Treatment of Anxiety with Kava-kava


Treatment of Anxiety with Kava-kava

Reference: Lehmann E, Kinzler E, Friedemann J. Efficacy of a special kava extract (Piper methysticum) in patients with states of anxiety, tension and excitedness of non-mental origin -- a double-blind placebo-controlled study of four weeks treatment. Phytomed 1996; 3:113-9.

Summary: In this double-blind-placebo-controlled study, 58 patients (43 females and 15 males) with a diagnosis of anxiety were divided into two groups of 29 patients each. These patients were given either 100 mg tid of standardized kava extract WS 1490 (70% kava lactones) or placebo, for a period of four weeks. Therapeutic outcome was measured using three scales: Hamilton Anxiety Scale (HAMA), Adjectives Check List (EWL), and the Clinical Global Inventory (CGI) Scale at one, two, and four weeks of treatment. In contrast to placebo, the reduction in HAMA scores was statistically significant for the kava group at all time periods (p < 0.02). The EWL subscale for anxiety/depression decreased to a greater extent with kava than with the placebo. The authors point out that CGI values decreased in contrast to placebo but no p value was given. Adverse drug reactions were not reported.

Comments/Opinions: Anxiety disorders are one of the most common psychiatric illnesses in the United States, with a lifetime prevalence of 15% in the general population. The anxiety disorders include social and simple phobia, obsessive-compulsive disorders, agoraphobia, post-traumatic stress disorder, generalized anxiety disorder and panic disorder. It is the latter two categories of neuroses, however, that clinicians are most likely to encounter on a day-to-day practice basis. This is especially true of panic disorders. Panic disorders (PD) usually begin between the ages of 15 and 35 years with patients complaining of such symptoms as heart palpitations, breathlessness, fatigue, nervousness, chest pain, etc. These symptoms can vary in degree from quite mild to being severely debilitating. While nonpharmacological interventions such as biofeedback and/or cognitive therapy are helpful strategies in the treatment of PD, drug management remains a popular choice. Benzodiazepine-type medications, tricyclic antideptressants, and fluoxetine are typical of the prescription agents recommended to patients. However, as side effects are common with these types of medications, phytosedatives like kava represent a welcome option.

This paper by Dr. Lehmann and his associates reaffirms the conclusion of earlier studies: that kava lactones (active constituents) are very effective anxiolytic agents. The majority of these clinical studies have employed a standardized extract of 70% kava lactones at a dose of 210 mg per day. This study highlights two important conclusions. First, the rapidity of kava's action insofar as it was able to dramatically lower anxiety levels after only one week of therapy. Second, its lack of adverse reactions at the recommended dose. This latter point is important given the close scrutiny kava is currently undergoing by federal regulatory agencies both in the US and Canada. While kava dermopathy is still a concern, Drs. Norton and Ruze conclude that an individual "...would need to consume an enormous quantity of kava to affect the skin so it is unlikely that kava dermopathy will occur in temperate users." However, this lack of side effects should not encourage clinicians to maintain kava therapy indefinitely. Although there are exceptions, anxiety disorders usually run a fluctuating course. As such clinicians should encourage their patients to taper and discontinue kava use with improving symptoms, resorting to the herb when needed only. Furthermore, the German Commission E monograph warns against the concomitant use of kava along with barbituates, antidepressant medications, and other agents acting on the central nervous system. Lactating or pregnant women should not use kava.

Natural Product Research Consultants, Inc.


By R. Reichert

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