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Yi L, Chen J, Li S, Cui W, Li J, Peng L, Peng C. Efficacy and safety of Chinese patent medicines combined with antidepressants for treatment of depression in adults: A multiple-treatment meta-analysis. J Psychiatr Res 2024; 176:205-212. [PMID: 38878648 DOI: 10.1016/j.jpsychires.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 07/29/2024]
Abstract
BACKGROUND Combinations of Chinese patent medicines (CPM) with antidepressants (including selective serotonin reuptake inhibitors (SSRI), selective serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants (TCA), and noradrenergic and specific serotonergic antidepressants (NaSSA)) are frequently utilized for treating depression in adults. However, the efficacy and safety of these combination treatments remain to be established. METHODS Systematic search was conducted in seven electronic databases, regulatory websites and international registers of trials from 1994 to 2023 that included adult patients with depressive disorders who received CPM combined with antidepressants. The Multiple-Treatment Meta-Analysis (MTMA) was conducted using a random effects model with Stata/MP17 and R4.3.5 software. Primary outcomes were total efficacy rate, Hamilton Depression Scale (HAMD) score, and Treatment Emergency Symptom Scale (TESS) score. Secondary outcomes included brain-derived neurotrophic factor (BDNF) levels. RESULTS A total of 146 randomized controlled trials (13,754 participants: 6929 in intervention and 6825 in control groups) were included. For total effective rate, Multiple-Treatment Meta-Analysis results showed that the overall effect of combined intervention was better compared with antidepressants alone, where Jieyuanshenkeli (JYASKL) presented the optimal option for improving total efficacy (OR = 5.39, 95% CI [2.60, 11.18], SUCRA = 84.50%). In reduding the HAMD, Shuganjieyujiaonang (SGJYJN) was most likely to reduce the HAMD score (SMD = -2.20, 95% CI [-3.06, -1.33], SUCRA = 86.10%), Jieyuanshenkeli (JYASKL),Tianewangbuxindan (TWBXD), Shuyukeli (SYKL), Anshenbuxinwan (ASBXW) combination intervention did not appear to be statistically superior to antidepressants alone. In theTreatment Emergency Symptom Scale (TESS), Wulinjiaonang induced the most significant reduction in TESS score (SMD = -1.98, 95% CI [-3.59, -0.36], SUCRA = 90.40%). Tianmengjiaonang (TMJN) + Antidepressants(AD) (SUCRA = 88.30%) displayed the highest scores in increasing the levels of BDNF, although not statistically significant compared to Antidepressants(AD) alone (SMD = 1.23, 95% CI [0.90, 1.55]). CONCLUSION Combinations of CPM and antidepressants showed superior efficacy over antidepressants alone. The optimal combinations were determined as Shuganjieyu Jiaonang (SGJYJN)/SSRIs and Jieyuanshenkeli (JYASKL)/SSRIs. In terms of safety, results showed that combination therapy did not show better TESS efficacy than antidepressants alone.Although some of the combination interventions were not superior than antidepressants alone in reducing HAMD scores,our findings provide a potentially significant alternative option for clinical complementary therapy. However, these results require further validation through larger sample sizes, multicenter randomized controlled trials, and real-world data.
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Affiliation(s)
- Lidan Yi
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Jing Chen
- Department of Pharmacy, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, 410011, China
| | - Sini Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wei Cui
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Jianhe Li
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Liubao Peng
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Ciyan Peng
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
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Qin J, Qin Z, Qin Z, Li F, Peng Y, Zhang Y, Yao Y. An automated approach for predicting HAMD-17 scores via divergent selective focused multi-heads self-attention network. Brain Res Bull 2024; 213:110984. [PMID: 38806119 DOI: 10.1016/j.brainresbull.2024.110984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/12/2024] [Accepted: 05/24/2024] [Indexed: 05/30/2024]
Abstract
This study introduces the Divergent Selective Focused Multi-heads Self-Attention Network (DSFMANet), an innovative deep learning model devised to automatically predict Hamilton Depression Rating Scale-17 (HAMD-17) scores in patients with depression. This model introduces a multi-branch structure for sub-bands and artificially configures attention focus factors on various branches, resulting in distinct attention distributions for different sub-bands. Experimental results demonstrate that when DSFMANet processes sub-band data, its performance surpasses current benchmarks in key metrics such as mean square error (MSE), mean absolute error (MAE), root mean square error (RMSE), and coefficient of determination (R2). This success is particularly evident in terms of MSE and MAE, where the performance of sub-band data is significantly superior, highlighting the model's potential in accurately predicting HAMD-17 scores. Concurrently, the experiment also compared the model's performance with sub-band and full-band data, affirming the superiority of the selective focus attention mechanism in electroencephalography (EEG) signal processing. DSFMANet, when utilizing sub-band data, exhibits higher data processing efficiency and reduced model complexity. The findings of this study underscore the significance of employing deep learning models based on sub-band analysis in depression diagnosis. The DSFMANet model not only effectively enhances the accuracy of depression diagnosis but also offers valuable research directions for similar applications in the future. This deep learning-based automated approach can effectively ascertain the HAMD-17 scores of patients with depression, thus offering more accurate and reliable support for clinical decision-making.
