Evidence-Based Reviews

CAM for your anxious patient: What the evidence says

Current Psychiatry. 2010 October;9(10):43-52

References

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Clinical Point

Evidence from RCTs shows inositol is effective for panic disorder but its use for other anxiety disorders is unproven

Inositol. Evidence from RCTs suggests inositol, a natural isomer of glucose and a precursor in the phosphatidylinositol cycle, can significantly improve panic disorder symptoms.^25-28 In 1 trial, efficacy and side effects were comparable to fluvoxamine.²⁸ Effective doses ranged from 12 g/d to 18 g/d. Researchers tested inositol as monotherapy or augmentation to SSRIs for patients with mild-to-moderate OCD. In small double-blind crossover RCTs, inositol monotherapy significantly reduced Yale-Brown Obsessive Compulsive Scale scores compared with placebo²⁶ but inositol augmentation added nothing to the effects of SSRIs.²⁷

Conclusion. Inositol appears to be effective in improving symptoms of panic disorder. Its use for other anxiety disorders is unproven.

Table 4

Dietary supplements for anxiety disorders

Study	Design	Results
Kava
Pittler et al, 2003²²	Meta-analysis of 11 RCTs with a total of 645 GAD patients	Compared with placebo, kava significantly reduced anxiety as measured by total HAM-A score
Witte et al, 2005²³	Meta-analysis of 6 RCTs using kava extract WS1490 in patients with nonpsychotic anxiety disorders	Kava reduced HAM-A score more than placebo and seemed to be more effective in women and younger adults
Sarris et al, 2009²⁴	60 adults with ≥1 month of elevated generalized anxiety randomly assigned to an aqueous extract of kava	Aqueous-extract kava was significantly more effective than placebo in reducing HAM-A score
Inositol
Benjamin et al, 1995²⁵	21 patients with panic disorder with or without agoraphobia randomly assigned to inositol, 12 g/d, or placebo	Inositol significantly reduced frequency and severity of panic attacks and severity of agoraphobia compared with placebo
Fux et al, 1996²⁶	13 OCD patients randomly assigned to inositol,18 g/d, or placebo for 6 weeks	Patients taking inositol had significantly lower Y-BOCS scores compared with those receiving placebo
Fux et al, 1999²⁷	10 OCD patients receiving an SSRI randomly assigned to augmentation with inositol, 18 g/d, or placebo for 6 weeks	No significant differences between treatments
Palatnik et al, 2001²⁸	In a crossover trial, 20 panic disorder patients completed 1 month of inositol, up to 18 g/d, and 1 month of fluvoxamine, up to 150 mg/d	Improvements in HAM-A, CGI, and agoraphobia scores were similar for both treatments
CGI: Clinical Global Impression scale; GAD: generalized anxiety disorder; HAM-A: Hamilton Anxiety Rating scale; OCD: obsessive-compulsive disorder; RCTs: randomized controlled trials; SSRI: selective serotonin reuptake inhibitor; Y-BOCS: Yale-Brown Obsessive Compulsive Scale

Supervision is recommended

The evidence base for most CAM interventions commonly used for anxiety is relatively poor and recent systematic reviews found few methodologically rigorous studies. This has not, however, diminished CAM treatments’ popularity. Despite a paucity of high-quality studies regarding CAM for anxiety disorders, there is enough data supporting yoga, exercise, bibliotherapy, kava, and inositol to allow psychiatrists to collaborate with patients who wish to try these treatments. Advise patients that they may need physician supervision similar to that used with standard psychiatric treatments.

Related Resources

National Center for Complementary and Alternative Medicine. http://nccam.nih.gov.
The Journal of Alternative and Complementary Medicine. www.liebertonline.com/loi/acm.
MedlinePlus: Complementary and Alternative Medicine. www.nlm.nih.gov/medlineplus/complementaryandalternativemedicine.html.

Drug Brand Names

Amitriptyline • Elavil
Chlordiazepoxide • Librium
Clomipramine • Anafranil
Diazepam • Valium
Fluvoxamine • Luvox

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.