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Special Swedish Rhodiola Extract Shows Benefit for Mild to Moderate Depression
Reviewed: Darbinyan V, Aslanyan G, Amroyan E, Gabrielyan E, Malmström C, Panossian A. Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression. Nord J Psyc. 2007;61:343-348.

Rhodiola (Rhodiola rosea, Crassulaceae) is a medicinal plant with adaptogenic, antioxidant, endocrine, reproductive, and central nervous system effects. Rhodiola root preparations have been extensively studied and used in Scandinavia and Russia as an herbal medicine.1

Although a Russian trial in 1986 tested a rhodiola extract as an adjunct to a tricyclic antidepressant drug in patients with depression,2 this is the first clinical trial to test a root extract of R. rosea by itself for its antidepressant activity.

In this double-blind, placebo-controlled, randomized phase III clinical trial, the authors examined the effect of the proprietary standardized rhodiola rhizome extract SHR-5 on subjects diagnosed with mild to moderate depression. Each 400 mg tablet of SHR-5 contains 170 mg of rhodiola root extract. SHR-5 is a standardized extract of rhodiola root that provides 4.5 mg of salidroside in 185 mg of extract. Both SHR-5 and the placebo were manufactured by the Swedish Herbal Institute (Gothenburg, Sweden) following Good Manufacturing Practices. (SHR-5 is used in the special extract Arctic Root® and is available in the United States from ProActive BioProducts, Inc., Sedona, AZ.) The placebo contained 170 mg lactose. The study medication and the placebo were virtually identical in appearance.

Male and female patients aged 18-70 years (n=89) and diagnosed with mild to moderate depression according to the DSM-IV3 were recruited from the clinics of Erebouni Medical Center (Armenian State Medical University, Yerevan, Armenia). There is no indication if these patients were inpatients or outpatients. During a 2week run-in period, the patients received no medication. Then, patients were randomized to receive 2 tablets once daily of SHR-5 (340 mg/day) (n=31), 2 tablets twice daily of SHR-5 (680 mg/day) (n=29), or 2 placebo tablets once daily (n=29). The randomization method used followed the “principles of total randomization, whereby each patient was randomly assigned an integer 1-90.”

The Beck Depression Inventory (BDI) and the 21-item Hamilton Rating Scale for Depression (HAMD) were used to determine depression severity twice during the study: on Day 0 and on Day 42 of the 6-week treatment. Two patients dropped out of the trial “for non-medical reasons.” No adverse effects were reported. After 6 weeks, the HAMD scores showed that symptoms were significantly improved for the 2 groups receiving SHR-5 (P<0.0001) compared to placebo. For the low-dose SHR-5 group (340 mg/ day), the average total HAMD score decreased from 24.5 to 16.0 (P<0.0001). The average total HAMD score decreased from 23.8 to 16.7 (P<0.0001) for the high-dose SHR-5 group (680 mg/day). The placebo group showed no improvement in HAMD scores, from 24.2 at the beginning to 23.4 at the end. The reason for the total lack of mood change in the placebo group was not discussed, but is unusual. The average total HAMD scores of the 2 SHR-5 groups were significantly different from the placebo group at the end of the study (P<0.001).

The study also measured certain secondary efficacy variables.

At both dosage levels of SHR-5, people in the HAMD subgroups experienced statistically significant improvements in insomnia, emotional instability, and levels of somatization (the conversion of anxiety into physical symptoms), while such measures did not significantly change in the placebo group. In addition, the HAMD items for self-esteem were significantly improved in the high-dose SHR-5 group (P=0.0002).

Both treatment groups also experienced statistically significant declines in mean BDI scores (from 12.2 to 7.1 in the lower-dose group and from 10.4 to 4.8 in the higher-dose group). The subjects in the placebo group did not show statistically significant decreases in BDI scores by the end of the trial.

In the words of the authors, this clinical trial shows that SHR-5 “possesses a clear and significant anti-depressive activity in patients suffering from mild to moderate depression.” In addition, the extract appears to be safe for short-term use, with no adverse effects reported. The authors expect that future clinical trials including a 12-week follow-up period and a larger multi-center study design will show how the efficacy of SHR-5 compares with conventional pharmaceutical antidepressants. In addition, more research is needed to confirm the mechanism of action for this observed antidepressant activity.

Richard P. Brown, MD, associate professor of clinical psychiatry at the Columbia University College of Physicians and Surgeons and a co-author of both a review article in HerbalGram1 and a book on R. rosea,4 states, “In addition to mood elevation, evidence indicates that R. rosea has numerous other benefits, including enhancement of cognitive function, sexual function, and both mental and physical performance under stress. Additional studies are needed to explore and establish the potential applications of this herbal extract. In the meantime, phytomedicinal researchers and consumers can be encouraged by these findings” (e-mail to M. Blumenthal, November 19, 2007).

—Marissa Oppel, MS
  1. Brown R, Gerbarg P, Ramazanov Z. Rhodiola rosea—a phytomedicinal overview. HerbalGram. 2002;56:40-52.

  2. Brichenko VS, Kupriyanova IE, Skorokhodova TF. The use of herbal adaptogens together with tricyclic antidepressants in patients with psychogenic depressions. Modern Problems of Pharmacology and Search for New Medicines. 1986;2:58-60.

  3. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Washington, DC: American Psychiatric Association; 1994.

  4. Brown R, Gerbarg P. Rhodiola Revolution. Emmaus, PA: Rodale Press, 2004.