Kava: A Comprehensive Review of Efficacy, Safety, and Psychopharmacology

@article{Sarris2011KavaAC,
  title={Kava: A Comprehensive Review of Efficacy, Safety, and Psychopharmacology},
  author={Jerome Sarris and E Laporte and Isaac Schweitzer},
  journal={Australian and New Zealand Journal of Psychiatry},
  year={2011},
  volume={45},
  pages={27 - 35}
}
Overview: Kava (Piper methysticum) is a South Pacific psychotropic plant medicine that has anxiolytic activity. This effect is achieved from modulation of GABA activity via alteration of lipid membrane structure and sodium channel function, monoamine oxidase B inhibition, and noradrenaline and dopamine re-uptake inhibition. Kava is available over the counter in jurisdictions such as the USA, Australia and New Zealand. Due to this, a review of efficacy, safety and clinical recommendations is… 
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119 Citations

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TLDR
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Preclinical and clinical evidence is revealed for various phytomedicines modulating GABA‐pathways, with comparative anxiolytic effect to the current array of pharmaceuticals, along with good safety and tolerability profiles.
Kava in the Treatment of Generalized Anxiety Disorder: A Double-Blind, Randomized, Placebo-Controlled Study
TLDR
Standardized kava may be a moderately effective short-term option for the treatment of generalized anxiety disorder (GAD), and specific GABA transporter polymorphisms appear to potentially modify anxiolytic response to kava.
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TLDR
Given its growing popularity in clinical and recreational use, the urgent need for quality control and quality assurance of kava products, pharmacokinetics, absorption, distribution, metabolism, excretion, and foundational pharmacology is emphasized.
Kava for Generalized Anxiety Disorder: A Review of Current Evidence.
TLDR
Current evidence, although promising, is insufficient to confirm the effect of Kava for GAD treatment beyond placebo, and new evidence is expected from a large, multisite ongoing trial.
Kava for the Treatment of Generalized Anxiety Disorder RCT: Analysis of Adverse Reactions, Liver Function, Addiction, and Sexual Effects
TLDR
There was a highly significant correlation between ASEX reduction (improved sexual function and performance) and anxiety reduction in the whole sample and kava significantly increased female's sexual drive compared to placebo, with no negative effects seen in males.
Plant-Based Medicines for Anxiety Disorders, Part 2: A Review of Clinical Studies with Supporting Preclinical Evidence
TLDR
A comprehensive narrative review of plant-based medicines that have clinical and/or preclinical evidence of anxiolytic activity and conclusions need to be tempered due to methodological issues such as small sample sizes, brief intervention durations and non-replication.
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References

SHOWING 1-10 OF 110 REFERENCES
The Neurobehavioural Effects of Kava
TLDR
The context in which kava is used is considered, together with its underlying psychopharmacological mechanisms, to investigate the neurobehavioural effects associated with kava use to gain an understanding of its immediate neuropsychiatric effects and long-term cognitive effects.
A Systematic Review of the Safety of Kava Extract in the Treatment of Anxiety
TLDR
When taken as a short-term monotherapy at recommended doses, kava extracts appear to be well tolerated by most users, and a possible interaction with benzodiazepines has been reported.
Kava extract for treating anxiety.
TLDR
The data imply that kava extract is superior to placebo and relatively safe as a symptomatic treatment for anxiety, and warrant further and more rigorous investigations into the efficacy and safety of kava Extract.
Kava-kava and anxiety: growing knowledge about the efficacy and safety.
The Kava Anxiety Depression Spectrum Study (KADSS): A randomized, placebo-controlled, cross-over trial using an aqueous extract of Piper methysticum
TLDR
The aqueous Kava preparation produced significant anxiolytic and antidepressant activity and raised no safety concerns at the dose and duration studied, and appears equally effective in cases where anxiety is accompanied by depression.
Kava kava: examining new reports of toxicity.
The Kava Anxiety Depression Spectrum Study (KADSS): a randomized, placebo-controlled crossover trial using an aqueous extract of Piper methysticum
TLDR
The aqueous Kava preparation produced significant anxiolytic and antidepressant activity and raised no safety concerns at the dose and duration studied, and appears equally effective in cases where anxiety is accompanied by depression.
Therapeutic Potential of Kava in the Treatment of Anxiety Disorders
TLDR
Clinical studies have shown that kava and kavalactones are effective in the treatment of anxiety at subclinical and clinical levels, anxiety associated with menopause and anxiety due to various medical conditions, and kava should be used with caution.
The controvertible role of kava (Piper methysticum G. Foster) an anxiolytic herb, on toxic hepatitis
TLDR
The incidence of kava toxicity on the liver remains to be investigated; however, some concerns before or during kava use are important, due to the possibility of severe liver dysfunction.
A placebo-controlled study of Kava kava in generalized anxiety disorder
TLDR
Although kava was not superior to placebo, it would be premature to rule it out as efficacious in GAD, and both treatments were well tolerated.
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