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Passionflower in the treatment of generalized anxiety: A pilot double-blind randomized controlled trial with oxazepam


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Objective: Passionflower (Passiflora incarnata) is a folk remedy for anxiety. A double-blind randomized trial compared the efficacy of Passiflora incarnata extract with oxazepam in the treatment of generalized anxiety disorder. Methods: The study was performed on 36 out-patients diagnosed with GAD using DSM IV criteria. Patients were allocated in a random fashion: 18 to the Passiflora extract 45 drops/day plus placebo tablet group, and 18 to oxazepam 30 mg/day plus placebo drops for a 4-week trial. Results: Passiflora extract and oxazepam were effective in the treatment of generalized anxiety disorder. No significant difference was observed between the two protocols at the end of trial. Oxazepam showed a rapid onset of action. On the other hand, significantly more problems relating to impairment of job performance were encountered with subjects on oxazepam. Conclusion: The results suggest that Passiflora extract is an effective drug for the management of generalized anxiety disorder, and the low incidence of impairment of job performance with Passiflora extract compared to oxazepam is an advantage. A large-scale trial is justified.
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Passion¯ower in the treatment of generalized anxiety:
a pilot double-blind randomized controlled trial
with oxazepam
S. Akhondzadeh*PhD, H. R. Naghavi* MD, M. Vazirian* MD,
A. ShayeganpourPharmD,H.RashidiPharmD and M. KhaniMSc
*Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, South Kargar Avenue, Tehran and
Institute of Medicinal Plants, Jehad-E-Daneshgahi, Tehran, Iran
Objective: Passion¯ower (Passi¯ora incarnata)
is a folk remedy for anxiety. A double-blind
randomized trial compared the ef®cacy of Passi-
¯ora incarnata extract with oxazepam in the
treatment of generalized anxiety disorder.
Methods: The study was performed on 36 out-
patients diagnosed with GAD using DSM IV
criteria. Patients were allocated in a random
fashion: 18 to the Passi¯ora extract 45 drops/day
plus placebo tablet group, and 18 to oxazepam
30 mg/day plus placebo drops for a 4-week trial.
Results: Passi¯ora extract and oxazepam were
effective in the treatment of generalized anxiety
disorder. No signi®cant difference was observed
between the two protocols at the end of trial.
Oxazepam showed a rapid onset of action. On the
other hand, signi®cantly more problems relating
to impairment of job performance were encoun-
tered with subjects on oxazepam.
Conclusion: The results suggest that Passi¯ora
extract is an effective drug for the management of
generalized anxiety disorder, and the low inci-
dence of impairment of job performance with
Passi¯ora extract compared to oxazepam is an
advantage. A large-scale trial is justi®ed.
Keywords: herbal medicines, Passi¯ora incarnata,
RCT, traditional medicine
Generalized Anxiety Disorder (GAD) is the most
common anxiety disorder but is generally less
severe than panic disorder. GAD is probably the
disorder most often found with a coexisting mental
disorder, usually another anxiety disorder or a
mood disorder (1). The ratio of women to men is
about 2 : 1. The cause of GAD is not known. The
primary symptoms of GAD are anxiety, motor
tension, autonomic hyperactivity and cognitive
vigilance (1). DSM IV (2) employs the following
criteria for GAD: excessive anxiety and worry,
occurring more days than not for at least 6 months,
about a number of events or activities that are
dif®cult to control. Autonomic symptoms are no
longer required for diagnosis. The principal
neurotransmitter systems thought to modify anxi-
ety are the gamma-aminobutyric acid (GABA)
system, and the noradrenergic, serotonergic,
dopaminergic and histaminergic system (3, 4).
GABA is an important and abundant inhibitory
transmitter in the mammalian nervous system.
Three types of GABA receptor may be distin-
guished on the basis of their pharmacological
properties and the physiological consequences of
their activation: GABA
and GABA
receptors can be allosterically regulated by
a diverse range of both naturally occurring and
synthetic compounds (5±10). These substances
include the barbiturates and benzodiazepines,
which have important sedative, anxiolytic and
anticonvulsant uses (11±16). The most effective
treatment of patients with GAD is probably one
that combines psychotherapeutic, pharmacothera-
peutic and supportive approaches. Because of the
long-term nature of the disorder, a treatment plan
must be carefully thought out. The two major
drugs to be considered for the treatment of GAD
are buspirone and the benzodiazepines (3, 4).
