-Targeted Nasal Delivery: Natural Volatiles or Essential Oils on Mood Disorders. Front Pharmacol 2022; 13:860043. [PMID: 35496310 PMCID: PMC9041268 DOI: 10.3389/fphar.2022.860043] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/22/2022] [Indexed: 02/05/2023] Open
Abstract
Mood disorders, also often referred to as affective disorders, are a group of psychiatric illnesses that severely impact mood and its related functions. The high medical expenditures have placed a significant financial burden on patients and their families. Aromatherapy is an alternative and complementary treatment that utilizes essential oils (EOs) or volatile oils (VOs) to achieve major therapeutic goals. In general, EOs are volatile chemicals that enter the body primarily through skin absorption and/or nasal inhalation. In addition, they can work through oral administration. Inhalation aromatherapy has shown unique advantages for treating mood disorders, especially depression, anxiety and mental disorders such as sleep disorder, which have been validated over the last decade through clinical and animal studies. Accumulating evidence has shown that EOs or VOs can bypass the blood-brain barrier to target brain tissue through the nasal-brain pathway. Subsequently, they act on the cerebral cortex, thalamus, and limbic system in the brain to improve symptoms of anxiety, depression and improve sleep quality. Here, we review the natural aromatic plants’ volatiles or essential oils used commonly as adjuncts to manage mood disorders and illustrate the mechanisms of inhalation aromatherapy, and mainly summarized the application of transnasal inhalation aromatherapy in depression, anxiety, and sleep disorders. We conclude that aromatherapy does not cause side-effects, which is vastly different from commonly used psychotropic drugs. Inhalation aromatherapy via brain-targeted nasal delivery offers potentially efficacious treatment for mental disorders and merits further study.
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Affiliation(s)
- Jieqiong Cui
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Meng Li
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Yuanyuan Wei
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Huayan Li
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Xiying He
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Qi Yang
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Zhengkun Li
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Jinfeng Duan
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Zhao Wu
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Qian Chen
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Bojun Chen
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Gang Li
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Xi Ming
- Department of TCM Pediatrics, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, China
| | - Lei Xiong
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Dongdong Qin
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
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Abstract
OBJECTIVES As clinical practice guidelines vary widely in their search strategies and recommendations of complementary and alternative medicine (CAM) for depression, this overview aimed at systematically summarising the level 1 evidence on CAM for patients with a clinical diagnosis of depression. METHODS PubMed, PsycInfo and Central were searched for meta-analyses of randomised controlled clinical trials (RCTs) until 30 June 2018. Outcomes included depression severity, response, remission, relapse and adverse events. The quality of evidence was assessed according to Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) considering the methodological quality of the RCTs and meta-analyses, inconsistency, indirectness, imprecision of the evidence and the potential risk of publication bias. RESULTS The literature search revealed 26 meta-analyses conducted between 2002 and 2018 on 1-49 RCTs in major, minor and seasonal depression. In patients with mild to moderate major depression, moderate quality evidence suggested the efficacy of St. John's wort towards placebo and its comparative effectiveness towards standard antidepressants for the treatment for depression severity and response rates, while St. John's wort caused significant less adverse events. In patients with recurrent major depression, moderate quality evidence showed that mindfulness-based cognitive therapy was superior to standard antidepressant drug treatment for the prevention of depression relapse. Other CAM evidence was considered as having low or very low quality. CONCLUSIONS The effects of all but two CAM treatments found in studies on clinical depressed patients based on low to very low quality of evidence. The evidence has to be downgraded mostly due to avoidable methodological flaws of both the original RCTs and meta-analyses not following the Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Further research is needed.
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Affiliation(s)
- Heidemarie Haller
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany
| | - Dennis Anheyer
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany
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No Author. Chapitre 9 : Médecine complémentaire et parallèle. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S122-S129. [DOI: 10.1016/j.jogc.2019.02.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sarris J. Herbal medicines in the treatment of psychiatric disorders: 10-year updated review. Phytother Res 2018; 32:1147-1162. [DOI: 10.1002/ptr.6055] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Jerome Sarris
- NICM Health Research Institute, School of Science and Health; Western Sydney University; Westmead NSW Australia
- Department of Psychiatry, The Melbourne Clinic, Professorial Unit, ARCADIA Research Group; The University of Melbourne; Melbourne VIC Australia
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Griesi-Oliveira K, Suzuki AM, Muotri AR. TRPC Channels and Mental Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 976:137-148. [PMID: 28508319 DOI: 10.1007/978-94-024-1088-4_12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Transient receptor potential canonical (TRPC) channels mediate the influx of different types of cations through the cell membrane and are involved in many functions of the organism. Evidences of involvement of TRPC channels in neuronal development suggest that this family of proteins might play a role in certain neurological disorders. As reported, knockout mice for different TRPC channels show alterations in neuronal morphological and functional parameters, with behavioral abnormalities, such as in exploratory and social behaviors. Although mutations in TRPC channels could be related to mental/neurological disorders, there are only a few cases reported in literature, indicating that this correlation should be further explored. Nonetheless, other functional evidences support the implication of these channels in neurological diseases. In this chapter, we summarize the main findings relating TRPC channels to neurological disorders, such as autism spectrum disorders, bipolar disorder, and intellectual disability among others.
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Affiliation(s)
| | - Angela May Suzuki
- Department of Genetics and Evolutionary Biology, Bioscience Institute, University of São Paulo, São Paulo, SP, Brazil
| | - Alysson Renato Muotri
- Department of Pediatrics and Department of Cellular & Molecular Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA. .,Rady Children's Hospital San Diego, San Diego, CA, USA. .,UCSD Stem Cell Program, Institute for Genomic Medicine, New York, NY, USA.
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Fracasso C, Bagnati R, Passoni A, Guiso G, Cantoni L, Riva A, Morazzoni P, Gobbi M. Brain Uptake of Tetrahydrohyperforin and Potential Metabolites after Repeated Dosing in Mice. JOURNAL OF NATURAL PRODUCTS 2015; 78:2029-2035. [PMID: 26287496 DOI: 10.1021/acs.jnatprod.5b00302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Tetrahydrohyperforin (IDN-5706) is a semisynthetic derivative of hyperforin, one of the main active components of Hypericum perforatum extracts. It showed remarkable positive effects on memory and cognitive performances in wild-type mice and in a transgenic mouse model of Alzheimer's disease, but little was known about the concentrations it can reach in the brain. The investigations reported herein show that repeated treatment of mice with tetrahydrohyperforin (20 mg/kg intraperitoneally, twice daily for 4 days and once on the fifth day) results in measurable concentrations in the brain, up to 367 ng/g brain (∼700 nM) 6 h after the last dose; these concentrations have significant effects on synaptic function in hippocampal slices. The other main finding was the identification and semiquantitative analysis of tetrahydrohyperforin metabolites. In plasma, three hydroxylated/dehydrogenated metabolites were the largest (M1-3) and were also formed in vitro on incubation of tetrahydrohyperforin with mouse liver microsomes; the fourth metabolite in abundance was a hydroxylated/deisopropylated derivative (M13), which was not predicted in vitro. These metabolites were all detected in the brain, with peak areas from 10% (M1) to ∼1.5% (M2, M3, and M13) of the parent compound. In summary, repeated treatment of mice with tetrahydrohyperforin gave brain concentrations that might well underlie its central pharmacological effects. We also provide the first metabolic profile of this compound.
