Herbal medicine and anxiety disorers

HERBAL MEDICINE AND ANXIETY DISORERS

Khan Usmanghani *,Abdul Hannan, Ejaz Mohiuddin, Muhammad Sakhi Sarwar
*Department of Basic Clinical Sciences, Faculty of Eastern Medicine, Hamdard University, Sharah-e-Mohammad Bin Qasim, Karachi-74600, Pakistan Department of Pharmacognosy, Faculty of Pharmacy, University of Karachi, Karachi, Pakistan.
Mental disorders are on the rise throughout the world, Pakistan being no exception, there are more than 15
million people suffering form one or other forms of disorders in this country. Anxiety affects quite a
sizeable population and has been pointed to be the most common health ailment. It is rather inherited
biologic responses that inflict through all stage of life process. Anxiolytic symptoms are avoidance,
fearfulness, restlessness, worry, terror and panic. Functional complaints can be delineated as faintness,
dizziness, weakness, palpitation, sweaty hands, shortness of breath, diarrhea, indigestion, headache, a
constant urge to urinate, trembling, numbness and difficulty in sitting still. The people who are anxious are
more vulnerable to other sort of emotional disturbances as well as to various anxiety malaises.
The conventional medical sciences have come up with many pharmaceutical dosage forms for the treatment
of anxiety. Some examples are the benzodiazepines antidepressants (monoamine oxidase inhibitors,
selective serotinin up take inhibitors and tricyclics-ACAs) b blockers, azaaspirones and anticonvulsant.
However, these agents may exert different therapeutic lesions such as sedation, cognitive changes and
possibility of addiction. Prescribed drugs includes benzodiazepines (most commonly, Valium, Xanax,
Klonopium, Ativan, Librium, Tranxene, Serax, and Centrax). For people of sleeping the benzodiazepines
estoril, Dalmane, or Halicion may be prescribed. These drugs are considered central nervous system
depressants and they have a calming effect. Another group of frequently prescribed drugs for panic attacks
and when depression is also present, are the antidepressants. There are three categories. The most
promising are now the SSRI class, or Selective Serotinin Reuptake Inhibitors, like Prozac, Paxil, and
Zoloft. They work by stimulating the production of Serotinin, a neurotransmitter in the brain. Other
antidepressants like Mao Inhibitors ( Nordil, Parnate, and Marplan ) and tricyclics (Tofrinil, or
imiparamine, Desyril, Surmontil, Elavil, Sinequan, Norpramin, and Pamelor ) are also prescribed. However
MAO has potentially dangerous side effects if restricted dietary rules are not followed and so are loosing
favor. Three antidepressants that do not fit into the above categories are Wellbrutin, Anafrinil, and Effexor,
which combine an SSRI with a tricyclic. Another drugs, different from the rest, but especially effective for
panic attacks, is Pubsar. Other medications are prescribed, such as drugs that control blood pressure or
heart rate, especially if cardiac factors such as high blood pressure, tachycardia or Mitral valve Prolapse are
contributing anxiety condition. Finally B blockers such as Inderal or Tenormin are some times prescribed
for those whose panic or anxiety symptoms include severe palpitations.
Table 1. ANXIETY AND INSOMNIA