Benzodiazepines are the drugs most frequently
prescribed for the treatment of anxiety disorders.
Received 13 June 2001, Accepted 24 July 2001
Correspondence: Dr Shahin Akhondzadeh PhD, No. 29, 39th
Street, Gisha Street, Tehran 14479, Iran. E-mail: s.akhond@
Journal of Clinical Pharmacy and Therapeutics (2001) 26, 363±367
Ó2001 Blackwell Science Ltd 363
They act through the benzodiazepines-GABA
receptor, where they inhibit neuronal activity by
increasing the chloride ion in¯ux into neurones.
This includes hyperpolarization of the nerve cell, a
condition that leads to decreased responsiveness to
incoming stimuli (17, 18).
Several problems are associated with the use of
benzodiazepines (BZDs) in GAD. About 25±30%of
all patients fail to respond, and tolerance and
dependence may occur. Some patients also experi-
ence impaired alertness while taking the drugs. In
addition, there are several reports that indicate
cognitive impairment induced by benzodiazepines
(19±25). The cessation of use of benzodiazepines
can induce a withdrawal syndrome, characterized
by psychological symptoms of anxiety, such as
apprehension and irritability. Physiological symp-
toms of anxiety include tremor and palpitation,
and perceptual disturbances include hypersensiv-
ity to light, sounds, touch or motion. Only one-
third of patients who have GAD seek psychiatric
treatment (19±25). Many patients go to general
practitioners, internists and cardiologists but they
also use herbal medicines like Passi¯ora.
Passion¯ower (Passi¯ora incarnata) is a woody,
hairy, climbing vine and is reputed to have seda-
tive/anxiolytic properties and has been used
widely as an ingredient of herbal remedies, chie¯y
in the form of a liquid tincture. The commission E
approved the internal use of passion¯ower for
nervous restlessness, and the British Herbal
Compendium indicates its use for sleep disorders,
restlessness, nervous stress and anxiety (26±29). In
our continuing study of traditional medicines with
neurotropic effects, we evaluated the use of this
plant for its anxiolytic effect in a double-blind,
randomized and parallel group trial, comparing it,
at a ®xed daily doses of 45 drops extract of Passi-
¯ora incarnata (Passipay
, Iran Darouk), with
oxazepam 30 mg/day.
Outpatients in group 1 received ®xed daily doses
of Passi¯ora extract 45 drops/day plus placebo
tablet (group 1), whereas those in group 2 received
oxazepam 30 mg/day plus Passi¯ora drop (group
2) for a period of 4 weeks. Thirty-six outpatients
(20 women and 16 men) aged between 19 and
47 years of age, who satis®ed the DSM IV (2) for a
diagnosis of GAD (duration of illness of 6 months)
and had a score of 14 or more on the Hamilton
Anxiety Rating Scale (HAM-A) were recruited.
Patients were excluded if screening showed a his-
tory of a serious suicide attempt or current acute
suicidal ideation, an unexpected recent panic attack
or full DSM IV panic disorder within the previous
6 months, a life-time diagnosis of DSM IV mania,
psychosis, paranoia or dementia, or if there was a
concurrent or recent diagnosis of substance abuse,
drug psychosis, obsessive-compulsive disorder,
hypomania or major depression. Pregnant and
lactating women were also excluded. Prior to the
study, the patients were free from all psychotropic
medication for a minimum of 7 days. After giving
informed consent, patients were randomly allo-
cated to the two treatment groups. Four subjects
dropped out of the trial due to non-compliance
(two from each group), leaving 32 subjects who met
the DSM IV criteria for GAD and completed the
trial. Patients were assessed by a psychiatrist at
baseline and 4, 7, 14, 21 and 28 days after the
medication started. The principal measure of the
outcome was the HAM-A score. The rater used
standardized instructions in the use of HAM-A.