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Affiliation(s)
- Claudia Fracasso
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" , 20156 Milan, Italy
| | - Renzo Bagnati
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" , 20156 Milan, Italy
| | - Alice Passoni
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" , 20156 Milan, Italy
| | - Giovanna Guiso
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" , 20156 Milan, Italy
| | - Lavinia Cantoni
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" , 20156 Milan, Italy
| | | | | | - Marco Gobbi
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" , 20156 Milan, Italy
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Deligiannidis KM, Freeman MP. Complementary and alternative medicine therapies for perinatal depression. Best Pract Res Clin Obstet Gynaecol 2014; 28:85-95. [PMID: 24041861 PMCID: PMC3992885 DOI: 10.1016/j.bpobgyn.2013.08.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/23/2013] [Accepted: 08/12/2013] [Indexed: 01/15/2023]
Abstract
Complementary and alternative medicine therapies are increasingly sought out by people with psychiatric disorders. In this chapter, we review the evidence for several commonly used CAM therapies (i.e. omega-3 fatty acids, folate, S-adenosyl-methionine, St John's Wort, bright light therapy, exercise, massage, and acupuncture) in the treatment of perinatal depression. A number of these treatments may be reasonable to consider for women during pregnancy or postpartum, but the safety and efficacy of these relative to standard treatments must still be systematically determined. Evidence-based use of complementary and alternative medicine therapies treatments for perinatal depression is discussed. Adequately powered systematic studies are necessary to determine the role of complementary and alternative medicine therapies in the treatment of perinatal depression.
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Affiliation(s)
- Kristina M Deligiannidis
- Center for Psychopharmacologic Research and Treatment, University of Massachusetts Medical School, 55 Lake Avenue, North Worcester, MA 01655, USA; Women's Mental Health Specialty Clinic, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.
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Mao JJ, Li QS, Soeller I, Xie SX, Amsterdam JD. Rhodiola rosea therapy for major depressive disorder: a study protocol for a randomized, double-blind, placebo- controlled trial. ACTA ACUST UNITED AC 2014; 4:170. [PMID: 25610752 DOI: 10.4172/2167-0870.1000170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Rhodiola rosea (R. rosea), a botanical of both western and traditional Chinese medicine, has been used as a folk remedy for improving stamina and reducing stress. However, few controlled clinical trials have examined the safety and efficacy of R. rosea for the treatment of major depressive disorder (MDD). This study seeks to evaluate the safety and efficacy of R. rosea in a 12-week, randomized, double-blind, placebo-controlled, parallel group study design. METHODS / DESIGN Subjects with MDD not receiving antidepressant therapy will be randomized to either R. rosea extract 340-1,360 mg daily; sertraline 50-200 mg daily, or placebo for 12 weeks. The primary outcome measure will be change over time in the mean 17-item Hamilton Depression Rating score. Secondary outcome measures will include safety and quality of life ratings. Statistical procedures will include mixed-effects models to assess efficacy for primary and secondary outcomes. DISCUSSION This study will provide valuable preliminary information on the safety and efficacy data of R. rosea versus conventional antidepressant therapy of MDD. It will also inform additional hypotheses and study design of future, fully powered, phase III clinical trials with R. rosea to determine its safety and efficacy in MDD.
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Affiliation(s)
- Jun J Mao
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA ; Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA ; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Qing S Li
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Irene Soeller
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sharon X Xie
- Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jay D Amsterdam
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Gagnier JJ, Moher D, Boon H, Bombardier C, Beyene J. An empirical study using permutation-based resampling in meta-regression. Syst Rev 2012; 1:18. [PMID: 22587815 PMCID: PMC3351721 DOI: 10.1186/2046-4053-1-18] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 02/23/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In meta-regression, as the number of trials in the analyses decreases, the risk of false positives or false negatives increases. This is partly due to the assumption of normality that may not hold in small samples. Creation of a distribution from the observed trials using permutation methods to calculate P values may allow for less spurious findings. Permutation has not been empirically tested in meta-regression. The objective of this study was to perform an empirical investigation to explore the differences in results for meta-analyses on a small number of trials using standard large sample approaches verses permutation-based methods for meta-regression. METHODS We isolated a sample of randomized controlled clinical trials (RCTs) for interventions that have a small number of trials (herbal medicine trials). Trials were then grouped by herbal species and condition and assessed for methodological quality using the Jadad scale, and data were extracted for each outcome. Finally, we performed meta-analyses on the primary outcome of each group of trials and meta-regression for methodological quality subgroups within each meta-analysis. We used large sample methods and permutation methods in our meta-regression modeling. We then compared final models and final P values between methods. RESULTS We collected 110 trials across 5 intervention/outcome pairings and 5 to 10 trials per covariate. When applying large sample methods and permutation-based methods in our backwards stepwise regression the covariates in the final models were identical in all cases. The P values for the covariates in the final model were larger in 78% (7/9) of the cases for permutation and identical for 22% (2/9) of the cases. CONCLUSIONS We present empirical evidence that permutation-based resampling may not change final models when using backwards stepwise regression, but may increase P values in meta-regression of multiple covariates for relatively small amount of trials.
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Affiliation(s)
- Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - David Moher
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
- Department of Epidemiology & Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Claire Bombardier
- Health-Policy Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Beyene
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Joos S, Musselmann B, Szecsenyi J. Integration of complementary and alternative medicine into family practices in Germany: results of a national survey. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2010; 2011:495813. [PMID: 19293252 PMCID: PMC3140199 DOI: 10.1093/ecam/nep019] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 02/12/2009] [Indexed: 12/17/2022]
Abstract
More than two-thirds of patients in Germany use complementary and alternative medicine (CAM) provided either by physicians or non-medical practitioners ("Heilpraktiker"). There is little information about the number of family physicians (FPs) providing CAM. Given the widespread public interest in the use of CAM, this study aimed to ascertain the use of and attitude toward CAM among FPs in Germany. A postal questionnaire developed based on qualitatively derived data was sent to 3000 randomly selected FPs in Germany. A reminder letter including a postcard (containing a single question about CAM use in practice and reasons for non-particpation in the survey) was sent to all FPs who had not returned the questionnaire. Of the 3000 FPs, 1027 (34%) returned the questionnaire and 444 (15%) returned the postcard. Altogether, 886 of the 1471 responding FPs (60%) reported using CAM in their practice. A positive attitude toward CAM was indicated by 503 FPs (55%), a rather negative attitude by 127 FPs (14%). Chirotherapy, relaxation and neural therapy were rated as most beneficial CAM therapies by FPs, whereas neural therapy, phytotherapy and acupuncture were the most commonly used therapies in German family practices. This survey clearly demonstrates that CAM is highly valued by many FPs and is already making a substantial contribution to first-contact primary care in Germany. Therefore, education and research about CAM should be increased. Furthermore, with the provision of CAM by FPs, the role of non-medical CAM practitioners within the German healthcare system is to be questioned.
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Affiliation(s)
- Stefanie Joos
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115 Heidelberg, Germany
| | - Berthold Musselmann
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115 Heidelberg, Germany
- Practice of Family Medicine, Academic Teaching Practice, University of Heidelberg, Hauptstrasse 120, 69168 Wiesloch, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115 Heidelberg, Germany
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Deligiannidis KM, Freeman MP. Complementary and alternative medicine for the treatment of depressive disorders in women. Psychiatr Clin North Am 2010; 33:441-63. [PMID: 20385346 DOI: 10.1016/j.psc.2010.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Complementary and alternative medicine (CAM) therapies are commonly practiced in the United States and are used more frequently among women than men. This article reviews several CAM treatments for depressive disorders in women, with a focus on major depressive disorder across the reproductive life cycle. The CAM therapies selected for this review (ie, S-adenosylmethionine, omega-3 fatty acids, St John's wort, bright light therapy, acupuncture, and exercise) were based on their prevalence of use and the availability of randomized, placebo-controlled data. Further study is necessary to delineate the role of specific CAM therapies in premenstrual syndrome, premenstrual dysphoric disorder, antepartum and postpartum depression, lactation, and the menopausal transition.