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Affiliation(s)
- Jing Qin
- School of Information and Software Engineering, University of Electronic Science and Technology of China, North Jianshe Road, Chengdu, Sichuan, PR China.
| | - Zhiguang Qin
- School of Information and Software Engineering, University of Electronic Science and Technology of China, North Jianshe Road, Chengdu, Sichuan, PR China
| | - Zhen Qin
- School of Information and Software Engineering, University of Electronic Science and Technology of China, North Jianshe Road, Chengdu, Sichuan, PR China
| | - Fali Li
- School of Life Science and Technology, University of Electronic Science and Technology of China, No. 2006, Xiyuan Avenue, High-tech Zone (West District), Chengdu, Sichuan, PR China
| | - Yueheng Peng
- School of Life Science and Technology, University of Electronic Science and Technology of China, No. 2006, Xiyuan Avenue, High-tech Zone (West District), Chengdu, Sichuan, PR China
| | - Yue Zhang
- Stanford University, Stanford, CA 94305, United States
| | - Yutong Yao
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
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Li X, La R, Wang Y, Hu B, Zhang X. A Deep Learning Approach for Mild Depression Recognition Based on Functional Connectivity Using Electroencephalography. Front Neurosci 2020; 14:192. [PMID: 32300286 PMCID: PMC7142271 DOI: 10.3389/fnins.2020.00192] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 02/24/2020] [Indexed: 12/15/2022] Open
Abstract
Early detection remains a significant challenge for the treatment of depression. In our work, we proposed a novel approach to mild depression recognition using electroencephalography (EEG). First, we explored abnormal organization in the functional connectivity network of mild depression using graph theory. Second, we proposed a novel classification model for recognizing mild depression. Considering the powerful ability of CNN to process two-dimensional data, we applied CNN separately to the two-dimensional data form of the functional connectivity matrices from five EEG bands (delta, theta, alpha, beta, and gamma). In addition, inspired by recent breakthroughs in the ability of deep recurrent CNNs to classify mental load, we merged the functional connectivity matrices from the three EEG bands that performed the best into a three-channel image to classify mild depression-related and normal EEG signals using the CNN. The results of the graph theory analysis showed that the brain functional network of the mild depression group had a larger characteristic path length and a lower clustering coefficient than the healthy control group, showing deviation from the small-world network. The proposed classification model obtained a classification accuracy of 80.74% for recognizing mild depression. The current study suggests that the combination of a CNN and functional connectivity matrix may provide a promising objective approach for diagnosing mild depression. Deep learning approaches such as this might have the potential to inform clinical practice and aid in research on psychiatric disorders.
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Affiliation(s)
- Xiaowei Li
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Rong La
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Ying Wang
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Bin Hu
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Xuemin Zhang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China
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EEG-based mild depression recognition using convolutional neural network. Med Biol Eng Comput 2019; 57:1341-1352. [DOI: 10.1007/s11517-019-01959-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
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Timosaponin B-III exhibits antidepressive activity in a mouse model of postpartum depression by the regulation of inflammatory cytokines, BNDF signaling and synaptic plasticity. Exp Ther Med 2017; 14:3856-3861. [PMID: 29042992 DOI: 10.3892/etm.2017.4930] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/11/2017] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to investigate the antidepressive effects of timosaponin B-III (TB-III) and the underlying mechanism. A postpartum depression (PPD) mouse model was established by the administration of dexamethasone sodium phosphate during pregnancy. Mice with PPD were assigned to the following groups: Model, fluoxetine and high, medium and low doses of TB-III. Post-parturient mice without PPD served as a normal control group. To examine the effect of TB-III, mice were treated with TB-III, then forced swimming tests (FSTs) and tail suspension tests (TSTs) were performed to evaluate depression. Serum and hippocampal cytokines, namely tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6 and IL-10, were quantified using ELISAs and protein levels of hippocampal brain-derived neurotrophic factor (BDNF), glucagon synthase kinase (GSK)-3β, glutamate receptor subunit 1 (GluR1), postsynaptic density protein 95 (PSD95) and synapsin I were quantified using western blot analysis. Compared with those in the control group, immobility time in the FST and TST, serum and hippocampal TNF-α, IL-1β and IL-6 levels and hippocampal IL-10 levels were increased significantly in the model group (P<0.01). Serum IL-10 levels and hippocampal levels of BDNF, GSK-3β, GluR1, PSD95 and synapsin I decreased significantly in the model group compared with the control group (P<0.01). Fluoxetine or TB-III (10, 20 or 40 mg/kg) treatment significantly decreased immobility times in the FST and TST (P<0.01) and significantly reversed the aforementioned alterations in cytokine and protein levels (P<0.01). Thus, TB-III exhibited a protective effect against depression in PPD and such effects may have been mediated via the regulation of inflammatory cytokines, the BNDF signaling pathway and synaptic plasticity-related proteins.
