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Review
. 2021 Oct;66(10):849-862.
doi: 10.1177/0706743720979917. Epub 2021 Feb 18.

Plant-based Medicines (Phytoceuticals) in the Treatment of Psychiatric Disorders: A Meta-review of Meta-analyses of Randomized Controlled Trials: Les médicaments à base de plantes (phytoceutiques) dans le traitement des troubles psychiatriques: une méta-revue des méta-analyses d'essais randomisés contrôlés

Jerome Sarris  1   2 , Wolfgang Marx  3 , Melanie M Ashton  3 , Chee H Ng  2 , Nicole Galvao-Coelho  1   4   5 , Zahra Ayati  1   6 , Zhang-Jin Zhang  7   8 , Siegfried Kasper  9 , Arun Ravindran  10 , Brian H Harvey  11 , Adrian Lopresti  12   13 , David Mischoulon  14 , Jay Amsterdam  15 , Lakshmi N Yatham  16 , Michael Berk  3   17   18
Affiliations
Review

Plant-based Medicines (Phytoceuticals) in the Treatment of Psychiatric Disorders: A Meta-review of Meta-analyses of Randomized Controlled Trials: Les médicaments à base de plantes (phytoceutiques) dans le traitement des troubles psychiatriques: une méta-revue des méta-analyses d'essais randomisés contrôlés

Jerome Sarris et al. Can J Psychiatry. 2021 Oct.

Abstract
in English, French

Objectives: Plant-based medicines have had a long-standing history of use in psychiatric disorders. Highly quantified and standardized extracts or isolates may be termed "phytoceuticals," in a similar way that medicinal nutrients are termed as "nutraceuticals." Over the past 2 decades, several meta-analyses have examined the data for a range of plant-based medicines in the treatment of psychiatric disorders. The aim of this international project is to provide a "meta-review" of this top-tier evidence.

Methods: We identified, synthesized, and appraised all available up to date meta-analyses... of randomized controlled trials (RCTs) reporting on the efficacy and effectiveness of individual phytoceuticals across all major psychiatric disorders.

Results: Our systematic search identified 9 relevant meta-analyses of RCTs, with primary analyses including outcome data from 5,927 individuals. Supportive meta-analytic evidence was found for St John's wort for major depressive disorder (MDD); curcumin and saffron for MDD or depression symptoms, and ginkgo for total and negative symptoms in schizophrenia. Kava was not effective in treating diagnosed anxiety disorders. We also provide details on 22 traditional Chinese herbal medicine formulas' meta-analyses (primarily for depression studies), all of which revealed highly significant and large effect sizes. Their methodology, reporting, and potential publication bias were, however, of marked concern. The same caveat was noted for the curcumin, ginkgo, and saffron meta-analyses, which may also have significant publication bias.

Conclusions: More rigorous international studies are required to validate the efficacy of these phytoceuticals before treatment recommendations can be made. In conclusion, the breadth of data tentatively supports several phytoceuticals which may be effective for mental disorders alongside pharmaceutical, psychological therapies, and standard lifestyle recommendations.

Objectif:: Les médicaments à base de plantes ont des antécédents de longue date d’utilisation dans les troubles psychiatriques. Des extraits ou isolats hautement quantifiés et normalisés peuvent porter le nom de « phytoceutiques », parallèlement aux nutriments médicinaux qui sont appelés « ‘nutraceutiques ». Au cours des vingt dernières années, plusieurs méta-analyses ont examiné les données d’une série de médicaments à base de plantes dans le traitement des troubles psychiatriques. Ce projet international vise à offrir une « méta-revue » de ces données probantes de niveau supérieur.

Méthodes:: Nous avons identifié, synthétisé et estimé toutes les méta-analyses disponibles d’essais randomisés contrôlés (ERC) portant sur l’efficience et l’efficacité des phytoceutiques individuels dans tous les principaux troubles psychiatriques.

