The efficacy of Crocus sativus (Saffron) versus placebo and Fluoxetine in treating depression: a systematic review and meta-analysis

References

• Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med. 2013;10(11):e1001547. doi:10.1371/journal.pmed.100154724223526
   PubMed Web of Science ®Google Scholar
• Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119–138. doi:10.1146/annurev-publhealth-031912-11440923514317
   PubMed Web of Science ®Google Scholar
• Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3(11):e442. doi:10.1371/journal.pmed.003044217132052
   PubMed Web of Science ®Google Scholar
• World Health Organization. Depression 2017 Available from: http://www.who.int/mediacentre/factsheets/fs369/en/. Accessed April 10, 2019.
   Google Scholar
• Marcus SM, Young EA, Kerber KB, et al. Gender differences in depression: findings from the STAR*D study. J Affect Disord. 2005;87(2–3):141–150. doi:10.1016/j.jad.2004.09.00815982748
   PubMed Web of Science ®Google Scholar
• Alonso J, Angermeyer MC, Bernert S, et al. Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. 2004;(420):47–54.15128387
   PubMedGoogle Scholar
• Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007;370(9590):851–858. doi:10.1016/S0140-6736(07)61415-917826170
   PubMed Web of Science ®Google Scholar
• Windle M, Windle RC. Recurrent depression, cardiovascular disease, and diabetes among middle-aged and older adult women. J Affect Disord. 2013;150(3):895–902. doi:10.1016/j.jad.2013.05.00823721922
   PubMed Web of Science ®Google Scholar
• Murray CJ, Lopez D. Global Burden of Disease, A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Boston: Harvard University Press; 1996.
   Google Scholar
• Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151(4):W65–94.19622512
   PubMed Web of Science ®Google Scholar
• Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration‘s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. doi:10.1136/bmj.d592822008217
   PubMed Web of Science ®Google Scholar
• Sarris J, Panossian A, Schweitzer I, Stough C, Scholey A. Herbal medicine for depression, anxiety and insomnia: a review of psychopharmacology and clinical evidence. Eur Neuropsychopharmacol. 2011;21(12):841–860. doi:10.1016/j.euroneuro.2011.04.00221601431
   PubMed Web of Science ®Google Scholar
• Velehorschi C, Bleau P, Vermani M, Furtado M, Klassen LJ. Understanding the role of adjunctive nonpharmacological therapies in management of the multiple pathways to depression. Psychiatry Res. 2014;220(Suppl 1):S34–44. doi:10.1016/S0165-1781(14)70004-625539873
   PubMed Web of Science ®Google Scholar
• Roy T, Lloyd CE. Epidemiology of depression and diabetes: a systematic review. J Affect Disord. 2012;142(Suppl):S8–21. doi:10.1016/S0165-0327(12)70004-623062861
   PubMed Web of Science ®Google Scholar
• Pirotta M, Willis K, Carter M, Forsdike K, Newton D, Gunn J. ‘Less like a drug than a drug‘: the use of St John‘s wort among people who self-identify as having depression and/or anxiety symptoms. Complement Ther Med. 2014;22(5):870–876. doi:10.1016/j.ctim.2014.07.00725440378
   PubMed Web of Science ®Google Scholar
• Szafrański T. Herbal remedies in depression–state of the art. Psychiatr Pol. 2014;48(1):59–73.24946435
   PubMed Web of Science ®Google Scholar
• Kermani T, Mousavi SH, Shemshian M, et al. Saffron supplements modulate serum pro-oxidant-antioxidant balance in patients with metabolic syndrome: a randomized, placebo-controlled clinical trial. Avicenna J Phytomed. 2015;5(5):427–433.26468462
   PubMed Web of Science ®Google Scholar
• Abdullaev FI, Espinosa-Aguirre JJ. Biomedical properties of saffron and its potential use in cancer therapy and chemoprevention trials. Cancer Detect Prev. 2004;28(6):426–432. doi:10.1016/j.cdp.2004.09.00215582266
   PubMedGoogle Scholar
• Schmidt M, Betti G, Hensel A. Saffron in phytotherapy: pharmacology and clinical uses. Wien Med Wochenschr. 2007;157(13–14):315–319. doi:10.1007/s10354-007-0428-417704979
   PubMedGoogle Scholar
• White IR, Thomas J. Standardized mean differences in individually-randomized and cluster-randomized trials, with applications to meta-analysis. Clin Trials. 2005;2(2):141–151. doi:10.1191/1740774505cn081oa16279136
   PubMed Web of Science ®Google Scholar
• Higgins J, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–1558. doi:10.1002/sim.118612111919
   PubMed Web of Science ®Google Scholar
• Akhondzadeh S, Tahmacebi-Pour N, Noorbala AA, et al. Crocus sativus L. in the treatment of mild to moderate depression: a double-blind, randomized and placebo-controlled trial. Phytother Res. 2005;19(2):148–151. doi:10.1002/ptr.164715852492
   PubMed Web of Science ®Google Scholar
• Noorbala AA, Akhondzadeh S, Tahmacebi-Pour N, Jamshidi AH. Hydro-alcoholic extract of Crocus sativus L. versus fluoxetine in the treatment of mild to moderate depression: a double-blind, randomized pilot trial. J Ethnopharmacol. 2005;97(2):281–284. doi:10.1016/j.jep.2004.11.00415707766
   PubMed Web of Science ®Google Scholar
• Moshiri E, Basti AA, Noorbala AA, Jamshidi AH, Hesameddin Abbasi S, Akhondzadeh S. Crocus sativus L. (petal) in the treatment of mild-to-moderate depression: a double-blind, randomized and placebo-controlled trial. Phytomedicine. 2006;13(9–10):607–611. doi:10.1016/j.phymed.2006.08.00616979327
   PubMed Web of Science ®Google Scholar
• Akhondzadeh Basti A, Moshiri E, Noorbala AA, Jamshidi AH, Abbasi SH, Akhondzadeh S. Comparison of petal of Crocus sativus L. and fluoxetine in the treatment of depressed outpatients: a pilot double-blind randomized trial. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31(2):439–442. doi:10.1016/j.pnpbp.2006.11.01017174460
   PubMed Web of Science ®Google Scholar
• Akhondzadeh Basti A, Ghoreishi SA, Noorbala AA, Akhondzadeh SH, Rezazadeh S. Petal and stigma of Crocus sativus L. in the treatment of depression: a pilot double - blind randomized trial. J Medicinal Plants. 2008;7(4):29–36.
