Abstract
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 presented for the efficacy of these substances in addressing mood disorders.
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St John’s wort (Hypericum perforatum)
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Saffron (Crocus sativus)
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ω-3 polyunsaturated fatty acids
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Zinc
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SAMe (S-Adenosyl methionine)
Keywords
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Kessler RC et al. Co-morbid major depression and generalized anxiety disorders in the National Comorbidity Survey follow-up. Psychol Med. 2008;38(3):365–74.
Mellman TA. Sleep and anxiety disorders. Psychiatr Clin North Am. 2006;29(4):1047–58 ; abstract x.
Roth T. Insomnia as a risk factor for depression. Int J Neuropsychopharmacol. 2004;7:S34–5.
Brady KT, Verduin ML. Pharmacotherapy of comorbid mood, anxiety, and substance use disorders. Subst Use Misuse. 2005;40(13–14):2021–41 ,2043–8.
Nierenberg AA. Current perspectives on the diagnosis and treatment of major depressive disorder. Am J Manag Care. 2001;7(Suppl11):S353–66.
Sarris J et al. The Kava Anxiety Depression Spectrum Study (KADSS): a randomized, placebo-controlled, cross-over trial using an aqueous extract of Piper methysticum. Psychopharmacology (Berl). 2009;205(3):399–407.
Sarris J et al. Nutritional medicine as mainstream in psychiatry. Lancet Psychiatry. 2015;2(3):271–4.
Sarris J, Kavanagh DJ. Kava and St John’s wort: current evidence for use in mood and anxiety disorders. J Altern Complement Med. 2009;15(8):827–36.
Hypericum Depression Trial Study Group. Effect of Hypericum perforatum (St John’s wort) in major depressive disorder: a randomized controlled trial. JAMA. 2002;287(14):1807–14.
Shelton RC et al. Effectiveness of St John’s wort in major depression: a randomized controlled trial. JAMA. 2001;285(15):1978–86.
Fournier J et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010;303(1):47–53.
Werneke U, Horn O, Taylor D. How effective is St John’s wort? The evidence revisited. J Clin Psychiatry. 2004;65(5):611–7.
Butterweck V, Schmidt M. St. John’s wort: role of active compounds for its mechanism of action and efficacy. Wien Med Wochenschr. 2007;157(13–14):356–61.
Butterweck V. Mechanism of action of St John’s wort in depression : what is known? CNS Drugs. 2003;17(8):539–62.
Sublette, M., S. Ellis, A. Geant and J. Mann (2011). “Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression.” J Clin Psychiatry 72(12): 1577-1584.
Wurglics M, Schubert-Zsilavecz M. Hypericum perforatum: a ‘modern’ herbal antidepressant: pharmacokinetics of active ingredients. Clin Pharmacokinet. 2006;45(5):449–68.
Schulz HU et al. Investigation of pharmacokinetic data of hypericin, pseudohypericin, hyperforin and the flavonoids quercetin and isorhamnetin revealed from single and multiple oral dose studies with a hypericum extract containing tablet in healthy male volunteers. Arzneimittelforschung. 2005;55(10):561–8.
Biber A. Oral bioavailability of hyperforin from hypericum extracts in rats and human volunteers. Pharmacopsychiatry. 1998;31(Suppl 1):36–43.
Linde K, Berner M, Kriston L. St John’s wort for major depression. Cochrane Database Syst Rev. 2008;4:CD000448.
Rahimi R, Nikfar S, Abdollahi M. Efficacy and tolerability of Hypericum perforatum in major depressive disorder in comparison with selective serotonin reuptake inhibitors: a meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33(1):118–27.
Taylor LH, Kobak KA. An open-label trial of St. John’s Wort (Hypericum perforatum) in obsessive-compulsive disorder. J Clin Psychiatry. 2000;61(8):575–8.
Kobak KA et al. St John’s wort versus placebo in obsessive-compulsive disorder: results from a double-blind study. Int Clin Psychopharmacol. 2005;20(6):299–304.
