Abk�rzung zur Hauptnavigation Abk�rzung zu den Newsmeldungen Abk�rzung zu den Topstories  
  Barrierefreiheit    Kontakt MedUni Wien    Intranet    MedUni Wien - Shop    Universitätsbibliothek    Universitätsklinikum AKH Wien  
 
ccc_logo_en.gif
 
AKH Wien
 
 
Hauptnavigation
  • Home
  • Über das CCC
    • Allgemeines
    • Leitung der Organisationseinheit
    • CCC-Office Team
    • Kliniken und Partner
    • Qualitätsmanagement
    • Kontakt
  • PatientInnen
    • Covid-19
    • Allgemeines
    • Cancer School
    • Terminvereinbarung
    • Pflegeambulanz
    • PatientInnenvertretung
    • Links
  • Klinischer Bereich
    • Allgemeines
    • CCC Tumorboards
  • Wissenschaft & Forschung
    • Young CCC
    • CCC-ExpertInnenvideos
    • CCC Forschungscluster
    • CCC Units
    • CCC Platforms
    • Translationale Forschung
    • CCC Best Paper Award
    • CCC-TRIO Symposium
    • Kontakt/Links
  • Lehre
    • CCC Cancer School
    • CCC Cancer Update
    • Vienna International Summer School on Clinical and Experimental Oncology - VSSO
    • Interdisziplinäre onkologische Ausbildung
    • Klinisch-Praktisches Jahr (KPJ)
    • PhD Programme
    • Postgraduelle Fort- und Weiterbildung
    • Information/Contact
 
 
Subnavigation
    Inhaltsbereich


    Zurück zur Übersicht
    The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry. 2022 Mar 21. doi: 10.1080/15622975.2021.2013041
    Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce.
    Sarris J1,  Ravindran A2,  Yatham LN3,  Marx W4,  Rucklidge JJ5,  McIntyre RS6,  Akhondzadeh S7,  Benedetti F8,  Caneo C9,  Cramer H10,  Cribb L11,  de Manincor M12,  Dean O13,  Deslandes AC14,  Freeman MP15,  Gangadhar B16,  Harvey BH17,  Kasper S18,  Lake J19,  Lopresti A20,  Lu L21,  Metri NJ22,  Mischoulon D23,  Ng CH24,  Nishi D25,  Rahimi R26,  Seedat S27,  Sinclair J28,  Su KP29,  Zhang ZJ30,  Berk M31
    Author information
    1NICM Health Research Institute, Western Sydney University, Westmead, Australia.
    2University of Toronto and Centre for Addiction and Mental Health, Toronto, Canada.
    3University of British Columbia, Vancouver, Canada.
    4Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.
    5School of Psychology, Speech, and Hearing, University of Canterbury, Christchurch, New Zealand.
    6University of Toronto, Mood Disorders Psychopharmacology Unit, Toronto, Canada.
    7Psychiatry and Psychology Research Centre, Roozbeh Hospital, Tehran University of Medical Science, Tehran, Iran.
    8School of Medicine, Università Vita-Salute San Raffaele, Milan, Italy.
    9Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile.
    10Department of Internal and Integrative Medicine, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
    11The Professorial Unit, The Melbourne Clinic; Department of Psychiatry, University of Melbourne, Melbourne, Australia.
    12NICM Health Research Institute, Western Sydney University, Westmead, Australia.
    13Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.
    14Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
    15Women's Mental Health Program, Department of Psychiatry, Obstetrics and Gynaecology and Department of Nutritional Sciences, College of Medicine, University of Arizona, Tucson, United States.
    16Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
    17Division of Pharmacology, Centre of Excellence for Pharmaceutical Sciences, School of Pharmacy, North West University, Potchefstroom, South Africa.
    18Department of Psychiatry and Psychotherapy, Center for Brain Research, Medical University of Vienna, Vienna, Austria.
    19NICM Health Research Institute, Western Sydney University, Westmead, Australia.
    20College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia.
    21Institute of Mental Health and Peking University Sixth Hospital, Peking University and National Institute of Drug Dependence, Beijing, China.
    22NICM Health Research Institute, Western Sydney University, Westmead, Australia.
    23Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
    24The Professorial Unit, The Melbourne Clinic; Department of Psychiatry, University of Melbourne, Melbourne, Australia.
    25Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
    26Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Science, Tehran, Iran.
    27Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
    28NICM Health Research Institute, Western Sydney University, Westmead, Australia.
    29Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.
    30School of Chinese Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China.
    31Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Melbourne, Australia.
    Abstract

    OBJECTIVES: The therapeutic use of nutrient-based 'nutraceuticals' and plant-based 'phytoceuticals' for the treatment of mental disorders is common; however, despite recent research progress, there have not been any updated global clinical guidelines since 2015. To address this, the World Federation of Societies of Biological Psychiatry (WFSBP) and the Canadian Network for Mood and Anxiety Disorders (CANMAT) convened an international taskforce involving 31 leading academics and clinicians from 15 countries, between 2019 and 2021. These guidelines are aimed at providing a definitive evidence-informed approach to assist clinicians in making decisions around the use of such agents for major psychiatric disorders. We also provide detail on safety and tolerability, and clinical advice regarding prescription (e.g. indications, dosage), in addition to consideration for use in specialised populations.

