Ethnophytomedicines as Golden Green Remedy for Various ...

© 2019 JETIR May 2019, Volume 6, Issue 5 www.jetir.org (ISSN-2349-5162)

JETIR1905G70 Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org 486

Ethnophytomedicines as Golden Green Remedy for

Various Anxiety Disorders.

Zahida shah, Riehana Gani, Sabeeha Shafi*

Department of Pharmaceutical Sciences, School of Applied Sciences and Technology, University of Kashmir, Hazratbal,

Srinagar-190006, India.

ABSTRACT

Anxiety is a type of mental illness which may be defined as an apprehension, fear or physical tension as a

consequence of an anticipated danger or misfortune, whether external or internal. Anxiety and apprehension

as isolated symptoms are common and occur in connection with a number of mental disorders, including

depression and psychoses. Anxiety is actually a state of excessive fear and is characterized by motor

sympathetic hyperactivity, apprehension and vigilance syndromes which ultimately lead to a wide variety of

CNS disorders if remained untreated. Anxiety disorders are observed as an acute stress response

characterized by a state of exaggerated or an abnormal arousal or fear. Allopathic medicines used in various

anxiety disorders like benzodiazepines, Selective Serotonin Inhibitors, Tricyclic antidepressants are

encountered with enormous side effects and one of the major ill effect is their potential to cause

dependence. Herbal drugs can serve as opportunistic alternative golden green therapy for the Anxiety

disorders which are free from the ill effects.

Key Words: Anxiety, CNS disorders, ill Effects, Dependence, Golden Green therapy

INTRODUCTION:

Mental, physical and social health, are the vital strands of life that are closely interwoven and deeply

interdependent. Defining health as physical, mental and social wellbeing, A.V. Shah has expressed that

mental health is the most essential and inseparable component of health. Anxiety is a psychological and

physiological state characterized by somatic, emotional, cognitive, and behavioral components. (Chris

Scarre, Thames & Hudson, 1995)1. It is the displeasing feeling of fear and concern. The root meaning of the

word anxiety is 'to vex or trouble; in either presence or absence of psychological stress, anxiety can create

feelings of fear, worry, uneasiness, and dread (Bouras, N. and Holt, G 2007).2 Anxiety is considered to be a

normal reaction to a stressor. Anxiety is an aversive emotional state, in which the feeling of fear is

disproportionate to the threat (Weinberger, 2001).3 Anxiety is a generalized mood that can occur without an

identifiable triggering stimulus. As such, it is distinguished from fear, which is an appropriate cognitive and

emotional response to a perceived threat. Additionally, fear is related to the specific behaviors of escape and

avoidance, whereas anxiety is related to situations perceived as uncontrollable or unavoidable (Ohman, A.

2000)4 The ongoing violence, the constant threat and poor future perspective put a heavy strain on the

natural coping mechanisms of the people in Kashmir, as a result, a lot of people suffer from stress (normal

http://www.jetir.org/

http://en.wikipedia.org/wiki/Psychology

http://en.wikipedia.org/wiki/Physiology

http://en.wikipedia.org/wiki/Somatic_nervous_system

http://en.wikipedia.org/wiki/Emotion

http://en.wikipedia.org/wiki/Cognition

http://en.wikipedia.org/wiki/Behavior

http://en.wiktionary.org/wiki/anxiety

http://en.wikipedia.org/wiki/Normality_(behavior)

http://en.wikipedia.org/wiki/Stress_(biological)

http://en.wikipedia.org/wiki/Mood_(psychology)

http://en.wikipedia.org/wiki/Stimulus_(psychology)

http://en.wikipedia.org/wiki/Fear

http://en.wikipedia.org/wiki/Fight-or-flight_response



or related to traumatic event), psychosocial problems (substance abuse, distrust) and disorders like anxiety,

mood and post-traumatic disorders.

SYMPTOMS

Anxiety can be accompanied by physical effects such as heart palpitations, fatigue, nausea, and chest pain,

shortness of breath, stomach aches, or headaches. Blood pressure and heart rate are increased, sweating is

increased, and blood flow to the major muscle groups is increased. Immune and digestive system functions

are inhibited. External signs of anxiety may include pale skin, sweating, trembling, and papillary dilation.

