Evidence Helps Clarify Alternative Med Options

By MacReady, Norra | Clinical Psychiatry News, March 2004 | Go to article overview

Evidence Helps Clarify Alternative Med Options


MacReady, Norra, Clinical Psychiatry News


LA JOLLA, CALIF. -- Vitamins, soy protein, chondroitin, and other dietary supplements once thought to be of dubious therapeutic value are playing a growing role in medical practice, thanks to evidence supporting their use, speakers said at a meeting on natural supplements in evidence-based practice sponsored by the Scripps Clinic.

The speakers reviewed the data behind the claims for many supplements, warned about products known to have harmful effects, and reported on some emerging supplements that show promise.

Mental Health

In placebo-controlled studies, SAMe, 5-hydroxytryptophan, and St. John's wort were effective remedies for depression, said Dr. Scott Shannon, a psychiatrist at the McKee Center for Holistic Medicine, Loveland, Colo.

SAMe is "as good as anything we have," Dr. Shannon said. The studies demonstrating its efficacy, conducted in the 1980s, found it to be as effective as imipramine, which is rarely prescribed today. The pharmaceutical agents currently in use are no more effective than imipramine; they simply have fewer side effects, so Dr. Shannon said the data appear to still be valid.

As for 5-hydroxytryptophan, it is a mildly sedating serotonin precursor that is usually prescribed in doses of 50 mg to 400 mg per day. It acts quickly and appears to be safe and well tolerated.

St. John's wort relieves mild to moderate depression but is ineffective against major depression. Its use has been limited by concerns over its interactions with other drugs, most notably warfarin, digoxin, cyclosporine, and theophylline, he said.

Inositol, an isomer of glucose that is necessary for serotonin activity, was shown in randomized, clinical trials to be effective against depression, anxiety, and obsessive-compulsive disorder.

Kava, an herb from the South Pacific, also is an effective anxiolytic, but it has been associated with hepatotoxicity and other adverse effects. Its use should be limited to 3 months, Dr. Shannon said.

Pain Management

Feverfew, willow bark, devil's claw, and other supplements relieve pain through the same mechanisms as conventional drugs, said Dr. Robert Bonakdar, director of integrative pain services at the Scripps Center for Integrative Medicine.

Feverfew has been used as a folk remedy for headache, arthritis, and fever. Its main active ingredient, parthenolide, has been shown to inhibit prostaglandin synthetase and cyclooxygenase activity in leukocytes. Three of four double-blind, placebo-controlled trials showed that the dried, powdered leaves of the feverfew plant reduced the severity, duration, and frequency of migraines by a mean of 24% across the three studies.

Feverfew should be taken in capsules that provide at least 250 [micro]g of parthenolide per day, and patients should be warned that it may take as long as 4-6 weeks before they notice an effect, Dr. Bonakdar said. Its use has not been studied in pregnancy, and it is not recommended for pregnant women.

Willow bark is a rich source of salicin, the naturally occurring form of salicylic acid. In at least two open-label studies, willow bark was as effective as rofecoxib in relieving arthritis pain.

The South African plant known as devil's claw also is used for arthritis pain and myalgia, and as an external ointment for burns and sores. In four double-blind, placebo-controlled trials involving 50-197 patients with osteoarthritis and low back pain, devil's claw at a dose of 50-100 mg/day for 3-8 weeks significantly relieved pain, improved joint function, and reduced the need for rescue medication. Its only adverse effects were mild and infrequent gastrointestinal symptoms.

Another agent that shows promise is Sadenosylmethionine (SAMe). A metaanalysis of 11 studies showed that it was as effective as NSAIDs in relieving arthritis pain and restoring joint function, but with fewer adverse effects (J. …

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