Kobak KA et al. St. John’s wort versus placebo in social phobia: results from a placebo-controlled pilot study. J Clin Psychopharmacol. 2005;25(1):51–8.
Volz HP et al. St John’s wort extract (LI 160) in somatoform disorders: results of a placebo-controlled trial. Psychopharmacology (Berl). 2002;164(3):294–300.
Muller T et al. Treatment of somatoform disorders with St. John’s wort: a randomized, double-blind and placebo-controlled trial. Psychosom Med. 2004;66(4):538–47.
Kessler RC et al. Epidemiology of anxiety disorders. Curr Top Behav Neurosci. 2010;2:21–35.
Tyrer P, Baldwin D. Generalised anxiety disorder. Lancet. 2006;368(9553):2156–66.
Newcorn JH, Weiss M, Stein MA. The complexity of ADHD: diagnosis and treatment of the adult patient with comorbidities. CNS spectr. 2007;12(8 Suppl 12):1–14.
Weber W et al. Hypericum perforatum (St John’s wort) for attention-deficit/hyperactivity disorder in children and adolescents: A randomized controlled trial. JAMA. 2008;299(22):2633–41.
Schmidt M, Betti G, Hensel A. Saffron in phytotherapy: pharmacology and clinical uses. Wien Med Wochenschr. 2007;157(13–14):315–9.
Hosseinzadeh H, Noraei NB. Anxiolytic and hypnotic effect of Crocus sativus aqueous extract and its constituents, crocin and safranal, in mice. Phytother Res. 2009;23(6):768–74.
Lechtenberg M et al. Quality and functionality of saffron: quality control, species assortment and affinity of extract and isolated saffron compounds to NMDA and sigma1 (sigma-1) receptors. Planta Med. 2008;74(7):764–72.
Hosseinzadeh H, Sadeghnia H. Protective effect of safranal on pentylenetetrazol-induced seizures in the rat: involvement of GABAergic and opioids systems. Phytomedicine. 2007;14(4):256–62.
Pathan SA et al. Quantitative analysis of safranal in saffron extract and nanoparticle formulation by a validated high-performance thin-layer chromatographic method. Phytochem Anal. 2010;21(3):219–23.
Ghadrdoost B et al. Protective effects of saffron extract and its active constituent crocin against oxidative stress and spatial learning and memory deficits induced by chronic stress in rats. Eur J Pharmacol. 2011;667(1–3):222–9.
Nam KN et al. Anti-inflammatory effects of crocin and crocetin in rat brain microglial cells. Eur J Pharmacol. 2010;648(1–3):110–6.
Mehri S et al. Neuroprotectiveeffect of crocin on acrylamide-induced cytotoxicity in PC12 cells.Cell MolNeurobiol. 2011;32(2):227–35.
Akhondzadeh S et al. Crocus sativus L. in the treatment of mild to moderate depression: a double-blind, randomized and placebo-controlled trial. Phytother Res. 2005;19(2):148–51.
Moshiri E et al. Crocus sativus L. (petal) in the treatment of mild-to-moderate depression: a double-blind, randomized and placebo-controlled trial. Phytomedicine. 2006;13(9–10):607–11.
Akhondzadeh S et al. Comparison of Crocus sativus L. and imipramine in the treatment of mild to moderate depression: a pilot double-blind randomized trial [ISRCTN45683816]. BMC Complement Altern Med. 2004;4:12.
Noorbala AA et al. Hydro-alcoholic extract of Crocus sativus L. versus fluoxetine in the treatment of mild to moderate depression: a double-blind, randomized pilot trial. J Ethnopharmacol. 2005;97(2):281–4.
Akhondzadeh B et al. Comparison of petal of Crocus sativus L. and fluoxetine in the treatment of depressed outpatients: a pilot double-blind randomized trial. Prog Neuropsychopharmacol Biol Psychiatry. 2007;30(2):439–42.
Mischoulon D, Freeman MP. Omega-3 fatty acids in psychiatry. Psychiatr Clin North Am. 2013;36(1):15–23.
