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Long Term Chamomile Therapy for Anxiety

Long-Term Chamomile Therapy for Generalized Anxiety Disorder (GAD)

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01072344
Enrollment
180
Registered
2010-02-22
Start date
2010-02-28
Completion date
2015-06-30
Last updated
2017-07-06

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Generalized Anxiety Disorder

Keywords

Anxiety, Chamomile, Herbal Remedy, Complementary and Alternative Medicine

Brief summary

Prior research has shown that chamomile may be an effective, short-term anti-anxiety treatment. This study will examine the initial and long-term benefits of chamomile extract therapy for the prevention of recurrent anxiety disorder.

Detailed description

Anxiety disorders are among the most common psychiatric conditions. They affect up to 25% of the US adult population. Generalized anxiety disorder (GAD) is a chronic, recurrent form of the disorder. Although benzodiazepines and serotonin reuptake inhibitors have become the mainstay therapy of GAD, these drugs are often associated with unwanted side effects, habituation, and withdrawal symptoms. Many individuals decline using conventional drug therapy for financial, cultural, or personal reasons such as the stigma of mental illness. As a result, many individuals will seek alternative therapy for their anxiety symptoms. The identification of effective alternative therapies for GAD would be of particular relevance. Among alternative therapies for anxiety, chamomile has been used as a traditional herbal medicine for its calming effect. It is well tolerated and demonstrates pharmacological activity in animal models of anxiety. Despite its widespread use and availability, there has been only one clinical trial of chamomile safety and efficacy in GAD. The current application seeks to build upon the results of that prior chamomile study. In that 8-week, double-blind, placebo-controlled trial, we found a significant superiority of chamomile (vs. placebo) in reducing GAD symptoms. We also found chamomile to be exceedingly well tolerated (vs. placebo). The current application seeks to extend these promising preliminary results by conducting a randomized, double-blind, parallel group, placebo-substitution, long-term safety and efficacy study of chamomile in preventing GAD relapse. For specific aim #1 we will ask: Does long-term chamomile therapy (vs. placebo) prolong the time to relapse of anxiety symptoms following recovery from GAD? To answer this question, 180 patients with moderate to severe GAD will receive open-label chamomile extract 500-1,500 mg daily for 8 weeks. Responders to chamomile, who remain well for 4 additional weeks of consolidation therapy, will be randomized to double-blind continuation therapy with chamomile 500-1,500 mg daily or placebo for an additional 26 weeks. We hypothesize that continuation chamomile therapy will result in a prolonged time to relapse (vs. placebo). For specific aim #2 we will ask: What is the relative safety and tolerability of long-term chamomile therapy (vs. placebo) in patients who have recovered from GAD? To answer this question, we will examine the following outcome measures: (i) the proportion of patients in each treatment condition who relapse; (ii) the frequency, severity, and duration of treatment-emergent adverse events; (iii) the frequency of discontinuation symptoms during initial double-blind therapy; and, (iv) the frequency of early study discontinuation. We hypothesize that chamomile therapy will result in a lower proportion of anxiety relapses and a lower study discontinuation rate (vs. placebo). We further hypothesize that chamomile therapy will result in a similar frequency of discontinuation symptoms and treatment-emergent adverse events (vs. placebo).

Interventions

500 mg 3 times daily

Sponsors

University of Pennsylvania
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No

Inclusion criteria

* Men and women at least 18 years old (all races and ethnicity) * DSM IV diagnosis of GAD as the primary anxiety disorder * Baseline GAD-7 score ≥ 10 * Baseline CGI/S score at least 4 * Not taking anti-anxiety medication (e.g., Benzodiazepines, buspirone, antidepressants) * Not taking antidepressant, mood stabilizer, or tranquilizer therapy for a prior DSM IV Axis I mood disorder that is in remission * Able to understand and provide informed consent * Able to participate in a 38-week study