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Geraghty AWA, Santer M, Williams S, Mc Sharry J, Little P, Muñoz RF, Kendrick T, Moore M. 'You feel like your whole world is caving in': A qualitative study of primary care patients' conceptualisations of emotional distress. Health (London) 2017; 21:295-315. [PMID: 28177273 PMCID: PMC5439536 DOI: 10.1177/1363459316674786] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
General practitioners are tasked with determining the nature of patients' emotional distress and providing appropriate care. For patients whose symptoms appear to fall near the 'boundaries' of psychiatric disorder, this can be difficult with important implications for treatment. There is a lack of qualitative research among patients with symptoms severe enough to warrant consultation, but where general practitioners have refrained from diagnosis. We aimed to explore how patients in this potentially large group conceptualise their symptoms and consequently investigate lay understandings of complex distinctions between emotional distress and psychiatric disorder. Interviews were conducted with 20 primary care patients whom general practitioners had identified as experiencing emotional distress, but had not diagnosed with major depressive disorder. Participants described severe emotional experiences with substantial impact on their lives. The term 'depression' was used in many different ways; however, despite severity, they often considered their emotional experience to be different to their perceived notions of 'actual' depression or mental illness. Where anxiety was mentioned, use appeared to refer to an underlying generalised state. Participants drew on complex, sometimes fluid and often theoretically coherent conceptualisations of their emotional distress, as related to, but distinct from, mental disorder. These conceptualisations differ from those frequently drawn on in research and treatment guidelines, compounding the difficulty for general practitioners. Developing models of psychological symptoms that draw on patient experience and integrate psychological/psychiatric theory may help patients understand the nature of their experience and, critically, provide the basis for a broader range of primary care interventions.
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Affiliation(s)
- Adam WA Geraghty
- Adam WA Geraghty, Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK.
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Lee G, Bae H. Therapeutic Effects of Phytochemicals and Medicinal Herbs on Depression. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6596241. [PMID: 28503571 PMCID: PMC5414506 DOI: 10.1155/2017/6596241] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/22/2017] [Accepted: 04/04/2017] [Indexed: 01/21/2023]
Abstract
Background. Depression is a recurrent, common, and potentially life-threatening psychiatric disease related to multiple assignable causes. Although conventional antidepressant therapy can help relieve symptoms of depression and prevent relapse of the illness, complementary therapies are required due to disadvantage of the current therapy such as adverse effects. Moreover, a number of studies have researched adjunctive therapeutic approaches to improve outcomes for depression patients. Purpose. One potential complementary method with conventional antidepressants involves the use of medicinal herbs and phytochemicals that provide therapeutic benefits. Studies have revealed beneficial effects of medical herbs and phytochemicals on depression and their central nervous system mechanism. Here, we summarize the current knowledge of the therapeutic benefits of phytochemicals and medicinal herbs against depression and describe their detailed mechanisms. Sections. There are two sections, phytochemicals against depression and medical herbs against depression, in this review. Conclusion. Use of phytomedicine may be an alternative option for the treatment of depression in case conventional drugs are not applicable due to their side effects, low effectiveness, or inaccessibility. However, the efficacy and safety of these phytomedicine treatments for depression have to be supported by clinical studies.
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Affiliation(s)
- Gihyun Lee
- Department of Physiology, College of Korean Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Republic of Korea
- Department of Research and Development, National Development Institute of Korean Medicine, 94 Hwarang-ro, Gyeongsan-si, Gyeongsangbuk-do 38540, Republic of Korea
| | - Hyunsu Bae
- Department of Physiology, College of Korean Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Republic of Korea
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General and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders: a report by the WPA section of pharmacopsychiatry. Eur Arch Psychiatry Clin Neurosci 2011; 261 Suppl 3:207-45. [PMID: 22033583 DOI: 10.1007/s00406-011-0259-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Current gold standard approaches to the treatment of depression include pharmacotherapeutic and psychotherapeutic interventions with social support. Due to current controversies concerning the efficacy of antidepressants in randomized controlled trials, the generalizability of study findings to wider clinical practice and the increasing importance of socioeconomic considerations, it seems timely to address the uncertainty of concerned patients and relatives, and their treating psychiatrists and general practitioners. We therefore discuss both the efficacy and clinical effectiveness of antidepressants in the treatment of depressive disorders. We explain and clarify useful measures for assessing clinically meaningful antidepressant treatment effects and the types of studies that are useful for addressing uncertainties. This includes considerations of methodological issues in randomized controlled studies, meta-analyses, and effectiveness studies. Furthermore, we summarize the differential efficacy and effectiveness of antidepressants with distinct pharmacodynamic properties, and differences between studies using antidepressants and/or psychotherapy. We also address the differential effectiveness of antidepressant drugs with differing modes of action and in varying subtypes of depressive disorder. After highlighting the clinical usefulness of treatment algorithms and the divergent biological, psychological, and clinical efforts to predict the effectiveness of antidepressant treatments, we conclude that the spectrum of different antidepressant treatments has broadened over the last few decades. The efficacy and clinical effectiveness of antidepressants is statistically significant, clinically relevant, and proven repeatedly. Further optimization of treatment can be helped by clearly structured treatment algorithms and the implementation of psychotherapeutic interventions. Modern individualized antidepressant treatment is in most cases a well-tolerated and efficacious approach to minimize the negative impact of otherwise potentially devastating and life-threatening outcomes in depressive disorders.