The mean decrease in HAM-A score from baseline
was used as the main outcome measure of
Statistical analysis
Repeated measures analysis of variance (
with a two-tailed post-hoc Tukey mean comparison
test was performed on the change in HAM-A
scores from baseline. To compare the outcome of
two groups in the same week, an unpaired two-
sided Student's t-test was used. Results are
presented as mean  SEM Differences were
considered signi®cant when P<0á05. To compare
the demographic data and the frequency of side-
effects between the two groups, Pearson Chi square
test was performed.
The mean  SEM scores for the two groups of
patients are shown in Fig. 1. There were no signi®-
cant differences between the two groups on day 0
Ó2001 Blackwell Science Ltd, Journal of Clinical Pharmacy and Therapeutics,26, 363±367
364 S. Akhondzadeh et al.
(baseline) on the HAM-A (t0á1563, d.f. 30,
P0á8769). A repeated measures
showed a
signi®cant effect of treatment on the GAD scores. In
both groups post-hoc comparisons of the baseline
GAD scores with the scores at week 4 by means of the
Tukey procedure revealed a signi®cant reduction
from baseline (P<0á001). However, post-hoc testing
revealed a signi®cant reduction from baseline from
day 4 in oxazepam group and from day 7 in the
Passi¯ora group. At days 4, 7 and 14 the mean
HAM-A scores for the Passi¯ora placebo group were
higher than the oxazepam group. The differences
between the two treatments were signi®cant at day 4
(t2á842, d.f. 30, P0á008). However, after day 4
the differences were no longer signi®cant.
Clinical complications and side-effects
A number of probable side-effects were studied
(Table 1). Although impairment of job performance
was observed more often in the oxazepam group,
there were no signi®cant differences between the
two treatments in terms of total side-effects pro®le
(P0á831, NS; Table 1).
Anxiety is a common reaction to a signi®cant life
stress. It is characterized by fear and apprehension
that may or may not be associated with a clearly
identi®able stimulus (30±32). BZDs are considered
as ®rst line in the pharmacotherapy of anxiety (33).
They were hailed as a breakthrough because they
have fewer of the drawbacks of prior sedative-
hypnotics and are effective in a range of disorders
(20). However, BZDs have been the subject of
debate that tends to centre on issues related to
overuse, misuse and abuse (15). The realization
that BZDs have a narrow safety margin between
Trial (Days)
-5 0 5 10 15 20 25 30
Hamilton Anxiety Score
Oxazepam Tablet + Placebo Drop
Passiflora Drop + Placebo Tablet
Fig. 1. Mean SEM scores of two protocols on Hamilton
anxiety score. ns = non-signi®cant.
Table 1. Clinical complication and side-effects
Passi¯ora drop + placebo tablet Placebo drop + oxazepam tablet
Complications None Mild Moderate Severe
Disabling None Mild Moderate Severe
Disabling P
Dizziness 9 3 4 0 0 8 3 4 1 0 0á787
Drowsiness 10 6 0 0 0 9 5 2 0 0 0á342
Confusion 12 4 0 0 0 12 3 1 0 0 0á565
Slurred speech 16 0 0 0 0 16 0 0 0 0 None
Ataxia 14 1 1 0 0 12 3 1 0 0 0á562
Hypore¯exia 16 0 0 0 0 15 0 1 0 0 0á310
16 0 0 0 0 13 1 2 0 0 0á191
Dyspenea 16 0 0 0 0 14 0 2 0 0 0á144
Allergic reaction 14 1 1 0 0 13 2 1 0 0 0á831
Aggression 16 0 0 0 0 16 0 0 0 0 None
Disinhibition 16 0 0 0 0 16 0 0 0 0 None
Impairment of job
85 3 0 0 43 2 6 1 0á049*
*Signi®cantly more problems relating to impairment of job performance were encountered with patients on oxazepam.
Ó2001 Blackwell Science Ltd, Journal of Clinical Pharmacy and Therapeutics,26, 363±367
Passion¯ower in the treatment of general anxiety 365
the anxiolytic effect and the untoward side-effects
has prompted many researchers to evaluate new
compounds in the hope that safer alternative drugs
will be discovered (20). Among these alternative
drugs, medicinal plants such as Passi¯ora have a
special place. To the best of our knowledge, the
present study is the ®rst double-blind controlled
trial of Passi¯ora in the treatment of GAD (27±29).
