Phytoceuticals, nutraceuticals could play role in psychiatric care, review finds

22 Mar 2022 --- An international review of alternative psychological treatments found nutraceuticals and phytoceuticals could supplement mental health treatment. Looking at the “best of the best” scientific evidence, researchers and clinicians generated first-of-their-kind tentative clinical guidelines for natural treatment options, but caution more research is needed.

“Unfortunately, there are less financial incentives for manufacturers to spend large sums of money on randomized controlled trials that would provide more robust proof of benefit, as would normally occur for pharmaceutical products,” Dr. Arun Ravindran, researcher and clinician-scientist for Canada’s Centre for Addiction and Mental Health, tells NutritionInsight.

The review highlights the role of ingredients such as adjunctive probiotics, botanicals, vitamins D and C or zinc for mood disorders as a provisional recommendation. It aims to address current guideline gaps and assist clinicians in an evidence-informed approach to decision-making around the growing interest and use of supplements for major psychiatric disorders.

Lavender is weakly recommended in treating anxiety.Specifically, researchers examined the role ingredients could have in providing mild relief for symptoms of mood disorders, anxiety disorders, schizophrenia and ADHD. 

Emerging patient preference for “natural options”
According to Ravindran, more psychologists and care providers find themselves faced with demands for natural remedies.

“Patients are often expressing interest or even preference for more ‘natural’ treatment options that would include nutraceuticals. As a result, clinicians are reviewing and generating more evidence in the field to make appropriate clinical recommendations. 

Clinicians and the public often aren’t sure of what is effective and isn’t, notes Dr. Jerome Sarris of integrative mental health at NICM Health Research Institute at Western Sydney University in Australia and lead researcher of the review. 

“Our research and guidelines provide much more assurance based on the evidence, giving firmer guidance on effectiveness, dosage, population base for use, conditions and special considerations,” he continues.

Ravindran highlights that a major advantage to a lot of natural alternatives is the lower chance of side effects and greater tolerability, which is linked with higher compliance rates for use directions, especially for longer-term symptoms.

“It is also important to note that in general, the adverse effects associated with nutraceuticals are considerably less than those seen with pharmaceutical agents. Improved tolerability means better compliance and adherence, particularly long-term for chronic forms of illness.”

Deficiencies can have psychological implications
Ravindran continues that sophisticated information and data is limited with nutraceuticals but there has been emergence of more recent studies that are rectifying this deficiency, at least with some compounds such as S-adenosyl methionine and omega-3 fatty acids

“Some nutraceuticals help regulate the stress response and are referred to as adaptogens. They include ashwagandha, rhodiola, ginseng and lavender,” he says.The review was commissioned by the World Federation of Societies of Biological Psychiatry and the Canadian Network for Mood and Anxiety Treatments.

“Unfortunately, there are deficiencies in many research designs used to evaluate nutraceuticals and many studies are of poor quality due to small sample sizes, poor standardization of interventions and lack of standardized measures. Large studies that correct these deficiencies would be helpful to improve the data on nutraceuticals.”

Noting that vitamins have been highlighted for their potential role in treatment, Ravindran adds certain mental disorders and symptoms can be associated with deficiencies of essential vitamins and nutrients: 

“Other nutraceuticals make up for deficiencies that have been linked to symptoms of mood and anxiety disorders, and these include vitamins C and D.” 

“The initial signals are good, but we need more robust studies with large numbers of subjects to determine the threshold of efficacy by a measure such as effect size.”

Nutraceuticals, phytoceuticals and pharmaceuticals
Researchers distinguished nutraceuticals as nutrient-based natural products, while phytoceuticals are plant-based natural products. Ravindran distinguishes these from pharmaceuticals based on the level of research on the substance in question:

Saffran is noted for its role in aiding depressive symptoms.“Nutraceuticals are dietary supplements and food items, while pharmaceuticals involve one or a few compounds produced and tested in a controlled environment, and thus their effects on the body are more tailored and well-known.”

“With the classical pharmaceuticals, there is much more data on the chemistry of the compounds and how they mediate therapeutic benefit. Furthermore, there is evidence on biomarkers that can predict response for a particular drug.”

Nutraceuticals and phytoceuticals are not generally accepted to have the same level of targeted efficacy and reliability as traditional pharmaceutical psychiatric drugs. Consequently, the scientists are calling for more clinical trials to better understand the role these substances may play in treating patients who dislike traditional psychiatric drugs.

Ravindran recommends that it would be helpful for groups of clinicians interested in using nutraceuticals to get together and document benefits naturalistically but with good tools that can measure change. 

“It is also to note that nutraceuticals may not only help in treating certain disorders but can help to maintain wellness, as they may help optimize stress responses and prevent illness recurrences.”

Recently, NutritionInsight highlighted mental health as a “game-changer” in the nutrition world. 

By Olivia Nelson