Rhodiola rosea (R. rosea), or roseroot, may be a beneficial treatment option for major depressive disorder, according to a randomized, double-blind, placebo-controlled, comparison trial of oral R. rosea extract versus conventional antidepressant for mild to moderate major depressive disorder.

Depression is a non-specific symptom and conventional antidepressants, when they work at all, quickly decline in efficacy, so 19 million Americans, 70 percent of whom do not fully respond to initial therapy, could just be wasting money. A natural treatment that may or may not work as well as a pharmaceutical would at least be cheaper, unless we factor in the $120 million each year that taxpayers waste on the National Center for Complementary and Alternative Medicine/National Center for Complementary and Integrative Health.

All of the study's 57 adult participants, enrolled from December 2010 and April 2013, had a DSM IV Axis 1 diagnosis of MDD, meaning they exhibited two or more major depressive episodes, depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks, as well as symptoms including significant unintentional weight loss or gain, insomnia or sleeping too much, fatigue, and diminished ability to think or concentrate, and recurrent thoughts of death.

The participants received 12 weeks of standardized R. rosea extract, sertraline, or placebo. Changes over time in Hamilton Depression Rating (HAM-D), Beck Depression Inventory (BDI), and Clinical Global Impression (CGI) change scores were measured among groups.

Patients who took sertraline were somewhat more likely - as measured by Ham-D scores - to report improvement in their symptoms by week 12 of treatment than those who took R. rosea, although these differences were not found to be statistically significant. Patients taking R. rosea had 1.4 times the odds of improvement, and patients on sertraline had 1.9 times the odds of improvement versus those on a placebo. However, patients on sertraline experienced twice the side effects - most commonly nausea and sexual dysfunction -- than those on R. rosea: 63 percent versus 30 percent, respectively, reported side effects. These findings suggest that R. rosea may possess a more favorable risk to benefit ratio for individuals with mild to moderate major depressive disorder.

"These results are a bit preliminary but suggest that herbal therapy may have the potential to help patients with depression who cannot tolerate conventional antidepressants due to side effects," said Jun J. Mao, MD, MSCE, associate professor of Family Medicine, Community Health and Epidemiology and colleagues at the Perelman School of Medicine of University of Pennsylvania. "Larger studies will be needed to fully evaluate the benefit and harm of R. rosea as compared to conventional antidepressants."

Citation: Jun J. Mao, Sharon X. Xieb, Jarcy Zee, Irene Soeller, Qing S. Lia,  Kenneth Rockwell, Jay D. Amsterdam, Rhodiola rosea versus sertraline for major depressive disorder: A randomized placebo-controlled trial, Phytomedicine Volume 22, Issue 3, 15 March 2015, Pages 394–399. Funded by the National Institutes of Health Center for Complementary and Integrative Health R21 AT005230, and the Jack Warsaw Fund for Research in Biological Psychiatry at the University of Pennsylvania. Mao was also supported by the National Institutes of Health Center for Complementary and Integrative Health K23 AT004112.