Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce.
Level 1 - systematic review of randomized trials
Clinical practice guideline synthesized from meta-reviews of meta-analyses and randomized controlled trials
PubMed 35311615 · doi:10.1080/15622975.2021.2013041
What was done
An international taskforce of 31 academics and clinicians from 15 countries (convened by WFSBP and CANMAT from 2019 to 2021) developed clinical guidelines for nutraceutical and phytoceutical use in major psychiatric disorders. The taskforce evaluated Grade A evidence (meta-analyses or two or more RCTs), synthesizing data from two previous meta-reviews of meta-analyses alongside an updated search of relevant RCTs. Recommendations were categorized into Recommended (+++), Provisionally Recommended (++), Weakly Recommended (+), Not Currently Recommended (+/-), or Not Recommended (-). Isolated RCTs, open-label studies, and preclinical data were excluded.
What was found
The abstract reports no numerical effect sizes or confidence intervals, providing categorical recommendation levels instead: - **Unipolar depression**: Positive adjunctive support was found for omega-3 fatty acids (+++), probiotics (++), zinc (++), vitamin D (+), methylfolate (+), and SAMe (+), as well as phytoceuticals St John's wort (+++), saffron (++), curcumin (++), and lavender (+). Monotherapy omega-3, tryptophan, creatine, NAC, and SAMe were not currently recommended (+/-); folic acid, vitamin C, inositol, magnesium, and rhodiola were not recommended (-). - **Bipolar disorder**: Omega-3 had weak support for bipolar depression (+); NAC was not currently recommended (+/-). - **Schizophrenia (negative symptoms)**: NAC (++), methylfolate (++), vitamin D (+), and adjunctive ginkgo (+) were supported; omega-3 was not supported for negative symptoms. - **Anxiety and OCD**: NAC was weakly supported (+) for OCD; ashwagandha (++), lavender (++), and galphimia (+) were supported for anxiety disorders, while kava (-) and chamomile (+/-) were not recommended for generalized anxiety disorder. - **ADHD**: Micronutrients (+) and vitamin D (+) were weakly supported, while omega-3 (+/-), zinc (+/-), ginkgo (+/-), omega-9 (-), and acetyl-L-carnitine (-) were not supported or not recommended.
Why it matters
This guideline establishes an international, evidence-based standard to guide clinicians on which nutraceuticals and phytoceuticals possess sufficient trial evidence to justify adjunctive use in psychiatric care, and which lack therapeutic support.
Limits
The abstract reports no numerical effect sizes, sample sizes, or total study counts. Many reviewed meta-analyses contained heterogeneous trials with methodological shortcomings. Interventions evaluated in only a single isolated RCT were excluded from consideration, and commercial product standardization and quality variations remain major confounding factors in clinical practice.
Cited by
- context St. John's wort has been shown to significantly improve both depression and anxiety.