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Affiliation(s)
- Kristina M Deligiannidis
- Depression Specialty Clinic, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, USA
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Wang Y, Shi X, Qi Z. Hypericin prolongs action potential duration in hippocampal neurons by acting on K+ channels. Br J Pharmacol 2010; 159:1402-7. [PMID: 20233218 DOI: 10.1111/j.1476-5381.2009.00513.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Synaptic deficiency is generally accepted to be involved in major depression, and accordingly classic antidepressants exert their effects through enhancing synaptic efficiency. Hypericin is one of the major active constituents of extracts of St. John's Wort (Hypericum perforatum L.) with antidepressive actions, but little is known about its therapeutic mechanisms. Our aim was to explore whether hypericin has a modulatory effect on neuronal action potential (AP) duration by acting on voltage-gated ion channels. EXPERIMENTAL APPROACH We used voltage-clamp and current-clamp techniques in a whole-cell configuration to study primary cultures of neonatal rat hippocampal neurones. We measured the effects of extracellularly applied hypericin on AP duration as well as on voltage-gated Na(+), I(A) and I(K) currents. KEY RESULTS Extracellularly applied hypericin dose-dependently increased AP duration but barely affected its amplitude. Further analysis revealed that hypericin inhibited both transient I(A) and delayed rectifier I(K) potassium currents. In contrast, hypericin exerted no significant effect on both Na(+) peak current and its decay kinetics. CONCLUSIONS AND IMPLICATIONS Extracellularly applied hypericin increased AP duration, which might be ascribed to its effect on I(A) and I(K) currents. As a small increase in AP duration could lead to a dramatic increase in synaptic efficiency, our results imply that hypericin might exert its antidepressant effects by enhancing presynaptic efficiency.
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Affiliation(s)
- Y Wang
- Department of Physiology, Medical College of Xiamen University, Xiamen, China
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Galeotti N, Vivoli E, Bilia AR, Bergonzi MC, Bartolini A, Ghelardini C. A Prolonged Protein Kinase C-Mediated, Opioid-Related Antinociceptive Effect of St John's Wort in Mice. THE JOURNAL OF PAIN 2010; 11:149-59. [DOI: 10.1016/j.jpain.2009.06.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 05/18/2009] [Accepted: 06/24/2009] [Indexed: 02/08/2023]
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Abstract
The popularity of natural or "alternative" remedies to treat medical and psychiatric disorders has accelerated dramatically over the past decade, in the United States and worldwide. This article reviews the evidence for clinical efficacy, active ingredients, mechanisms of action, recommended dosages, and toxicities of the 3 best-studied putative natural antidepressants, St. John's wort (hypericum), S-adenosyl methionine, and the Omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid. Despite growing evidence for efficacy and safety, more comprehensive studies are required before these remedies can be recommended as safe and effective alternatives or adjuncts to conventional psychotropic agents. There are limited data regarding safety in pregnancy and during lactation, and caution is therefore recommended in women who are pregnant or breastfeeding.
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Affiliation(s)
- David Mischoulon
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Suite 401, Boston, MA 02114, USA.
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Buettner C, Mukamal KJ, Gardiner P, Davis RB, Phillips RS, Mittleman MA. Herbal supplement use and blood lead levels of United States adults. J Gen Intern Med 2009; 24:1175-82. [PMID: 19575271 PMCID: PMC2771230 DOI: 10.1007/s11606-009-1050-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 03/06/2009] [Accepted: 06/03/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Some herbal supplements may contain lead. OBJECTIVE To examine whether use of specific herbal dietary supplements during the last 30 days is associated with blood lead levels in US men and women. DESIGN Cross-sectional analysis. STUDY POPULATION NHANES participants from 1999-2004, a representative sample of the civilian non-institutionalized US population. MEASUREMENTS Lead was measured in blood. Associations between lead and self-reported supplement use were estimated using multivariable regression weighted to account for NHANES sampling. Herbal supplements investigated were those previously reported to contain high heavy metal content: Ayurvedic or traditional Chinese medicine herbs, echinacea, ginkgo, ginseng, St. John's wort, and "other" herbs (specifically, kava, valerian, black cohosh, bee pollen, and nettle). MAIN RESULTS Among 6,712 women > or =20 years, those using herbal supplements had lead levels that were 10% higher than non-users (95% CI 3%-17%, p = 0.005). Women using Ayurvedic or traditional Chinese medicine herbs, St. John's wort, and "other" herbs had lead levels 24% (95% CI 5%-45%, p = 0.01), 23% (95% CI 4%-46%), p = 0.02), and 21% (95% CI 2%-44%, p = 0.03) higher, respectively, than non-users. No significant associations were observed between herb use and lead levels among men (n = 6,095). Among reproductive-aged women (16-45 years), herbal supplement users had lead levels 20% higher than non-users (95% CI 5%-34%, p = 0.008). In contrast, garlic and other dietary supplements were not associated with higher lead levels. CONCLUSION Use of specific herbal supplements is associated with higher blood lead levels among women. Our data suggest testing guidelines for herbal supplements and regulations limiting lead in supplements are needed.
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Affiliation(s)
- Catherine Buettner
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
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CAM — trick or treatment? Br J Gen Pract 2009; 59:541; author reply 541-2. [DOI: 10.3399/bjgp09x453585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Malhi GS, Adams D, Porter R, Wignall A, Lampe L, O'Connor N, Paton M, Newton LA, Walter G, Taylor A, Berk M, Mulder RT. Clinical practice recommendations for depression. Acta Psychiatr Scand 2009:8-26. [PMID: 19356154 DOI: 10.1111/j.1600-0447.2009.01382.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To provide clinically relevant evidence-based recommendations for the management of depression in adults that are informative, easy to assimilate and facilitate clinical decision making. METHOD A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. The recommendations then underwent consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives. RESULTS The clinical practice recommendations for depression (Depression CPR) summarize evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative. CONCLUSION These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of depression. Further, the novel style and practical approach should promote uptake and implementation.
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Affiliation(s)
- G S Malhi
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, University of Sydney, NSW, Australia.
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Piccolo P, Gentile S, Alegiani F, Angelico M. Severe drug induced acute hepatitis associated with use of St John's wort (Hypericum perforatum) during treatment with pegylated interferon α. BMJ Case Rep 2009; 2009:bcr08.2008.0761. [PMID: 21686643 DOI: 10.1136/bcr.08.2008.0761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A 61-year-old woman with chronic hepatitis C received peginterferon α 180 μg/week, and obtained undetectable qualitative hepatitis C virus (HCV) RNA (lower limit of detection 50 IU/ml) after 8 weeks of treatment. Shortly thereafter aminotransferase values greatly increased (>20 × upper limit of normal) and did not decline after treatment suspension. The patient admitted taking St John's wort (Hypericum perforatum) for depressed mood, recommended by a friend, during the preceding 6 weeks. Liver function tests continued to worsen and international normalised ratio (INR) prolongation developed; the patient was hospitalised. Test for antinuclear antibody was positive (1:320) and treatment with methylprednisolone was started; bilirubin and aminotransferase levels slowly declined, though a new flare occurred when steroids were tapered. After 6 months of prednisone treatment, the liver function tests returned to baseline levels. The combination of peginterferon α and St John's wort resulted in a severe acute hepatitis in this patient. Patients should be advised of this potential toxic effect of this herbal remedy.