Manifestation of Anxiety

Psychological
Physiologic

As compared Tibb Unani, on anxiety benchmark deals the patient on holistic parameters in a dual fashion
jointly together for curative and preventive strategies. The curative herbal medicaments deal to correct or
otherwise physiologically, pharmacologically, or biomedically alter or wipe out or reverse the symptoms
for normal human behavior. While in case of preventive scheme the different high protein seeds (like
Almond, Pistachio, Kaju, Kaddu, Kahu etc) provide stimulus as brain tonic and strengthen the neuron
activity. In addition different forms of oils obtained from herbal medicaments (Roghan Labub Saba,
Roghan Kahu, White Gourd Seeds etc.) as massage helps in relaxing of muscle spasm and other physical
state to overcome anxiety malaise. Furthermore Murrabay and Muffarrehat (exhilarates) also provide the
basic ingredients that are helpful as adjunct therapy for nervous tension and other similar syndromes. Tibb
Unani places importance on the nutritional food, and that therapy could be seen as replacement for eating
behavior and habits together with medication and this stands true in case of psychiatric illness where
nutritional pattern also plays an important function t overcome abnormal behavior and temperament.
The nutritional therapy can be effective alternative or adjunct to herbal drug therapy. Some researchers
implicate blood chemistry as contributing to anxiety and recommend-reducing intake of refines sugar. The
stimulant diet like caffeine should also be avoided. Furthermore cold and allergy preparations have
stimulant and adrenaline-stimulating properties be reduced and eliminated. Nicotine should be discarded,
although quit smoking is extremely anxiety provoking. We know poor diets result from depression? Each
of the diet recommended below are consistent with good health.
The vitamin B6 (pyridoxine hydrochloride) and B-complex deficiencies is also suspected in depression
syndrome, and that carbohydrates (fruits, beans, and grains) may be especially helpful with the depression.
Most of the side effects of the antidepressant medications are not diet related. However two possible side
effects, constipation and dry mouth, can be alleviated by diet changes. It is advisable to eat more fibers and
increase water intake.
Diet and nutritional factors are probably the most significant determine factors, other than physiological or
genetic causes, for predisposing mental disorders. Virtually any nutrition deficiency can result in
depression. The researches have been directed which have shown that vitamins C, thiamin (B1), pyridoxine
(B6), cyanocobalamine (B12), niacin (B2) and folic acid could be linked to depression and emotional
disorders. The trace metal imbalances (copper, zinc, lithium, and cobalt) were also inked to mental illness.
Those suffering from schizophrenia had low levels of histamine, a chemical present in the cells throughout
the body that is in high concentration at the base of the brain cell. It is suggested that, most important
dietary rules to follow for optimal psychological and physiological health be:
Variety:
Eat natural food (whole grains, fresh vegetables and fruits) rather than processed food. Eat food free of pesticides and additive free, preferable organic. Eat a diet that is specifically suited to your own individual needs and body. Anxiety and stress increase the production of adrenal corticosteriods, which interferes with the healing, compromise the immune system and encourage cardiovascular and digestive tract diseases. Fear and anxiety inhibit the cell repair mechanisms. Joy and relaxation increase circulations to painful and wounded areas and improve tissue repair. Controlled research studies of these herbal medicine are limited. Except where specifically documented otherwise, all claims in reference to the products noted here are anecdotal in nature and meant to be interpreted using good medical judgment. It was difficult to make specific recommendations for their clinical use based on DSM-IV nosology for anxiety disorders. Descriptions of indications, even in such new references as the PDR for Herbal Medicines (Fleming, 1998), tend to be verified and revised., and use such terms as "nervous anxiety,.mental straina and nervous agitation.
Table 2. CURATIVE UNANI ANXIOLYTICS

Trade Name
Sherbet Ahmed Shah
Lavandula stoechas (Ustukhuddus) Nepeta hindostana (Badrang Boya) Cassia senna (senna) Polypodium vulgare (Bisfaij) Nymphea alba (Nilofar) Rosa damascena (Gulab) Ocimum basilicum (Franjmushk) Terminalia belerica (Halilah Siyah) Viola odorata (Banafshah) Onosma echoides (Gaozaban) Sumbalin
Barshaasha
Violoa odorata (Banafshah) Onosma echoides (Gaozaban) Anacyclus pyrethrum (Aqarqrah) Piper nigrum (Filfil Siyah) Euphorbia caudicifolia)
Table 3. FIXED/ESSENTIAL OILS (ROGHNIYAT) ANXIOLYTICS
Roghan Labub Saba
Papaver somniferum (Khashkhash) Lactuca serriola (Kahu) Prunus amygdalus (Badam) Pistacia vera (Pistah) Citrulus vulgaris (Turbuz)