Rapaport MH et al. Inflammation as a predictive biomarker for response to omega-3 fatty acids in major depressive disorder: a proof-of-concept study. Mol Psychiatry. 2015;21(1):71–9.
Raison CL, Capuron L, Miller AH. Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol. 2006;27(1):24–31.
Tassoni D et al. The role of eicosanoids in the brain. Asia Pac J Clin Nutr. 2008;17(Suppl 1):220–8.
Sarris J, Mischoulon D, Schweitzer I. Omega-3 for bipolar disorder: meta-analyses of use in mania and bipolar depression. J Clin Psychiatry. 2012;73(1):81–6.
Stoll A. Omega-3 fatty acids in mood disorders: a review of neurobiological and clinical actions.In: Rosenbaum J,Mischoulon D, editors.Natural medications for psychiatric disorders: considering the alternatives. Philadelphia: Lippincott Williams & Wilkins;2008.p. 39–67.
Hamazaki K et al. Effect of omega-3 fatty acid-containing phospholipids on blood catecholamine concentrations in healthy volunteers: a randomized, placebo-controlled, double-blind trial. Nutrition. 2005;21(6):705–10.
Appleton KM, Rogers PJ, Ness AR. Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. Am J Clin Nutr. 2010;91(3):757–70.
Lin PY et al. Are omega-3 fatty acids antidepressants or just mood-improving agents? The effect depends upon diagnosis, supplement preparation, and severity of depression. Mol Psychiatry. 2012;17(12):1161–3 ; author reply 1163–7.
Sarris, J., J. Murphy, D. Mischoulon, M. Fava, M. Berk and C. Ng (2016). “Adjunctive Nutrient Nutraceuticals for Depression: A Systematic Review and Meta-analyses.” The American Journal Of Psychiatry; 1;173(6):575-87.
Martins JG. EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr. 2009;28(5):525–42.
Mischoulon D et al. A double-blind, randomized controlled clinical trial comparing eicosapentaenoic acid versus docosahexaenoic acid for depression. J Clin Psychiatry. 2015;76(1):54–61.
Papakostas GI. Evidence for S-adenosyl-L-methionine (SAM-e) for the treatment of major depressive disorder. J Clin Psychiatry. 2009;70(Suppl 5):18–22.
Fava M, Mischoulon D. Folate in depression: efficacy, safety, differences in formulations, and clinical issues. J Clin Psychiatry. 2009;70(Suppl 5):12–7.
Alpert JE et al. Folinic acid (Leucovorin) as an adjunctive treatment for SSRI-refractory depression. Ann Clin Psychiatry. 2002;14(1):33–8.
Papakostas GI et al. L-methylfolate as adjunctive therapy for SSRI-resistant major depression: results of two randomized, double-blind, parallel-sequential trials. Am J Psychiatry. 2012;169(12):1267–74.
Williams AL et al. S-adenosylmethionine (SAMe) as treatment for depression: a systematic review. Clin Invest Med. 2005;28(3):132–9.
Baek J, Bernstein E, Nierenberg A. One-carbon metabolism and bipolar disorder. Aust N Z J Psychiatry. 2013;47(11):1013–8.
Genedani S et al. Influence of SAMe on the modifications of brain polyamine levels in an animal model of depression. Neuroreport. 2001;12(18):3939–42.
Zomkowski AD, Santos AR, Rodrigues AL. Putrescine produces antidepressant-like effects in the forced swimming test and in the tail suspension test in mice. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30(8):1419–25.
Berlanga C et al. Efficacy of S-adenosyl-L-methionine in speeding the onset of action of imipramine. Psychiatry Res. 1992;44(3):257–62.
Papakostas GI et al. S-adenosyl methionine (SAMe) augmentation of serotonin reuptake inhibitors for antidepressant nonresponders with major depressive disorder: a double-blind, randomized clinical trial. Am J Psychiatry. 2010;167(8):942–8.