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Affiliation(s)
- Paola Piccolo
- Tor Vergata University, Hepaotology Unit, via Montpellier, Rome, 00135, Italy
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Linde K. [St. John's wort for depression--development of a Cochrane review from 1993 to 1996]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2009; 102:487-92. [PMID: 19216197 DOI: 10.1016/j.zefq.2008.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present contribution describes the history of the Cochrane review on St. John's wort (hypericum perforatum L.) for depression. Work for the first version started in 1993, the year that saw the official foundation of the Cochrane Collaboration, but 3 years before a pertinent Cochrane review group was established. After the registration of the Collaborative Review Group for Depression, Anxiety and Neuroses (CCDAN) and the publication of a first print version of the review that included 23 trials in 1996 the first Cochrane version with 27 trials became available in 1998. Updates were completed in 2005 (37 included trials) and 2008 (29 trials). Due to changes in selection criteria and review methods the resources needed to complete the 2005 and 2008 updates were similar to those for the first version in 1996. Only one trial included in the 1996 version is still part of the 2008 version. Despite the large number of available trials and improvements in review methodology the current evidence is more difficult to interpret than in 1996.
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Affiliation(s)
- Klaus Linde
- Zentrum für naturheilkundliche Forschung, II. Medizinische Klinik und Poliklinik, Technische Universität München.
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Lavretsky H. Complementary and alternative medicine use for treatment and prevention of late-life mood and cognitive disorders. ACTA ACUST UNITED AC 2009; 5:61-78. [PMID: 19956796 DOI: 10.2217/1745509x.5.1.61] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Late-life mood disorders and cognitive aging are the most common reasons for using complementary and alternative therapies. The amount of rigorous scientific data to support the efficacy of complementary therapies in the treatment of depression or cognitive impairment is extremely limited. The areas with the most evidence for beneficial effects are exercise, herbal therapy (Hypericum perforatum), the use of fish oil, and, to a lesser extent, acupuncture and relaxation therapies. There is a need for further research involving randomized, controlled trials to investigate the efficacy of complementary and alternative therapies in the treatment of depression and cognitive impairment in late-life. This research may lead to the development of effective treatment and preventive approaches for these serious conditions.
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Affiliation(s)
- Helen Lavretsky
- Associate Professor of Psychiatry, Department of Psychiatry & Biobehavioral Sciences, and, Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, Tel.: +1 310 794 4619, ,
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Sarris J, Kavanagh DJ, Deed G, Bone KM. St. John's wort and Kava in treating major depressive disorder with comorbid anxiety: a randomised double-blind placebo-controlled pilot trial. Hum Psychopharmacol 2009; 24:41-8. [PMID: 19090505 DOI: 10.1002/hup.994] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We report the first randomised controlled trial (RCT) using a combination of St. John's wort (SJW) and Kava for the treatment of major depressive disorder (MDD) with comorbid anxiety. METHODS Twenty-eight adults with MDD and co-occurring anxiety were recruited for a double-blind RCT. After a placebo run-in of 2 weeks, the trial had a crossover design testing SJW and Kava against placebo over two controlled phases, each of 4 weeks. The primary analyses used intention-to-treat and completer analyses. RESULTS On both intention-to-treat (p = 0.047) and completer analyses (p = 0.003), SJW and Kava gave a significantly greater reduction in self-reported depression on the Beck Depression Inventory (BDI-II) over placebo in the first controlled phase. However, in the crossover phase, a replication of those effects in the delayed medication group did not occur. Nor were there significant effects on anxiety or quality of life. CONCLUSION There was some evidence of antidepressant effects using SJW and Kava in a small sample with comorbid anxiety. Possible explanations for the absence of anxiolysis may include a potential interaction with SJW, the presence of depression, or an inadequate dose of Kava.
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Affiliation(s)
- Jerome Sarris
- School of Medicine, The University of Queensland, Australia.
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Yeung KS, Gubili J, Cassileth B. Evidence-based botanical research: applications and challenges. Hematol Oncol Clin North Am 2008; 22:661-70, viii. [PMID: 18638694 DOI: 10.1016/j.hoc.2008.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Use of herbal supplements is on the rise around the world, but limited data exist on the safety and efficacy of botanical products. Efforts to subject botanicals to rigorous scientific research began recently. There are many problems associated with botanicals research, however. These include procuring the study agents, selecting appropriate study method and clinical trial design, navigating through regulatory obstacles, and obtaining funding. Evidence-based botanical research can help to validate traditional uses and to facilitate new drug development. Concerted efforts of governmental agencies and industry are essential to ensure continuance of high-quality botanicals research.
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Affiliation(s)
- K Simon Yeung
- Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, 1429 First Avenue, New York, NY 10021, USA
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25
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Abstract
BACKGROUND In some countries extracts of the plant Hypericum perforatum L. (popularly called St. John's wort) are widely used for treating patients with depressive symptoms. OBJECTIVES To investigate whether extracts of hypericum are more effective than placebo and as effective as standard antidepressants in the treatment of major depression; and whether they have fewer adverse effects than standard antidepressant drugs. SEARCH STRATEGY Trials were searched in computerised databases, by checking bibliographies of relevant articles, and by contacting manufacturers and researchers. SELECTION CRITERIA Trials were included if they: (1) were randomised and double-blind; (2) included patients with major depression; (3) compared extracts of St. John's wort with placebo or standard antidepressants; (4) included clinical outcomes assessing depressive symptoms. DATA COLLECTION AND ANALYSIS At least two independent reviewers extracted information from study reports. The main outcome measure for assessing effectiveness was the responder rate ratio (the relative risk of having a response to treatment). The main outcome measure for adverse effects was the number of patients dropping out due to adverse effects. MAIN RESULTS A total of 29 trials (5489 patients) including 18 comparisons with placebo and 17 comparisons with synthetic standard antidepressants met the inclusion criteria. Results of placebo-controlled trials showed marked heterogeneity. In nine larger trials the combined response rate ratio (RR) for hypericum extracts compared with placebo was 1.28 (95% confidence interval (CI), 1.10 to 1.49) and from nine smaller trials was 1.87 (95% CI, 1.22 to 2.87). Results of trials comparing hypericum extracts and standard antidepressants were statistically homogeneous. Compared with tri- or tetracyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), respectively, RRs were 1.02 (95% CI, 0.90 to 1.15; 5 trials) and 1.00 (95% CI, 0.90 to 1.11; 12 trials). Both in placebo-controlled trials and in comparisons with standard antidepressants, trials from German-speaking countries reported findings more favourable to hypericum. Patients given hypericum extracts dropped out of trials due to adverse effects less frequently than those given older antidepressants (odds ratio (OR) 0.24; 95% CI, 0.13 to 0.46) or SSRIs (OR 0.53, 95% CI, 0.34-0.83). AUTHORS' CONCLUSIONS The available evidence suggests that the hypericum extracts tested in the included trials a) are superior to placebo in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants. The association of country of origin and precision with effects sizes complicates the interpretation.
