Black Cohosh (Actaea racemosa) and Low mood / depression: evidence and sources

A systematic literature search revealed 35 clinical studies and one meta-analysis comprising 43,759 women, of which 13,096 were treated with isopropanolic Cimicifuga racemosa extract (iCR). Compared to placebo, iCR was significantly superior for treating neurovegetative and psychological menopausal symptoms, with a standardized mean difference of -0.694 in favor of iCR ( p Hypericum perforatum [HP]) were given (-1.020 and -0.999, respectively), suggesting a dose-dependency. For psychological symptoms, the iCR+HP combination was superior to iCR monotherapy. Efficacy of iCR was comparable to low-dose transdermal estradiol or tibolone. Yet, due to its better tolerability, iCR had a significantly better benefit-risk profile than tibolone. Treatment with iCR/iCR+HP was well tolerated with few minor adverse events, with a frequency comparable to placebo. The clinical data did not reveal any evidence of hepatotoxicity. Hormone levels remained unchanged and estrogen-sensitive tissues (e.g. breast, endometrium) were unaffected by iCR treatment. As benefits clearly outweigh risks, iCR/iCR+HP should be recommended as an evidence-based treatment option for natural climacteric symptoms. With its good safety profile in general and at estrogen-sensitive organs, iCR as a non-hormonal herbal therapy can also be used in patients with hormone-dependent diseases who suffer from iatrogenic climacteric symptoms.

Objective The main objective in this systematic review was to analyse herbal medicine interventions for anxiety and depression to detect possible benefits of herbal medicines in peri- and postmenopausal women. Material and method The trials published since inception to August 2017 were searched on the databases of MEDLINE, ISI Web of Science, Scopus and Cochran central register of controlled trials Results Twenty-one trials were included into systematic review. The anxiety score (standardized mean difference = −1.19; p = 0.04; six trials) and depression (standardized mean difference = −0.952; p = 0.023; five trials) was lower in the phytoestrogen group compared to the placebo. However, the heterogeneity was notably high among trials that assessed anxiety outcome (p < 0.0001; I 2 = 97.12%) and depression (p < 0.0001; I 2 = 94.51%), and we were unable to reduce the heterogeneity to below 90% after one with one exclusion of the studies; 1000 mg of fenugreek extract on depression and anxiety, 600 mg of Trigonella foenum‐graecum de‐husked seed extract on psychosocial symptoms, 0.4 mg/ml Maca extract on anxiety, 500 mg of Hop plant on depression and anxiety, 80 mg or more than 80 mg of red clover-derived isoflavones on psychological symptoms had significant effect. Non-significant effect was observed in black cohosh on anxiety. However, significant effect of black cohosh was seen on psychological symptoms. Fennel had a positive effect in both patients with anxiety or depression and healthy women. Flaxseed group showed a non-significant effect on psychological symptoms. Conclusion The present systematic review found that some of the herbal medicines may have good effect in the relief of the anxiety and the depression.