Table 4. EXILARANTS (MUFFAREHAT) ANXIOLYTICS
Muffareh Shaikh-al-Rais
Onosma echioides (gaozaban) Elettaria cardamomum (Ilaichi Khurd) Santalum album(Sandal Safaid) Pterocarpus santalinus Sandal Surkh) Bambusa arundinacea (Banslochan ) Centurea behen Behman Safaid) Lactuca serriola (Kahu) Rosa damascena(Gulab) Doronicum hookeri (Daronj Aqrabi) Portulaca oleracea (Khurfa Siyah) Lagenaria vulgaris (Kaddu) Curcuma zeddoria (Zaranbad) Scilla serrata (Crab) Cucumis melo (Khurbuza) Cucumis sativus (Khiyarain) Cinnnamomum camphora (Kafur) Coralium rubrum (Marjan, Coral) Bombyx moris (Abresham Muqraz) Crocus sativus (Zafran) Mixed with honey, apple, Pyrus cydonia(Behi) juices Muffareh Azam
Muffareh Barid Sada
Muffareh Buqrat
Muffareh Kabeer
MuffarehMoatadil
Muffareh Yaquti Moatadil


Table 5. MURRABAY (________) ANXIOLYTICS
Murraba Aamla
Murraba Halilah (har)
Murraba Petha
Murraba Saib
Murraba Gazar
Murraba Anannas
Murraba Bahi

Table 6. DIET AND DEPRESSION

A chemical in the brain called serotonin has an important regulatory effect on a person's mood. Specifically, feelings of well being are heightened when seratonin is active in the brain. It is thought that some depressed people have a deficiency of serotonin. A high carbohydrate diet increased the brain's production of serotonin. Carbohydrate Without knowing it, depressed people may be turning to carbohydrates in an
attempt to improve their mood. While there is no evidence that eating carbohydrates will cure depression, eating a diet with adequate healthyfoods can help. Deficiencies in th(especially folic acid, thiamin, riboflavin, niacin and B6) have been associated with depression. It is best to get these nutrients B-Complex
from your diet. If you decide to take a supplement, select a multiple vitamin with no Vitamins
more than 100-150% of the RDAs. Large amounts can pose health risks of their own. Too much fat in anyone's diet is considered a health risk for heart disease and some cancers. But not enough fat can be a problem for our mental health. One goal to Essential
help manage mood is to eat an adequate, not excessive, amount of fat. The second goal is to select the right kinds of fat. Polyunsaturated fats are essential for a healthy human diet. In western diets, one type of these essential fats is hard to get unless effort is made to do so.
Fiber
It is recommended that the diet include about 20 to 30 grams of fiber a day. Most of us probably get only
10 to 11 grams a day - only half as much as we need. Inadequate fiber intake contributes to constipation.
Some medications can make the situation worse.
Insoluble Fiber
Insoluble fiber doesn't absorb water; it simply adds bulk to your stool. It helps to sweep everything through.
If you put wheat bran in water, the water will evaporate, but the bran will not have absorbed any water. The
More frequently you eliminate, the less chance of carcinogens or other undesirable substances being
Absorbed into the body. This type of fiber helps to correct or prevent constipation. It also reducing one's
Risk of diverticulosis and colon cancer.
Soluble Fiber
Soluble fiber is beneficial for lowering blood sugar and cholesterol levels. It works by absorbing water and
forming a gel. Think of what happens when you put oatmeal or rice in a pan of water. Even without heat,
they absorb all the water and become gel-like. This is what happens in your body. The gel traps cholesterol
and sugar, preventing it from being absorbed from the intestine.

