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Rhodiola in the management of depression--a review.

Amsterdam JD, Panossian AG. 2016. Rhodiola rosea as a putative botanical antidepressant. Phytomedicine. In print: http://dx.doi. org/10.1016/j.phymed.2016.02.009

Depression is a common and debilitating psychiatric condition with an estimated lifetime prevalence of about 16.2%. Conventional medicines currently available for depression are often associated with an incomplete response to therapy, therapeutic failure, or relapse or recurrence. Accordingly, there is interest in the identification of safe and effective complementary and alternative therapies for depression.

Rhodiola rosea (rhodiola) has been traditionally used to increase endurance and work performance, longevity, and to treat fatigue, weakness and other nervous system disorders. Classified as an adaptogenic remedy, rhodiola has been demonstrated to inhibit monoamine oxidase A and B in vitro, with antidepressant and anxiolytic effects reported in animals and humans. In this literature review, authors sought to identify studies to identify possible mechanisms of action and the safety and effectiveness of R. rosea extracts as an antidepressant in humans and animals using a variety of databases.

The authors identified numerous studies conducted in humans, and reported on a number of older clinical trials conducted in the former Soviet Union. These older trials, however, were generally uncontrolled, not adequately powered or randomised, had poorly differentiated subjects or un-validated diagnoses, and often lacked clarity regarding intervention dosing, duration, and extract description. On the other hand, more recent studies were identified that did provide a small body of randomised, placebo-controlled trials with standardised pharmaceutical grade R. rosea extracts. The authors reported overall findings that rhodiola may produce modest antidepressant effects in subjects with mild to moderate depression, and may be almost as effective as conventional antidepressants but with superior tolerability. No pooling of data or results was conducted as a part of the study, and this should be considered with the authors reporting.

Numerous potential and relevant mechanisms of actions of R. rosea were listed, including effects on key mediators of stress response, regulation of homeostasis of hypothalamic-pituitary-adrenal axis activity, modulation of the G-protein coupled receptors and associated signalling pathways, upregulation of neuropeptides, and other molecular networks involved in depression. The likelihood of the presence of several biochemical and pharmacological antidepressant-like actions were noted, with authors commenting that the apparent broad spectrum of mechanisms making it an attractive treatment.

The study provides a narrative of some of the potential mechanisms of action of rhodiola and discusses some studies investigating the effectiveness and tolerability of the herbal intervention. The authors recognise the limitations of some of the trials included and note inconsistencies in findings. Furthermore, the challenge of reproducibility of effectiveness in clinical trials for herbal medicine generally is acknowledged. The study does not describe well the method of searching for journal articles, nor the inclusion or exclusion criteria for using studies and accordingly these are key limitations of the review. The review further highlights the limited number of quality well-designed clinical trials and how this limits greater interpretation of the effects of rhodiola and its therapeutic potential in the treatment of depression.
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Author:Tester, Jodie
Publication:Australian Journal of Herbal Medicine
Geographic Code:8AUST
Date:Sep 1, 2016
Words:502
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