Effects of Saffron on Cognition, Anxiety, and Depression in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Double-Blind Placebo-Controlled Trial

OBJECTIVES

Cognitive decline, depression, and anxiety are among the major concerns in patients undergoing coronary artery bypass grafting (CABG). Crocus sativus L. (saffron) seems to be a promising candidate for treatment of these conditions.

DESIGN

In this 12-week, randomized, double-blind, placebo-controlled clinical trial, men and women with on-pump CABG, who had Wechsler Memory Scale (WMS) score >70 and age <70 years, received either saffron capsules (15 mg/twice daily) or placebo. Patients were excluded if they had history of treatment with saffron or acetylcholinesterase inhibitors, comorbid neuropsychiatric disorders, serious medical conditions other than cardiovascular diseases, and hypersensitivity to herbal compounds. The primary outcome was defined as the difference in mean total score changes for WMS-Revised from the baseline to week 12 between the saffron and placebo groups. Secondary outcomes included difference in mean score changes from baseline to endpoint between the two treatment groups for Mini Mental Status Examination and subscales of Hospital Anxiety and Depression Scale ( www.irct.ir ; IRCT201408071556N63).

RESULTS

No significant difference was detected in primary or secondary outcomes between the saffron and placebo groups. Also, no significant time × treatment interaction effect was found for any of the scales.

CONCLUSIONS

The results of this trial do not support the hypothesis of potential benefits of saffron in treatment of CABG-related neuropsychiatric conditions.

Simvastatin versus atorvastatin for improving mild to moderate depression in post-coronary artery bypass graft patients: A double-blind, placebo-controlled, randomized trial

BACKGROUND

A decreased risk of developing depression has been reported among statin users. Aside from their lipid-lowering effects, statins are considered immunomodulatory agents and have protective effects against oxidative stress and inflammation which are well known for their association with depression. The aim of the present study was to compare the probable antidepressant effects of simvastatin and atorvastatin among post-coronary artery bypass graft (CABG) surgery patients with high and low potentials for blood-brain-barrier penetration, respectively.

METHOD

Forty-six outpatients who had undergone CABG in the last 6 months and suffered from mild to moderate depression participated in a parallel, double-blind, placebo-controlled trial, and were randomized to undergo 6 weeks of treatment with either simvastatin (20mg/day) or atorvastatin (20mg/day). Participants were evaluated using Hamilton depression rating scale (HDRS) at baseline and weeks 3 and 6. The primary outcome was to evaluate the efficacy of simvastatin in improving the depressive symptoms.

RESULT

General linear model repeated measures demonstrated significant effect for time×treatment interaction on the HDRS scores [F (1.62, 71.06)=3.41, P=0.048]. There was no significant difference between the treatment groups regarding the adverse events. No one experienced serious adverse event.

LIMITATION

The limitations of the present study were its small sample size and the short-term follow-up period.

CONCLUSION

Treatment with simvastatin seems to be well tolerated with superior antidepressant effects compared to atorvastatin in post-CABG patients. Long-term outcomes of this practice and its probable influence on other psychological aspects are yet to be investigated in future studies.

TRIAL REGISTRATION

Iranian registry of clinical trials (http://www.irct.ir): IRCT201410271556N68.

A randomized, double-blind, clinical trial comparing the efficacy and safety of Crocus sativus L. with fluoxetine for improving mild to moderate depression in post percutaneous coronary intervention patients

OBJECTIVE

A significant correlation exists between coronary artery diseases and depression. The aim of this trial was to compare the efficacy and safety of saffron versus fluoxetine in improving depressive symptoms of patients who were suffering from depression after performing percutaneous coronary intervention (PCI).

METHODS

In this randomized double-blind parallel-group study, 40 patients with a diagnosis of mild to moderate depression who had undergone PCI in the last six months were randomized to receive either fluoexetine (40mg/day) or saffron (30mg/day) capsule for six weeks. Participants were evaluated by Hamilton depression rating scale (HDRS) at weeks 3 and 6 and the adverse events were systemically recorded.

RESULTS

By the study endpoint, no significant difference was detected between two groups in reduction of HDRS scores (P=0.62). Remission and response rates were not significantly different as well (P=1.00 and P=0.67; respectively). There was no significant difference between two groups in the frequency of adverse events during this trial.

LIMITATIONS

Relatively small sample size and short observational period were the major limitations of this study.

CONCLUSION

Short-term therapy with saffron capsules showed the same antidepressant efficacy compared with fluoxetine in patients with a prior history of PCI who were suffering from depression.

Added ondansetron for stable schizophrenia: a double blind, placebo controlled trial

It is well documented that 5-hydroxytryptamine3 (5-HT3) receptors are involved in the pathogenesis of schizophrenia and cognitive impairment. The purpose of this study was to assess the efficacy of ondansetron, a 5-HT3 receptor antagonist as an adjuvant agent in the treatment of chronic schizophrenia in particular for cognitive impairments. This investigation was a 12-week, double blind study of parallel groups of patients with stable chronic schizophrenia. Thirty patients were recruited from inpatient and outpatient departments. All participants met Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision (DSM-IV-TR) criteria for schizophrenia. To be eligible, patients were required to have been treated with a stable dose of risperidone as their primary antipsychotic treatment for a minimum period of 8 weeks. The subjects were randomized to receive ondansetron (8 mg/day) or the placebo in addition to risperidone. Clinical psychopathology was assessed with Positive and Negative Syndrome Scale (PANSS). Cognition was measured by a cognitive battery. Patients were assessed at baseline and after 8, and 12 weeks after the medication started. The PANSS scores and cognitive performance were used as the outcome measures. The ondansetron group had significantly greater improvement in the negative symptoms, general psychopathological symptoms and PANSS total scores over the trial. Administration of ondansetron significantly improved visual memory based on improvement on visual reproduction, visual paired associate and figural memory sub tests of Wechsler Memory Scale--Revised. The present study indicates ondansetron as potential adjunctive treatment strategy for chronic schizophrenia particularly for negative symptoms and cognitive impairments.

Asymptomatic bacteriuria in type 2 Iranian diabetic women: a cross sectional study

Background

The risk of developing infection in diabetic patients is higher and urinary tract is the most common site for infection. Serious complications of urinary infection occur more commonly in diabetic patients. To study the prevalence and associates of asymptomatic bacteriuria (ASB) in women with type 2 diabetes mellitus in the Iranian population, this study was conducted.

Methods

Between February 10, 2004 and October 15, 2004; 202 nonpregnant diabetic (type 2) women (range: 31 to 78 years old) with no abnormalities of the urinary tract system were included in this clinic based study. We defined ASB as the presence of at least 10⁵ colony-forming units/ml of 1 or 2 bacterial species, in two separated cultures of clean-voided midstream urine. All the participants were free from any symptoms of urinary tract infection (UTI). Associates for developing bacteriuria was assessed and compared in participants with and without bacteriuria.

Results

In this study, the prevalence of ASB was 10.9% among diabetic women. E. coli was the most prevalent microorganism responsible for positive urine culture. Most of the isolated microorganisms were resistant to Co-trimoxazole, Nalidixic acid and Ciprofloxacin. Pyuria (P < 0.001) and glucosuria (P < 0.05) had a meaningful relationship with bacteriuria but no association was evident between age (P < 0.45), duration of diabetes (P < 0.09), macroalbuminuria (P < 0.10) and HbA_1c level (P < 0.75), and the presence of ASB.

Conclusion

The prevalence of ASB is higher in women with type 2 diabetes, for which pyuria and glucosuria can be considered as associates. Routine urine culture can be recommended for diabetic women even when there is no urinary symptom.