1 Centre for Complementary and Alternative Medicine , Singapore, Singapore .
2 School of Biomedical Sciences, Charles Sturt University , Bathurst, Australia .
J Altern Complement Med. 2018 Aug;24(8):770-780. doi: 10.1089/acm.2018.0001. Epub 2018 Apr 11.
Generalized anxiety disorder (GAD) is a chronic and debilitating condition characterized by persistent and overpowering anxiety. Treatment of GAD with antidepressants and benzodiazepines is only moderately effective and not free from side effects. Kava (Piper methysticum) has been explored as a potential phytotherapeutic option for GAD.
To perform a systematic review and meta-analysis of the available evidence on Kava as a treatment for GAD.
Systematic search of English-language publications from major databases for clinical trials reporting the effects of Kava for the treatment of GAD.
Twelve articles were included in this review. Evidence supporting Kava as an effective treatment for GAD was found in two placebo-controlled trials and a reference-controlled trial. One negative trial demonstrated that Kava was not more effective than placebo. Meta-analyses of the results of three placebo-controlled trials (n = 130) favored Kava for GAD treatment with effect sizes between 0.59 and 0.99 (standard mean difference) without reaching statistical significance. Kava is an appealing treatment option to GAD patients who are more attune to natural remedies or lifestyle approaches to reduce stress. Positive patient experiences and improvement of vagal cardiac control due to Kava treatment were also reported in the literature. Kava is safe and well tolerated for short-term (4-8 weeks) therapeutic use at a dosage of 120-280 mg per day of Kavalactones, regardless of dosage schedule.
Current evidence, although promising, is insufficient to confirm the effect of Kava for GAD treatment beyond placebo. New evidence is expected from a large, multisite ongoing trial.
广泛性焦虑障碍（GAD）是一种慢性和使人虚弱的疾病，其特征是持续且强烈的焦虑。使用抗抑郁药和苯二氮䓬类药物治疗 GAD 的效果仅为中度有效，且并非没有副作用。卡瓦（Piper methysticum）已被探索作为治疗 GAD 的潜在植物治疗选择。
对卡瓦治疗 GAD 的现有证据进行系统评价和荟萃分析。
系统搜索主要数据库中以英语发表的关于卡瓦治疗 GAD 效果的临床试验报告。
本综述纳入了 12 篇文章。两项安慰剂对照试验和一项对照试验提供了支持卡瓦作为 GAD 有效治疗方法的证据。一项阴性试验表明，卡瓦并不比安慰剂更有效。对三项安慰剂对照试验（n=130）结果的荟萃分析（n=130）表明，卡瓦对 GAD 的治疗效果有利，效应大小在 0.59 到 0.99 之间（标准均数差），但未达到统计学意义。卡瓦是一种有吸引力的治疗选择，适用于那些更倾向于使用天然药物或生活方式来减轻压力的 GAD 患者。文献中还报道了卡瓦治疗可改善迷走神经心脏控制以及患者的积极体验。卡瓦在短期（4-8 周）治疗中是安全且耐受良好的，每天剂量为 120-280mg 的卡瓦内酯，无论剂量方案如何。
目前的证据虽然有希望，但不足以证实卡瓦治疗 GAD 的效果优于安慰剂。一项大型多中心正在进行的试验预计会提供新的证据。
