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Ka9.0
Kava Research
Probably helpsLimited safety
34 peer-reviewed studies
What the evidence says
Probably helps
Kava helped in about half (4/7) of the studies that measured an effect — promising, but not unanimous.
Most evidence is from high-quality meta-analyses and randomised trials published 2003–2024 with a typical study size of 71 participants.
Based on 34 studies · 8 meta-analyses · 11 RCTs · 8,032 total participants
Confidence
High
What the studies found
4helped1unclear2didn't help· 27 more without graded effect data
2Clinical efficacy measures for insomniaMeta-AnalysisCited 90×n=1,602 · large study2015
There was no statistically significant difference between any herbal medicine and placebo, or any herbal medicine and active control, for any of the thirteen measures of clinical efficacy.
Leach MJ et al. · Sleep medicine reviews (2015)
No clear effect
← WorseNo effectBetter →
There was no statistically significant difference between any herbal medicine and placebo, or any herbal medicine and active control, for any of the thirteen measures of clinical efficacy.
As for safety, a similar or smaller number of adverse events per person were reported with kava, chamomile and wuling when compared with placebo.
By contrast, a greater number of events per person were reported with valerian.
3Systematic ReviewCited 10×n=1,020 · large study2020
Psychotherapy seems indicated for mildly symptomatic adjustment disorder.
Constantin D et al. · American journal of therapeutics (2020)
Psychotherapy seems indicated for mildly symptomatic adjustment disorder.
Given the fact that adjustment disorder with severe symptoms is associated with a high risk of suicidal ideation and suicide attempts, clinicians must consider the potential benefit of using psychotropic agents such as benzodiazepines, antidepressants, or etifoxine.
Existing guidelines are generally limited in providing clear, evidence-informed recommendations for the use of CAM therapies for insomnia management due to a lack of high-quality evidence and multidisciplinary consultation in CPG development.
Zhao FY et al. · Frontiers in public health (2023)
The reporting rate of eligible CPGs ranged from 42.9 to 97.1%.
Existing guidelines are generally limited in providing clear, evidence-informed recommendations for the use of CAM therapies for insomnia management due to a lack of high-quality evidence and multidisciplinary consultation in CPG development.
More well-designed studies to provide reliable clinical evidence are therefore urgently needed.
6Treatment recommendations for nutraceuticals and phytoceuticals in psychiatric disordersMeta-AnalysisCited 117×2022
Based on the current data and clinician input, a range of nutraceuticals and phytoceuticals were given either a supportive recommendation or a provisional recommendation across a range of various psychiatric disorders.
Sarris J et al. · The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry (2022)
Based on the current data and clinician input, a range of nutraceuticals and phytoceuticals were given either a supportive recommendation or a provisional recommendation across a range of various psychiatric disorders.
However several had only a weak endorsement for potential use; for a few it was not possible to reach a clear recommendation direction, largely due to mixed study findings; while some other agents showed no obvious therapeutic benefit and were clearly not recommended for use.
It is the intention of these guidelines to inform psychiatric/medical, and health professional practice globally.
7Anxiety symptoms (HAMA scores)Meta-AnalysisCited 48×n=29 · very small study2022
Medicinal herbs may be promising for the treatment of anxiety.
Zhang W et al. · Pharmacological research (2022)
Noticeable benefit
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Kava was found to be an effective anxiolytic (MD: -2.46, 95% CrI: -4.47 to -0.32) but possibly ineffective in patients with generalized anxiety disorder (MD: -0.17, 95% CrI: -2.55 to -1.97).
Ginkgo biloba (MD: -4.63, 95% CrI: -9.01 to -0.23) and Withania somnifera (MD: -4.90, 95% CrI: -9.70 to -0.17) were efficacious, as measured by HAMA scores but the trials were limited by their small sample sizes.
Conversely, although Passionflower (MD: -4.20, 95% CrI: -8.82 to 0.16) and Saffron (MD: -2.71, 95% CrI: -6.06 to 0.57) did not reduce HAMA scores significantly in the summary network, both were worthy of further study because of support from separate networks.
There was heterogeneity of study models and methods of investigation across the studies identified.
Celentano A et al. · Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology (2019)
There was heterogeneity of study models and methods of investigation across the studies identified.
Components of kava appear to present an area of interest with chemotherapeutic potential in cancer prevention and treatment, particularly for epithelial neoplasms.
To date, there is a paucity of literature of the utility of kava components in the prevention and treatment of oral squamous cell carcinoma.
Aside from this, future focus should involve the incorporation of more biomarker analysis, in particular pharmacogenomics, to determine genetic factors moderating response to herbal medicines.
Sarris J · Phytotherapy research : PTR (2018)
Other encouraging herbal medicines with preliminary evidence include Curcuma longa (turmeric) in depression, Withania somnifera (ashwagandha) in affective disorders, and Ginkgo biloba (ginkgo) as an adjunctive treatment in Schizophrenia.