Other symptoms include problems in sleeping, Nightmares, Repeated thoughts or flashbacks of traumatic

experiences, Cold or sweaty hands or feet.

Types of anxiety disorders

The Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV, 1994) and Tenth Edition of

the International Classification of Diseases (ICD- 10) classified anxiety disorders in following categories:

Generalized anxiety disorder (GAD)

Generalized anxiety disorder (GAD) is characterized by excessive and inappropriate worrying that is

persistent (lasting some months in ICD-10, six months or longer in DSM-IV) and not restricted to particular

circumstances. Patients have physical anxiety symptoms and key psychological symptoms (restlessness,

fatigue, difficulty concentrating, irritability, muscle tension and disturbed sleep).

Panic disorder (with or without agoraphobia)

Panic disorder is characterized by recurrent unexpected surges of severe anxiety (‘panic attacks’), with

varying degrees of anticipatory anxiety between attacks. Panic attacks are discrete periods of intense fear or

discomfort, accompanied by at least four physical or psychological anxiety symptoms. Around two-thirds of

patients with panic disorder develop agoraphobia, defined as fear in places or situations from which escape

might be difficult or in which help might not be available, in the event of having a panic attack.

Social phobia (social anxiety disorder)

Social phobia is characterized by a marked, persistent and unreasonable fear of being observed or evaluated

negatively by other people, in social or performance situations, associated with physical and psychological

anxiety symptoms.




Specific phobia

Specific, simple or isolated phobia is characterized by excessive or unreasonable fear of (and restricted to)

single people, animals, objects, or situations (for example, flying, dentists, seeing blood, etc.) which are

either avoided or are endured with significant personal distress (avoidance must be prominent for ICD-10

diagnosis).

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder is characterized by a history of exposure to trauma (actual or threatened death,

serious injury, or threats to the physical integrity of the self or others) with a response of intense fear,

helplessness or horror: with the later development of re-experiencing symptoms (intrusive recollections,

flashbacks or dreams), avoidance symptoms (for example efforts to avoid activities or thoughts associated

with the trauma), and hyper-arousal symptoms (including disturbed sleep, hypervigilance and an

exaggerated startle response).

Obsessive–compulsive disorder (OCD)

Obsessive–compulsive disorder is characterized by recurrent obsessional ruminations, images or impulses,

and/or recurrent physical or mental rituals, which are distressing, time-consuming and cause interference

with social and occupational function. Common obsessions relate to contamination, accidents, and religious

or sexual matters: common rituals include washing, checking, cleaning, counting and touching

Separation anxiety disorder

Separation anxiety disorder (SepAD) is the feeling of excessive and inappropriate levels of anxiety over

being separated from a person or place. Separation anxiety is a normal part of development in babies or

children, and it is only when this feeling is excessive or inappropriate that it can be considered a

disorder(Siegler2006).5 Separation anxiety disorder affects roughly 7% of adults and 4% of children, but the

childhood cases tend to be more severe; in some instances even a brief separation can produce panic.

Epidemiology

Epidemiological studies in the general population aged 18–65 years indicate that when taken together

anxiety disorders have a 12-month period prevalence of approximately 15%, and a lifetime prevalence of

approximately 21%.Individual disorders are less frequent, with estimated 12- month prevalence rates

ranging between 0.7% (OCD) and 7.6%(specific phobia), and estimated lifetime prevalence rates between

0.8% (OCD) and 13.2% (specific phobia). Anxiety disorders are common during the perinatal period, with

reported rates of obsessive compulsive disorder and generalized anxiety disorder being higher in postpartum

women than in the general population. Social anxiety disorder (SAD) is among the most common of all


http://en.wikipedia.org/wiki/Developmental_psychology



psychiatric disorders with lifetime prevalence estimates ranging from 7% to 13% Epidemiological studies

indicate that approximately 62% of subjects with an anxiety disorder fulfill diagnostic criteria for another

psychiatric disorder, most commonly depression, which is present in around 33.5% of subjects with any

disorder being considerably more common in subjects with GAD and social phobia.

