Complementary and Alternative Medicine Treatments for Generalized Anxiety Disorder: Systematic Review and Meta-analysis of Randomized Controlled Trials

• Published in: Advances in therapy 2018-03, Vol.35 (3), p.261-288
• Main Authors: Barić, Hrvoje, Đorđević, Veljko, Cerovečki, Ivan, Trkulja, Vladimir
• Format: Article
• Language: English
• Subjects: Cardiology; Endocrinology; Health technology assessment; Internal Medicine; Medicine; Medicine & Public Health; Oncology; Pharmacology/Toxicology; Review; Rheumatology
• ISSN: 0741-238X; 1865-8652
• DOI: 10.1007/s12325-018-0680-6

Introduction The objective was to evaluate efficacy/safety of complementary and alternative medicine (CAM) methods for generalized anxiety disorder (GAD) based on randomized controlled trials in adults. Methods Data sources . Six electronic databases (“generalized anxiety (disorder)” and “randomized trial”) and reference lists of identified publications were searched to March 2017. Study selection . Eligibility: full-text publications (English, German language); CAM versus conventional treatment, placebo/sham or no treatment; GAD diagnosed according to standard criteria; and a validated scale for disease severity. Of the 6693 screened records, 32 were included (18 on biologically-based therapies, exclusively herbal preparations; eight on manipulative and body-based therapies; and three on alternative medical systems and three on mind–body therapies). Data extraction . Cochrane Collaboration methodology was used for quality assessment and data extraction. Results Direct comparisons of Kava Kava ( Piper methysticum ) extracts to placebo (4 quality trials, n  = 233) were highly heterogeneous. Network meta-regression reduced heterogeneity and suggested a modest Kava effect [end-of-treatment Hamilton Anxiety scale score difference adjusted for baseline scores and trial duration: − 3.24 (95% CI − 6.65, 0.17; P  = 0.059), Kava Kava 4 arms, n  = 139; placebo 5 arms, n  = 359]. Lavender ( Lavandula angustifolia ) extract (1 quality trial, 10 weeks, n  = 523) and a combination of extracts of C. oxycantha , E. californica and magnesium (1 quality trial, 12 weeks, n  = 264) were superior to placebo and balneotherapy was superior to paroxetine (1 quality trial, 8 weeks, n  = 237) indicating efficacy. All other trials were small and/or of modest/low quality and/or lacked assay sensitivity. Safety reporting was poor. Conclusion Evidence about efficacy/safety of most CAM methods in GAD is limited. Apparent efficacy of certain herbal preparations and body-based therapies requires further confirmation.