Anxiolytic Effects of Some Herbal Medicines: Evidence from Animal Studies and the Possibility of Clinical Use in Humans
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Published:
Dec 31, 2016
Keywords:
anxiolytic effects anxiety disorder Piper methysticum (kava) Passiflora incarnata (passionflower) Hypericum perforatum (St. John’s wort) Centella asiatica (buabok)
Main Article Content
Abstract
Anxiety is a mental disorder which leads to the impairment of emotion and behavior. If the symptoms occur for a long period of time, they could alter daily routines and reduce quality of life. This article presents an overview of the clinical presentation of anxiety disorders, classical medications and anxiolytic properties of some herbal medicines. In addition, the animal models for the assessment of anxiety are also mentioned. This review focuses on four herbal medicines that have been proved to possess anxiolytic effects in both preclinical and clinical studies including Piper methysticum (kava), Passiflora incarnata (passionflower), Hypericum perforatum (St. John’s wort) and Centella asiatica (buabok). Nevertheless, consistent clinical outcome is expected when those herbal medicines are to be used clinically. Thus, it is necessary to standardize all of these herbal medicines to ensure that clinical equivalence could be obtained, and to establish their acceptability as alternative medicines.
Article Details
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Review Article
References
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10. Bourin M, Hascoet M. The mouse light/dark box test. Eur J Pharmacol. 2003 Feb 28;463(1-3):55-65.
11. Prut L, Belzung C. The open field as a paradigm to measure the effects of drugs on anxiety-like behaviors: a review. Eur J Pharmacol. 2003 Feb 28;463(1-3):3-33.
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52. Beijamini V, Andreatini R. Effects of Hypericum perforatum and paroxetine on rat performance in the elevated T-maze. Pharmacological research. 2003;48(2):199-207.
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2. Bureau of Policy and Strategy, Ministry of Public Health. Thailand Health Profile 2008-2010. Bangkok: The War Veterans Organization of Thailand. 2013. Available from: http://wops.moph.go.th/ops/thp/thp/en/index.php?id=288&group_=05&page=view_doc
3. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. 4th ed, Text Revision. Washington, DC. 2000 p. 429-430.
4. Hoffman EJ, Mathew SJ. Anxiety disorders: a comprehensive review of pharmacotherapies. Mt Sinai J Med. 2008 May-Jun;75(3):248-62.
5. Sarris J, McIntyre E, Camfield DA. Plant-based medicines for anxiety disorders, Part 1: a review of preclinical studies. CNS Drugs. 2013 Mar;27(3):207-19.
6. Kalueff AV, Tuohimaa P. Experimental modeling of anxiety and depression. Acta Neurobiol Exp (Wars). 2004;64(4):439-48.
7. Lister RG. Ethologically-based animal models of anxiety disorders. Pharmacol Ther. 1990;46(3):321-40.
8. Pellow S, Chopin P, File SE, Briley M. Validation of open:closed arm entries in an elevated plus-maze as a measure of anxiety in the rat. J Neurosci Methods. 1985 Aug;14(3):149-67.
9. Wanasuntronwong A, Tantisira MH, Tantisira B, Watanabe H. Anxiolytic effects of standardized extract of Centella asiatica (ECa 233) after chronic immobilization stress in mice. J Ethnopharmacol. 2012 Sep 28;143(2):579-85.
10. Bourin M, Hascoet M. The mouse light/dark box test. Eur J Pharmacol. 2003 Feb 28;463(1-3):55-65.
11. Prut L, Belzung C. The open field as a paradigm to measure the effects of drugs on anxiety-like behaviors: a review. Eur J Pharmacol. 2003 Feb 28;463(1-3):3-33.
12. Singh YN, Singh NN. Therapeutic potential of kava in the treatment of anxiety disorders. CNS Drugs. 2002;16(11):731-43.
13. Clouatre DL. Kava kava: examining new reports of toxicity. Toxicology letters. 2004;150(1):85-96.
14. Magura EI, Kopanitsa MV, Gleitz J, Peters T, Krishtal OA. Kava extract ingredients, (+)-methysticin and (+/-)-kavain inhibit voltage-operated Na(+)-channels in rat CA1 hippocampal neurons. Neuroscience. 1997 Nov;81(2):345-51.
15. Gleitz J, Tosch C, Beile A, Peters T. The protective action of tetrodotoxin and (+/-)-kavain on anaerobic glycolysis, ATP content and intracellular Na+ and Ca2+ of anoxic brain vesicles. Neuropharmacology. 1996;35(12):1743-52.
