Chinese herbal medicine for anxiety disorders and obsessive-compulsive disorder: A systematic review with meta-analysis

The objective of this systematic review is to assess the effectiveness and safety of Chinese Herbal Medicine (CHM) for anxiety disorders and obsessive-compulsive disorder (OCD). EMBase, PubMed, CINAHL, CNKI, Wanfang, CQVIP, clinicaltrials.gov and Chinese Clinical Trial Registry were searched from database inception to January 2025 using search terms defining “anxiety/OCD”, “Chinese herbal medicine” and “randomized controlled trial”. From a total of 9805 reports screened, 92 randomised-controlled trials in which CHM was tested against anxiolytics in the treatment of anxiety disorders and OCD were included in the review. The sample size, mean and standard deviation at end-of-intervention (for continuous outcomes) and number of participants who experienced adverse events were collected for each arm. Compared to anxiolytic medication, CHM was more effective in reducing anxiety (Hamilton Anxiety Rating Scale Mean Difference = −1.50 points, 95 % CI -2.21 to −0.78, p < 0.001) and produced fewer adverse events (Incidence Rate Ratio = 0.33, 95 % CI 0.24 to 0.45, p < 0.001) in participants with generalised anxiety disorder. These results are supported by studies with a low risk of bias. No study with a low risk of bias tested CHM for panic disorders and OCD. This systematic review indicates a favourable risk/benefit profile of CHM compared with anxiolytic medication for GAD, and therefore CHM could be considered as an alternative to anxiolytics. Studies with a low risk of bias are required to assess the effectiveness of CHM for panic disorders, phobic disorders and OCD.