Although depression and anxiety are commonly researched, many other mental disorders still require further prospective investigation.
Although the previous review suggested increasing the adjunctive study of select herbal medicines with pharmaceuticals, this was still only found to sparingly occur in research designs.
Collectively, the literature reveals preclinical and clinical evidence for various phytomedicines modulating GABA-pathways, with comparative anxiolytic effect to the current array of pharmaceuticals, along with good safety and tolerability profiles.
Savage K et al. · Phytotherapy research : PTR (2018)
An open-ended search to 5 July 2017 was conducted using MEDLINE (PubMed), Scopus, and Cochrane library online databases and performed in a stepped format from preclinical to clinical investigations.
Eligible studies must have had (a) in vitro evidence of GABA-modulating activity, (b) animal studies using anxiety models to test an anxiolytic effect, and (c) human clinical trials.
Ten phytomedicines were identified as having preclinical investigations showing interaction with the GABA system, in addition to human clinical trials: kava, valerian, pennywort, hops, chamomile, Ginkgo biloba, passionflower, ashwagandha, skullcap, and lemon balm.
Current evidence, although promising, is insufficient to confirm the effect of Kava for GAD treatment beyond placebo.
Ooi SL et al. · Journal of alternative and complementary medicine (New York, N.Y.) (2018)
Large benefit
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Meta-analyses of the results of three placebo-controlled trials (n = 130) favored Kava for GAD treatment with effect sizes between 0.59 and 0.99 (standard mean difference) without reaching statistical significance.
Current evidence, although promising, is insufficient to confirm the effect of Kava for GAD treatment beyond placebo.
New evidence is expected from a large, multisite ongoing trial.
The majority of evidence suggests that kava has no replicated significant negative effects on cognition.
LaPorte E et al. · Human psychopharmacology (2011)
One acute study found that kava significantly improved visual attention and working memory processes while another found that kava increased body sway.
The majority of evidence suggests that kava has no replicated significant negative effects on cognition.
14Anxiety and anxiety-related conditionsSystematic ReviewCited 98×n=2,619 · very large study2010
Based on the available evidence, it appears that nutritional and herbal supplementation is an effective method for treating anxiety and anxiety-related conditions without the risk of serious side effects.
Lakhan SE et al. · Nutrition journal (2010)
Huge benefit
← WorseNo effectBetter →
Of the randomized controlled trials reviewed, 71% (15 out of 21) showed a positive direction of evidence.
Based on the available evidence, it appears that nutritional and herbal supplementation is an effective method for treating anxiety and anxiety-related conditions without the risk of serious side effects.
There is the possibility that any positive effects seen could be due to a placebo effect, which may have a significant psychological impact on participants with mental disorders.
17ADHD symptom improvementSystematic ReviewCited 43×n=16 · very small study2011
The research suggests only some CAMs may be beneficial in ADHD, thus clinicians need to be aware of the current evidence.
Sarris J et al. · Complementary therapies in medicine (2011)
The research suggests only some CAMs may be beneficial in ADHD, thus clinicians need to be aware of the current evidence.
Promising candidates for future research include Bacopa monniera (brahmi) and Piper methysticum (kava), providing potential efficacy in improving attentional and hyperkinetic disorders via a combination of cognitive enhancing and sedative effects.
While the significance of many interactions is uncertain, several interactions, particularly those with St John's wort, may have serious clinical consequences.
Izzo AA et al. · Drugs (2009)
Echinacea might affect the clearance of caffeine (a CYP1A2 probe) and midazolam (a CYP3A4 probe).
No interactions have been reported for saw palmetto (Serenoa repens).
Numerous interactions between herbal medicines and conventional drugs have been documented.
19Treatment response in anxiety disordersMeta-AnalysisCited 47×2005
Kava seems to be more effective in females and in younger patients.
Witte S et al. · Phytotherapy research : PTR (2005)
Huge harm
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WS1490 has an effective success rate of OR=3.3 (95% confidence interval of 2.09-5.22) in patients with non-psychotic anxiety disorders.
The continuous outcome supports this result: mean improvement with WS1490 by 5.94 (95% confidence interval -0.86 to 12.8) points on the HAMA scale better than placebo.
20Mood and anxiety disorders treatmentSystematic ReviewCited 71×2009
Current evidence for herbal medicines in the treatment of depression and anxiety only supports the use of Hypericum perforatum for depression, and Piper methysticum for generalized anxiety.
Sarris J et al. · Journal of alternative and complementary medicine (New York, N.Y.) (2009)
Current evidence for herbal medicines in the treatment of depression and anxiety only supports the use of Hypericum perforatum for depression, and Piper methysticum for generalized anxiety.