16. Martin HB, McCallum M, Stofer WD, Eichinger MR. Kavain attenuates vascular contractility through inhibition of calcium channels. Planta Med. 2002 Sep;68(9):784-9.
17. Baum SS, Hill R, Rommelspacher H. Effect of kava extract and individual kavapyrones on neurotransmitter levels in the nucleus accumbens of rats. Prog Neuropsychopharmacol Biol Psychiatry. 1998;22(7):1105-20.
18. Seitz U, Schule A, Gleitz J. [3H]-monoamine uptake inhibition properties of kava pyrones. Planta Med. 1997;63(6):548-9.
19. Boonen G, Haberlein H. Influence of genuine kavapyrone enantiomers on the GABA-A binding site. Planta Med. 1998;64(6):504-6.
20. Jussofie A, Schmiz A, Hiemke C. Kavapyrone enriched extract from Piper methysticum as modulator of the GABA binding site in different regions of rat brain. Psychopharmacology (Berl). 1994 Dec;116(4):469-74.
21. Yuan CS, Dey L, Wang A, Mehendale S, Xie JT, Aung HH, et al. Kavalactones and dihydrokavain modulate GABAergic activity in a rat gastric-brainstem preparation. Planta Med. 2002;68(12):1092-6.
22. Rex A, Morgenstern E, Fink H. Anxiolytic-like effects of kava-kava in the elevated plus maze test--a comparison with diazepam. Prog Neuropsychopharmacol Biol Psychiatry. 2002 Jun;26(5):855-60.
23. Volz HP, Kieser M. Kava-kava extract WS 1490 versus placebo in anxiety disorders--a randomized placebo-controlled 25-week outpatient trial. Pharmacopsychiatry. 1997;30(1):1-5.
24. Malsch U, Kieser M. Efficacy of kava-kava in the treatment of non-psychotic anxiety, following pretreatment with benzodiazepines. Psychopharmacology (Berl). 2001;157(3):277-83.
25. Watkins LL, Connor KM, Davidson JR. Effect of kava extract on vagal cardiac control in generalized anxiety disorder: preliminary findings. J Psychopharmacol. 2001;15(4):283-6.
26. Boerner RJ, Sommer H, Berger W, Kuhn U, Schmidt U, Mannel M. Kava-Kava extract LI 150 is as effective as Opipramol and Buspirone in Generalised Anxiety Disorder--an 8-week randomized, double-blind multi-centre clinical trial in 129 out-patients. Phytomedicine. 2003;10 Suppl 4:38-49.
27. Sarris J, Kavanagh DJ, Byrne G, Bone KM, Adams J, Deed G. The Kava Anxiety Depression Spectrum Study (KADSS): a randomized, placebo-controlled crossover trial using an aqueous extract of Piper methysticum. Psychopharmacology (Berl). 2009 Aug;205(3):399-407.
28. Connor KM, Davidson JR. A placebo-controlled study of Kava kava in generalized anxiety disorder. Int Clin Psychopharmacol. 2002;17(4):185-8.
29. Gastpar M, Klimm HD. Treatment of anxiety, tension and restlessness states with Kava special extract WS 1490 in general practice: a randomized placebo-controlled double-blind multicenter trial. Phytomedicine. 2003;10(8):631-9.
30. Jacobs BP, Bent S, Tice JA, Blackwell T, Cummings SR. An internet-based randomized, placebo-controlled trial of kava and valerian for anxiety and insomnia. Medicine. 2005;84(4):197-207.
31. Poolsup N, Li Wan Po A, Knight TL. Pharmacogenetics and psychopharmacotherapy. J Clin Pharm Ther. 2000;25(3):197-220.
32. Wanwimolruk S, Bhawan S, Coville PF, Chalcroft SC. Genetic polymorphism of debrisoquine (CYP2D6) and proguanil (CYP2C19) in South Pacific Polynesian populations. European journal of clinical pharmacology. 1998;54(5):431-5.
33. Sarris J, LaPorte E, Schweitzer I. Kava: a comprehensive review of efficacy, safety, and psychopharmacology. Aust N Z J Psychiatry. 2011;45(1):27-35.
34. Wohlmuth H, Penman KG, Pearson T, Lehmann RP. Pharmacognosy and chemotypes of passionflower (Passiflora incarnata L.). Biological & pharmaceutical bulletin. 2010;33(6):1015-8.