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Rapaport MH, Nierenberg AA, Howland R, Dording C, Schettler PJ, Mischoulon D. The treatment of minor depression with St. John's Wort or citalopram: failure to show benefit over placebo. J Psychiatr Res 2011; 45:931-41. [PMID: 21632064 PMCID: PMC3137264 DOI: 10.1016/j.jpsychires.2011.05.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 04/08/2011] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
Abstract
This paper presents new data addressing two important controversies in psychiatry: the construct of Minor Depression (MinD) and the efficacy of St. John's Wort for milder forms of depressive disorders. Data are from a three-arm, 12 week, randomized clinical trial of investigating the efficacy of St. John's Wort (810 mg/day), citalopram (20 mg/day), or placebo for acute treatment of MinD. Due to a high placebo response on all outcome measures, neither St. John's Wort nor citalopram separated from placebo on change in depressive symptom severity, quality of life, or well-being. However, systematic assessment of potential adverse effects (AEs) led to three important observations: (1) prior to the administration of study compound, 60% of subjects endorsed items that would be characterized as AEs once study compound was administered, (2) St. John's Wort and citalopram were each associated with a significant number of new or worsening AEs during treatment, and (3) using a structured interview for identifying AEs at baseline and during treatment is informative. MinD was not responsive to either a conventional antidepressant or a nutraceutical, and both compounds were associated with a notable side effects burden. Other treatment approaches for MinD should be investigated.
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Affiliation(s)
- Mark Hyman Rapaport
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
| | | | | | | | - Pamela J. Schettler
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center
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Baghai TC, Eser D, Möller HJ. Effects of different antidepressant treatments on the core of depression. DIALOGUES IN CLINICAL NEUROSCIENCE 2008. [PMID: 18979944 PMCID: PMC3181885 DOI: 10.31887/dcns.2008.10.3/tcbaghai] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Core symptoms of depression are a combination of psychological and somatic symptoms, often combined with psychomotor and cognitive disturbances. Diagnostic classification of depression including the concepts of melancholic, endogenous, or severe depression describe severely depressed patients suffering from most of the core symptoms, together with clinical characteristics of a cyclic unipolar or bipolar course, lower placebo response rates, higher response rates to electroconvulsive therapy, to antidepressant treatments with dually or mixed modes of action, or to lithium augmentation. Higher rates ofhypothalamic-pituitary-adrenal axis hyperactivity and specific electroencephalograph patterns have also been shown in this patient group. Summarizing the symptomatology of depression in these patients, a broad overlap between the abovementioned subgroups can be suggested. Because the positive diagnosis of those core symptoms of depression may include clinical consequences, it would be of use to integrate all the mentioned concepts in the upcoming new versions of the diagnostic systems DSM-V and ICD-11.
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Affiliation(s)
- Thomas C Baghai
- Dept of Psychiatry, Ludwig-Maximilians-University Munich, Germany.
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Linden M, Wurzendorf K, Ploch M, Schaefer M. Self medication with St. John's wort in depressive disorders: an observational study in community pharmacies. J Affect Disord 2008; 107:205-10. [PMID: 17707513 DOI: 10.1016/j.jad.2007.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 07/14/2007] [Accepted: 07/15/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Depressive disorders are frequent. They are frequently unrecognised or sufferers use self help or self medication, e.g. with St. John's wort (SJW), instead of seeking professional help. The purpose of this study is to examine patients who buy SJW for the treatment of depression. METHODS In pharmacies from all over Germany customers who bought SJW and the pharmacists were asked to fill in a questionnaire on the cause for buying SJW, their health status and the type of counselling they received. RESULTS 588 individuals were included, 293 purchased SJW as an OTC preparation, 230 had a prescription (65 missing answers). The majority in both groups were women (78.8% in OTC group, 74.3% in prescription group. Self medication patients were significantly younger. Subjects with a prescription took SJW longer (26.99+/-26.84 vs. 15.25+/-20.84 months). Both groups did not differ in self rated symptoms of depression (severity of depression, anxiety, endurance). LIMITATIONS No standardized interviews were used to establish the diagnosis of depression. CONCLUSIONS Patients who buy SJW for self medication report pronounced and persistent depressive symptoms. As this is a large group of patients they should get more attention in research. Pharmacists are the only professionals who come in contact with these patients and should therefore be considered as an important group of carers.
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Affiliation(s)
- Michael Linden
- Research Group Psychosomatic Rehabilitation at the Charité University Medicine Berlin, Germany.
