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October 2009

Divalproex for Mania in Children and Adolescents: A Negative Study
The first double-blind study of divalproex (Depakote) in pediatric patients with bipolar disorder found no greater efficacy than placebo.

Chamomile Calms
A double-blind study suggests efficacy for chamomile as an alternative treatment for anxiety.

Quetiapine for GAD and MDD
In a variety of studies, quetiapine (Seroquel) was found to be effective in treating generalized anxiety and major depressive disorders.

In Brief
Valproate Does Not Improve Agitation in Patients with Dementia; Three More Atypical Antipsychotics May Be Approved for Pediatric Patients

Child and Adolescent Topics
Keep an eye out for BTP's new icon denoting articles about children and adolescents.

Chamomile Calms

October 2009

Matricaria recutita or Chamomilla recutita (chamomile) is a traditional herbal remedy reputed to help people relax. Most of us are familiar with chamomile as an herbal tea. Animal experiments suggest chamomile has anti-anxiety properties.1 In the first controlled clinical trial of chamomile in patients with generalized anxiety disorder (GAD), funded by the U.S. National Institutes of Health, Amsterdam and collaborators report positive findings.1

The authors recruited 57 patients with mild to moderate GAD for an 8-week randomized, double-blind, placebo-controlled trial of oral chamomile extract. Fifteen women and 14 men took placebo, while 19 women and 9 men took pharmaceutical-grade German chamomile extract, standardized to a content of 1.2% apigenin and prepared as 220-mg capsules.

Total scores on the Hamilton Anxiety Scale showed a significantly greater reduction over time (P = .047) for patients in the chamomile group versus those taking placebo. Secondary outcome measures failed to reach statistical significance, but they changed in the same direction as the primary outcome measure, suggesting efficacy for the active compound.

Chamomile was well tolerated. One patient in each treatment group discontinued treatment for adverse events. More overall adverse events were reported by placebo-treated patients than by those taking chamomile. Chamomile patients experienced a greater mean reduction over time in resting pulse rate than placebo patients, but there were no differences in systolic or diastolic blood pressure or body weight.

In light of these positive results, it would make sense to study chamomile further as an anti-anxiety treatment. It would, however, be premature to recommend chamomile to anxious patients at this early stage of knowledge. Herbal preparations are often poorly standardized and inconsistent in purity, and it is hard to know how much of what preparation patients would need to take—even assuming safety and efficacy were validated.

Nonetheless, it has become an axiom that the public uses alternative medicine products to a great degree. A recent survey found that Americans spend approximately $34 billion a year out-of-pocket on alternative therapies, an increase of 25% over the past decade.2 Many people "self-prescribe" alternative treatments in addition to conventional medicine and may not discuss these therapies with their doctors. Therefore, to anticipate interactions and adverse events, it is prudent to ask patients if they are using chamomile or other herbal remedies. But the time has not yet come to prescribe chamomile, although an occasional cup of its tea is unlikely to harm.

1Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J: A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol 2009;29:378-382.

2Szabo L: Americans spend $34 billion a year on alternative medicine. USA Today July 31, 2009.