Using chinese herbs to treat different types of Depression

Source: The beneficial effects of the herbal medicine Free and Easy Wanderer Plus (FEWP) for mood disorders: Double-blind,placebo-controlled studies. Zhang-Jin Zhang a,*, Wan-Hu Kang b, Qiang Li b, Qing-Rong Tan c. Journal of Psychiatric Research 41 (2007) 828-836

About research

Free and Easy Wandering Pills (FEWP) is a old and well known Chinese formula used to treat premenstrual tension, depression, mood swings and stress related gastrointestinal symptoms (bloating, abdominal pain, alternating bowel habits) where there is no underlying weakness. There are have been clinical some trials to conducted determine whether FEWP has any beneficial effect on people with unipolar or bi-polar depression.

This post will summarize the two types of trials discussed from 1) to test whether FEWP was beneficial to patients on no other drug. 2) to test whether FEWP increase tolerance of CBZ and also reduced discontinuation of CBZ treatment due to its strong side effects.

 

Trials

Trial One  – 26 week random controlled double blinded: FEWP+ Placebo compared with FEWP + CBZ. 49 bi-polar depression without mania, 43 bipolar with mania).

Trial Two – 12 week random controlled double blinded weeks: FEWP compared with a Placebo group. 62 bi-polar and 87 with unipolar.

Treatment

FEWP used in trials contains these ingredients

Bupleurum (Chai Hu)

Scutellaria baicalensis Georgi (Huang Qin)

Zingiber officinale Rosc (Sheng jiang)

Angelica sinensis (Dang Gui)

Gardenia jasminoides Elles (Zhi Zi)

Paeonia suffruticosa (QIng Xian Bai)

Paeonia lactiflora (Bai Shao)

Paeonia Cocos Wolf (Fu ling)

Metha hapacalyx Briq (Bo He)

Glycrrhiza uralansis Fisch (Gan Cao)

Medical Condition

Bi-polar is a more severe type of depression with symptoms that can include: cognitive impairment, withdrawal,  mania:  hallucinations, grandiose ideas and delusions, drug and alcohol use, reckless behavior and overspending. The drug CBZ is one medication used to control bi-polar symptoms.

Uni-polar depression is another way to describe the most common types of depression that do not have more severe and psychotic symptoms but still impact people’s lives.  Symptoms’ include: poor appetite, low libdo, loss of pleasure in things, withdrawal, prolonged sadness, feelings of hopelessness and dread, low self-worth, may include use of drugs and alcohol as self-medication, more serious condition can include suicidal ideation. Major depressive disorder is diagnosed when patients have been experienced a number of symptoms for two weeks or more.

Outcomes Measured

Clinical Global Impression-Severity (CGI-S)

Clinical response of > or equal to 50% reduction in Hamilton rating scale for Depression (HAMD)

Montgomery and Asberg depression rating scale (MADRS)

Clinical response of > or equal to 50% reduction in CGI-S and YMRS

Bech-Rafaelsen Mania scale (BRMS)

Side effects were assessed at each visit

Results (for full details read article)

Trail One

Patients in adjunctive FEWP showed a significantly lower overall dis- continuation rate (31%) at endpoint compared to placebo (51%, p = 0.009), and of 15% in adjunctive FEWP discontinued due to intol- erable side effects, markedly lower than those in placebo (28%, p = 0.019). No difference in discontinuation for lack of efficacy and exacerbation was observed in the two groups. Patients receiving adjunctive FEWP had significantly fewer adverse side effects and lower serum levels of CBZ than those in placebo.

Trail Two

Both unipolar and bipolar patients assigned to FEWP displayed significantly greater improvement on the three efficacy indices and significantly higher clinical response rate (74%) than those treated with placebo (42%, p < 0.001) at endpoint.

 

Comments

FEWP does have anti-depressant effects associated with inhibition of MAO activity and modulation of monaminergic neurotransmission. Interestingly the effects of FEWP kick in late in a treatment cycle just like SSRIS, which take a few weeks to take effect. FEWP has been analyzed for other pharmaceutical actions and neuroprotective effects, for more details refer to the paper or other research.

The limitations of testing FEWP on depression is that it overlooks depression manifests with different symptoms and the formula should be adjusted to treat those symptoms. For example western diagnosed clinical depression can be presented as yin deficiency or yang deficiency or or excess patterns like liver qi stagnation caused by stress. These patterns have distinctive symptoms and pathogenesis, which a generic formula would not be suitable.

References

The beneficial effects of the herbal medicine Free and Easy Wanderer Plus (FEWP) for mood disorders: Double-blind,placebo-controlled studies: Zhang-Jin Zhang a,*, Wan-Hu Kang b, Qiang Li b, Qing-Rong Tan c. Journal of Psychiatric Research 41 (2007) 828-836

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