Table 7. FIBER CONTENTS OF SELECTED FOODS

Serving Size Total Fiber (gms) Soluble Fiber (gms) Insoluble Fiber (gms)
Fruits
Apple, with skin
Pear, Bartlett
Prunes, dried
Strawberries
Vegetables
Beans, green, cooked
Broccoli, raw
Brussel Sprouts, Cooked
Carrot, raw
Corn, cooked
Peas, cooked
Potato, with skin
Sweet potato, peeled
Dried Beans and Peas (cooked)
Blackeyed peas
Garbonza beans
Kidney beans
Pinto beans
Split peas
Breads/Rice/Pasta
Rye bread
Sourdough bread
Whole wheat bread
Brown rice
Spiral pasta, whole wheat. cooked 1 cup
Nuts and Seeds
Peanuts,dry roasted
Sesame seeds
Sunflower seeds
Breakfast Cereal
All-Bran with Extra Fiber
Bran Buds
Fiber One
Oatmeal, cooked
Shredded Wheat, small biscuits
Total Raisin Bran

The nervous system and herbal remedies
In no other system of the body is the connection between physical and psychological aspects of our being
as apparent as in the nervous system. The tissues of the nervous system is part of the physical makeup of
type body but just as clearly, all the psychological process are anchored in the nervous system. Therefore, if
there is “disease” on the psychological level, it will be reflected on the phsysiogical level, and vice versa. A
holistic approach to healing knowledge in the interconnectedness of physiological and psychological
factors, and regards the nervous system and its function as vital system in the treatment of whole being. In
the alternative or complimentary therapy and system of treatment, herbs that acts on central nervous system
are called nervines. A listing of the categories of nervines and biomedical and herbal supplements are as
follows:
A.
Nervine Tonic: Oats, St John Wort, and Scullcap. Nervine Relaxing: Balm, Black Chosh, Chamomile, Hops, Lavender, PassionFlower, and Valerian. Nervine Stimulating: Kola, Coffee, Gotu-Kola, Guarana. Hypnotic: Poppy, Chamomile, Hops, and PassionFlower. Valerian. Antispasmodic: Cramp bark, Black Haw, Valerian. Antidepressant: St John Wort, Mugwort, Damania, Vervain, Lavender, Oats, Balm. Analgesic: Jamaican Dogwood, Valerian, Wood Betony, and Yellow Jasmine.
In general, a number of phytomedicines are used for the treatment of anxiety, tension and stress such as
Kava-Kava (Piper methysticum), PassionFlower (Passiflora incarnata), Valerian (Valeriana officinalis), and
antidepressant St John Wort (Hypericum perforatum).
Kava-Kava

Kava-Kava (Piper methysticum) can reduce anxiety and tension, and it can promote restful sleep. Its ability
to promote relaxation without loss of mental sharpness makes it particulary useful for the day time
mangemnt of anxiety. Kava-Kave can reduce skeletal muscle tension(Bone,1993/1994). In some people
with epilepsy, it seems to prevent seizure as effectively as some prescription anticonvulsants (Krezschmar
and Mayer,1969). Using electroencepha;logram studies of anxious subjects, researches have indicated that
Kava-Kava is as effectuive as benzodiazepines ( Keville and Korn, 1996). In addition, it produces
anxiolytic changes similar to thos eseen diazepam (Vakium) (Gessner et al.,1994).
In placebo controlled, double blind study ( Lehman et al,1996), one group of 29 patients received three
daily doses of 100 mg Kva extarct, while second group receive a placebo. The research showed that Kava-
Kava significantly reduced the anxiety syndromes not caused by menatl disordes. Similarly, 25 week
multicenter, randomized, placebo controlled double blind study involving 102 poples supported Kava-Kava
use as the tratment alternatives in anxiety disorders. This study aso showed that Kava-Kava long term
efficacy without tolerance problem commonly associated with benzodiazepines (Volvz and Kieser,1998).
Kava-Kava works as mild skletal muscle relaxant by acting on the central spinal nerves. It exerts a relaxing
effects on the centralnervous system. The active compounds demonstarte that V-aminobytyric acid
(GABA) receptor-binding activity. The adult dose of Kava-Kava extract (standadized to cntain 30% Kava
lactons) is 60 mg/day to 200 mg/day in either divided dose for general anxiety or single dose before sleep
for insomnia (Bone,1993/1994). The side effects of this botancal product include dermatitis, shrtness of
breadth and visual disturbences.
PassionFlower