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Baghai TC, Volz HP, Möller HJ. Drug treatment of depression in the 2000s: An overview of achievements in the last 10 years and future possibilities. World J Biol Psychiatry 2007; 7:198-222. [PMID: 17071541 DOI: 10.1080/15622970601003973] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
During the past 10 years our knowledge about the pharmacotherapy of depression has been consolidated, and a variety of very interesting new compounds launched onto the market. The pipeline of the pharmaceutical industry is still filled with an assortment of new developments and very promising new approaches towards the pharmacotherapy of depressive disorders. Future pharmacological treatments of depression will not only enhance serotonergic and noradrenergic neurotransmission: other systems, such as the melatonergic receptor system and the hypothalamus-pituitary-adrenal axis, are also the targets of newly developed and upcoming substances with putative antidepressant effects. The main advantages of the currently available newer pharmacotherapeutic options are the broadening of the spectrum of possible antidepressant treatments, which is of particular importance for the growing number of patients suffering from difficult-to-treat depression, and a far better tolerability profile in comparison to older compounds such as tricyclic antidepressants. Unresolved issues are the unacceptably high rate of non-responsiveness during antidepressant treatment, a latency of sometimes several weeks until clinical improvement and remission can be achieved, and a variety of possible side effects also present during treatment with modern compounds. This review mainly presents the development of antidepressant pharmacotherapies during the past 10 years, together with pharmacokinetic and pharmacodynamic information and a comparison of different pharmacological treatment principles evaluated in randomized controlled clinical trials. In addition, new pharmacological strategies that are not yet available on the market and strategies currently under development are reviewed in detail. The study of new treatment options is of major importance to provide better strategies for the clinical management of depression in the future, and is thus also of great socio-economic importance.
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Affiliation(s)
- Thomas C Baghai
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.
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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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Gramowski A, Jügelt K, Stüwe S, Schulze R, McGregor GP, Wartenberg-Demand A, Loock J, Schröder O, Weiss DG. Functional screening of traditional antidepressants with primary cortical neuronal networks grown on multielectrode neurochips. Eur J Neurosci 2006; 24:455-65. [PMID: 16903853 DOI: 10.1111/j.1460-9568.2006.04892.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We optimized the novel technique of multielectrode neurochip recordings for the rapid and efficient screening of neuroactivity. Changes in the spontaneous activity of cultured networks of primary cortical neurons were quantified to evaluate the action of drugs on the firing dynamics of complex network activity. The multiparametric assessment of electrical activity changes caused by psychoactive herbal extracts from Hypericum, Passiflora and Valeriana, and various combinations thereof revealed a receptor-specific and concentration-dependent inhibition of the firing patterns. The spike and burst rates showed significant substance-dependent effects and significant differences in potency. The effects of specific receptor blockades on the inhibitory responses provided evidence that the herbal extracts act on gamma-amino butyric acid (GABA) and serotonin (5-HT) receptors, which are recognized targets of pharmacological antidepressant treatment. A biphasic effect, serotonergic stimulation of activity at low concentrations that is overridden by GABAergic inhibition at higher concentrations, is apparent with Hypericum alone and the triple combination of the extracts. The more potent neuroactivity of the triple combination compared to Hypericum alone and the additive effect of Passiflora and Valeriana suggest a synergy between constituent herbal extracts. The extracts and their combinations affected the set of derived activity parameters in a concomitant manner suggesting that all three constituent extracts and their combinations have largely similar modes of action. This study also demonstrates the sensitivity, selectivity and robustness of neurochip recordings for high content screening of complex mixtures of neuroactive substances and for providing multiparametric information on neuronal activity changes to assess the therapeutic potential of psychoactive substances.
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Affiliation(s)
- Alexandra Gramowski
- Division of Cell Biology and Biosystems Technology, Institute of Biological Sciences, University of Rostock, Albert-Einstein-Strasse, 318059 Rostock, Germany.
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17
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Moreno RA, Teng CT, Almeida KMD, Tavares Junior H. Hypericum perforatum versus fluoxetine in the treatment of mild to moderate depression: a randomized double-blind trial in a Brazilian sample. BRAZILIAN JOURNAL OF PSYCHIATRY 2006; 28:29-32. [PMID: 16612487 DOI: 10.1590/s1516-44462006000100007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVE: Hypericum perforatum has demonstrated antidepressant efficacy when compared to placebo, but comparisons with other antidepressants remain controversial. We assessed the efficacy and safety of Hypericum perforatum in comparison with fluoxetine, in a 8-week double-blind trial in patients with mild to moderate depression. METHOD: Seventy-two outpatients were randomly assigned to receive Hypericum perforatum 900 mg/day, fluoxetine 20 mg/day or placebo. Efficacy measures included the HAM-D21 scale, the Montgomery-Åsberg Rating Scale, and the Clinical Global Impression. Safety was assessed with the UKU Side Effect Rating Scale. RESULTS: Intention-to-treat analysis showed no differences between the mean scores of the three groups. In the analyses of observed cases, patients receiving Hypericum perforatum had the lowest remission rates (12%, p = 0.016) compared to fluoxetine (34.6%) and placebo (45%). CONCLUSIONS: Hypericum perforatum was less efficacious than both fluoxetine and placebo. Both drugs were safe and well-tolerated. Larger trials are needed for definite conclusions.
