Medicinal plants useful in anxiety and insomnia

Plants are a good natural option to treat different pathologies, but they are still drugs and the doses and interactions with other plants or drugs will have to be taken into account.

The plants used to treat symptoms in psychiatry are no exception, they are also drugs, studied in a specialty known as Natural Medicine or Phytotherapy.

Contents

The most used plants in psychiatry

The following medicinal plants are the most used and have been the subject of scientific studies and approval.

HYPERICUM:

Hyperium (Hypericum perforatum) or St. John’s wort (Saint John’s Worth) is an herb widely used to treat depression, sometimes in an effort to avoid the adverse effects associated with antidepressants. To date, several studies show the usefulness of this plant and others who reject it. However, a Cochrane review (famous independent institute that analyzes studies conducted on medical subjects) considered that its effect was similar to antidepressants (3). This beneficial effect would place it as an antidepressant worth considering.

On the other hand, the use of this plant should not be taken lightly and considered harmless because it is a plant, that is, because it is something natural. The most serious problem reported from its unsupervised use occurs when used in combination with other antidepressants. Cases of serious interactions have been reported when used with paroxetine, sertraline or nefazodone (4, 5). This interaction is known as serotonin syndrome, which results from excessive activity on the neurotransmitter serotonin, which can be fatal (6).

That is why it is not recommended to use it with the vast majority of antidepressants, nor to neglect the interaction with other drugs that are not so little used, as is the case with some drugs for treatment of human immunodeficiency virus, medicines to treat cancer, immunomodulators, medicines to treat high cholesterol, blood thinners, oral contraceptives, digoxin, omeprazole, antibiotics such as erythromycin and azithromycin (7, 8).

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VALERIAN

This plant, known in the academic world as valerian officinalis, has been known for centuries as a hypnotic (a substance that produces sleep) and anxiolytic (a substance that reduces anxiety). It has been speculated that its effectiveness is determined by two of its components; valerenic acid and gamma-aminobutyric acid.

The multiple lines of evidence on the usefulness of this compound as a hypnotic (9), are specified in its acceptance by the European Agency for the Evaluation of Medicines (10). Valerian has been compared to the drugs that are the masters of prescriptions for insomnia and anxiety, the so-called benzodiazepines (lorazepam, alprazolam, ketazolam, clonazepam, etc.), although its effect is less. Valerian has given scale with one of them, oxazepam (not marketed in Spain) to reduce anxiety in people with insomnia who have not been diagnosed with a psychiatric disorder or another organic disorder (11, 12).

Its continued use showed a better subjective perception of sleep quality (13) and other improvements recorded by polysomnography (14), i.e. the sleep study procedure, as well as a reduction insomnia due to stress (15). Its safety has been evaluated in adults, children and pregnant women (13, 16).

PASSION FLOWER

This other plant, whose scientific name is Passiflora incarnata Linnaeus It has also been known since antiquity as an anxiolytic. Commonly called passionflower, rose or passion flower (since the inner part of its flower recalls the crown of thorns with which Christ was “crowned” before his crucifixion). Its therapeutic effect is to the detriment of one of its components: chrisine.

Its effectiveness as an anxiolytic has also been compared to the group of benzodiazepines, and although its effect is lower, it is comparable in the treatment of anxiety, in this variety and in other varieties of Passionflower (17-19 ). Significant side effects of this product have not yet been reported, nor drug interactions with other therapeutic substances.

Due to the lack of studies, we advise against its use in children under twelve, pregnancy and breastfeeding (19). The use of valerian and passionflower with antiepileptic drugs is not recommended as they potentiate their sedative effect (7).

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BALM

the plant of Melissa officinalis it has a well-documented medicinal history dating back to around 50–80 BC (20). Its use has been documented in the treatment of anxiety caused by stress (21, 22), as well as its use in adults and children in other processes such as fever (23). Its main active component is an essential oil, the main element of which is citral (24). No adverse effects were reported in adults (20) and in children it was found to be more effective than placebo (25).

antidepressants, medicinal herbs, medicinal plants, anxiety, insomnia, stress, sleep, depression, St. John's wort, St. John's wort, valerian, lemon balm, passionflower, passionflower, psychiatryBalm

General recommendations on the use of medicinal plants:

  • It is recommended to use valerian in combination with passionflower and lemon balm as their effect may be greater than if they were used separately.
  • The absence of significant side effects of valerian and passionflower allows them to be used in adults and children over 12 years old. Its use in pregnant women is less documented and not recommended.
  • Self-medication with Hypericum for depression is not recommended, although its effectiveness as an antidepressant has been demonstrated, due to its extensive interaction with other medications.
  • The use of passionflower or valerian with antiepileptics is not recommended because they increase their sedative effect.

