Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Victoria, Australia.
Aust N Z J Psychiatry. 2011 Jan;45(1):27-35. doi: 10.3109/00048674.2010.522554. Epub 2010 Nov 15.
Kava (Piper methysticum) is a South Pacific psychotropic plant medicine that has anxiolytic activity. This effect is achieved from modulation of GABA activity via alteration of lipid membrane structure and sodium channel function, monoamine oxidase B inhibition, and noradrenaline and dopamine re-uptake inhibition. Kava is available over the counter in jurisdictions such as the USA, Australia and New Zealand. Due to this, a review of efficacy, safety and clinical recommendations is advised.
To conduct a comprehensive review of kava, in respect to efficacy, psychopharmacology, and safety, and to provide clinical recommendations for use in psychiatry to treat generalized anxiety disorder (GAD).
A review was conducted using the electronic databases MEDLINE, CINAHL, PsycINFO and the Cochrane Library during mid 2010 of search terms relating to kava and GAD. A subsequent forward search was conducted of key papers using Web of Science cited reference search.
The current weight of evidence supports the use of kava in treatment of anxiety with a significant result occurring in four out of six studies reviewed (mean Cohen's d = 1.1). Safety issues should however be considered. Use of traditional water soluble extracts of the rhizome (root) of appropriate kava cultivars is advised, in addition to avoidance of use with alcohol and caution with other psychotropic medications. Avoidance of high doses if driving or operating heavy machinery should be mandatory. For regular users routine liver function tests are advised.
While current evidence supports kava for generalized anxiety, more studies are required to assess comparative efficacy and safety (on the liver, cognition, driving, and sexual effects) versus established pharmaceutical comparators.
卡瓦（Piper methysticum）是一种南太平洋精神药物，具有抗焦虑作用。这种作用是通过改变脂质膜结构和钠通道功能、单胺氧化酶 B 抑制以及去甲肾上腺素和多巴胺再摄取抑制来调节 GABA 活性而实现的。卡瓦在司法管辖区（如美国、澳大利亚和新西兰）可在柜台上购买。因此，建议对其疗效、安全性和临床建议进行审查。
对卡瓦在疗效、精神药理学和安全性方面进行全面审查，并为精神病学中用于治疗广泛性焦虑症（GAD）的使用提供临床建议。
在 2010 年年中，使用 MEDLINE、CINAHL、PsycINFO 和 Cochrane 图书馆的电子数据库，对与卡瓦和 GAD 相关的搜索词进行了综述。随后使用 Web of Science 引用参考文献搜索对关键论文进行了正向搜索。
目前的证据支持使用卡瓦治疗焦虑症，在综述的六项研究中有四项（平均 Cohen's d = 1.1）显示出显著效果。然而，应考虑安全性问题。建议使用传统的水溶性根茎（根）提取物，并使用适当的卡瓦品种，避免与酒精一起使用，并谨慎使用其他精神药物。如果要开车或操作重型机械，应避免使用高剂量。对于常规使用者，建议定期进行肝功能检查。
虽然目前的证据支持卡瓦用于广泛性焦虑症，但需要更多的研究来评估其与已确立的药物比较剂的相对疗效和安全性（对肝脏、认知、驾驶和性影响）。