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Affiliation(s)
- Klaus Linde
- Technische Universität München / Klinikum rechts der IsarInstitut für Allgemeinmedizin / Institute of General PracticeWolfgangstr. 8MünchenGermany81667
| | - Michael M Berner
- University Medical Center FreiburgDepartment of Psychiatry and PsychotherapyHauptstrasse 5Freiburg im BreisgauGermanyD‐79104
| | - Levente Kriston
- University Medical Center FreiburgDepartment of Psychiatry and PsychotherapyHauptstrasse 5Freiburg im BreisgauGermanyD‐79104
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Morgan AJ, Jorm AF. Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Ann Gen Psychiatry 2008; 7:13. [PMID: 18710579 PMCID: PMC2542367 DOI: 10.1186/1744-859x-7-13] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Accepted: 08/19/2008] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Research suggests that depressive disorders exist on a continuum, with subthreshold symptoms causing considerable population burden and increasing individual risk of developing major depressive disorder. An alternative strategy to professional treatment of subthreshold depression is population promotion of effective self-help interventions that can be easily applied by an individual without professional guidance. The evidence for self-help interventions for depressive symptoms is reviewed in the present work, with the aim of identifying promising interventions that could inform future health promotion campaigns or stimulate further research. METHODS A literature search for randomised controlled trials investigating self-help interventions for depressive disorders or depressive symptoms was performed using PubMed, PsycINFO and the Cochrane Database of Systematic Reviews. Reference lists and citations of included studies were also checked. Studies were grouped into those involving participants with depressive disorders or a high level of depressive symptoms, or non-clinically depressed participants not selected for depression. A number of exclusion criteria were applied, including trials with small sample sizes and where the intervention was adjunctive to antidepressants or psychotherapy. RESULTS The majority of interventions searched had no relevant evidence to review. Of the 38 interventions reviewed, the ones with the best evidence of efficacy in depressive disorders were S-adenosylmethionine, St John's wort, bibliotherapy, computerised interventions, distraction, relaxation training, exercise, pleasant activities, sleep deprivation, and light therapy. A number of other interventions showed promise but had received less research attention. Research in non-clinical samples indicated immediate beneficial effects on depressed mood for distraction, exercise, humour, music, negative air ionisation, and singing; while potential for helpful longer-term effects was found for autogenic training, light therapy, omega 3 fatty acids, pets, and prayer. Many of the trials were poor quality and may not generalize to self-help without professional guidance. CONCLUSION A number of self-help interventions have promising evidence for reducing subthreshold depressive symptoms. Other forms of evidence such as expert consensus may be more appropriate for interventions that are not feasible to evaluate in randomised controlled trials. There needs to be evaluation of whether promotion to the public of effective self-help strategies for subthreshold depressive symptoms could delay or prevent onset of depressive illness, reduce functional impairment, and prevent progression to other undesirable outcomes such as harmful use of substances.
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Affiliation(s)
- Amy J Morgan
- Orygen Youth Health Research Centre, Department of Psychiatry, University of Melbourne, Parkville, Australia.
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Pollard NA. Commercialism, choice and consumer protection: regulation of complementary medicines in Australia. Med J Aust 2008; 189:50-2; author reply 52-3. [DOI: 10.5694/j.1326-5377.2008.tb01901.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 04/11/2008] [Indexed: 11/17/2022]
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Weber W, Vander Stoep A, McCarty RL, Weiss NS, Biederman J, McClellan J. Hypericum perforatum (St John's wort) for attention-deficit/hyperactivity disorder in children and adolescents: a randomized controlled trial. JAMA 2008; 299:2633-41. [PMID: 18544723 PMCID: PMC2587403 DOI: 10.1001/jama.299.22.2633] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Stimulant medication can effectively treat 60% to 70% of youth with attention-deficit/hyperactivity disorder (ADHD). Yet many parents seek alternative therapies, and Hypericum perforatum (St John's wort) is 1 of the top 3 botanicals used. OBJECTIVE To determine the efficacy and safety of H. perforatum for the treatment of ADHD in children. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, placebo-controlled trial conducted between March 2005 and August 2006 at Bastyr University, Kenmore, Washington, among a volunteer sample of 54 children aged 6 to 17 years who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for ADHD by structured interview. INTERVENTION After a placebo run-in phase of 1 week, participants were randomly assigned to receive 300 mg of H. perforatum standardized to 0.3% hypericin (n = 27) or a matched placebo (n = 27) 3 times daily for 8 weeks. Other medications for ADHD were not allowed during the trial. MAIN OUTCOME MEASURES Performance on the ADHD Rating Scale-IV (range, 0-54) and Clinical Global Impression Improvement Scale (range, 0-7), and adverse events. RESULTS One patient in the placebo group withdrew because of an adverse event. No significant difference was found in the change in ADHD Rating Scale-IV scores from baseline to week 8 between the treatment and placebo groups: inattentiveness improved 2.6 points (95% confidence interval [CI], -4.6 to -0.6 points) with H. perforatum vs 3.2 points (95% CI, -5.7 to -0.8 points) with placebo (P = .68) and hyperactivity improved 1.8 points (95% CI, -3.7 to 0.1 points) with H. perforatum vs 2.0 points (95% CI, -4.1 to 0.1 points) with placebo (P = .89). There was also no significant difference between the 2 groups in the percentage of participants who met criteria for improvement (score < or = 2) on the Clinical Global Impression Improvement Scale (H. perforatum, 44.4%; 95% CI, 25.5%-64.7% vs placebo, 51.9%; 95% CI, 31.9%-71.3%; P = .59). No difference between groups was found in the number of participants who experienced adverse effects during the study period (H. perforatum, 40.7%; 95% CI, 22.4%-61.2% vs placebo, 44.4%; 95% CI, 25.5%-64.7%; P = .78). CONCLUSION In this study, use of H. perforatum for treatment of ADHD over the course of 8 weeks did not improve symptoms. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00100295.
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Affiliation(s)
- Wendy Weber
- School of Naturopathic Medicine, Bastyr University, Kenmore, Washington, USA.
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Bent S. Herbal medicine in the United States: review of efficacy, safety, and regulation: grand rounds at University of California, San Francisco Medical Center. J Gen Intern Med 2008; 23:854-9. [PMID: 18415652 PMCID: PMC2517879 DOI: 10.1007/s11606-008-0632-y] [Citation(s) in RCA: 311] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 12/11/2007] [Accepted: 03/24/2008] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Herbal products have gained increasing popularity in the last decade, and are now used by approximately 20% of the population. Herbal products are complex mixtures of organic chemicals that may come from any raw or processed part of a plant, including leaves, stems, flowers, roots, and seeds. Under the current law, herbs are defined as dietary supplements, and manufacturers can therefore produce, sell, and market herbs without first demonstrating safety and efficacy, as is required for pharmaceutical drugs. Although herbs are often perceived as "natural" and therefore safe, many different side effects have been reported owing to active ingredients, contaminants, or interactions with drugs. RESULTS Unfortunately, there is limited scientific evidence to establish the safety and efficacy of most herbal products. Of the top 10 herbs, 5 (ginkgo, garlic, St. John's wort, soy, and kava) have scientific evidence suggesting efficacy, but concerns over safety and a consideration of other medical therapies may temper the decision to use these products. CONCLUSIONS Herbal products are not likely to become an important alternative to standard medical therapies unless there are changes to the regulation, standardization, and funding for research of these products.
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Affiliation(s)
- Stephen Bent
- Osher Center for Integrative Medicine, University of California, San Francisco, CA, USA.
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Ashar BH, Rowland-Seymour A. Advising patients who use dietary supplements. Am J Med 2008; 121:91-7. [PMID: 18261493 DOI: 10.1016/j.amjmed.2007.10.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 10/05/2007] [Accepted: 10/06/2007] [Indexed: 11/18/2022]
Abstract
Public use of dietary supplements is quite prevalent, with an estimated 1 of 5 patients using such substances in an effort to maintain or promote their health. Despite their popularity, patients and physicians are often unaware of the limited regulation of these products as well as their potential risks and benefits. Lack of physician knowledge in these areas has the potential to strain the doctor-patient relationship. In this review, we present a 6-step approach to advising patients who are considering use of dietary supplements. Our framework includes a discussion of regulatory issues, efficacy and safety, potential supplement-drug interactions, and monitoring for adverse events and therapeutic effects.
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Affiliation(s)
- Bimal H Ashar
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Abstract
Pediatric mood disorders (unipolar depression and bipolar disorder) are serious, common, persistent, and recurrent medical conditions. Depression is the second leading cause of illness and disability among young people worldwide. A healthy lifestyle and healthy environment are the cornerstones for promoting positive moods. In addition, several complementary therapies, including nutritional supplements, herbs, mind-body therapies, massage, and acupuncture can be helpful. The focus of this article is the fundamental lifestyle approaches and complementary therapies that enhance mental health in young people. Various resources are available to clinicians to help patients and families promote mental health.
