Evidence-Based Herbal and Nutritional Treatments for Anxiety in Psychiatric Disorders

Transcription

1 Evidence-Based Herbal and Nutritional Treatments for Anxiety in Psychiatric Disorders

2 David Camfield Erica McIntyre Jerome Sarris Editors Evidence-Based Herbal and Nutritional Treatments for Anxiety in Psychiatric Disorders

3 Editors David Camfield School of Psychology University of Wollongong Wollongong New South Wales Australia Jerome Sarris Department of Psychiatry Faculty of Medicine The University of Melbourne Melbourne Australia Erica McIntyre School of Psychology Charles Sturt University Bathurst New South Wales Australia ISBN ISBN (ebook) DOI / Library of Congress Control Number: Springer International Publishing Switzerland 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland The registered company address is Gewerbestrasse 11, 6330 Cham, Switzerland

4 For Kath, Jordan and Tyler DC For Martin and Monique If the person you are talking to does not appear to be listening, be patient. It may simply be that he has a small piece of fluff in his ear. - A.A. Milne, Winnie-the-Pooh EM To the Mermaid, the Goblin, and the Leprechaun Maintenant, je sais ce qu est l amour JS

5 Foreword A common theme today across many media articles about herbal and nutritional treatments is there is no valid evidence for their efficacy, and the risk of harm is high due to potential issues such as adulteration (sometimes deliberately with pharmaceutical drugs), idiosyncratic hepatotoxicity, and herb drug interactions. While the lack of data may have held true three or four decades ago, even a cursory search of the published literature reveals an accumulating evidence of safety and efficacy for such treatments, sometimes in a complementary role with mainstream pharmaceuticals. For example, there are now more than 30 clinical trials on the herb kava ( Piper methysticum ), including several by one of the editors of this text (Jerome Sarris). The clinical research on the psychiatric applications of N-acetylcysteine is particularly promising (as will be outlined in the context of anxiety in Chap. 5 ). This growing evidence for herbal treatments is occurring in a landscape of increasing challenges for the use of mainstream drugs in psychiatric disorders. Again, even a cursory review of the literature highlights a few of these. Not the least is the complexity of the modern patient and our increasing understanding of the many factors involved in such conditions. Taking depression as one example, one review highlighted that there are now more than five plausible hypotheses of the cause of depression, with the likelihood that these aetiological factors interact with each other in unique and complex ways in the individual patient [1]. Hence a one size fits all approach to depression, especially using a single pharmaceutical intervention, might see many patients miss out on optimal treatment. It should be no surprise therefore that the numbers needed to treat (NNTs) for a single patient to respond to a selective serotonin reuptake inhibitor (SSRI) can be as high as 12 [2]. Another review concluded that Although recent work suggests that cognitive impairment is a treatable component of major depressive disorder, and regulatory agencies seem to be encouraging treatment development for this indication, existing treatments do little to return patients level of cognitive performance to normal [3]. Hence, Chap. 4 on cognitive anxiolytics is a timely contribution to the debate, as is Chap. 6 on herbal and nutritional treatments for comorbid anxiety and mood disorders. But there are other looming problems. One example is the renewed concerns over the safety of SSRIs in teenagers, which are used to manage both anxiety and mood disorders. A reanalysis of a decade-old trial on paroxetine and imipramine in adolescence found no evidence of benefit over placebo, and found, in fact, evidence vii

6 viii Foreword of harm, including suicidal ideation and behaviour [4]. The authors concluded that The extent of the clinically significant increases in adverse events in the paroxetine and imipramine arms, including serious, severe, and suicide related adverse events, became apparent only when the data were made available for reanalysis. Researchers and clinicians should recognise the potential biases in published research, including the potential barriers to accurate reporting of harms that we have identified. Regulatory authorities should mandate accessibility of data and protocols. Not surprisingly, modern patients are increasingly looking for a third treatment option for their psychiatric problems, and this becomes urgently relevant in the case of children an option that sits between taking a drug and doing nothing. However, engaging this third option by using herbs and nutraceuticals must be credible; it needs to be underpinned by evidence. On the other hand, it is acknowledged that such agents are gentle and subtle; indeed that is their strength and what renders them valid third options. How can a pharmacologically mild agent render a clinically relevant outcome? Here enters the new concept of network pharmacology, at least as it applies to medicinal plants. Due to their chemical complexity, even a single herbal extract is a nature-designed multi-agent medicine that can simultaneously target a range of pharmacological effects. This helps to explain why identifying the active constituent in many herbal extracts has proved to be so difficult. For most if not all herbal extracts, the active constituent is the whole extract itself, as illustrated by research on the antidepressant activity of St John s wort. The potential for chemical complexity to confer polyvalent activity or polypharmacology can also explain the apparent therapeutic versatility of herbal extracts. In a review, Gertsch observed that herbal extracts might in fact be intelligent mixtures of secondary plant metabolites that have been shaped by evolutionary pressures. As such, they could represent complex therapeutic mixtures possessing an inherent and coherent synergy and polyvalence. Gertsch also notes that another important concept related to polyvalence is that of network pharmacology, as originally proposed by Hopkins. In the context of plant extracts (which, for commonly used herbs as described in this book, typically contain hundreds of potentially bioactive natural products with only mild activity), it is possible that different proteins within the same signalling network are only weakly targeted. However, this is sufficient to shut down or activate a whole pathway by network pharmacology. In other words, network pharmacology can explain how a number of weakly active plant secondary metabolites in an extract may be sufficient to exert a potent pharmacological effect without the presence of a highly bioactive compound. In the context of herbal network pharmacology, Paul Ehrlich s concept of the magic bullet is supplanted by one of a green shotgun, to paraphrase Gertsch and James Duke. The authors of this book have responded admirably to the considerable challenge of reviewing the current evidence that supports the role of herbal and nutritional treatments for anxiety (including anxiety comorbid with depression). They are well published in the field, including a recent survey of herbal medicine use behaviour in Australian adults experiencing anxiety [5]. The high level of self-prescribing discovered is of significant concern in terms of both adequate treatment and potential