Anti Anxiety Drugs

The ideal anxiety drugs would suppress all the symptoms like irritability, uneasiness, jumpiness, feelings of

apprehension, rapid or irregular heartbeat, stomachache, nausea, faintness, and breathing problems

associated with it, without causing any unwanted effects. Numbers of drugs are available for the treatment

of anxiety like diazepam, alprazolam, lorazepam, clonozepam, buspirone, escitalopram, venlafaxine and

sertraline etc. Among them the most widely prescribed are the benzodiazepines. However, the clinical uses

of benzodiazepines are limited by their side effects such as psychomotor impairment, potentiating of other

central depressant drugs and dependence liability. It has lead scientists to investigate plants, which are

commonly employed in traditional and alternate system of medicine for sleep disorders and related diseases.

Various plants are being used in complementary and alternative medicines for management of anxiety.

Active Phytoconstituents from Herbal Plants having Anxiolytic activity:

A total of 33 purified natural compounds with proven anxiolytic activity were recorded from the 112 plants

listed in Table. The reported compounds include a variety of secondary metabolites, i.e., flavonoids,

terpenoids, alkaloids, and phenols, with the terpenoids (total 14 compounds) forming the majority of the

reported purified natural anxiolytic compounds (42%), and the flavonoids (nine compounds) forming the

second major group. Other secondary metabolites such as alkaloids (five compounds), phenols (four

compounds), and other derivatives were less reported.

Active compounds from Anxiolytic plants

Compound Type of

compound Plant species References

1-α-hydroxy-

erythravine Alkaloid Erythrina mulungu

Flausino OA et al.,

20076

4-hyroxybenzaldehyde Phenol Gastrodia elata Jung JW et al., 20067

4-hydroxybenzyl

alcohol Phenol Gastrodia elata Jung JW et al., 20067

6-methylapigenin Flavonoid Valeriana

officinalis

Wasowski C et al.,

20028

Apigenin Flavonoid

Matricaria

recutita/Turnera

aphrodisiaca

Kumar S et al., 20089

Bacoside A Terpenoid Bacopa monniera Bhattacharya SK, et

al., 201110




Baicalein Flavonoid Scutellaria

baicalensis

De Carvalho RS et al.,

201111

Baicalin Flavonoid Scutellaria

lateriflora Awad R et al., 200312

Cardiospermin Cyanogenic

-glucoside

Cardiospermum

halicacabum

Kumar R et al.,

201113

Chrysin Flavonoid Passiflora

incarnata Brown E et al., 200714

Crocins Terpenoid Crocus sativus Pitsikas N et al.,

200815

Dihydrokavain Terpenoid Piper methysticum Smith KK et al.,

200116

Essential oil Terpenoid Citrus

aurantiuman Carvalho et al., 200217

Essential oil Terpenoid Cymbopo

goncitratus

Costa CA et al.,

201118

Erysothrine Alkaloid Erythrina mulungu Santos Rosa et al.,

201219

Erythravine Alkaloid Erythrina mulungu Flausino OA et al.,

200720

Galphimines A-I Terpenoid Galphimia glauca Cardoso Taketa et al.,

200421

Geniposide Terpenoid Gardeniae

jasminoides

Toriizukaa K et al.,

200522

Ginkgolic acid

conjugates Phenol Ginkgo biloba

Satyan KS et al.,

199823

Ginsenoside Rb1 Terpenoid Panax ginseng Carr MN et al., 200624

Ginsenosides Rg3 and

Rh2 Terpenoid Panax ginseng Kim TW et al., 200925

Ginkgolide-A Terpenoid Ginkgo biloba

Kaempferol Flavonoid Apocynum

venetum

Grundmann O et al.,

200926

Mangiferin Phenol Canscora

decussata

Sethiya KN et al.,

201027

Neferine Alkaloid Nelumbo nucifera Sugimoto Y et al.,

200828

Quercetin Flavonoid Tilia Americana Aguirre-Hernández E

et al., 201029

Safranal Terpenoid Crocus sativus

Wogonin Flavonoid Scutellaria

baicalensis Hui KM et al., 200230

Sanjoinine A Alkaloid Ziziphus jujube Han H et al., 200931

Seed oil Terpenoid Lactuca sativa Yakoot M 201132

Tiliroside Flavonoid Tilia americana Herrera-Ruiz M et al.,

200833

Valepotriates Terpenoid Valeriana

officinalis

Valerenic acid Terpenoid Valeriana

officinalis Hui K M et al., 200234




Polyherbal formulations

In Ayurveda, compound formulations are generally used in the therapy as the combination of many drugs