Our main overall ®nding was that Passi¯ora extract
and oxazepam are effective in the treatment of
GAD. No signi®cant difference in ef®cacy was
observed between the two treatments. Neverthe-
less, in the oxazepam group, but not the Passi¯ora
group, signi®cant effects were observed by day 4.
This indicates a rapid onset of action for BZDs. On
the other hand, the substantially lower incidence of
impairment of job performance could be an
important advantage of Passi¯ora extract. However,
it should be emphasized that there was no signi®-
cant difference between the two treatments in
terms of the overall frequency of side-effects. We
conclude that Passi¯ora extract is potentially a
signi®cant improvement over benzodiazepines in
the management of GAD, particularly when drug-
induced impairment of job performance is to be
avoided. A large-scale trial is justi®ed.
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Passion¯ower in the treatment of general anxiety 367
... Of significant concern with kava however is the reports since the late 1990s and early 2000s of cases of hepatotoxicity sometimes leading to need for liver transplant and even death. As a result of these cases, kava was Possibly unsafe in pregnancy due to some case reports of premature rupture of membranes, meconium aspiration and persistent pulmonary hypertension of the newborn, though note that causality could not be confirmed [17] temporarily banned from over the counter sales in Germany and subsequently other European countries. In 2015, the ban was lifted in Germany based on largely inconclusive evidence regarding risk of hepatotoxicity and proposed benefits. ...
... Mild drowsiness and confusion were reported side effects in the passionflower group as well as mild to moderate dizziness. Importantly, there was a lower incident of impairment in job performance in the passionflower group compared to the oxazepam group [17]. In this Cochrane review, the Akhondzadeh et al. study along with a 1993 randomized control trial out of Japan by Mori et al. [18] were reviewed. ...
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Purpose of Review The goal of this paper is to summarize the evidence for the use of botanical medicines for the treatment of anxiety disorders. We sought to make this review practical for psychiatrists and psychiatric prescribers. Recent Findings In 2018, the Natural Medicines database produced a Clinical Management of Anxiety guide that summarized the conventional and natural treatments of anxiety disorders. Based on this guide, four herbal supplements (also referred to as botanicals) were selected for deeper study including kava, lavender, lemon balm and passionflower. All four were considered possibly safe and possibly effective according to the Natural Medicines database. Summary There is scientific evidence supporting the use of kava, lavender, lemon balm and passionflower in anxiety disorders. Lavender appears to have the best available evidence including comparable efficacy to conventional first line treatments and is available in a patented form that was used in the cited studies (Silexan).
... These conflicting affects need to be reconciled with further, more careful research, although a partial benzodiazepine agonist mechanism is still possible and other mechanisms may exist [85]. A small controlled trial showed that passionflower extract improved anxiety in general anxiety disorder better than placebo [106]. There are no formal studies on the toxicity of passionflower and no adverse effects have been reported [85]. ...
Sleep is one of the attributes of wellness that needs further research and is often neglected in all disciplines of medicine except Psychiatry. The important aspects of sleep are Rapid Eye movement (REM) sleep, Non- Rapid Eye Movement (NREM) sleep and Dreaming. This review mentions the fundamental processes of sleep, the causes of sleep deprivation and dreaming. The physiological changes that occur through sleep are discussed along with medications aids in sleeping and the substances that affect or change the sleep pattern. The common factors associated with sleeplessness are emotional or mental tension, anxiety, depression, work problems, and an unsatisfactory sex life. Sleep medicine as a recent branch of medicine is reviewed as well as the use of Plant Medicine to deal with sleep disorders. Common substances used to induce sleep are hypnotic sedatives, and over the counter medications such as Benadryl and Nyquil. Alcohol is also used as a sleep aid. Herbal medicines are also commonly used as sleep aids. How sleep medication affects then biological pathways of man is emphasized (The Biochemistry of Sleep). Two hypothetical enzymes are proposed for the Biochemical Pathway starting with tryptophan and terminating in melatonin, a known sleep hormone. The two hypothetical enzymes proposed are 5-hydroxytryptophan synthetase and 5-hydroxytryptophan decarboxylase. The major problems associated with insufficient in the society is explained as well as the causes of sleep deprivation in this modern civilization. Some of the behavioral changes in the society that have contributed to sleep problems are shift work, increased work hours and extensive socialization.
