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Anna V. Dwyer, BNat, MNHAA; Dawn L. Whitten, BNat (Hons), MNHAA; Jason A. Hawrelak, PhD (SCU), BNat (Hons), MNHAA
Abstract OBJECTIVE: To evaluate herbal medicines, other than St. John’s wort, in the treatment of depression. DATA SOURCES/SEARCH METHODS: A computer-based search of Medline, Cinahl, AMED, ALT Health Watch, Psych Articles, Psych Info, Current Contents databases, CochraneControlled Trials Register, and Cochrane Database of Systematic Reviews, was performed. Researchers were contacted, and bibliographies of relevant papers and previous meta-analysis were hand searched for additional references. REVIEW METHODS: Trials were included in the review if they were prospective human trials assessing herbal medicines, other than St. John’s wort, in the treatment ofmild-to-moderate depression and utilized validated instruments to assess participant eligibility and clinical endpoints. RESULTS: Nine trials were identi ed that met all eligibility requirements. Three studies investigated sa ron stigma, two investigated sa ron petal, and one compared sa ron stigma to the petal. Individual trials investigating lavender, Echium, and Rhodiola were also located. DISCUSSION: Resultsof the trials are discussed. Sa ron stigma was found to be signi cantly more e ective than placebo and equally as e cacious as uoxetine and imipramine. Sa ron petal was signi cantly more e ective than placebo and was found to be equally e cacious compared to uoxetine and sa ron stigma. Lavender was found to be less e ective than imipramine, but the combination of lavender and imipramine was signicantly more e ective than imipramine alone. When compared to placebo, Echium was found to signi cantly decrease depression scores at week 4, but not week 6. Rhodiola was also found to signi cantly improve depressive symptoms when compared to placebo. CONCLUSION: A number of herbal medicines show promise in the management of mild-to-moderate depression. (Altern Med Rev 2010;16(1):40-49)

ReviewArticle

Herbal Medicines, other than St. John’s Wort, in the Treatment of Depression: A Systematic Review

Introduction
Depression is one of the top five most prevalent diseases worldwide.1 By 2020 it is expected to be the second-leading cause of disability globally.2 Depression typically presents as lowered mood, difficulty in thinking, loss of interest, and physical complaints such asheadache, disturbed sleep, loss of energy, and change in sex drive.3,4 It incurs substantial personal, economic, and social costs for both the individuals afflicted and those close to them.5 In Australia, 40 percent of women and 30 percent of men are estimated to experience one or more episodes of major depression during their lifetime.1,6 e prevalence of major depression is reported as 7.5 percent inAustralia, 8 percent in Canada, and 5.4-8.9 percent in the United States.2,6 While there are many potential precipitating factors, it is currently believed that depression is primarily the result of biochemical alterations in the brain.3,6 Pharmaceutical treatments, including selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants (TCA), and monoamine oxidase inhibitors (MAOI), causealterations in brain chemistry through neurotransmitter amplification and regulation and have been shown to be effective in the treatment of depression.4 Yet, a number of adverse reactions occur with pharmaceutical antidepressant administration, including anticholinergic effects, gastrointestinal effects including nausea and constipation, orthostatic hypotension, arrhythmias, weight gain, and sexualdysfunction.4 In an attempt to avoid such unwanted adverse reactions, as well as being prompted by a desire to use something natural, individuals are seeking alternatives to pharmaceutical medications. Population-based studies in Australia, Europe, and

Anna V. Dwyer, BNat, MNHAA – Naturopathic physician, based in Sydney, Australia. Dawn Whitten, BNat(Hons), MNHAA - Naturopathic physician....