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Affiliation(s)
- Kathi J. Kemper
- Caryl J Guth Chair for Holistic and Integrative Medicine, Professor, Pediatrics and Public Health Sciences, Medical Center Blvd., Wake Forest University School of Medicine, Winston-Salem, NC 27157, TEL: (336) 716-9640, FAX: (336) 716-7100,
| | - Scott Shannon
- Northern Colorado Center for Holistic Medicine, 7603 Colland Drive, Fort Collins, CO 80525, TEL: (970) 663-2686, FAX: (970) 663-1226,
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Butterweck V, Schmidt M. St. John's wort: role of active compounds for its mechanism of action and efficacy. Wien Med Wochenschr 2007; 157:356-61. [PMID: 17704987 DOI: 10.1007/s10354-007-0440-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 05/10/2007] [Indexed: 11/26/2022]
Abstract
St. John's wort (Hypericum perforatum L., SJW) contains numerous compounds with documented biological activity. Constituents that have stimulated the most interest include the naphthodianthrones hypericin and pseudohypericin, a broad range of flavonoids, and the phloroglucinols hyperforin and adhyperforin. According to the actual state of scientific knowledge the total extract has to be considered as the active substance. Although there are some open questions, the bulk of data suggests that several groups of active compounds are contributing to the antidepressant efficacy of the plant extract.
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Affiliation(s)
- Veronika Butterweck
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32608, USA.
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How should clinical psychologists approach complementary and alternative medicine? Empirical, epistemological, and ethical considerations. Clin Psychol Rev 2007; 28:657-75. [PMID: 17996344 DOI: 10.1016/j.cpr.2007.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 09/24/2007] [Accepted: 09/24/2007] [Indexed: 11/21/2022]
Abstract
As complementary and alternative medicine (CAM) practices are often recommended for mental health problems, many clients in clinical psychology will be in receipt of such treatments from other practitioners. Some psychologists have argued that CAM and psychology are natural bedfellows, given their sharing of philosophies (e.g., holism), professional orientations (e.g., person-centeredness), and theoretical positions (e.g., mind-body connectionism). It has specifically been argued that the practices of CAM could productively be appropriated, or at least promoted, by clinical psychologists. However, other commentators have criticized CAM for comprising therapies that, by definition, are both intrinsically unscientific and lacking in empirical evidence. This article examines the current standing of CAM from empirical, epistemological, and ethical perspectives. CAM treatments are found to be based on heterogeneous epistemologies and to suffer from poor records in empirical efficacy research. Attention is given to possible psychological explanations for CAM's popularity in the face of poor evidence for efficacy. It is argued that, given the likely incompatibility of CAM with clinical psychology's positivist scientific ethos, CAM practices should not be integrated into clinical psychology at this time.
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Kraft K. [New developments in hypericum extracts: data on efficacy and interactions]. Wien Med Wochenschr 2007; 157:284-7. [PMID: 17704973 DOI: 10.1007/s10354-007-0439-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Accepted: 05/08/2007] [Indexed: 10/22/2022]
Abstract
The recent clinical studies on hypericum extract support the present indications for its use in mild to moderate depression and depressive episodes. The effectiveness is superior to placebo and comparable with synthetic antidepressive drugs. The rate of unwanted events is explicitly lower and their severity in general only mild. A further indication for hypericum could be somatoform disorders, but further clinical studies are recommended. The main compound responsible for interactions is presumably hyperforin, but further ingredients could contribute according to the specific composition of the particular extract.
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Affiliation(s)
- Karin Kraft
- Klinik und Poliklinik für Innere Medizin, Lehrstuhl für Naturheilkunde, Rostock, Germany.
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Leuner K, Kazanski V, Müller M, Essin K, Henke B, Gollasch M, Harteneck C, Müller WE. Hyperforin--a key constituent of St. John's wort specifically activates TRPC6 channels. FASEB J 2007; 21:4101-11. [PMID: 17666455 DOI: 10.1096/fj.07-8110com] [Citation(s) in RCA: 176] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Hyperforin, a bicyclic polyprenylated acylphloroglucinol derivative, is the main active principle of St. John's wort extract responsible for its antidepressive profile. Hyperforin inhibits the neuronal serotonin and norepinephrine uptake comparable to synthetic antidepressants. In contrast to synthetic antidepressants directly blocking neuronal amine uptake, hyperforin increases synaptic serotonin and norepinephrine concentrations by an indirect and yet unknown mechanism. Our attempts to identify the molecular target of hyperforin resulted in the identification of TRPC6. Hyperforin induced sodium and calcium entry as well as currents in TRPC6-expressing cells. Sodium currents and the subsequent breakdown of the membrane sodium gradients may be the rationale for the inhibition of neuronal amine uptake. The hyperforin-induced cation entry was highly specific and related to TRPC6 and was suppressed in cells expressing a dominant negative mutant of TRPC6, whereas phylogenetically related channels, i.e., TRPC3 remained unaffected. Furthermore, hyperforin induces neuronal axonal sprouting like nerve growth factor in a TRPC6-dependent manner. These findings support the role of TRPC channels in neurite extension and identify hyperforin as the first selective pharmacological tool to study TRPC6 function. Hyperforin integrates inhibition of neurotransmitter uptake and neurotrophic property by specific activation of TRPC6 and represents an interesting lead-structure for a new class of antidepressants.
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Affiliation(s)
- Kristina Leuner
- Pharmakologisches Institut für Naturwissenschaftler, Biocenter Niederursel, 60438 Frankfurt, Germany
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Gödtel-Armbrust U, Metzger A, Kroll U, Kelber O, Wojnowski L. Variability in PXR-mediated induction of CYP3A4 by commercial preparations and dry extracts of St. John’s wort. Naunyn Schmiedebergs Arch Pharmacol 2007; 375:377-82. [PMID: 17593354 DOI: 10.1007/s00210-007-0172-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Accepted: 05/16/2007] [Indexed: 11/24/2022]
Abstract
St. John's wort (SJW, Hypericum perforatum) is a well-tolerated herbal medicine widely used for the treatment of mild and moderate depressions. In the last 5 years, SJW has been implicated in drug interactions, which are largely mediated by the induction of the drug metabolizing enzymes, especially CYP3A4. There is still some controversy regarding the exact mechanism of induction and the identity of the SJW constituents involved. We investigated in LS174T cells the induction of CYP3A4 by ten SJW extracts, six commercial preparations, and the purified SJW constituent hyperforin. The content of hyperforin among the commercial preparations of SJW varied 62-fold (range 0.49-30.57 mg/dose). The CYP3A4 induction was mediated by PXR, but not by CAR. The magnitude of the induction correlated statistically significantly with the content of hyperforin in commercial SJW preparations (R = 0.87, p = 0.004) and in dry extracts (R = 0.65, p = 0.03), but not with their content of flavonoids or hypericin. Most of the CYP3A4 induction response occurred in the hyperforin range encountered in the blood of patients treated with SJW preparations. A temperature-induced decrease in the hyperforin content of a selected dry SJW extract abolished the induction of CYP3A4. In conclusion, commercial SJW preparations still exhibit an enormous variability in CYP3A4 induction, which is mediated by hyperforin and PXR. SJW preparations with lower hyperforin content should reduce the frequency of clinical interactions involving this herbal drug.