... The clinical utility of not many types of Passiflora has been experimentally considered. Passion flower extricates been characterized into a few classifications of synthetic exercises like an anxiolytic, spasmolytic, sleep-inducing, calming, opiate [1][2][3][4] . These concentrates are a piece of a treatment that has effectively treated outpatients with change issues and on edge mind-set. ...
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... According to research, Passiflora has both edible and therapeutic properties. Anxiety, attention deficit hyperactivity disorder, insomnia, cancer, and opiates withdrawal are among the therapeutic qualities of Passiflora plant parts (4,5,6,7,8,9). P. edulis Sims and P. edulis f. flavicarpa seeds have been found to be edible and high in oil in a number of tests (10). ...
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Passiflora edulis is a commonly cultivated plant in the Passifloraceae family that is also known as passion fruit. Passion fruit is high in antioxidants and a good source of nutrients, particularly fibre, vitamin C, and provitamin A. According to a review of the plant's literature, the leaves, flowers, and fruits are used as medicine in many countries. The current study is concerned with the physicochemical, powder behaviour, and preliminary phytochemical screening of fruit pulp. A physicochemical analysis of fruit pulp reveals that it contains 92 percent ash, 70 percent moisture, and 30 percent dry matter. The presence of phenols, flavones, tannins, coumarins, saponins, alkaloids, starch, xanthoproteins, reducing sugar, and oil has been confirmed by powder behaviour and preliminary phytochemical analysis of the results. Dry fruit pulp was extracted in various solvents to study preliminary phytochemical screening. According to the study findings, methanol extract had a high extractive yield as well as phytochemical constituents. As a result of these findings, the passion fruit has been identified as a possible source for the development of novel drugs.
... Additionally, 500 mg passionflower significantly reduced the levels of subjective anxiety when compared to controls in individuals receiving surgery (Movafegh et al., 2008), with similar results found in individuals who underwent spinal anaesthesia following 700 mg passionflower (Aslanargun et al., 2012). Following chronic administration, passionflower has shown similar anxiolytic potency to oxazepam (Akhondzadeh et al., 2001). Within the few studies that investigate the anxiolytic mechanisms of action of passionflower, research has found that passionflower (Passiflora caerulea) acts as a partial agonist on benzodiazepine receptors (Appel et al., 2011;Wolfman et al., 1994). ...
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Background Global lifetime prevalence of anxiety disorders has been estimated at approximately 16.6%, with subclinical prevalence likely much higher. Herbal approaches to reduce anxiety may be as effective as pharmacological treatments and are less likely to be associated with adverse side effects. The herbal species, namely, valerian, passionflower, hawthorn and ballota, have a long history of use as anxiolytics in traditional medicine, further supported by recent pre-clinical and clinical trials. Aims To assess the effects of chronic (14 days) supplementation with a multi-herb extract preparation (MHEP, Euphytose ® ) on psychological state and psychological and physiological stress responses during a laboratory stressor. Methods In this crossover study, 31 healthy participants (aged 19–58 years) received a MHEP and placebo for 14 days with a 28-day washout. Anxiety (State-Trait Anxiety Inventory), mood and physiological measures of stress (heart rate, galvanic skin response, salivary α-amylase and cortisol levels) were measured before and after an Observed Multitasking Stressor. Cognitive performance was also assessed. Results MHEP was associated with reduced tension-anxiety ( p = 0.038), with participants showing an attenuated response to the observed multitasking psychosocial stressor following MHEP, evidenced by lower salivary α-amylase ( p = 0.041) and galvanic skin response ( p = 0.004). Conclusions The combination of herbal extracts contained within the MHEP reduced subjective anxiety in a healthy population and lowered electrodermal skin conductance and concentration of salivary α-amylase in response to a psychosocial stressor, compared to placebo. The study was registered on (identifier: NCT03909906).
... Passiflorae herba-Passiflora incarnata L. Characteristic compounds (Table 1) Flavonoids-C-glycosides of apigenin (isovitexin) and luteolin (isoorientin) In in vitro studies, passionflower extract showed affinity only for the GABA A receptor. However, it did not affect the serotonin receptor and subreceptors [39]. Passionflower extract has also been included in clinical trials in patients with anxiety symptoms. ...