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Affiliation(s)
- Ricardo Alberto Moreno
- Institute of Psychiatry, Clinical Hospital, Medical School, Universidade de São Paulo, São Paulo, SP, Brazil.
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18
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Simeon J, Nixon MK, Milin R, Jovanovic R, Walker S. Open-label pilot study of St. John's wort in adolescent depression. J Child Adolesc Psychopharmacol 2005; 15:293-301. [PMID: 15910213 DOI: 10.1089/cap.2005.15.293] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM Clinical experience suggests the use of alternative remedies, such as St. John's Wort (SJW), in adolescents with affective disorders is increasing. In view of the paucity of documented, well-established, and safe antidepressant medications for children and adolescents, it was important to investigate the potential usefulness of SJW in adolescents with major depressive disorders (MDD). METHODS AND RESULTS An 8-week, open-label study evaluated the potential efficacy and safety of SJW (300 mg TID) in adolescents with MDD. Twenty-six patients, 12-17 years of age (mean age, 14.8 years) were enrolled in the study. Of the 11 patients who completed the study, 9 patients (82%) showed significant clinical improvement based on Clinical Global Improvement (CGI) change scores (treatment response was indicated by a clinical improvement rating of either very much improved or much improved at the final visit). Of the 15 patients (58%) who did not complete the study, 8 patients were noncompliant and 7 patients were discontinued because of persisting or worsening depression. Of the 8 noncompliant patients, at week 8, 2 patients (25%) remained unchanged, 1 patient (12.5%) was minimally improved, 4 patients (75%) were much improved, and 1 patient (12.5%) was very much improved, based on the CGI change score. CONCLUSION Preliminary findings suggest that SJW is well tolerated and may be clinically effective in the treatment of some adolescents with mild depression. Controlled trials of SJW in adolescents with MDD are suggested.
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Affiliation(s)
- Jovean Simeon
- Royal Ottawa Hospital, Child and Adolescent Psychiatry, Ottawa, Canada.
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19
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Bjerkenstedt L, Edman GV, Alken RG, Mannel M. Hypericum extract LI 160 and fluoxetine in mild to moderate depression: a randomized, placebo-controlled multi-center study in outpatients. Eur Arch Psychiatry Clin Neurosci 2005; 255:40-7. [PMID: 15538592 DOI: 10.1007/s00406-004-0532-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2004] [Accepted: 05/05/2004] [Indexed: 10/26/2022]
Abstract
Efficacy and tolerability of Hypericum LI 160 was compared to fluoxetine and placebo in mild to moderate Major Depression (DSM-IV) in a 4-week randomized, double-blind trial. One hundred and sixty-three outpatients from 15 general practitioner centers received either 900 mg Hypericum LI 160, 20 mg fluoxetine, or placebo daily. Amelioration was measured by the Hamilton and the Montgomery-Asberg Depression scales. Response and remission rates and global ratings by investigators and patients were measured. Adverse event reports, laboratory screening, vital signs, physical exams and ECG were collected. No significant differences could be observed regarding efficacy measures except for remission rate (Hypericum 24%; fluoxetine 28%; placebo 7 %). Hypericum was significantly better tolerated than fluoxetine. Hypericum LI 160 or fluoxetine were not more effective in short-term treatment in mild to moderate depression than placebo.
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Affiliation(s)
- Lars Bjerkenstedt
- Department of Clinical Neuroscience, Psychiatry Section Karolinska Hospital, 17176, Stockholm, Sweden.
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20
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Rodríguez-Landa JF, Contreras CM. A review of clinical and experimental observations about antidepressant actions and side effects produced by Hypericum perforatum extracts. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2003; 10:688-699. [PMID: 14692732 DOI: 10.1078/0944-7113-00340] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Hypericum perforatum is an herbaceous perennial plant, also known as "St. John's wort", used popularly as a natural antidepressant. Although some clinical and experimental studies suggest it has some properties similar to conventional antidepressants, the proposed mechanism of action seems to be multiple: a non-selective blockade of the reuptake of serotonin, noradrenaline and dopamine; an increase in density of serotonergic and dopaminergic receptors and an increased affinity for GABAergic receptors; moreover, the inhibition of monoaminoxidase enzyme activity has been involved. In any case, the increase of monoamine concentrations in the synaptic cleft resembles several actions exerted by clinically effective antidepressants. In the present article, we review some of the controversial evidence derived from clinical and experimental studies suggesting that H. perforatum exerts antidepressant-like actions, and we also review some of its side effects, such as nausea, rash, fatigue, restlessness, photosensitivity, acute neuropathy, and even episodes of mania and serotonergic syndrome when administered simultaneously with other antidepressant drugs. All of the foregoing suggests that H. perforatum extracts appear to exert potentially significant pharmacological activity involving several neurotransmission systems supposed to be involved in the pathophysiology of depression. However, little information regarding the safety of H. perforatum is available, including potential herb-drug interactions. There is a need for additional research on the pharmacological and biochemical activity of H. perforatum, as well as its side-effects and its several bioactive constituents to further elucidate the mechanisms of antidepressant actions.
