Chamomile has been known since ancient times as a medicinal plant that provides relief from stomach problems and inflammatory processes on the skin and mucous membranes. In recent years, clinical studies have been published which show that chamomile extracts can also be effective in supporting mental problems.
Every child knows chamomile as a medicinal plant and has certainly drunk chamomile tea against stomach problems. Matricaria recutica L., family of composite plants (Asteraceae), which is the correct botanical name of the medicinal plant known for thousands of years, was originally called Matricaria chamomilla or Chamomilla recutica and is one of the best known and most widely used medicinal plants. Their original home is in southern and eastern Europe. However, it is now widespread in practically all European countries and can be found in alpine areas up to altitudes of 1300 meters. But chamomile can be used not only as a tea against digestive problems!
Ingredients
The ingredients responsible for the effectiveness of chamomile are various compounds present in chamomile oil (Matricariae etheroleum), such as bisabolol. The blue color of chamomile oil is caused by the ingredient chamazulene. In addition to sesquiterpene lactones such as matricin, flavonoids are also found in chamomile. Pharmaceutically, the flower heads are used, from which the essential oil is obtained by steam distillation. In this process, blue chamazulene is formed from colorless precursors (Fig. 2).
Medical use
The monograph “Matricaria recutica” of the Herbal Medicinal Products Committee (HMPC) of the European Medicines Agency (EMA) in London lists five different indications for the “Traditional Use” of chamomile [1].
- Mild gastrointestinal symptoms such as flatulence and minor spasms
- Treatment of colds
- Treatments for inflammation of the mouth and throat area
- Additional treatment of skin irritation and irritation of the mucous membrane in the anal and genital area.
- Treatment of minor skin burns (sunburn), superficial injuries and small boils.
Various pharmacological and clinical studies document these applications. The anti-inflammatory effect of chamomile is due to a decrease in TNF-alpha formation [2]. Surprisingly, however, Matricaria recutica extracts also seem to have beneficial effects on psychological complaints. In recent years, several articles have appeared reporting on related studies.
Generalized anxiety disorder
In 2016, two clinical trials were published that investigated the efficacy of chamomile extract on generalized anxiety disorder [3,4]. Both came to a positive conclusion. Keefe’s study reviewed moderate to severe anxiety disorders as an open-label, short-term study. Mao’s study was a long-term investigation that also studied efficacy in moderate to severe anxiety disorders.
Keefe et al. treated patients with corresponding symptoms with 1500 mg chamomile extract per day for up to eight weeks. The study demonstrated a clinically meaningful reduction in Generalized Anxiety Disorder that was comparable to the reduction seen with conventional types of therapy, but had a more favorable adverse event profile.
In the study by Mao et al. patients with generalized anxiety disorder were treated with 500 mg chamomile extract three times daily during a twelve-week open-label therapy in a first phase. In the second randomized, placebo-controlled, double-blind phase, treatment responders randomized into two groups continued to receive either daily chamomile extract treatment or placebo for an additional 26 weeks.
Of the 179 phase 1 subjects, 93 proved to be treatment responders and were enrolled in phase 2. There were more relapses in the placebo group (n=47) than in the verum group (n=7) during the 26 weeks of follow-up. The relapse rate was not significantly lower in the chamomile group. During follow-up, chamomile patients suffered significantly fewer symptoms of Generalized Anxiety Disorder than placebo patients (p=0.0063).
The two studies show well-tolerated efficacy of chamomile extract in short-term and long-term treatment of generalized anxiety disorder.
Premenstrual syndrome
Chamomile extract can also apparently reduce symptoms of premenstrual syndrome (PMS). This was shown in a publication published in 2014 [5]. In this study conducted in Iran, the efficacy of chamomile extract on the one hand and mefenamic acid on the other hand was compared in a randomized, double-blind comparative study. For this purpose, 90 female students were recruited who recorded the intensity of PMS on a daily basis for two months. After PMS was definitively diagnosed, the subjects were randomized into two groups, one receiving 100 mg chamomile extract three times daily and the other receiving 250 mg mefenamic acid three times daily. After two cycles, the intensity of emotional discomfort was determined. A significantly greater reduction was determined in the chamomile group than in the mefenamic acid group (p<0.001). There was no difference in the reduction of physical symptoms between the two groups (p>0.05). It concludes that treatment of psychological aspects of PMS is more effective with chamomile extract than with mefenamic acid.