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COVID-19 infection causes complications, even in people who have had a mild course of the disease. The most dangerous seem to be neurological ailments: anxiety, depression, mixed anxiety–depressive (MAD) syndromes, and irreversible dementia. These conditions can negatively affect the respiratory system, circulatory system, and heart functioning. We believe that phytotherapy can be helpful in all of these conditions. Clinical trials confirm this possibility. The work presents plant materials (Valeriana officinalis, Melissa officinalis, Passiflora incarnata, Piper methysticum, Humulus lupulus, Ballota nigra, Hypericum perforatum, Rhodiola rosea, Lavandula officinalis, Paullinia cupana, Ginkgo biloba, Murraya koenigii, Crataegus monogyna and oxyacantha, Hedera helix, Polygala senega, Pelargonium sidoides, Lichen islandicus, Plantago lanceolata) and their dominant compounds (valeranon, valtrat, apigenin, citronellal, isovitexin, isoorientin, methysticin, humulone, farnesene, acteoside, hypericin, hyperforin, biapigenin, rosavidin, salidroside, linalool acetate, linalool, caffeine, ginkgolide, bilobalide, mihanimbine, epicatechin, hederacoside C,α-hederine, presegenin, umkaline, 6,7,8-trixydroxybenzopyranone disulfate, fumaroprotocetric acid, protolichesteric acid, aucubin, acteoside) responsible for their activity. It also shows the possibility of reducing post-COVID-19 neurological, respiratory, and cardiovascular complications, which can affect the functioning of the nervous system.
... According to a report, the plant Passiflora incarnata extracts were proved as effective in anxiolytic efficiency compared to chemical treatment with standard anxiolytic oxazepam [25]. However, many other recorded properties of plants belonging to the Passiflora genus are well known as factories of various phytochemicals [26,27]. The antioxidant activity of extracts of E. suberosa plant has been documented by reducing the free radicals [28]. ...
The present study describes the synthesis of silver nanoparticles (AgNPs) using Passiflora vitifolia (P. vitifolia) leaf extract as reducing and capping agent. Characterization of the synthesised AgNPs was done with the help of UV-Vis. spectroscopy, atomic force microscopy (AFM), fourier transform infrared microscopy (FTIR), zeta potential, thermo gravimetric analysis (TGA), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and X-ray diffraction (XRD) analysis. The formation of AgNPs was confirmed by the presence of an absorption peak at 388 nm in UV-Vis. spectrum, poly-dispersed nature and size range from 39.06 to 58.24 nm was displayed by AFM and different functional groups were recognized by FTIR analysis. AgNPs showed stability at -20.3 mV through zeta potential. SEM and TEM analysis revealed that AgNPs were spherical, poly-dispersed particles with minimum size of 11.61 nm and XRD analysis showed face-centered cubic and crystalline nature. The AgNPs demonstrated a notable antimicrobial efficacy against pathogenic microorganisms and showed a substantial antioxidant activity against DPPH free radicals. Further AgNPs conveyed potent anticancer activity against murine macrophage (RAW-264.7) cell line with a significant IC50 value of 57.63 µg/mL. The synthesized AgNPs signified good antimicrobial, antioxidant and anticancer activity; hence it has the possibility to be used in various biomedical applications after successful clinical trials.
O Transtorno de Ansiedade Generalizada (TAG) é uma patologia que atinge indivíduos em uma escala global, e tem índices crescentes a cada ano. Pessoas com essa patologia relatam sintomas como fadiga, tensão muscular, palpitação e suor excessivo, o que afeta diretamente a forma como o indivíduo interage com a sociedade ao seu redor. Diante do exposto, este estudo tem como objetivo apresentar uma revisão de literatura narrativa, com intuito de analisar o uso da Passiflora incarnata L. no tratamento do TAG. Foram utilizadas como base de dados os portais SciELO, PubMed, Lilacs, Google acadêmico, ScienceDirect e ANVISA, artigos publicados nos anos de 1993 a 2017. Os resultados foram obtidos através de cinco estudos, que demonstraram uma possível eficácia da Passiflora incarnata L. em indivíduos com TAG, uma vez que esta espécie é capaz de oferecer efeitos ansiolíticos através de sua atuação no Sistema Nervoso Central. Os estudos analisados mostraram que a espécie Passiflora incarnata L. demonstrou eficácia considerável no tratamento de pacientes com TAG.