Résultats:: Notre recherche systématique a identifié 9 méta-analyses pertinentes d’ERC, les analyses primaires comportant les données des résultats de 5 927 personnes. Des données probantes méta-analytiques de soutien ont été trouvées pour le millepertuis dans le trouble dépressif majeur (TDM); la curcumine et le safran pour le TDM ou les symptômes dépressifs, et le ginkgo pour les symptômes totaux et négatifs de la schizophrénie. Le kava n’était pas efficace pour traiter les troubles anxieux diagnostiqués. Nous donnons aussi des détails sur 22 méta-analyses de formules de phytothérapie traditionnelles chinoises (surtout pour des études sur la dépression), qui ont toutes révélé des tailles d’effet très significatives et larges. Les biais de leur méthodologie, de leurs études et de leur publication éventuelle ont cependant soulevé des préoccupations. La même mise en garde a été notée pour les méta-analyses sur la curcumine, le ginkgo, et le safran, qui peuvent aussi présenter des biais de publication significatifs.

Conclusions:: Des études internationales plus rigoureuses sont donc requises pour valider l’efficacité de ces phytoceutiques avant de pouvoir recommander des traitements. En conclusion, l’ampleur des données tente de refléter plusieurs phytoceutiques qui peuvent être efficaces pour les troubles mentaux avec la pharmacologie, les thérapies psychologiques et les recommandations usuelles de mode de vie.

Keywords: Chinese herbal medicine; anxiety; clinical trials; depression; herbal medicine; mental disorders; mental health; nutraceutical; psychiatry; schizophrenia; treatment.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.Sarris has received either presentation honoraria, travel support, clinical trial grants, book royalties, or independent consultancy payments from: Integria Healthcare & MediHerb, Pfizer, Scius Health, Key Pharmaceuticals, Taki Mai, Fiji Kava, FIT-BioCeuticals, Blackmores, Soho-Flordis, Healthworld, HealthEd, HealthMasters, Kantar Consulting, Grunbiotics, Australian Natural Therapeutics Group, Research Reviews, Elsevier, Chaminade University, International Society for Affective Disorders, Complementary Medicines Australia, SPRIM, Terry White Chemists, ANS, Society for Medicinal Plant and Natural Product Research, Sanofi-Aventis, Omega-3 Centre, the National Health and Medical Research Council, CR Roper Fellowship. C.N. had served as a consultant for Lundbeck, Grunbiotics, Servier, Janssen-Cilag, Wyeth and Eli Lilly; received research grant support from Wyeth and Lundbeck; and speaker honoraria from Servier, Lundbeck, Bristol-Myers Squibb, Organon, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, Astra-Zenaca, Wyeth, and Pfizer. M.B. has received Grant/Research Support from the NIH, Cooperative Research Centre, Simons Autism Foundation, Cancer Council of Victoria, Stanley Medical Research Foundation, Medical Benefits Fund, National Health and Medical Research Council, Medical Research Futures Fund, Beyond Blue, Rotary Health, A2 milk company, Meat and Livestock Board, Woolworths, Avant, and the Harry Windsor Foundation; has been a speaker for Astra Zeneca, Lundbeck, Merck, Pfizer; and served as a consultant to Allergan, Astra Zeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Lundbeck Merck, Pfizer, and Servier. DM has received research support from Nordic Naturals. He has provided unpaid consulting for Pharmavite LLC and Gnosis USA, Inc. He has received honoraria for speaking from the Massachusetts General Hospital Psychiatry Academy, Blackmores, Harvard Blog, and PeerPoint Medical Education Institute, LLC. He has received royalties from Lippincott Williams & Wilkins for published book “Natural Medications for Psychiatric Disorders: Considering the Alternatives.” B.H. over the past 3 years has participated in advisory boards, received honoraria from Servier, and received research funding from Servier, Lundbeck, Deakin University, Cannabis Science Inc, and HG&H Pharmaceuticals. AL has received either presentation honoraria or clinical trial grants from Arjuna Natural Ltd, Dolcas-Biotech LLC, Pharmactive Biotech Products SL, Ixoreal Biomed, Metagenics Australia, and EuroPharma Inc.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; TCHM = traditional Chinese herbal medicine.
Figure 2.
Figure 2.
Effects of phytoceuticals in psychiatric disorders, shown as standardized mean difference with 95% CI. Circles represent no significant difference from placebo; diamonds represent P ≤ 0.05 compared to placebo; A2 = AMSTAR-2 total score; CI, confidence interval; GAD = generalized anxiety disorder; MDD = major depressive disorder.
See this image and copyright information in PMC

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