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Affiliation(s)
- Ute Gödtel-Armbrust
- Institut für Pharmakologie, Johannes Gutenberg Universität, Obere Zahlbacher Str. 67, 55131 Mainz, Germany
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Akhondzadeh Basti A, Moshiri E, Noorbala AA, Jamshidi AH, Abbasi SH, Akhondzadeh S. Comparison of petal of Crocus sativus L. and fluoxetine in the treatment of depressed outpatients: a pilot double-blind randomized trial. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:439-42. [PMID: 17174460 DOI: 10.1016/j.pnpbp.2006.11.010] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 11/07/2006] [Accepted: 11/08/2006] [Indexed: 11/17/2022]
Abstract
Depression is one of the most common neuropsychiatric conditions, with a lifetime prevalence approaching 17%. Although a variety of pharmaceutical agents is available for the treatment of depression, psychiatrists find that many patients cannot tolerate the side effects, do not respond adequately, or finally lose their response. On the other hand, many herbs with psychotropic effects have far fewer side effects. They can provide an alternative treatment or be used to enhance the effect of conventional antidepressants. A number of recent preclinical and clinical studies indicate that stigma and petal of Crocus sativus have antidepressant effect. Our objective was to compare the efficacy of petal of C. sativus with fluoxetine in the treatment of depressed outpatients in an 8-week pilot double-blind randomized trial. Forty adult outpatients who met the DSM- IV criteria for major depression based on the structured clinical interview for DSM- IV participated in the trial. Patients have a baseline Hamilton Rating Scale for Depression score of at least 18. In this double-blind and randomized trial, patients were randomly assigned to receive capsule of petal of C. sativus 15 mg bid (morning and evening) (Group 1) and fluoxetine 10 mg bid (morning and evening) (Group 2) for a 8-week study. At the end of trial, petal of C. sativus was found to be effective similar to fluoxetine in the treatment of mild to moderate depression (F=0.03, d.f.=1, P=0.84). In addition, in the both treatments, the remission rate was 25%. There were no significant differences in the two groups in terms of observed side effects. The present study is supportive of other studies which show antidepressant effect of C. sativus.
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Abstract
Natural medications such as St. John's Wort, SAMe, and omega-3 fatty acids eventually may prove to be valuable additions to the psychiatrist's pharmacologic armamentarium, both as monotherapy and as adjunctive therapy for mood disorders. Current research data are compelling, from a standpoint of both efficacy and safety, but before clinicians can recommend these as first-line treatments, more well-designed controlled studies in large patient populations are needed. During the past decade, the National Institutes of Health, the National Institute for Mental Health, and the National Center for Complementary and Alternative Medicine have widened their support for research on the efficacy and safety of alternative treatments, and increasing numbers of academic institutions are undertaking large-scale, multicenter studies on the natural medications reviewed here, as well as others. These studies should help answer some of the yet-unsettled questions about natural medications. Psychiatrists who are considering recommending natural antidepressants to their patients should emphasize that these treatments are relatively unproven and that it remains to be seen whether they would be appropriate or preferable to the conventional psychotropic agents. in the absence of more conclusive data, the best candidates for alternative treatments may be patients for whom a delay in adequate treatment would not be devastating(eg, the mildly symptomatic patient who has a strong interest in natural remedies). Other good candidates may include patients who have been unresponsive to conventional antidepressants or particularly intolerant of side effects; these patients, however, often are the most difficult to treat, and alternative agents seem best suited for the mildly ill. Care should be taken with patients who are taking multiple medications, in view of adverse drug-drug interactions that have emerged with increased use of alternative treatments. Finally, as with all psychotropic agents, natural medications should be used preferably under the supervision of a physician.
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Affiliation(s)
- David Mischoulon
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, WAC-812, 15 Parkman Street, Boston, MA 02114, USA.
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Abstract
Increasing numbers of patients are using complementary medicine for the treatment of depression, which complicates management. What is the evidence in support of one medication over another? What medications are safe to use in children and pregnant women? Is there any evidence supporting over-the-counter supplements? These are just a few of the questions that primary care physicians face on a daily basis. This article attempts to answer these questions and many others in an evidence-based approach to the management of depression, which focuses on diagnosis, medical management, and complementary treatments.
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Affiliation(s)
- Douglas Maurer
- Madigan Army Medical Center, Building 9040, Fitzsimmons Drive, Tacoma, WA 98431, USA.
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Schneider C, Lovett E. Depression. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Thachil AF, Mohan R, Bhugra D. The evidence base of complementary and alternative therapies in depression. J Affect Disord 2007; 97:23-35. [PMID: 16926053 DOI: 10.1016/j.jad.2006.06.021] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 06/22/2006] [Accepted: 06/23/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Depression is one of the leading indications for using Complementary and Alternative Medicine (CAM). This paper reviews the evidence of efficacy of different types of CAM in depression with the aim of identifying the highest level of evidence. METHODS We conducted literature searches restricted to the English language for studies on CAM as monotherapy in depression. All papers were reviewed by two researchers and the evidence was ranked according to a widely referenced hierarchy of evidence. RESULTS 19 papers formed the final review. We found Grade 1 evidence on the use of St. John's wort, Tryptophan/5-Hydroxytryptophan, S-adenosyl methionine, Folate, Inositol, Acupuncture and Exercise in Depressive disorders, none of which was conclusively positive. We found RCTs at the Grade 2 level on the use of Saffron (Herbal medicine), Complex Homoeopathy and Relaxation training in Depressive disorders, all of which showed inconclusive results. Other RCTs yielded unequivocally negative results. Studies below this level yielded inconclusive or negative results. LIMITATIONS Searches were restricted to the English language. Our list of CAM approaches may not have been comprehensive. We excluded studies on the use of CAM as an adjunctive treatment and this review aimed to identify only the highest level of evidence. CONCLUSIONS None of the CAM studies show evidence of efficacy in depression according to the hierarchy of evidence. The RCT model and the principles underlying many types of CAM are dissonant, making its application in the evaluation of those types of CAM difficult. The hierarchy of evidence we used has limited utility in grading trials of CAM.
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Affiliation(s)
- A F Thachil
- Kings College London, Section of Cultural Psychiatry, HSRD, PO: 25, Institute of Psychiatry, DeCrespigny Park, London SE5 8AF, UK.
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Pilkington K, Boshnakova A, Richardson J. St John's wort for depression: Time for a different perspective? Complement Ther Med 2006; 14:268-81. [PMID: 17105697 DOI: 10.1016/j.ctim.2006.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Accepted: 01/02/2006] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To review the development of the evidence on the herbal remedy, St John's wort (SJW) (Hypericum perforatum), in the treatment of depression. METHODS Searches of major biomedical and specialist databases including EMBASE, MEDLINE, PsycINFO, AMED and HerbMed were conducted. Searches aimed to identify quantitative research (systematic reviews and meta-analyses) and relevant qualitative studies. Data were extracted systematically. RESULTS Systematic reviews have been published regularly over the past 10 years. Methodology has varied resulting in differing estimates of effectiveness but overall findings have been positive when compared with placebo for mild to moderate depression. Recent reviews have focused on adverse effects and interactions. One qualitative study focusing on SJW in depression was retrieved. CONCLUSIONS SJW has received intensive and continued attention since initial indications of its potential effectiveness for depression. The focus appears to be moving from effectiveness to safety but the patient's perspective has received less attention and may prove a valuable avenue for future studies.