provides a synergistic therapeutic effect and also includes ingredients which help to minimize the adverse

effects of few other major drugs. A recent study demonstrated adaptogenic potential of a compound natural

health product which had Withania as the main herb in an open label human trial. An aqueous-based liquid

herbal preparation consisting of eight herbs as follows: W. somnifera, Lagerstroemia speciosa, Bacopa

monniera, Zizyphus jujuba, Morinda citrifolia, Punica granatum, Shisandrae chinensis and Lycium

barbarum. (Seely and Singh, 2007).35

Another herbal formulation, Sumind is (Ayurvedic nomenclature and the quantity of each ingredient are

given in parentheses), Nardostachys atamans (Jatamansi), Acorus calamus (Vacha), Celastrus paniculata

(Jyotishmati), Convolvulus microphyllus (Shankapushpi), Bacopa monnieri (Brahmi), Withania somnifera

Ashwagadha), Valerian wallichii (Tagara), Eclipta alba (Bhringaraja). Sumind showed antidepressant

activity as indicated by reduced immobility time in rats subjected to swim stress. It also restored biogenic

amine levels to normal levels and reduced corticosterone levels in stressed rats. (Nanjappa et al., 2007).36

Mentat (BR-16A) is an herbal medication contains 20 different ingredients. The main herbspresent in the

mentat are Brahmi (Bacopa monnieri), Mandookparni (Centella asiatica). Ashwagandha (Withania

somnifera), Jatamansi (Nardostachys jatamansi), Shankhapuspi (Evolvulus alsinoides), Tagar (Valeriana

wallichi). Vach (Acorus calamus), Guduchi (Tinospora cordifolia), Malkangni (Celastrus paniculatus),

Kuth (Saussurea lappa) Amla (Embelica officinalis), Terminaliachebula and Terminalia belerica. Some of

these plants namely, B. monnieri, C. asiatica, W.somnifera, N. jatamansi, E. alsinoides, V. wallichi, A.

calamus, T. cordifolia and C. paniculatus, have been classified in Ayurveda as Medharasayanas and claimed

to improve memory and intellect

Another polyherbal formulation Geriforte showed significant anxiolytic effect in clinical studies. Geriforte

contains Chyavanprash concentrate and the extracts of Asparagus adscendens, Withania somnifera,

Glycyrrhiza glabra, Centella asiatica, Mucuna pruriens, Shilajeet, Asparagus racemosus, Terminalia

arjuna, Makardhwaj and Piper longum, besides some others. An earlier open study demonstrated the

beneficial effects of Geriforte in anxiety patients asper DSM III R criteria. There was significant reduction

in the total Hamilton Anxiety Rating Scale (HARS) score at the end of four weeks.(Boral et al., 1989; Shah

et al., 1990).37,38Another doubleblind, placebo-controlled study authors have observed improvement in

HARS scores in patients of mixed anxiety-depression following 4 weeks of Geriforte treatment in

comparison with placebo.(Upadhyaya et al., 1990)39




Another common polyherbal formulation Euphytose, which is a combination of six extracts: crataegus,

ballota, passiflora and valeriana, which have mild sedative effects, and cola and paullinia, which mainly act

as mild stimulants. euphytose reduced HAMMA scores in out patients with adjustment disorder with

anxious mood in multicenter, double-blind, placebo controlled study.(Bourin et al., 1997)40

Conclusion:

Green therapy acts as Golden therapy in C.N.S. Disorders like Anxiety. Major Phytoconstituents from

herbal plants such as Alkaloids, Flavonoids, Terpenoids, Phenol can help in reducing anxiety disorders

which are devoid of ill effects caused by synthetic drugs. Herbal formulations of these major herbal

phytoconstituents can serve as safe allternative therapy for Anxiety disorders.

Conflict of interest:

There are no conflict of interest.

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