This herbal supplement is helpful in anxiety, and it can be used as sedative, hypnotic and antispasmodic.
The active ingredient is chrysin, which appears to be aprtial agonist of benzodiazeoine recptor (Wolfman et
al.,1994). Therefore it does not produce tolerance or noted with the full agonist. The following dosage are
reported anecdotally. It can be aken for anxiety as a tincture in dose of one dropfull in warm water, or as 1-
2 capsule of freeze dried plnat material (Weil,1995/1990). At night time hypnotic, doses range from 200
mg-300 mg of the extract, taken one hour before bed time (Blloomfield,1998). In Europe, it is combined
with valerian for insomnia, anxiety and irritability.
One randomized controlled stydu using a commercial product conatining both PassionFlower and valeriana
exhibited benefirt in the treatment of adjustment disorders with anxiety (Bourin et al,1997). Excessive use
of this herb should e avoided during pregnancy and lactation (Newall et al,1996).
Valerian

Valerian is a sedative obtained from Valeriana ooficinalis. It can act as minor tranquilizer for restlessness,
anxiety and sleep disturences. Animal testing with Valerian shows result consistent with other hypnotic
agents such as benzodiazepines (hendricks et al.,1985). Human clinical studies confirm a mild sedatie
effect (Houghton, 1988). It is sold as tea, tincture or extract. For insomnia, the dosage is one teaspoonful
(2-3 gm) or 300-500mg capsule at bedtime (Weil,1995). Valerian has been used for a long time as a mild
sedative and traquilizer.
St. John’s Wort
Pharmacopoeial grade St. John’s Wort
Consists of dried flowering tops or aerail parts of Hypericum perforatum. In December,1984, the German
Herbal Commisssion E approved the internal use of St. John’s Wort of psycovegetative (psychoautonomic)
disturbences, depessive moods, anxiety and nervous unrest. ESCOP indicates its use for mild to moderate
depressive state, restlessness, anxiety, and irritibilaty (ESCOP, 1997). The German Standard Liscense for
St. John’s Wort tea list it for nervous excitement and sleep disturbences (Wichtl and Bisset, 1994).
Contraindication: none known. Dosage and administration; 2-4 gm per day of chopped or powdered herb
for nternal use, or 0.2 –1 mg of total hypericin of pharmaceutical preparations.The Bitish Herbal
Pharmacopoeia reported antidepressant action (BHP, 1996). In numerous controlled double blind study
using hroalcoholic St. John’s Wort preparations, a significant improvement of mood and loss interest and
activity and other depressive symptoms, such as sleep, concentration and somatic compalints, has been
reported (ESCOP,1997).
Phytopharmaceutical Anxiolytics

