Comparison of Crocus sativus L. and imipramine in the treatment of mild to moderate depression: A pilot double-blind randomized trial [ISRCTN45683816]

BACKGROUND: The morbidity and mortality associated with depression are considerable and continue to increase. Depression currently ranks fourth among the major causes of disability worldwide, after lower respiratory infections, prenatal conditions, and HIV/AIDS. Crocus sativus L. is used to treat depression. Many medicinal plants textbooks refer to this indication whereas there is no evidence-based document. Our objective was to compare the efficacy of stigmas of Crocus sativus (saffron) with imipramine in the treatment of mild to moderate depression in a 6-week pilot double-blind randomized trial. METHODS: Thirty adult outpatients who met the Diagnostic and Statistical Manual of Mental Disorders, 4(th )edition for major depression based on the structured clinical interview for DSM IV participated in the trial. Patients have a baseline Hamilton Rating Scale for Depression score of at least 18. In this double-blind, single-center trial, patients were randomly assigned to receive capsule of saffron 30 mg/day (TDS) (Group 1) and capsule of imipramine 100 mg/day (TDS) (Group 2) for a 6-week study. RESULTS: Saffron at this dose was found to be effective similar to imipramine in the treatment of mild to moderate depression (F = 2.91, d.f. = 1, P = 0.09). In the imipramine group anticholinergic effects such as dry mouth and also sedation were observed more often that was predictable. CONCLUSION: The main overall finding from this study is that saffron may be of therapeutic benefit in the treatment of mild to moderate depression. To the best of our knowledge this is the first clinical trial that supports this indication for saffron. A large-scale trial with placebo control is warranted

Pharmacotherapy of schizophrenia

Traditionally, schizophrenia was considered to be a severe psychiatric disorder, with a chronic course and an unfavorable outcome. Throughout history, there has been incidence of schizophrenia, roughly one percent of the population, consistently, in every culture. It is generally acknowledged that schizophrenia has multifactorial etiology, with multiple susceptibility genes interacting with environmental insults to yield a range of phenotypes in the schizophrenia spectrum. The discovery of antipsychotics in the 1950s revolutionized the treatment of schizophrenia and focused on the positive symptoms. By the 1960s, however, it became evident that the reduction in positive symptoms did not lead to recovery from schizophrenia and did not significantly improve the functional outcome. The advent of the novel antipsychotics during the last 15 years represents a significant improvement over the effectiveness of conventional antipsychotics. These agents are, however, not a magic bullet and bear their own side effects, such as weight gain, diabetes, hyperprolactinemia, and QTc prolongation. Nevertheless, at this point, they seem to be more effective and safer than the conventional antipsychotics. Moreover, advances in the treatment of schizophrenia have been and continue to be urgently needed

Antipsychotic Drugs and Sudden Death

Sudden, unexpected death may occur in apparently healthy individuals. Its occurrence in psychiatric patients has raised the concern that the use of psychotropics, especially antipsychotics, may be associated with an increased risk of sudden death. This concern is maintained even though not all psychiatric patients who have succumbed to sudden death have been on psychotropics. Early reports presented the concern that the use of chlorpromazine and thioridazine were associated with sudden death. More recently, the focus shifted to the more potent agents. Indeed, the FDA Advisory Committee discussed the possibility of a connection between sudden death and haloperidol. No decision could be reached by the FDA Committee because of the enormous complexity of the problem. Nonetheless, since sudden death continues to catastrophically complicate the course of some patients, the scope of this review is to further investigate the relationship between antipsychotic agents and sudden death