Natural substances are increasingly used to treat mental health disorders, in particular, but not limited to, anxiety and depression. Now, finally, a useful tool has arrived to orient oneself in a galaxy of offers sometimes of dubious effectiveness. Thanks to an international working group made up of researchers from fifteen countries, which has developed new guidelines on the effectiveness of nutraceuticals and medicinal plants. Important information, recently published in the World Journal of Biological Psychiatry, based on studies involving more than ten thousand subjects. And which make it possible to distinguish the most solid proofs from the only partial ones.
“These recommendations clarify many substances often used in the hope of obtaining results, without there being confirmation of effectiveness,” he explains. Pariant Crimson, a lecturer in psychiatry at King’s College London. “With a few exceptions, these are substances that can accompany a drug, not replace it, without forgetting that natural does not mean without risk”.
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Among the few substances that can be used alone is St. John’s wort, whose recommendations confirm its effectiveness as an antidepressant, with the warning to use standardized extracts that guarantee a sufficient dose of active ingredients. A common problem with many herbal supplements and medicines: “There is a lot of confusion in this area,” he points out Fabio FirenzuoliProfessor of Phytotherapy at the University of Florence and Director of CERFIT, Center for Research and Innovation in Phytotherapy and Integrated Medicine.
“There may be extracts from the same plants, with similar characteristics, but with very different quality, safety and efficacy guarantees,” continues Firenzuoli. “As for hypericum, it has been available for years among registered drugs, which guarantees quality, the right dosage and all the information on the many drug interactions”. Interactions, let us remember, which also concern the Hypericum present in the supplements, which also has a different role from the therapeutic role.
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Saffron and turmeric
According to Firenzuoli, other herbs whose guidelines indicate some confirmation of efficacy “at high concentrations of active ingredients are saffron and turmeric.” “They can be useful in certain patients, by exploiting their antioxidant characteristics in ad hoc preparations, as a support for therapy”, explains the teacher. More compelling is the evidence for the antidepressant effects of omega 3s, especially EPA (eicosapentaenoic acid), when used in addition to medications. “These are indications that confirm what we knew – specifies Pariante -. It should be remembered that the best results are obtained in subjects who present a level of inflammation in the body, and that these substances are only effective in large doses, otherwise it just gets a placebo effect.”
For anxiety, the herbal remedies that seem to work best are Lavender and Ashwaganda (Withania somnifera) also known as Indian ginseng: “Lavender essential oil is a good anxiolytic, well tolerated, also studied by our group, and it is available in the form of a drug”, specifies Firenzuoli, “while Ashwaganda is interesting for its anti-stress effect, but before entering into real directives, it would still be necessary to ‘study for both efficacy and safety’.
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The other substances
The list of substances whose effectiveness is not confirmed is very long, or is only effective in the event of proven deficiencies. “In general, this type of supplement is only useful if specific deficiencies are found,” recalls Pariante.
These include magnesium, vitamin C and tryptophan to treat depression, vitamin D in schizophrenia and, among herbs, Rhodiola as an antidepressant and Kava to treat anxiety. “The Rodiola, if anything, can be useful in favoring the adaptations of the organism – from a physical and mental point of view – to internal physiological and environmental changes – recalls Firenzuoli – as for Kava, it is a promising plant that we are studying, but it is too early to give indications”.
They don’t work for ADHD or schizophrenia
Indications for treatments of other disorders, such as ADHD or schizophrenia, are less encouraging, for which there are no really effective supplements or herbs. “A moderate positive effect of N acetyl cysteine appeared, which acts on the toxic substances produced by oxidative stress which can damage the functionality of neurons”, explains Pariante. “Depending on the area of the brain in which it acts, it can be useful for various pathologies: for schizophrenia, it shows some effectiveness in the treatment of negative symptoms such as social withdrawal”. Similar effects could have ginkgo biloba in some cases, although the confirmations are modest. And, as Firenzuoloi reminds us, “it is still essential to avoid doing it yourself and to leave it to expert hands”.
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