Sleep quality
Another psychological use of chamomile appears to be sleep quality in the elderly. A recent single-blind randomized trial [6] showed corresponding results. In this study, 60 subjects aged 60 years or older were randomized into two groups and received either 400 mg of chamomile extract twice daily or the same amount of wheat flour for 28 days. The sleep quality of the subjects was assessed with the Pittsburgh Sleep Quality Index immediately before the start of the study, two weeks after the start of intake, at the end of treatment, and another two weeks later. At baseline, no differences were found between the two groups in terms of sleep quality (p=0.639). These were low for both groups. After this four-week treatment, sleep quality was significantly better in the treatment group than in the comparison group (p<0.05). Thus, it was demonstrated that chamomile extract is a safe therapeutic option for the elderly to improve sleep quality.
Postpartum disorders
Many women suffer from postpartum depression and/or postpartum sleep disorders after giving birth. Chang and Chen studied the effect of drinking chamomile tea on these complaints [7]. For this, they randomized 80 postnatal women with poor sleep quality (Postpartum Sleep Quality Scale: PSQAS ≥16) into two groups, one of which was asked to drink chamomile tea regularly for two weeks. The other group received only conventional postpartum care. The results were obtained using the PSQS. Compared with the control group, sleep quality significantly improved in the chamomile tea group (p=0.015). Depression symptoms also showed significant improvement in this group (p=0.020), as did postpartum fatigue. However, these improvements disappeared again four weeks after intake. However, chamomile tea still seems to be an option for short-term treatment of postpartum sleep disturbances and depression.
Discussion
Chamomile seems to be not only a medicinal plant suitable for the treatment of gastrointestinal disorders and inflammatory processes in the oral cavity and on the skin, which is known since ancient times. The clinical studies presented here show alleviating effects in Generalized Anxiety Disorder, emotional discomfort as part of PMS, sleep disorders in the elderly, and postpartum sleep disorders and depression. These studies can be accused of having been carried out with small groups of patients and only for a short period of time. In addition to a study conducted in the USA, the others come primarily from Iran. There are always research teams from Iran working on herbal medicines and publishing studies with relevant results.
Of course, these results would need to be confirmed with further and larger-scale studies. However, these studies still prove a positive effect of chamomile extract on various psychological complaints. And also the positive safety of Matricaria recutica could encourage doctors and physicians to use chamomile extract in appropriate situations.
Literature:
- www.ema.europa.eu/European: Union herbal monograph on Matricaria recutica L. flos.
- Miguel FG, et al: Validation of a RP-HPLC-DAD Method of Chamomile (Matricaria recutica) Preparations and Assessment of the Marker Apigenin-7-glucoside, Safety and Anti-Inflammatroy Effect, Evid Based Complement Alternat Med 2015; 9: Doi:10.1155/2015/828437.
- Mao JJ, et al: Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: a randomized clinical trial, Phytomedicine 2016; 23(14): 1735-1742.
- Keefe JR, et al: Short-term open-label chamomile (Matricara chamomilla L.) therapy of moderate to severe generalized anxiety disorder, Phytomedicine 2016; 23(14): 1699-1705.
- Sharif F, et al: Comparision of the effects of Matricaria chamomilla (chamomile) extract and mefenacid acid on the intensity of prenmenstrual syndrome, Complement Ther Clin Pract 2014; 1(20): 81-88.
- Adid-Hajbaghery M, Mossavi SN: The effects o chamomile extract on sleep quality among eldery people: A clinical trial, Complement Ther Med 2017; 35: 109-114.
- Chang SM, Chen CH: Effects of an intervention with drinking chamomile tea on sleep quality and depression in sleep disturbed postnatal women: a randomized controlled trial, J Adv Nurs 2016; 72(2): 306-315.
HAUSARZT PRAXIS 2018; 13(2): 3-5