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Affiliation(s)
- J F Rodríguez-Landa
- Laboratorio de Neurofarmacología, Instituto de Neuroetología, Universidad Veracruzana, México
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21
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Linden M. [Epidemology and treatment of depressive disorders]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2003; 49:333-45. [PMID: 14579201 DOI: 10.13109/zptm.2003.49.4.333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
5-10% of the general population suffer from depressive disorders, one third of which are chronic. Depression impairs the quality of life, and 30.8% of patients show reduced working capacity. Patients are on average 10.9 days per month on sick leave. About half of the depressed patients undergo treatment, contacting general practitioners at an average of 14.5 times, psychotherapists 2 times and psychiatrists 1.4 times per year. Approximately 100 million daily doses of specific antidepressants are prescribed per year in Germany, an amount enough to treat 1% of the general population, which is indicative of an insufficient treatment rate. Pharmacotherapy has been found to be more effective than psychotherapy in acute episodes. However, psychotherapy patients show better long term results in respect to relapses and social adaptation. Due to the large number of depressed patients, general practitioners are the primary therapists. Referral to psychiatrists or psychotherapists is indicated in cases of chronic and complicated courses.
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Affiliation(s)
- Michael Linden
- Forschungsgruppe Psychosomatische Rehabilitation an der Charité, Universitätsklinik Benjamin Franklin und der Rehabilitationsklinik Seehof der BfA, Lichterfelder Allee 55, D-14513 Teltow/Berlin, Germany.
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22
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Abstract
Evidence for alternative treatments for depression, anxiety, and insomnia are reviewed in this article. Treatment of depression with St. John's wort, L-tryptophan, 5-hydroxytryptophan, S-adenosylmethionine, dehydroepiandosterone, folate, exercise, acupuncture, and meditation are examined. Evidence for the efficacy of kava kava, exercise, relaxation therapies, and acupuncture in treatment anxiety is reviewed. The use of valerian, melatonin, chamomile, passionflower, exercise, acupuncture, and behavioral therapies (i.e., sleep restriction, stimulus control, relaxation, and sleep hygiene) for insomnia is discussed.
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Affiliation(s)
- Michele M Larzelere
- Department of Family Medicine, Louisiana State University Health Sciences Center, School of Medicine, 200 West Esplanade Avenue, Suite 510, Kenner, LA 70065, USA.
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23
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Behnke K, Jensen GS, Graubaum HJ, Gruenwald J. Hypericum perforatum versus fluoxetine in the treatment of mild to moderate depression. Adv Ther 2002; 19:43-52. [PMID: 12008860 DOI: 10.1007/bf02850017] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In a randomized, controlled, double-blind trial, 70 patients (mean age, 49.7 years) suffering from mild to moderate depression received one tablet of either St. John's Wort (Hypericum perforatum) extract (Calmigen) or fluoxetine hydrochloride (Prozac) twice a day for 6 weeks. Efficacy was determined according to the 17-item Hamilton Rating Scale for Depression (HAMD), the von Zerssen depression scale (DS), Clinical Global Impression (CGI), and patients' overall evaluation. Significant decreases (P<.001) of 50% in the Hypericum group and 58% in the fluoxetine group in the HAMD score and of 42% and 52% on the DS spoke to the efficacy of both medications. The Hypericum extract achieved 83% of the efficacy of fluoxetine on the HAMD and 78% on the DS. Assessments by physicians (CGI) and patients indicated considerable improvement with no between-treatment differences. Of the 9 dropouts (13%), 2 in the Hypericum group and 2 in the fluoxetine group were due to adverse reactions. Safety evaluations demonstrated only minor changes. The Hypericum preparation tested in this study is therapeutically equivalent to fluoxetine and is therefore a rational alternative to synthetic antidepressants.
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Affiliation(s)
- Kirsten Behnke
- PhytoPharm Consulting, Institute for Phytopharmaceuticals, Berlin, Germany
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24
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Abstract
The widespread availability and use of herbal medicines raise the potential for adverse effects in the epilepsy population. Herbal sedatives (kava, valerian, chamomile, passionflower) may potentiate the effects of antiepileptic medications, increasing their sedative and cognitive effects. Despite some antiseizure effects in animal models, they should not be used in place of standard seizure medications because efficacy has not been established. Anecdotal, uncontrolled observations suggest that herbal stimulants containing ephedrine (ephedra or ma huang) and caffeine (cocoa, coffee, tea, maté, guarana, cola or kola) can exacerbate seizures in people with epilepsy, especially when taken in combination. Ginkgo and ginseng may also exacerbate seizures although the evidence for this is similarly anecdotal and uncertain. St. John's wort has the potential to alter medication pharmacokinetics and the seizure threshold. The essential oils of many plants contain epileptogenic compounds. There is mixed evidence for evening primrose and borage lowering the seizure threshold. Education of both health care providers and patients is the best way to avoid unintentional and unnecessary adverse reactions to herbal medicines.
