Treatments for Comorbid Anxiety and Mood Disorders
This chapter was included in the current book because of the high degree of comorbidity between anxiety and mood disorders that are commonly experienced by physicians when patients first present for treatment. In recent years, strong evidence has been pre
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Treatments for Comorbid Anxiety and Mood Disorders Jerome Sarris and David Mischoulon
6.1
Introduction
Anxiety disorders (such as generalized anxiety disorder) are highly comorbid with depression [1–3], and the polyvalent effects from herbal medicines can potentially target a range of symptoms that commonly overlap in these disorders. Herbal medicines with mood-elevating effects may also have anxiolytic effects. This may be due to modulation of neurological pathways that have both antidepressant and anxiolytic effects (in particular, the GABA and serotonin systems), or this may be due to anxiety being reduced when depression is adequately treated [4, 5]. For example, this effect was found in the case of a recent double-blind, randomized controlled trial (RCT) involving participants with generalized anxiety, which found that while Piper methysticum (kava) significantly reduced participants’ anxiety beyond placebo, this also occurred for their depression levels [6]. Various nutraceuticals have been shown to provide antidepressant activity, with several having notable antidepressant effects: Hypericum perforatum (St John’s wort), Crocus sativus (saffron), omega-3 fatty acids, S-adenosyl methionine (SAMe), and zinc [7]. These may have a prescriptive role in treating depression co-occurring with anxiety, though it should be noted that none of these agents have been shown to have primary anxiolytic effects. J. Sarris (*) University of Melbourne, Department of Psychiatry, The Melbourne Clinic, The Professorial Unit, ARCADIA Mental Health Research Group, 2 Salisbury St, Richmond, Melbourne, VIC 3121, Australia Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia e-mail: [email protected] D. Mischoulon Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA © Springer International Publishing Switzerland 2017 D. Camfield et al. (eds.), Evidence-Based Herbal and Nutritional Treatments for Anxiety in Psychiatric Disorders, DOI 10.1007/978-3-319-42307-4_6
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J. Sarris and D. Mischoulon
6.2
St John’s Wort (Hypericum perforatum)
6.2.1
Overview
Hypericum perforatum (St John’s wort: SJW) has been used for millennia for a range of nervous system conditions, including depression [8]. While dozens of clinical trials have consistently demonstrated SJW’s efficacy in improving mood, after two RCTs a decade ago revealed no greater efficacy than placebo [9, 10], clinical regard for the nutraceutical lessened. Notably, the negative results in those studies did not reveal a lack of antidepressant efficacy per se, but rather reflected a pattern of increasing placebo-response (and decreasing effect sizes), which also exists with conventional antidepressant studies for mild to moderate depression [11, 12]. While an abundance of SJW depression studies have been conducted, a paucity of research exists on its clinical applications in other psychiatric disorders, in particular anxiety disorders.
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