    METHODS: The methodology was based on the WFSBP guidelines development process. Evidence was assessed based on the WFSBP grading of evidence (and was modified to focus on Grade A level evidence - meta-analysis or two or more RCTs - due to the breadth of data available across all nutraceuticals and phytoceuticals across major psychiatric disorders). The taskforce assessed both the 'level of evidence' (LoE) (i.e. meta-analyses or RCTs) and the assessment of the direction of the evidence, to determine whether the intervention was 'Recommended' (+++), 'Provisionally Recommended' (++), 'Weakly Recommended' (+), 'Not Currently Recommended' (+/-), or 'Not Recommended' (-) for a particular condition. Due to the number of clinical trials now available in the field, we firstly examined the data from our two meta-reviews of meta-analyses (nutraceuticals conducted in 2019, and phytoceuticals in 2020). We then performed a search of additional relevant RCTs and reported on both these data as the primary drivers supporting our clinical recommendations. Lower levels of evidence, including isolated RCTs, open label studies, case studies, preclinical research, and interventions with only traditional or anecdotal use, were not assessed.

    RESULTS: Amongst nutraceuticals with Grade A evidence, positive directionality and varying levels of support ( or was found for adjunctive omega-3 fatty acids (+++), vitamin D (+), adjunctive probiotics (++), adjunctive zinc (++), methylfolate (+), and adjunctive s-adenosyl methionine (SAMe) (+) in the treatment of unipolar depression. Monotherapy omega-3 (+/-), folic acid (-), vitamin C (-), tryptophan (+/-), creatine (+/-), inositol (-), magnesium (-), and n-acetyl cysteine (NAC) (+/-) and SAMe (+/-) were not supported for this use. In bipolar disorder, omega-3 had weak support for bipolar depression (+), while NAC was not currently recommended (+/-). NAC was weakly recommended (+) in the treatment of OCD-related disorders; however, no other nutraceutical had sufficient evidence in any anxiety-related disorder. Vitamin D (+), NAC (++), methylfolate (++) were recommended to varying degrees in the treatment of the negative symptoms in schizophrenia, while omega-3 fatty acids were not, although evidence suggests a role for prevention of transition to psychosis in high-risk youth, with potential pre-existing fatty acid deficiency. Micronutrients (+) and vitamin D (+) were weakly supported in the treatment of ADHD, while omega-3 (+/-) and omega-9 fatty acids (-), acetyl L carnitine (-), and zinc (+/-) were not supported. Phytoceuticals with supporting Grade A evidence and positive directionality included St John's wort (+++), saffron (++), curcumin (++), and lavender (+) in the treatment of unipolar depression, while rhodiola use was not supported for use in mood disorders. Ashwagandha (++), galphimia (+), and lavender (++) were modestly supported in the treatment of anxiety disorders, while kava (-) and chamomile (+/-) were not recommended for generalised anxiety disorder. Ginkgo was weakly supported in the adjunctive treatment of negative symptoms of schizophrenia (+), but not supported in the treatment of ADHD (+/-). With respect to safety and tolerability, all interventions were deemed to have varying acceptable levels of safety and tolerability for low-risk over-the-counter use in most circumstances. Quality and standardisation of phytoceuticals was also raised by the taskforce as a key limiting issue for firmer confidence in these agents. Finally, the taskforce noted that such use of nutraceuticals or phytoceuticals be primarily recommended (where supportive evidence exists) adjunctively within a standard medical/health professional care model, especially in cases of more severe mental illness. Some meta-analyses reviewed contained data from heterogenous studies involving poor methodology. Isolated RCTs and other data such as open label or case series were not included, and it is recognised that an absence of data does not imply lack of efficacy.

    CONCLUSIONS: Based on the current data and clinician input, a range of nutraceuticals and phytoceuticals were given either a supportive recommendation or a provisional recommendation across a range of various psychiatric disorders. However several had only a weak endorsement for potential use; for a few it was not possible to reach a clear recommendation direction, largely due to mixed study findings; while some other agents showed no obvious therapeutic benefit and were clearly not recommended for use. It is the intention of these guidelines to inform psychiatric/medical, and health professional practice globally.


    KEYWORDS: ADHD, Nutrients, affective disorders, herbal medicines, schizophrenia

    Publikations ID: 35311615
    Quelle: öffnen
     
    Drucken
     
    ccc_logo_en.gif
    ccc_logo_en.gif
    ccc_logo_en.gif

    Schnellinfo

     
    -- Initiative Krebsforschung / Krebsforschungslauf

    -- Cancer Care
    -- Kliniken und Partner
    -- CCC Cancer School
    -- Young CCC
    -- CCC Tumorboards
    -- CCC Forschungscluster
    -- CCC Units
    -- CCC Platforms
    -- SOPs / Leitlinien
    -- Kontakt
    Zuklappen
     
    Ausklappen
     
     

    Featured

     
     
     
     
     
     
     
     
     
     
     
     
     
    © MedUni Wien |
     Impressum | Nutzungsbedingungen | Kontakt