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CONTINUING PROFESSIONAL DEVELOPMENT
In randomised placebo‐controlled trials
the addition of saffron (15 mg twice
daily) for 4 weeks has also been shown
to reduce the sexual impairment
associated with fluoxetine use. In
males saffron use resulted in significant
improvements in erectile function and
and in females
improvements in arousal, lubrication,
Other measures of sexual
function including orgasm and desire
were not affected.
In short‐term clinical studies saffron
(30 mg/day) for 4–8 weeks appears to
be well tolerated.54 Longer term safety
studies are required.
An additive effect is likely when saffron
is combined with other antidepressant
medicines such as SSRIs50 and
concomitant use may reduce some of the
sexual impairment reported by fluoxetine
While these effects may be
beneficial, concomitant use should
be supervised for signs of serotonin
syndrome and antidepressant dosage
requirements reduced if necessary.
Use in Pregnancy and lactation
At usual dietary intake saffron is likely
to be safe in pregnancy.
animal studies of crocin and safranal
suggest that very high doses may
induce embryonic malformations when
administered to pregnant mice.
Avoid in patients with a known allergy to
saffron or its components.
Cautions and counselling points
More studies are required to
confirm efficacy and safety however,
a therapeutic trial of 15 mg saffron
twice daily may be warranted in
patients who cannot or prefer not to
take pharmaceutical antidepressants.
Careful co‐administration with
fluoxetine may provide additive
effects for patients with mild‐
moderate depression and reduce
some of the sexual impairment
associated with fluoxetine use.
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THE COMPLEMENTARY APPROACH
Many patients with depressive symptoms
are unable or unwilling to take
pharmaceutical antidepressants or do
not experience sufficient relief from their
symptoms. In such cases some patients will
consider herbal options as an alternative
to, or in addition to, conventional
antidepressant medicines. There is growing
evidence to suggest that the use of herbs
such as St John’s wort, Rhodiola or saffron
may benefit some patients. However, care
needs to be taken when administering
concomitant antidepressant medicines and
the potential for drug interactions needs
to be carefully evaluated, especially for St
KEY LEARNING POINTS
The use of St John’s wort for the
treatment of mild‐moderate depression
has been extensively studied with
benefits expected to be greater
than placebo and similar to other
A number of potential drug interactions
are possible when St John’s wort is used
concurrently with other medicines so
patients should be carefully evaluated
before treatment is initiated.
The evidence base for Rhodiola and
saffron is still growing but these may
also be beneficial for some patients.
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