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Phytopharmaceutical treatment of anxiety, depression, and dementia in the elderly: evidence from randomized, controlled clinical trials

Phytopharmaka bei der Behandlung von Angststörungen, Depressionen und Demenz bei älteren Patienten – Evidenz aus randomisierten, klinischenStudien

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Summary

Based on subgroup analyses of randomized, controlled clinical trials, we review the efficacy of three phytopharmaceutical drugs, respectively of the corresponding active substances silexan® (WS® 1265, lavender oil) in anxiety disorders, WS® 5570 (Hypericum extract) in major depression, and EGb 761® (Ginkgo biloba extract) in Alzheimer, vascular, or mixed type dementia, in elderly patients aged ≥ 60 years.

Four trials were eligible in each indication. Meta-analyses and analyses based on pooled raw data showed that the three drugs were significantly superior to placebo in the elderly subset, and that their treatment effects reflected in the main outcome measures (Hamilton Anxiety scale, Hamilton Depression scale, Neuropsychiatric Inventory) were comparable with those observed in the original trials without age restrictions.

The results confirm the efficacy of the three herbal active substances in elderly patients of ≥ 60 years of age. In anxiety, depression, and dementia, they thus represent efficacious and well-tolerated alternatives to synthetic drugs.

Zusammenfassung

Auf der Grundlage randomisierter, kontrollierter Studien untersuchten wir die Wirksamkeit dreier Phytopharmaka mit den Wirkstoffen Silexan® (WS® 1265, Lavendelöl) bei Angststörungen, WS® 5570 (Hypericum-Extrakt) bei Depressionen und EGb 761® (Ginkgo-biloba-Extrakt) bei Alzheimer- oder vaskulärer Demenz und bei Mischformen, bei Patienten im Alter ab 60 Jahren.

In jeder der drei Indikationen genügten vier Studien unseren Auswahlkriterien. Metaanalysen und Analysen auf der Grundlage der gepoolten Rohdaten wiesen auch im Kollektiv der Patienten ab 60 Jahren die Überlegenheit der drei Phytopharmaka gegenüber Plazebo nach. Dabei waren die Behandlungseffekte ähnlich jenen, die in den Ausgangsstudien für die nicht nach Alter ausgelesenen Wirksamkeitskollektive beobachtet worden waren. Das galt für die Hauptzielvariablen Hamilton Angstskala, Hamilton Depressionsskala und Neuropsychiatrisches Inventar.

Die Ergebnisse bestätigen die Wirksamkeit der drei pflanzlichen Wirkstoffe auch für ältere Patienten ab 60 Jahre. Die Präparate bieten sich damit als wirksame und gut verträgliche Alternative zu synthetischen Therapeutika bei Angststörungen, Depressionen oder Demenz an.

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Notes

  1. Silexan® (WS® 1265) is the active substance of Lasea®(Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany).

  2. WS® 5570 is the active substance of Neuroplant® (Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany).

  3. EGb 761®is the active substance of Tebonin® (Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany).

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  1. Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18–20, 1090, Vienna, Austria

    Siegfried Kasper

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Herrn Prof. Hippius zum 90. Geburtstag gewidmet.

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Kasper, S. Phytopharmaceutical treatment of anxiety, depression, and dementia in the elderly: evidence from randomized, controlled clinical trials. Wien Med Wochenschr 165, 217–228 (2015). https://doi.org/10.1007/s10354-015-0360-y

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