   Google Scholar
• Shahmansouri N, Farokhnia M, Abbasi SH, et al. A randomized, double-blind, clinical trial comparing the efficacy and safety of Crocus sativus L. with fluoxetine for improving mild to moderate depression in post percutaneous coronary intervention patients. J Affect Disord. 2014;155:216–222. doi:10.1016/j.jad.2013.11.00324289892
   PubMed Web of Science ®Google Scholar
• Mazidi M, Shemshian M, Mousavi SH, et al. A double-blind, randomized and placebo-controlled trial of Saffron (Crocus sativus L.) in the treatment of anxiety and depression. J Complement Integr Med. 2016;13(2):195–199. doi:10.1515/jcim-2015-004327101556
   PubMedGoogle Scholar
• Kashani L, Eslatmanesh S, Saedi N, et al. Comparison of Saffron versus Fluoxetine in treatment of mild to moderate postpar-tum depression: a double-blind, randomized clinical trial. Pharmacopsychiatry. 2017;50(2):64–68. doi:10.1055/s-0042-11530627595298
   PubMed Web of Science ®Google Scholar
• Judd L. Mood disorders in the general population represent an important and worldwide public health problem. Int J Clin Psychopharm. 1995;10(suppl 4):5–10. doi:10.1097/00004850-199512004-00002
   PubMed Web of Science ®Google Scholar
• Karimi G, Hosseinzadeh H, Khaleghpanah P. Study of antidepressant effect of aqueous and ethanolic extracts of Crocus sativus in mice. Iranian J Basic Med Sci. 2001;4:11–15.
   Google Scholar
• Akhondzadeh S, Fallah-Pour H, Afkham K, Jamshidi AH, Khalighi-Cigaroudi F. Comparison of Crocus sativus L. and imipramine in the treatment of mild to moderate depression: a pilot double-blind randomized trial [ISRCTN45683816]. BMC Complement Altern Med. 2004;4:12. doi:10.1186/1472-6882-4-1215341662
   PubMedGoogle Scholar
• Rios JL, Recio MC, Giner RM, Manez S. An update review of saffron and its active constituents. Phytotherapy Res. 1996;10(3):189–193. doi:10.1002/(SICI)1099-1573(199605)10:3<189::AID-PTR754>3.0.CO;2-C
   Web of Science ®Google Scholar
• Georgiadou G, Tarantilis PA, Pitsikas N. Effects of the active constituents of Crocus Sativus L., crocins, in an animal model of obsessive-compulsive disorder. Neurosci Lett. 2012;528(1):27–30. doi:10.1016/j.neulet.2012.08.08122985509
   PubMed Web of Science ®Google Scholar
• Wang Y, Han T, Zhu Y, et al. Antidepressant properties of bioactive fractions from the extract of Crocus sativus L. J Nat Med. 2010;64(1):24–30. doi:10.1007/s11418-009-0360-619787421
   PubMed Web of Science ®Google Scholar
• Samarghandian S, Borji A. Anticarcinogenic effect of saffron (Crocus sativus L.) and its ingredients. Pharmacognosy Res. 2014;6(2):99–107. doi:10.4103/0974-8490.12896324761112
   PubMedGoogle Scholar
• Hosseinzadeh H, Younesi HM. Antinociceptive and anti-inflammatory effects of Crocus sativus L. stigma and petal extracts in mice. BMC Pharmacol. 2002;2:7. doi:10.1186/1471-2210-2-711914135
   PubMedGoogle Scholar
• Hausenblas HA, Saha D, Dubyak PJ, Anton SD. Saffron (Crocus sativus L.) and major depressive disorder: a meta-analysis of randomized clinical trials. J Integr Med. 2013;11(6):377–383. doi:10.3736/jintegrmed201305624299602
   PubMedGoogle Scholar
• Lopresti AL, Drummond PD. Saffron (Crocus sativus) for depression: a systematic review of clinical studies and examination of underlying antidepressant mechanisms of action. Hum Psychopharmacol. 2014;29(6):517–527. doi:10.1002/hup.243425384672
   PubMed Web of Science ®Google Scholar
• Yang X, Chen X, Fu Y, et al. Comparative efficacy and safety of Crocus sativus L. for treating mild to moderate major depressive disorder in adults: a meta-analysis of randomized controlled trials. Neuropsychiatr Dis Treat. 2018;21(14):1297–1305. doi:10.2147/NDT.S157550
   Web of Science ®Google Scholar
• Tóth B, Hegyi P, Lantos T, et al. The efficacy of saffron in the treatment of mild to moderate depression: a meta-analysis. Planta Med. 2019;85(1):24–31. doi:10.1055/a-0660-956530036891
   PubMed Web of Science ®Google Scholar