Exclusion criteria

* Patients \< 18 years old * Primary DSM IV Axis I anxiety disorder other than GAD (e.g., panic disorder with or without agoraphobia, phobia disorder, acute stress disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, substance-induced anxiety disorder) * Current DSM IV Axis I psychotic disorder * Substance abuse or dependence within the prior 3 months * Current DSM IV Axis I bipolar or major depressive disorder \[Note: Patients with co-morbid depressive disorder NOS (e.g., minor depression, recurrent brief depressive disorder, or premenstrual dysphoric disorder (PMDD)\] will not be excluded * Unstable medical condition * Allergy to chamomile * Documented allergy to plants of the asteraceae family (e.g., ragweed, asters, chrysanthemum) * Allergic to mugwort or birch pollen * Concurrent anti-anxiety tranquilizer, antidepressant or mood stabilizer therapy * Concurrent use of over-the-counter anti-anxiety and/or antidepressant preparations (e.g., chamomile, St. John's Wort, kava kava) * Concurrent use of established antidepressant, mood stabilizer, or tranquilizer therapy for pre-existing affective disorder. \[Note: Patients with a history of affective disorder (in remission) who are not currently taking antidepressant, mood stabilizer, or tranquilizer therapy are not excluded from the trial\] * Women of child-bearing potential not willing to use a medically proven form of contraception * Positive pregnancy test * Actively suicidal or suicide attempt within the preceding 12 months

Design outcomes

Primary

MeasureTime frameDescription
Time to Relapse in Each Treatment Condition.26 weeksThe primary outcome was time to relapse during continuation therapy, analyzed using Cox proportional hazards. Relapse is dichotomously defined as an increase in CGI/S (a clinician-rated global measure of anxiety's severity) score from ≤ 3 (at study visit 6) to ≥ 4 (on two consecutive scheduled or unscheduled study visits ≥ 2 weeks apart) plus meeting DSM IV-TR criteria for GAD (minus the 6-month time criterion).

Secondary

MeasureTime frameDescription
The Proportion of Subjects in Each Treatment Condition Who Relapse.26 weeksThe proportion of subjects in each treatment condition who relapsed after randomization
Frequency, Severity, and Duration of Treatment-emergent Adverse Events.26 weeksWe will report the frequency, severity, and duration of treatment-emergent adverse events by treatment arm.
Frequency of Discontinuation Symptoms at the Start of Double-blind Therapy in Each Treatment Condition.26 weeksDiscontinuation emergent signs and symptoms checklist (DESS) is a patient-rated measure of the presence and severity of discontinuation symptoms occurring after medication discontinuation. %
Frequency of Early Study Discontinuation in Each Treatment Condition.26 weeksThis is the # of subjects who discontinued the study during randomization phase due to other reasons.

Countries

United States

Participant flow

Pre-assignment details

The study has 3 phases. The 1st phase is open label cham.(N=179), subjects meeting response criteria enter 2nd phase (N=93), the consolidation phase of open label chamomile. At the end of 2nd phase, if subjects still meet response criteria, they will enter the 3rd phase (N=93). In the 3rd phase, subjects will be randomized to chamomile vs. placebo.

Participants by arm

ArmCount
Chamomile Extract
Pharmaceutical grade oral chamomile extract. Chamomile (Matricaria recutita): 500 mg 3 times daily
46
Placebo
Pharmaceutical grade lactose monohydrate. Chamomile (Matricaria recutita): 500 mg 3 times daily
47
Total93

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyLost to Follow-up34
Overall StudyProtocol Violation12
Overall StudyRelasped-reached end point712

Baseline characteristics

CharacteristicPlaceboChamomile ExtractTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
5 Participants6 Participants11 Participants
Age, Categorical
Between 18 and 65 years
42 Participants40 Participants82 Participants
Age, Continuous45.4 years
STANDARD_DEVIATION 16.1
49.2 years
STANDARD_DEVIATION 14.3
47.3 years
STANDARD_DEVIATION 15.3
Region of Enrollment
United States
47 participants46 participants93 participants
Sex: Female, Male
Female
31 Participants34 Participants65 Participants
Sex: Female, Male
Male
16 Participants12 Participants28 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
8 / 469 / 47
serious
Total, serious adverse events
0 / 460 / 47

Outcome results

Primary

Time to Relapse in Each Treatment Condition.