Mischoulon D et al. A Double-blind, randomized, placebo-controlled clinical trial of S-adenosyl-L-methionine (SAMe) versus escitalopram in major depressive disorder. J Clin Psychiatry2014;75(4):370–6.
Sarris J et al. S-adenosyl methionine (SAMe) versus escitalopram and placebo in major depression: efficacy and effects of histamine and carnitine as moderators of response. J Affect Disord. 2014;164:76–81.
Sarris J, Price LH, Carpenter L, Tyrka AR, Ng CH, Papakostas GI, Jaeger A, Fava M, Mischoulon D. Is S-adenosyl methionine (SAMe) for depression only effective in males? A re-analysis of data from a randomized clinical trial. Pharmacopsychiatry. 2015;48(4–5):141–4.
Mischoulon D, Raab MF. The role of folate in depression and dementia. J Clin Psychiatry. 2007;68(Suppl 10):28–33.
Deligiannidis KM, Freeman MP. Complementary and alternative medicine for the treatment of depressive disorders in women. Psychiatr Clin North Am. 33(2):441–63.
Spillmann M, Fava M. S-adenosyl-methionine (ademethionine) in psychiatric disorders. CNS Drugs. 1996;6:416–25.
Carrieri P et al. S-adenosylmethionine treatment of depressioin in patients with Parkinson’s disease: a double-blind, crossover study versus placebo. Curr Ther Res. 1990;48(1):154–60.
Di Rocco A et al. Adenosyl-Methionine improves depression in patients with Parkinson’s disease in an open-label clinical trial. Mov Disord. 2000;15(6):1225–9.
Szewczyk B, Kubera M, Nowak G. The role of zinc in neurodegenerative inflammatory pathways in depression. Prog Neuropsychopharmacol Biol Psychiatry. 2011;35(3):693–701.
Swardfager W et al. Potential roles of zinc in the pathophysiology and treatment of major depressive disorder. Neurosci Biobehav Rev. 2013;37(5):911–29.
Prasad AS. Zinc: role in immunity, oxidative stress and chronic inflammation. Curr Opin Clin Nutr Metab Care. 2009;12(6):646–52.
Yary T, Aazami S. Dietary intake of zinc was inversely associated with depression. Biol Trace Elem Res. 2011;145(3):286–90.
Swardfager W et al. Zinc in depression: a meta-analysis. Biol Psychiatry. 2013;74(12):872–8.
Lai J et al. The efficacy of zinc supplementation in depression: systematic review of randomised controlled trials. J Affect Disord. 2012;136(1–2):e31–9.
Cunha MP et al. Interaction of zinc with antidepressants in the tail suspension test. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32(8):1913–20.
Barrie SA et al. Comparative absorption of zinc picolinate, zinc citrate and zinc gluconate in humans. Agents Actions. 1987;21(1–2):223–8.
Mischoulon D, Fava M. Role of S-adenosyl-L-methionine in the treatment of depression: a review of the evidence. Am J Clin Nutr. 2002;76(5):1158S–61S.
Sarris J. Current challenges in appraising complementary medicine evidence. MJA. 2012;196(5):310–1.
Izzo AA. Drug interactions with St. John’s Wort (Hypericum perforatum): a review of the clinical evidence. Int J Clin Pharmacol Ther. 2004;42(3):139–48.
Whitten D et al. The effect of St John’s wort extracts on CYP3A: a systematic review of prospective clinical trials. Br J Clin Pharmacol. 2006;62(5):512–26.
FDA. http://www.fda.gov/Food/FoodIngredientsPackaging/GenerallyRecognizedasSafeGRAS/default.htm. 2012.
Modaghegh MH et al. Safety evaluation of saffron (Crocus sativus) tablets in healthy volunteers. Phytomedicine. 2008;15(12):1032–7.
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Sarris, J., Mischoulon, D. (2017). Treatments for Comorbid Anxiety and Mood Disorders. In: Camfield, D., McIntyre, E., Sarris, J. (eds) Evidence-Based Herbal and Nutritional Treatments for Anxiety in Psychiatric Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-42307-4_6
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