Abstract: From the three small (total n=250) short included studies, we were unable to extract any data on many broad clinically important outcomes such as global state, use of services, and satisfaction with treatment. When Ayurvedic herbs were compared with placebo, about 20% of people left the studies early (n=120, 2 RCTs, RR 0.77 CI 0.37 to 1.62). Mental state ratings were mostly equivocal with the exception of the brahmyadiyoga group using Ayurvedic assessment (n=68, 1 RCT, RR not improved 0.56 CI 0.36 to 0.88, NNT 4 CI 3 to 12). Behaviour seemed unchanged (n=43, 1 RCT, WMD Fergus Falls Behaviour Rating 1.14 CI -1.63 to 3.91). Nausea and vomiting were common in the brahmyadiyoga group (n=43, RR 13.13 CI 0.80 to 216.30). When the Ayurvedic herbs were compared with antipsychotic drugs (chlorpromazine), again, equal numbers left the study early (n=120, 2 RCTs, RR for brahmyadiyoga 0.91 CI 0.42 to 1.97) but people allocated herbs were at greater risk of no improvement in mental state compared to those allocated chlorpromazine (n=45, RR 1.82 CI 1.11 to 2.98). Again, nausea and vomiting were found with use of brahmyadiyoga (n=45, 1 RCT, RR 20.45 CI 1.09 to 383.97, NNH 2 CI 2 to 38). Finally, when Ayurvedic treatment, in this case a complex mixture of many herbs, is compared with chlorpromazine in acutely ill people with schizophrenia, it is equally (˜10% attrition, n=36, RR 0.67 CI 0.13 to 3.53), but skewed data does seem to favour the chlorpromazine group. Ayurvedic medication may have some effects for treatment of schizophrenia, but has been evaluated only in a few small pioneering trials.

Plain-language summary: This review examines randomised controlled trials which compare aspects of ayurvedic medicine with the use of antipsychotics for people with schizophrenia. All trials took place in India and were for 12 weeks or less. When the ayurvedic herbs brahmyadiyoga and tagara were compared to placebo (2 trials) there was no significant difference between the two groups in acceptability of treatment or overall improvement.  The brahmyadiyoga group did, however, show some improvement when assessed ayurvedically (a combination of assessing aspects of the mind, decision, orientation, memory and habit, and looking for the absence of symptoms of illness). When these two herbs were compared to groups of people taking the antipsychotic, chlorpromazine, again there was no difference in acceptability of treatment, but in one of the two trials there was an improvement in mental state in those taking chlorpromazine. There was also a trial comparing an ayurvedic package (of herbs and other treatment) to chlorpromazine, and although both treatments were acceptable, the rest of the data were not able to be used.  Brahmyadiyoga and tagara tended to have vomiting and nausea as an adverse effect, while chlorpromazine caused people to be sleepy. It may be possible that ayurvedic treatments could be used as adjuncts to antipsychotic medication. A new larger trial comparing ayurvedic herb(s) alone, chlorpromazine alone and both together would answer this question. (Plain language summary prepared for this review by Janey Antoniou of RETHINK, UK www.rethink.org).