Ayurvedic medicine for schizophrenia

Ayurvedic medicine was developed in India over 3000 years ago and is the oldest medical system to have survived until the present time.  It sees each individual as having a unique mind-body constitution and set of life circumstances. It is similar to traditional Chinese medicine in believing that matter and energy are the same thing. Treatment in an ayurvedic system is holistic, involving natural medicine, massage, diet and the regulation of lifestyle. Ayurveda has been used for the treatment of schizophrenia, a serious long-term mental health condition, since its formulation (c1000 BCE) although nowadays Western-style medication using antipsychotics and hospital treatment are also used. 

This review examines randomised controlled trials which compare aspects of ayurvedic medicine with the use of antipsychotics for people with schizophrenia. All trials took place in India and were for 12 weeks or less. When the ayurvedic herbs brahmyadiyoga and tagara were compared to placebo (2 trials) there was no significant difference between the two groups in acceptability of treatment or overall improvement.  The brahmyadiyoga group did, however, show some improvement when assessed ayurvedically (a combination of assessing aspects of the mind, decision, orientation, memory and habit, and looking for the absence of symptoms of illness). When these two herbs were compared to groups of people taking the antipsychotic, chlorpromazine, again there was no difference in acceptability of treatment, but in one of the two trials there was an improvement in mental state in those taking chlorpromazine. There was also a trial comparing an ayurvedic package (of herbs and other treatment) to chlorpromazine, and although both treatments were acceptable, the rest of the data were not able to be used.  Brahmyadiyoga and tagara tended to have vomiting and nausea as an adverse effect, while chlorpromazine caused people to be sleepy. It may be possible that ayurvedic treatments could be used as adjuncts to antipsychotic medication. A new larger trial comparing ayurvedic herb(s) alone, chlorpromazine alone and both together would answer this question.

 (Plain language summary prepared for this review by Janey Antoniou of RETHINK, UK www.rethink.org).


Authors' conclusions: 

Ayurvedic medication may have some effects for treatment of schizophrenia, but has been evaluated only in a few small pioneering trials.

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Background: 

Ayurvedic medicine has been used to treat mental health problems since1000 BC.

Objectives: 

To review effects of Ayurvedic medicine or treatments for schizophrenia.

Search strategy: 

We searched the Cochrane Schizophrenia Group Trials Register (March 2007) and AMED (March 2007), inspected references of all identified studies and contacted the first author of each included study.

Selection criteria: 

We included all clinical randomised trials comparing Ayurvedic medicine or treatments with placebo, typical or atypical antipsychotic drugs for schizophrenia and schizophrenia-like psychoses.

Data collection and analysis: 

We independently extracted data and calculated random effects, relative risk (RR), 95% confidence intervals (CI) and, where appropriate, numbers needed to treat/harm (NNT/H) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD).

Main results: 

From the three small (total n=250) short included studies, we were unable to extract any data on many broad clinically important outcomes such as global state, use of services, and satisfaction with treatment. When Ayurvedic herbs were compared with placebo, about 20% of people left the studies early (n=120, 2 RCTs, RR 0.77 CI 0.37 to 1.62). Mental state ratings were mostly equivocal with the exception of the brahmyadiyoga group using Ayurvedic assessment (n=68, 1 RCT, RR not improved 0.56 CI 0.36 to 0.88, NNT 4 CI 3 to 12). Behaviour seemed unchanged (n=43, 1 RCT, WMD Fergus Falls Behaviour Rating 1.14 CI -1.63 to 3.91). Nausea and vomiting were common in the brahmyadiyoga group (n=43, RR 13.13 CI 0.80 to 216.30). When the Ayurvedic herbs were compared with antipsychotic drugs (chlorpromazine), again, equal numbers left the study early (n=120, 2 RCTs, RR for brahmyadiyoga 0.91 CI 0.42 to 1.97) but people allocated herbs were at greater risk of no improvement in mental state compared to those allocated chlorpromazine (n=45, RR 1.82 CI 1.11 to 2.98). Again, nausea and vomiting were found with use of brahmyadiyoga (n=45, 1 RCT, RR 20.45 CI 1.09 to 383.97, NNH 2 CI 2 to 38). Finally, when Ayurvedic treatment, in this case a complex mixture of many herbs, is compared with chlorpromazine in acutely ill people with schizophrenia, it is equally (~10% attrition, n=36, RR 0.67 CI 0.13 to 3.53), but skewed data does seem to favour the chlorpromazine group.

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