What herbal supplements and dietary supplements are used to treat anxiety disorders, major depressive disorder, and Attention Deficit Hyperactivity Disorder (ADHD)?

From the Guidelines

Herbal supplements and dietary supplements used to treat anxiety disorders, major depressive disorder, and Attention Deficit Hyperactivity Disorder (ADHD) include St. John's wort, omega-3 fatty acids, and SAMe.

Key Findings

• St. John's wort has been compared with second-generation antidepressants in 11 RCTs, with estimates from network meta-analyses indicating no differences in response, remission, and discontinuation due to adverse events between St. John's wort and antidepressants 1.
• Omega-3 fatty acids have been evaluated in 5 trials, but the evidence is insufficient to draw conclusions about their benefits and harms as single treatments or when added to antidepressants 1.
• SAMe has been evaluated in 1 trial, but the evidence is insufficient to draw conclusions about its benefits and harms as a single treatment or when added to antidepressants 1.
• Acupuncture has been compared with second-generation antidepressants in 9 trials, with findings from network meta-analysis yielding no difference in response between participants treated with acupuncture and participants treated with antidepressants 1.
• The combination of acupuncture and antidepressants achieved higher remission rates than antidepressant monotherapy in a fixed-effect meta-analyses of 3 trials 1.

Important Considerations

• Many trials compared CAM treatments with fixed-dose second-generation antidepressants, not fully using the approved dosing ranges 1.
• The certainty of evidence for many of these findings is low, and results should be interpreted cautiously 1.
• Discontinuation due to adverse events was lower for participants treated with CBT, third-wave CBT, and acupuncture than for those receiving antidepressants 1.

From the Research

Herbal Supplements for Anxiety Disorders

• Kava has been found to have potential benefits in treating anxiety disorders, particularly in patients with mild to moderate anxiety 2, 3, 4
• Inositol has been found to have modest effects in patients with panic disorder or obsessive-compulsive disorder 2
• Passiflora incarnata (passionflower) has been suggested as a potential treatment for anxiety disorders, but more research is needed 5, 4
• Lavender, hops, maypop, lemon balm, and valerian have been shown to relieve mild forms of neurological disorders, including anxiety 6

Herbal Supplements for Major Depressive Disorder

• St. John's wort has been found to be effective in alleviating mild to moderate depression, but careful use is necessary due to possible interactions with other drugs 2, 6, 4
• Saffron has been found to have potential benefits in treating depression, but its toxicological profile raises safety concerns 6, 4
• Rhodiola rosea (roseroot) and Crocus sativus (saffron) have been suggested as potential treatments for depression, but more research is needed 4

Herbal Supplements for Attention Deficit Hyperactivity Disorder (ADHD)

• Melissa officinalis, Valeriana officinalis, and Passiflora incarnata have been found to have low evidence for treating ADHD symptoms 5
• Pine bark extract and Gingko biloba have been found to have limited evidence for treating ADHD symptoms 5, 3
• Zinc, iron, Pinus marinus (French maritime pine bark), and a Chinese herbal formula (Ningdong) have been found to have predominant evidentiary support for treating ADHD 3
• Bacopa monniera (brahmi) and Piper methysticum (kava) have been suggested as potential treatments for ADHD, but more research is needed 3