7 Foreword ix herb drug interactions. It highlights that clinicians of all persuasions need to be better informed on this topic. What better resource is available then than this comprehensive text that, through its various chapters, systematically looks at the evidence for and role of herbal anxiolytics, the all-important herbal adaptogens to support stress management, and cognitive anxiolytics (again primarily herbal), together with the key nutraceuticals for anxiety? The ever-pressing issue of herb drug interactions is covered by a handy table. Above all, the information is informed and supported by the unique blend of research and clinical experience that the authors bring to their work, something that is often lacking in texts from the complementary medicine field. Kerry Bone Director Research & Development - MediHerb Adjunct Professor - School of Applied Clinical Nutrition New York Chiropractic College, USA Queensland, Australia References 1. Dale E, Bang-Andersen B, Sánchez C (2015) Emerging mechanisms and treatments for depression beyond SSRIs and SNRIs. Biochem Pharmacol 2015;95(2): Magni LR, Purgato M, Gastaldon C et al (2013) Fluoxetine versus other types of pharmacotherapy for depression. Cochrane Database Syst Rev 2013;(7):CD Keefe RS (2016) Treating cognitive impairment in depression: an unmet need. Lancet Psychiatry 2016;3(5): Le Noury J, Nardo JM, Healy D et al (2015) Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ 2015;351:h McIntyre E, Saliba AJ, Wiener KK et al (2016) Herbal medicine use behaviour in Australian adults who experience anxiety: a descriptive study. BMC Complement Altern Med 2016;16(1):60

8 Acknowledgements We would like to thank all the people who generously contributed to this book, gave their support to the project and were involved in its production: Rachel Arthur, Richard Brown, Michael Coe, Patricia Gerbarg, Jane Hutchens, Dennis McKenna, David Mischoulon, Naomi Perry, Danielle Mathersul, Genevieve Steiner, Kerry Bone, Con Stough, Rodney Croft, Andrew Scholey, Corinna Schaefer, Geetha Dhandapani and Saanthi Shankhararaman. xi

9 Contents 1 The Need for Evidence-Based Herbal and Nutritional Anxiety Treatments in Psychiatry David A. Camfield, Erica McIntyre, and Jerome Sarris Part I Clinical Evidence in Support of Herbal and Nutritional Treatments for Anxiety 2 Herbal Anxiolytics with Sedative Actions Jerome Sarris and Erica McIntyre 3 Adaptogens Naomi L. Perry and David A. Camfield 4 Cognitive Anxiolytics Genevieve Z. Steiner and Danielle C. Mathersul 5 Nutritional-Based Nutraceuticals in the Treatment of Anxiety David A. Camfield 6 Treatments for Comorbid Anxiety and Mood Disorders Jerome Sarris and David Mischoulon Part II Traditional Treatments in Need of Further Study 7 The Therapeutic Potential of Ayahuasca Michael A. Coe and Dennis J. McKenna 8 Potential Herbal Anxiolytics Erica McIntyre, David A. Camfield, and Jerome Sarris xiii

10 xiv Contents Part III Clinical Perspectives and Case Studies 9 Integrative Treatments for Masked Anxiety and PTSD in Highly Sensitive Patients Patricia L. Gerbarg and Richard P. Brown 10 SAMe in the Treatment of Refractory Depression with Comorbid Anxiety: A Case Study in a High Histamine Patient Rachel Arthur 11 A Complex Case of Undiagnosed Generalised Anxiety Disorder with Episodic Panic Attacks Jane Hutchens Herb and Nutrient-Drug Interaction Table Index