35. Dhawan K, Kumar S, Sharma A. Anti-anxiety studies on extracts of Passiflora incarnata Linneaus. J Ethnopharmacol. 2001 Dec;78(2-3):165-70.
36. Appel K, Rose T, Fiebich B, Kammler T, Hoffmann C, Weiss G. Modulation of the gamma-aminobutyric acid (GABA) system by Passiflora incarnata L. Phytother Res. 2011;25(6):838-43.
37. Elsas SM, Rossi DJ, Raber J, White G, Seeley CA, Gregory WL, et al. Passiflora incarnata L. (Passionflower) extracts elicit GABA currents in hippocampal neurons in vitro, and show anxiogenic and anticonvulsant effects in vivo, varying with extraction method. Phytomedicine. 2010;17(12):940-9.
38. Grundmann O, Wahling C, Staiger C, Butterweck V. Anxiolytic effects of a passion flower (Passiflora incarnata L.) extract in the elevated plus maze in mice. Die Pharmazie. 2009;64(1):63-4.
39. Grundmann O, Wang J, McGregor GP, Butterweck V. Anxiolytic activity of a phytochemically characterized Passiflora incarnata extract is mediated via the GABAergic system. Planta Med. 2008;74(15):1769-73.
40. Soulimani R, Younos C, Jarmouni S, Bousta D, Misslin R, Mortier F. Behavioural effects of Passiflora incarnata L. and its indole alkaloid and flavonoid derivatives and maltol in the mouse. J Ethnopharmacol. 1997;57(1):11-20.
41. Aslanargun P, Cuvas O, Dikmen B, Aslan E, Yuksel MU. Passiflora incarnata Linneaus as an anxiolytic before spinal anesthesia. J Anesth. 2012 Feb;26(1):39-44.
42. Akhondzadeh S, Naghavi HR, Vazirian M, Shayeganpour A, Rashidi H, Khani M. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther. 2001 Oct;26(5):363-7.
43. Fisher AA, Purcell P, Le Couteur DG. Toxicity of Passiflora incarnata L. Journal of toxicology Clinical toxicology. 2000;38(1):63-6.
44. Gupta RK, Kumar D, Chaudhary AK, Maithani M, Singh R. Antidiabetic activity of Passiflora incarnata Linn. in streptozotocin-induced diabetes in mice. J Ethnopharmacol. 2012;139(3):801-6.
45. Nathan PJ. Hypericum perforatum (St John's Wort): a non-selective reuptake inhibitor? A review of the recent advances in its pharmacology. J Psychopharmacol. 2001 Mar;15(1):47-54.
46. Thiede HM, Walper A. Inhibition of MAO and COMT by hypericum extracts and hypericin. Journal of geriatric psychiatry and neurology. 1994;7 Suppl 1:S54-6.
47. Gobbi M, Moia M, Pirona L, Morizzoni P, Mennini T. In vitro binding studies with two hypericum perforatum extracts--hyperforin, hypericin and biapigenin--on 5-HT6, 5-HT7, GABA(A)/benzodiazepine, sigma, NPY-Y1/Y2 receptors and dopamine transporters. Pharmacopsychiatry. 2001;34 Suppl 1:S45-8.
48. Hunt EJ, Lester CE, Lester EA, Tackett RL. Effect of St. John's wort on free radical production. Life Sci. 2001;69(2):181-90.
49. Coleta M, Campos MG, Cotrim MD, Proenca da Cunha A. Comparative evaluation of Melissa officinalis L., Tilia europaea L., Passiflora edulis Sims. and Hypericum perforatum L. in the elevated plus maze anxiety test. Pharmacopsychiatry. 2001;34 Suppl 1:S20-1.
50. Kumar V, Jaiswal AK, Singh PN, Bhattacharya SK. Anxiolytic activity of Indian Hypericum perforatum Linn: an experimental study. Indian J Exp Biol. 2000;38(1):36-41.
51. Vandenbogaerde A, Zanoli P, Puia G, Truzzi C, Kamuhabwa A, De Witte P, et al. Evidence that total extract of Hypericum perforatum affects exploratory behavior and exerts anxiolytic effects in rats. Pharmacol Biochem Behav. 2000;65(4):627-33.
52. Beijamini V, Andreatini R. Effects of Hypericum perforatum and paroxetine on rat performance in the elevated T-maze. Pharmacological research. 2003;48(2):199-207.
53. Taylor LH, Kobak KA. An open-label trial of St. John's Wort (Hypericum perforatum) in obsessive-compulsive disorder. J Clin Psychiatry. 2000;61(8):575-8.
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