Does it work? Can saffron help depression?

 

BACKGROUND:Depression ranks among one of the five most common illnesses in the world. It is expected to be the second-leading cause of disability by 2020. While pharmaceutical treatments are commonly used, each has its limitations and side effects. Many have turned to herbal remedies as a more “natural” way of treating depression. St John’s wort has been shown to be effective, but it also has adverse effects especially when taken with other medications.

Other herbal remedies have reputations for treating depression and are now being tested in controlled trials.

A systematic review of all such herbs other than St John’s wort was published last month. It identified a total of nine randomised controlled trials of herbal remedies for depression, six of which involved saffron.

Saffron is an ancient spice made from the flowers of Crocus sativa. Unlike the spring crocus, the saffron crocus blooms in the autumn. In addition to the purple petals and yellow styles, saffron crocus flowers also have red stigmas. These thread-like structures are used to make saffron used in cooking and herbal remedies. Saffron has been cultivated in the Middle East for thousands of years.

Its collection is highly labour intensive as each stigma is separated from the flowers by hand. It takes tens of thousands of flowers to make one pound of spice. All this makes high-quality saffron very expensive, and substitution with less expensive spices relatively common.

Traditionally, saffron was used to treat many different ailments, including some that today might be called depression. A traditional Chinese medical text said it caused “a person’s heart to be happy”, while wealthy ancient Persians scattered saffron stigmas on their beds to relieve melancholy. Such traditional uses have led to recent research on saffron for depression.

EVIDENCE FROM STUDIES

Since the turn of the millennium, studies have validated an anti-depressant effect in animals. As noted above, this led to six controlled trials of saffron being published since 2004. Most of these involved people with mild to moderate depression, although two involved patients with major depression.

The studies used commercial extracts made by an Iranian company, not the saffron spice readily available in Ireland. In separate trials, saffron stigmas and petals were found to be significantly more effective than placebo. In two more trials, both saffron preparations were found to be as effective as Prozac. A saffron stigma preparation was found to be as effective as imipramine, an older antidepressant. The other trial found the stigma and petal preparations to be equally effective in relieving depression.

PROBLEMATIC ASPECTS

In the above trials, no differences in side effects were found between saffron and Prozac. Saffron has been found to be well tolerated at the

doses used in the trials (30mg of extract daily). However, large doses cause serious adverse effects. About 5g leads to yellowing of the skin, vomiting, vertigo and bleeding. Pregnant women who took 10g had miscarriages and 12-20g has been fatal.

RECOMMENDATIONS

The results of the trials of saffron extract are encouraging. However, all of these studies were conducted by the same research team and it would be important that they be replicated independently.

Each study involved a small number of patients (between 30 and 48). One was conducted over eight weeks, and the others lasted only six weeks. All these factors are important limitations and point to the need for larger and longer trials.

While people in these trials benefited from 30mg per day of the extracts, studies have not been published on saffron spice for cooking. It is unclear whether it would have any of the benefits reported for the commercial extract.

Herbal remedies, like medicines, are just one way of addressing depression. Various lifestyle factors and talking to others are also important. If the symptoms become more serious or debilitating, professional help should be considered.

Dónal OMathúna has a PhD in pharmacy, researching herbal remedies, and an MA in bioethics, and is a senior lecturer in the School of Nursing, Dublin City University.