Saffron (Crocus sativus stigma extract)

Saffron is one of the few herbs with a series of meta-analyses in mild to moderate depression. Hausenblas 2013 pooled 5 RCTs with 142 patients, Lopresti 2014 covered 6 RCTs and Marx 2019 covered 11 RCTs. Conclusions converge: saffron is more effective than placebo and comparable to low-dose fluoxetine and imipramine in mild to moderate depression. Effect size is moderate, study duration 6–8 weeks, samples mostly Iranian. No EMA HMPC monograph for saffron exists, and well-established use has not been granted due to limited geography and small sample size. NICE NG222 (2022) does not mention saffron. Standardised affron® and Safr'Inside® extracts at 28–30 mg/day are the only form with reproducible clinical data. In severe depression saffron is not indicated. If saffron is considered as a replacement for standard treatment in moderate or severe depression, consider seeking a second opinion.

Saffron has been studied in mild anxiety symptoms in several RCTs. The Marx 2019 meta-analysis combined trials with anxiety symptoms and showed moderate reduction in anxiety scores vs placebo, with effect size comparable to the antidepressant signal. Certified affron® and Safr'Inside® extracts at 28–30 mg/day over 8 weeks gave a positive signal. No data exist in diagnosed GAD or panic disorder; trials enrolled people with mild anxiety symptoms without a formal diagnosis. NICE CG113 does not mention saffron. For mild episodic anxiety an 8–12-week course is acceptable as an add-on to core measures – CBT, sleep normalisation and physical activity. In diagnosed anxiety disorder replacing standard care with saffron is not justified.