The behavioral effects of acute administration of apigenin and chrysin contained in Matricaria chamomilla
and Passiflora incarnata on animal model exhibited anxiolytic effects and reduced locomotor behavior
(Zanoli et al, 2000).
References
Almeida JC, Grimsley EW (1996), Coma from the health food store: interaction between kava and alprazolam. Ann
Intern Med 125(11):940-941 [letter].
Anxiety Disorders Association of America (1999), About anxiety disorders: medications. Available
at:www.adaa.org/aboutanxietydisorders/guidetotreatment/medication/. Accessed Jan. 26, 2000.
Astin JA (1998), Why patients use alternative medicine: results of a national study. JAMA 279(19):1548-1553 [see
comments].
Bloomfield HH (1998), Healing Anxiety with Herbs. New York: HarperCollins Publishers, pp97-98.
Bone K (1993/1994), Kava: a safe herbal treatment for anxiety. British Journal of Phytotherapy 3(4):147-153.
Bourin M, Bougerol T, Guitton B, Broutin E (1997), A combination of plant extracts in the treatment of outpatients with
adjustment disorder with anxious mood: controlled study versus placebo. Fundam Clin Pharmacol 11(2):127-132.
Fleming T, ed. (1998), PDR For Herbal Medicines. Montvale, N.J.: Medical Economics Co. Inc., pp1015-1016; 1043-
1045; 1204-1207.
Gessner B, Cnota P, Steinbach TS (1994), [Extract of kava-kava rhizome in comparison with diazepam and placebo.]
Zeitschrift für Phytotherapie 15:30-37.
Gerhard U, Linnenbrink N, Georghiadou C, Hobi V (1996), [Vigilance-decreasing effects of 2 plant-derived sedatives.]
Schweiz Rundsch Med Prax 85(15):473-81.
Head KA, Miller AL, eds. (1998), Piper methysticum (kava kava). Altern Med Rev 3(6):458-460.
Hendriks H, Bos R, Woerdenbag HJ, Koster AS (1985), Central nervous system depressant activity of valerenic acid in
the mouse. Planta Med 1:28-31.
Houghton PJ (1988), The biological activity of valerian and related plants. J Ethnopharmacol 22(2):121-142.
Keville K, Korn P (1996), Herbs for Health and Healing. Emmaus, Pa.: Rodale Press Inc., p33.
Kretzschmar R, Meyer HJ (1969), [Comparative experiments on the anticonvulsant efficacy of Piper methysticum
pyrone bonds.] Arch Int Pharmacodyn Ther 177(2):261-277.
Lehmann E, Kinzler E, Friedermann J (1996), Efficacy of a special kava extract (Piper methysticum) in patients with
states of anxiety, tension and excitedness of non-mental origin-a double-blind placebo-controlled study of four weeks
treatment. Phytomedicine 3(2):113-119.
Linderberg D, Pitule-Schodel H (1990), [D,L-kavain in comparison with oxazepam in anxiety states.] Forthsch Med
108(2):49-54. MacGregor FB, Abernethy VE, Dahabra S et al. (1989), Hepatotoxicity of herbal remedies. Br Med J 299(6708):1156-1157 [see comments]. National Institute of Mental Health (1999), Anxiety Disorders: Quick Facts. Available at: www.nimh.nih.gov/anxiety/anxiety/idx_fax.htm#top. Accessed Jan. 26, 2000. Newall C, Anderson LA, Phillipson JD (1996), Herbal Medicines: A Guide for Health Care Professionals. London: Pharmaceutical Press, p296. Norton SA (1998), Herbal medicines in Hawaii from traditional to convention. Hawaii Med J 57(1):382-386. Reader's Digest (1999), The Healing Power of Vitamins, Minerals and Herbs. Pleasantville, N.Y.: Reader's Digest Association Inc., pp320-321. Smith MW (1998), Herbal medicine and psychiatry: potential for toxicity. Presented at the 151st annual meeting of the American Psychiatric Association. June 3; Toronto. Smith GW, Chalmers TM, Nuki G (1993), Vasculitis associated with herbal preparation containing Passiflora extract. Br J Rheumatol 32(1):87-88 [letter]. Solbakken AM, Rorbakken G, Gundersen T (1997), [Nature medicine as intoxicant.] Tidsskr Nor Laegeforen 117(8):1140-1141. Volz HP, Kieser M (1998), Kava-kava extract WS 1490 versus placebo in anxiety disorders-a randomized placebo-controlled 25-week outpatient trial. Pharmacopsychiatry 30(1):1-5. Warnacke G (1991), [Psychosomatic disorders in the female climacterium: clinical efficacy and tolerance of kava extract WS1490.] Forthsch Med 109(4):119-122. Weil A (1995), Spontaneous Healing. New York: Knopf, p261. Weil A (1990), Natural Health, Natural Medicine. Boston: Houghton Mifflin Co., p244. Winokur G, Coryell W (1991), Anxiety Disorders: the Magnitude of the Problem. In: The Clinical Management of Anxiety Disorders, Coryell W, Winokur G, eds. New York: Oxford University Press Inc., p9. Wolfman C, Viola A, Paladini A et al. (1994), Possible anxiolytic effect of chrysin, a central benzodiazepine receptor legend isolated from Passiflora coerulea. Pharmacol Biochem Behav 47(1):1-4. Wong AH, Smith M, Boon HS (1998), Herbal remedies in psychiatric practice. Arch Gen Psychiatry 55(11):1033-1044.

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