O presente volume contém monografias completas de 11 plantas medicinais amplamente empregadas no país, sendo apenas duas exóticas. Nenhuma dessas espécies possui monografia farmacopeica nas seis edições já publicadas da Farmacopeia Brasileira; portanto, é significativa a contribuição desta obra para o desenvolvimento de fitoterápicos, importantes para a Atenção Primária à Saúde, principalmente quando se considera que 82% da população brasileira utiliza produtos à base de plantas medicinais.
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Central nervous system (CNS) disorders and diseases are expected to rise sharply in the coming years, partly because of the world’s aging population. Medicines for the treatment of the CNS have not been successfully made. Inadequate knowledge about the brain, pharmacokinetic and dynamic errors in preclinical studies, challenges with clinical trial design, complexity and variety of human brain illnesses, and variations in species are some potential scenarios. Neurodegenerative diseases (NDDs) are multifaceted and lack identifiable etiological components, and the drugs developed to treat them did not meet the requirements of those who anticipated treatments. Therefore, there is a great demand for safe and effective natural therapeutic adjuvants. For the treatment of NDDs and other memory-related problems, many herbal and natural items have been used in the Ayurvedic medical system. Anxiety, depression, Parkinson’s, and Alzheimer’s diseases (AD), as well as a plethora of other neuropsychiatric disorders, may benefit from the use of plant and food-derived chemicals that have antidepressant or antiepileptic properties. We have summarized the present level of knowledge about natural products based on topological evidence, bioinformatics analysis, and translational research in this review. We have also highlighted some clinical research or investigation that will help us select natural products for the treatment of neurological conditions. In the present review, we have explored the potential efficacy of phytoconstituents against neurological diseases. Various evidence-based studies and extensive recent investigations have been included, which will help pharmacologists reduce the progression of neuronal disease.
The GABAA/benzodiazepine receptor has been the focus of much study by pharmacologists, in particular with respect to the question of receptor heterogeneity. The recent application of molecular biological techniques to this area has revealed at least fourteen different GABAA receptor subunits, each encoded by a single gene. In addition, the primary transcripts of at least two genes are alternatively spliced, giving rise to two variant subunits in each case. For at least one subunit there is evidence for functional differences between variants and for their differential expression in the central nervous system.
• Risk of withdrawal was investigated in a prospective, double-blind comparison of clorazepate dipotassium, a benzodiazepine with a long half-life, and the nonbenzodiazepine buspirone hydrochloride in the long-term treatment of anxious outpatients. Patients were treated with therapeutic doses of clorazepate dipotassium (15 to 60 mg/d) or buspirone hydrochloride (10 to 40 mg/d) for six continuous months before their tranquilizer therapy was blindly and abruptly stopped. There was a significant increase in symptom severity consistent with a withdrawal reaction for the clorazepate group but not the buspirone group. For the clorazepate group, there was a suggestion that previous discontinuous exposure to benzodiazepines might sensitize patients to subsequent withdrawal effects. For the buspirone group, a higher dropout rate raised questions about patient satisfaction with therapy in this rather chronically anxious population.
• Bivariate twin analysis can determine the extent to which two disorders share common genetic, familial environmental, or individual-specific environmental risk factors. We applied this method to lifetime diagnoses of major depression and generalized anxiety disorder as assessed at personal interview in a population-based sample of 1033 pairs of female same-sex twins. Three definitions of generalized anxiety disorder were used that varied in minimum duration (1 vs 6 months) and in the presence or absence of a diagnostic hierarchy. For all definitions of generalized anxiety disorder, the best-fitting twin model was the same. Familial environment played no role in the etiology of either condition. Genetic factors were important for both major depression and generalized anxiety disorder and were completely shared between the two disorders. A modest proportion of the nonfamilial environmental risk factors were shared between major depression and generalized anxiety disorder. Within the limits of our statistical power, our findings suggest that in women, the liability to major depression and generalized anxiety disorder is influenced by the same genetic factors, so that whether a vulnerable woman develops major depression or generalized anxiety disorder is a result of her environmental experiences.