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25
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Abstract
Depression and anxiety are among the top 10 health problems for which complementary and alternative therapies (CATs) are most frequently used, and medicinal herbs are among the most popular of these treatments. St. John's wort (Hypericum perforatum) is a perennial herb that has become a widely used depression therapy. Extracts of hypericum have shown affinity for receptors within multiple neurochemical systems. The primary active substance responsible for the antidepressant effect is not well defined, but most work has concentrated specifically on the hypericin and hyperforin components. Although hypericum has demonstrated significant antidepressant and antianxiety effects in multiple studies, there are several recent studies that do not support the previous evidence. In all reported studies, hypericum extracts have been well tolerated. In addition, new psychiatric uses for hypericum in obsessive-compulsive disorder, generalized anxiety disorder, menopausal symptoms, and alcohol dependence have been reported. Because patients are choosing to pursue CAT as a first-line therapy, psychiatrists will need to have a better understanding of phytomedicines used for treating depression and anxiety, and thus be better prepared to serve as effective allies of their patients.
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Affiliation(s)
- S E Meltzer-Brody
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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26
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Linde K, ter Riet G, Hondras M, Vickers A, Saller R, Melchart D. Systematic reviews of complementary therapies - an annotated bibliography. Part 2: herbal medicine. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2001; 1:5. [PMID: 11518548 PMCID: PMC37540 DOI: 10.1186/1472-6882-1-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2001] [Accepted: 07/20/2001] [Indexed: 11/10/2022]
Abstract
BACKGROUND Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with herbal medicine. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of herbal medicines; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pre-tested form and summarized descriptively. RESULTS From a total of 79 potentially relevant reviews pre-selected in the screening process 58 met the inclusion criteria. Thirty of the reports reviewed ginkgo (for dementia, intermittent claudication, tinnitus, and macular degeneration), hypericum (for depression) or garlic preparations (for cardiovascular risk factors and lower limb atherosclerosis). The quality of primary studies was criticized in the majority of the reviews. Most reviews judged the available evidence as promising but definitive conclusions were rarely possible. CONCLUSIONS Systematic reviews are available on a broad range of herbal preparations prescribed for defined conditions. There is very little evidence on the effectiveness of herbalism as practised by specialist herbalists who combine herbs and use unconventional diagnosis.
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Affiliation(s)
- Klaus Linde
- Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universität, München, Kaiserstr. 9, 80801 München, Germany
- Institute for Social Medicine & Epidemiology, Charité Hospital, Humboldt University, Berlin, Germany
| | - Gerben ter Riet
- HS Centre for Reviews & Dissemination, University of York, UK
- Department of Epidemiology, Maastricht University, The Netherlands
| | - Maria Hondras
- Consortial Center for Chiropractic Research, Davenport, Iowa, USA
| | | | - Reinhard Saller
- Division of Complementary Medicine Department of Internal Medicine, Universitätsspital Zurich, Switzerland
| | - Dieter Melchart
- Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universität, München, Kaiserstr. 9, 80801 München, Germany
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27
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Abstract
Conventional antidepressants are associated with a range of adverse drug reactions. The herb Hypericum perforatum (St John's wort) might offer another approach to the treatment of depression. Biochemical and animal studies suggest that the phloroglucinol derivative hyperforin is the main active ingredient of St John's wort, and inhibits the synaptosomal uptake of 5-HT, noradrenaline, dopamine, glutamate and GABA. St John's wort has been shown to alleviate symptoms of mild to moderate depression, and seems to offer significant advantages over conventional antidepressants because it is associated with fewer adverse reactions. However, important herb--drug interactions have been described. In view of its efficacy and safety records, St John's wort should be considered for the first-line treatment of mild to moderate depression.
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Affiliation(s)
- G Di Carlo
- Department of Experimental Pharmacology, University of Naples Federico II, Via D. Montesano 49, 80131 Naples, Italy.
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28
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Nangia M, Syed W, Doraiswamy PM. Efficacy and safety of St. John's wort for the treatment of major depression. Public Health Nutr 2000; 3:487-94. [PMID: 11276296 DOI: 10.1017/s1368980000000562] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Extracts of St. John's wort have been widely used in the treatment of depression. Our aim was to review information related to the efficacy and safety of St. John's wort as an antidepressant. DATA SOURCES Primary and review articles were identified by a search of Medline (1960 to February 2000) and through secondary sources. STUDY SELECTION All the articles identified from the data sources were evaluated and all relevant information was included in this review. The pharmacokinetics, mechanism of action, efficacy, side effects and drug interactions of St. John's wort have been examined in various studies. CONCLUSION St. John's wort is a promising investigational antidepressant, but the data are not yet sufficient to accept hypericum as a first line antidepressant preparation for treatment of depression. Besides the need for dose standardization and adequate trial lengths, there is a need for studies in severely depressed patients and long-term studies to assess the risk of relapse and recurrence.
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Affiliation(s)
- M Nangia
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
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