BIBLIOGRAPHIC REFERENCES:

  1. Tylor F. A manual of the practice of medicine. London: J. & A. Churchill; 1894.
  2. Hollman A. Digoxin is from Digitalis lanata. BMJ. 1996;312:912.
  3. Linde K, Berner MM, Kriston L. St. John’s wort for major depression. The Cochrane Library. 2008.
  4. Barbenel D, Yusufi B, O’Shea D, Bench C. Mania in a patient receiving testosterone replacement after orchiectomy taking St. John’s wort and sertraline. J Psychopharmacol. 2000;66:133-9.
  5. J Markowitz, C DeVane, D Boulton, S Carson, Z Nahas, SC. R. Effect of St. John’s wort (Hipericum perforatum) on cytochrome P 450 2D6 and 3A4 activity in healthy volunteers. Life Sci.2000;66:133-9.
  6. Carrillo R, Garnica, MA, Rocha, MG, Carrillo, C A. Serotonin syndrome. Rev Fac Med (Mex). 2011;54(2):46-53.
  7. Tres J. Interaction between drugs and medicinal plants. An Sist Sanit Navar. 2006;29(2):233-52.
  8. Vanaclocha B, Risco E, Salvador Cañigueral S. Interactions between herbal preparations and synthetic drugs: review of EMA and ESCOP monographs. Rev plant. 2014:5-36.
  9. Hattesohl M, Feistel B, Sievers H, Lehnfeld R, Hegger M, Winterhoff H. Extracts of valerian effects but neither sedative nor muscle relaxant properties. Phytomedicine. 2008;15(1-2):2-15.
  10. EMA. Committee for Herbal Medicines 2006.
  11. Dorn M. Efficacy and tolerability of Baldrian versus oxazepam in nonorganic, nonphychiatric insomniacs: a randomized, double-blind, clinical comparative study. Forsch Komplementarmed Klass Naturheilkd. 2000;7(2):79-84.
  12. Ziegler G, Ploch M, Miettinen-Baumann A, Collet W. Efficacy and tolerability of valerian extract LI 156 compared to oxazepam in the treatment of nonorganic insomnia – a randomized, double-blind, comparative clinical study . European Journal of Medical Research. 2002;7(11):480-6.
  13. Hadley S, Petry JJ. Valerian. American family physician. 2003;67(8):1755-8.
  14. Donath F, Quispe S, Diefenbach K, Maurer A, Fietze I, Roots I. Critical evaluation of the effect of valerian extract on sleep structure and quality. Pharmacopsychiatry. 2000;33(02):47-53.
  15. Wheatley D. Kava and valerian in the treatment of stress-induced insomnia. Phytotherapy Research: PTR. 2001;15(6):549-51.
  16. Holst L, Nordeng H, Haavik S. Herbal use in early pregnancy in relation to maternal characteristics and pregnancy outcome. pharmacoepidemiology and drug safety. 2008;17(2):151-9.
  17. Brown E, Hurd NS, McCall S, Ceremuga TE. Evaluation of the anxiolytic effects of chrysin, an extract of Passiflora incarnata, in laboratory rats. AANA Journal. 2007;75(5).
  18. Soto MR, Arkin PA. Effect of “pure pure” Passiflora peduncularis flower fluid extract and guided meditation in patients with generalized anxiety disorder. Naturopathic medicine. 2016;10(2):9-14.
  19. EMA/HPMC. Community plant health monograph on Passiflora incarnata L., herba.
  20. European Medicines Agency. : EMEA/HMPC/230962/2006. ; 2007.
  1. Kennedy D, Scholey AB, Tildesley N, Perry E, Wesnes K. Modulation of mood and cognitive performance after acute administration of Melissa officinalis (lemon balm). Pharmacology Biochemistry and Behaviour. 2002;72(4):953-64.
  2. Mandos L. Relief of anxiety: an update on the treatment of general anxiety disorder. Am Drug. 1999;216:56-3.
  3. Kennedy DO, Scholey AB. The psychopharmacology of European herbs with cognition-enhancing properties. Current pharmaceutical design. 2006;12(35):4613-23.
  4. Romm A. 5 herbs for kids this cold and flu season. Better Nutrition. 2000;62:22-3.
  5. Lemes Hernandez C, Rodriguez Ferrada C, Acosta de la Luz L. Agronomic studies on Melissa officinalis L. (lemon balm): date of propagation and planting. Plant Rev Cubana Natural Medicine. 2001 6(3):93-7.
  6. Aldave KP, Pizán MED, Vilchez LFV, Ortiz EB. Effect of ethanolic extract of Melissa officinalis (lemon balm) on modifying the behavior of anxious children in the dental office. Stomatological magazine Herediana. 2009;19(2):91-5.

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