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Lee LS, Andrade ASA, Flexner C. HIV/AIDS: Interactions between Natural Health Products and Antiretroviral Drugs: Pharmacokinetic and Pharmacodynamic Effects. Clin Infect Dis 2006; 43:1052-9. [PMID: 16983620 DOI: 10.1086/507894] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 06/01/2006] [Indexed: 02/02/2023] Open
Abstract
Concurrent use of natural health products (NHPs) with antiretroviral drugs (ARVs) is widespread among human immunodeficiency virus-infected patients. This article reviews the clinical pharmacokinetic and pharmacodynamic interactions between NHPs and ARVs. Many NHPs are complex mixtures and are likely to contain organic compounds that may induce and/or inhibit drug metabolizing enzymes and drug transporters. Although the weight of evidence for the effects of certain NHPs varies and many studies of these products lack scientific rigor, it has been observed that St. John's wort clearly induces cytochrome P450 3A4 and P-glycoprotein and reduces protease inhibitor and nonnucleoside reverse-transcriptase inhibitor concentrations, thereby increasing the likelihood of therapeutic failure. Limited clinical research suggests that intake of garlic and vitamin C results in reductions in ARV concentrations. The intake of milk thistle, Echinacea species, and goldenseal inhibits cytochrome P450 enzymes in vitro and may increase ARV concentrations, but by clinically unimportant amounts. Intake of fish oil reduces ARV-induced hypertriglyceridemia without significantly affecting lopinavir concentrations. Before recommending the use of NHPs as adjuncts to ARV use, studies should first exclude significant pharmacokinetic interactions and ensure that ARV efficacy is maintained.
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Affiliation(s)
- Lawrence S Lee
- Division of Clinical Pharmacology, Johns Hopkins University, Baltimore, MD, USA
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Putnik K, Stadler P, Schäfer C, Koelbl O. Enhanced radiation sensitivity and radiation recall dermatitis (RRD) after hypericin therapy -- case report and review of literature. Radiat Oncol 2006; 1:32. [PMID: 16948841 PMCID: PMC1564402 DOI: 10.1186/1748-717x-1-32] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Accepted: 09/01/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modern radiotherapy (RT) reduces the side effects at organ at risk. However, skin toxicity is still a major problem in many entities, especially head and neck cancer. Some substances like chemotherapy provide a risk of increased side effects or can induce a "recall phenomenon" imitating acute RT-reactions months after RT. Moreover, some phototoxic drugs seem to enhance side effects of radiotherapy while others do not. We report a case of "radiation recall dermatitis" (RRD) one year after RT as a result of taking hypericin (St. John's wort). CASE REPORT A 65 year old man with completely resected squamous cell carcinoma of the epiglottis received an adjuvant locoregional RT up to a dose of 64.8 Gy. The patient took hypericin during and months after RT without informing the physician. During radiotherapy the patient developed unusual intensive skin reactions. Five months after RT the skin was completely bland at the first follow up. However, half a year later the patient presented erythema, but only within the area of previously irradiated skin. After local application of a steroid cream the symptoms diminished but returned after the end of steroid therapy. The anamnesis disclosed that the patient took hypericin because of depressive mood. We recommended to discontinue hypericin and the symptoms disappeared afterward. CONCLUSION Several drugs are able to enhance skin toxicity of RT. Furthermore, the effect of RRD is well known especially for chemotherapy agents such as taxans. However, the underlying mechanisms are not known in detail so far. Moreover, it is unknown whether photosensitising drugs can also be considered to increase radiation sensitivity and whether a recall phenomenon is possible. The first report of a hypericin induced RRD and review of the literature are presented. In clinical practise many interactions between drugs and radiotherapy were not noticed and if registered not published. We recommend to ask especially for complementary or alternative drugs because patients tend to conceal such medication as harmless.
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Affiliation(s)
- Kurt Putnik
- Department of Radiation Oncology, University of Regensburg, Josef-Strauss Allee 11, 93053 Regensburg, Germany
| | - Peter Stadler
- Department of Radiation Oncology, University of Regensburg, Josef-Strauss Allee 11, 93053 Regensburg, Germany
| | - Christof Schäfer
- Department of Radiation Oncology, University of Regensburg, Josef-Strauss Allee 11, 93053 Regensburg, Germany
| | - Oliver Koelbl
- Department of Radiation Oncology, University of Regensburg, Josef-Strauss Allee 11, 93053 Regensburg, Germany
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Kasper S, Anghelescu IG, Szegedi A, Dienel A, Kieser M. Superior efficacy of St John's wort extract WS 5570 compared to placebo in patients with major depression: a randomized, double-blind, placebo-controlled, multi-center trial [ISRCTN77277298]. BMC Med 2006; 4:14. [PMID: 16796730 PMCID: PMC1538611 DOI: 10.1186/1741-7015-4-14] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Accepted: 06/23/2006] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of the current study was to assess the antidepressant efficacy and safety of Hypericum perforatum (St. John's wort) extract WS 5570 at doses of 600 mg/day in a single dose and 1200 mg/day in two doses. METHODS The participants in this double-blind, randomized, placebo-controlled, multi-center clinical trial were male and female adult out-patients with an episode of mild or moderate major depressive episode (single or recurrent episode, DSM-IV criteria). As specified by the relevant guideline, the study was preceded by a medication-free run-in phase. For the 6-week treatment, 332 patients were randomized: 123 to WS 5570 600 mg/day, 127 to WS 5570 1200 mg/day, and 82 to placebo. The primary outcome measure was the change in total score on the Hamilton Rating Scale for Depression (HAM-D, 17-item version) between baseline and endpoint. Additional measures included the number of responders, the number of patients in remission, and several other standard rating scales. Efficacy and safety were assessed after 2 and 6 weeks. The design included an interim analysis performed after randomization with the option of early termination. RESULTS After 6 weeks of treatment, mean +/- standard deviation decreases in HAM-D total scores of 11.6 +/- 6.4, 10.8 +/- 7.3, and 6.0 +/- 8.1 points were observed for the WS 5570 600 mg/day, 1200 mg/day and placebo groups, respectively (endpoint analysis). Secondary measures of treatment efficacy also showed that both WS 5570 groups were statistically superior to placebo. Significantly more patients in the WS 5570 treatment groups than in the placebo group showed treatment response and remission. WS 5570 was consistently more effective than placebo in patients with either less severe or more severe baseline impairment. The number of patients who experienced remission was higher in the WS 5570 1200 mg/day group than the WS 5570 600 mg/day group. The incidence of adverse events was low in all groups. The adverse event profile was consistent with the known profile for Hypericum extract preparations. CONCLUSION Hypericum perforatum extract WS 5570 at doses of 600 mg/day (once daily) and 1200 mg/day (600 mg twice daily) were found to be safe and more effective than placebo, with comparable efficacy of the WS 5570 groups for the treatment of mild to moderate major depression.
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Affiliation(s)
- Siegfried Kasper
- Department of General Psychiatry, Vienna Medical University, Währinger Gürtel 18–20, A-1090 Wien, Austria
| | - Ion-George Anghelescu
- Klinik und Hochschulambulanz für Psychiatrie und Psychotherapie, Charité – Universitätsmedizin Berlin, Eschenallee 3, D-14050 Berlin, Germany
| | - Armin Szegedi
- Klinik und Hochschulambulanz für Psychiatrie und Psychotherapie, Charité – Universitätsmedizin Berlin, Eschenallee 3, D-14050 Berlin, Germany
| | - Angelika Dienel
- Clinical Research Department, Dr. Willmar Schwabe Pharmaceuticals, Willmar-Schwabe-Straße 4, D-76227 Karlsruhe, Germany
| | - Meinhard Kieser
- Clinical Research Department, Dr. Willmar Schwabe Pharmaceuticals, Willmar-Schwabe-Straße 4, D-76227 Karlsruhe, Germany
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Williams M. Dietary supplements and sports performance: herbals. J Int Soc Sports Nutr 2006; 3:1-6. [PMID: 18500959 PMCID: PMC2129138 DOI: 10.1186/1550-2783-3-1-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Accepted: 04/20/2006] [Indexed: 11/10/2022] Open
Abstract
This is the fourth in a series of six articles to discuss the major classes of dietary supplements (vitamins; minerals; amino acids; herbs or botanicals; metabolites, constituents/extracts, or combinations). The major focus is on efficacy of such dietary supplements to enhance exercise or sport performance.
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Affiliation(s)
- Melvin Williams
- Department of Exercise Science, Old Dominion University, Norfolk, VA.
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