The primary outcome was time to relapse during continuation therapy, analyzed using Cox proportional hazards. Relapse is dichotomously defined as an increase in CGI/S (a clinician-rated global measure of anxiety's severity) score from ≤ 3 (at study visit 6) to ≥ 4 (on two consecutive scheduled or unscheduled study visits ≥ 2 weeks apart) plus meeting DSM IV-TR criteria for GAD (minus the 6-month time criterion).

Time frame: 26 weeks

Population: All 93 subjects started randomization phase of the study were included in the analysis

ArmMeasureValue (MEAN)Dispersion
Chamomile ExtractTime to Relapse in Each Treatment Condition.11.4 weeksStandard Deviation 8.4
PlaceboTime to Relapse in Each Treatment Condition.6.3 weeksStandard Deviation 3.9
Secondary

Frequency of Discontinuation Symptoms at the Start of Double-blind Therapy in Each Treatment Condition.

Discontinuation emergent signs and symptoms checklist (DESS) is a patient-rated measure of the presence and severity of discontinuation symptoms occurring after medication discontinuation. %

Time frame: 26 weeks

Population: These are responders at the end of Phase II of the study and then were randomized in Phase III of the study

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Chamomile ExtractFrequency of Discontinuation Symptoms at the Start of Double-blind Therapy in Each Treatment Condition.# of subject had no new symptoms after randomizat31 Participants
Chamomile ExtractFrequency of Discontinuation Symptoms at the Start of Double-blind Therapy in Each Treatment Condition.# of subject had >=1 new symptom after randomizati14 Participants
PlaceboFrequency of Discontinuation Symptoms at the Start of Double-blind Therapy in Each Treatment Condition.# of subject had no new symptoms after randomizat33 Participants
PlaceboFrequency of Discontinuation Symptoms at the Start of Double-blind Therapy in Each Treatment Condition.# of subject had >=1 new symptom after randomizati11 Participants
Secondary

Frequency of Early Study Discontinuation in Each Treatment Condition.

This is the # of subjects who discontinued the study during randomization phase due to other reasons.

Time frame: 26 weeks

Population: These are responders at the end of Phase II of the study and were then randomized into Phase III of the study.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Chamomile ExtractFrequency of Early Study Discontinuation in Each Treatment Condition.# Lost to Follow-up3 Participants
Chamomile ExtractFrequency of Early Study Discontinuation in Each Treatment Condition.# withdrawn due to non-compliance1 Participants
PlaceboFrequency of Early Study Discontinuation in Each Treatment Condition.# Lost to Follow-up4 Participants
PlaceboFrequency of Early Study Discontinuation in Each Treatment Condition.# withdrawn due to non-compliance2 Participants
Secondary

Frequency, Severity, and Duration of Treatment-emergent Adverse Events.

We will report the frequency, severity, and duration of treatment-emergent adverse events by treatment arm.

Time frame: 26 weeks

Population: During phase II consolidation phase, treatment responders were randomized to either 26 weeks of continuation chamomile therapy or placebo.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Chamomile ExtractFrequency, Severity, and Duration of Treatment-emergent Adverse Events.8 Participants
PlaceboFrequency, Severity, and Duration of Treatment-emergent Adverse Events.9 Participants
Secondary

The Proportion of Subjects in Each Treatment Condition Who Relapse.

The proportion of subjects in each treatment condition who relapsed after randomization

Time frame: 26 weeks

Population: During phase II consolidation phase, treatment responders were randomized to either 26 weeks of continuation chamomile therapy or placebo.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Chamomile ExtractThe Proportion of Subjects in Each Treatment Condition Who Relapse.7 Participants
PlaceboThe Proportion of Subjects in Each Treatment Condition Who Relapse.12 Participants

Source: ClinicalTrials.gov · Data processed: Mar 12, 2026