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Costa DLDC, Furlan Damiano R, Alcalá JÁ, Hatzinger M, Mesa F, Perna G, Purebl G, Torzsa P, Vobořilová V, Zwanzger P, Ho R, Bandelow B. How to treat subsyndromal anxiety disorder - practical recommendations for implementation in primary care. Int J Psychiatry Clin Pract 2024:1-10. [PMID: 38909282 DOI: 10.1080/13651501.2024.2362131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/27/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Anxiety is a common and disabling condition that significantly impacts quality of life. Subsyndromal anxiety (SSA) refers to anxiety symptoms that do not meet the full diagnostic criteria for an anxiety disorder but pose a risk for developing such disorders. We aimed to provide practical recommendations for the treatment of SSA in primary care settings. METHODS A narrative review was conducted to identify strategies for recognizing and treating patients with SSA. RESULTS The recommendations for treating SSA include lifestyle modifications such as exercise and stress reduction techniques, psychotherapy, and pharmacological treatments, including natural compounds like the lavender oil extract Silexan. Regular follow-up care is essential to monitor treatment response and address ongoing symptoms. Additionally, the use of the GAD-7 tool is recommended for accurately identifying patients with SSA. CONCLUSION Implementing these recommendations in primary care can lead to effective treatment of SSA, preventing the development of more severe anxiety disorders. An integrative approach, combining lifestyle modifications, psychotherapy, and pharmacotherapy, including natural compounds, offers significant benefits for managing anxiety.
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Affiliation(s)
- Daniel Lucas da Conceição Costa
- Department and Institute of Psychiatry, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rodolfo Furlan Damiano
- Department and Institute of Psychiatry, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - José Ángel Alcalá
- Clinical Unit of Mental Health. Reina Sofia University Hospital, Cordoba, Spain
| | - Martin Hatzinger
- Psychiatric Services Solothurn, and Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Francisco Mesa
- Health Economy Unit, National Institute of Mental Health, Mexico City, Mexico
| | - Giampaolo Perna
- Department of Biological Sciences, Humanitas University, Milan, Italy
| | - György Purebl
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Věra Vobořilová
- Faculty of Health Care Studies, University of West Bohemia, Pilsen, The Czech Republic
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany; kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Wasserburg am Inn, Germany
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttin-gen, Germany
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Kasper S, Volz HP, Möller HJ, Schläfke S, Klement S, Anghelescu IG, Seifritz E. Lavender oil preparation Silexan is effective in mild-to-moderate major depression: a randomized, placebo- and reference-controlled trial. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01783-2. [PMID: 38558147 DOI: 10.1007/s00406-024-01783-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/16/2024] [Indexed: 04/04/2024]
Abstract
Anxiety and depressive disorders have overlapping symptoms and share common neurobiological pathways. Antidepressant drugs have been demonstrated to be efficacious in anxiety as well. Vice versa, it may also be promising to investigate the efficacy of anxiolytic drugs such as silexan in major depressive disorder (MDD). Patients with a mild or moderate, single or recurrent episode of MDD and a total score of 19-34 points on the Montgomery Åsberg Depression Rating Scale (MADRS) were randomized to receive 1 × 80 mg/d silexan, 1 × 50 mg/d sertraline, or placebo double-blind, double-dummy for 56 days. The primary outcome measure was the MADRS total score change between baseline and treatment end. Treatment groups were compared using a treatment policy estimand. 498 subjects (silexan 170, sertraline 171, placebo 157) were treated and analyzed. After 8 weeks, silexan and sertraline were superior to placebo for MADRS total score reduction, with absolute differences to placebo of 2.17 (95% confidence interval: 0.58; 3.76) points and 2.59 (1.02; 4.17) points, respectively (p < 0.01). Moreover, silexan was superior to placebo for alleviation of functional impairment according to the Sheehan Disability Scale with a difference of 2.40 (1.04; 3.76) points (p < 0.001). Both treatments were well tolerated; eructation was the most frequent adverse effect of silexan. The study confirms the antidepressant efficacy of silexan in mild or moderate MDD, including significant improvements in the subjects' functional capacity. The results for sertraline confirm the assay sensitivity of the trial. Both drugs were well tolerated.Trial registrationEudraCT2020-000688-22 first entered on 12/08/2020.
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Affiliation(s)
- Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Spitalgasse 4, 1090, Vienna, Austria.
| | - Hans-Peter Volz
- Würzburg, Former Medical Director Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Hans-Jürgen Möller
- Clinic and Policlinic for Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Sandra Schläfke
- Department of Research and Development, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Stephan Klement
- Department of Research and Development, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Ion-George Anghelescu
- Clinic of Psychiatry and Psychotherapy, Mental Health Institute Berlin, Berlin, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
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Dold M, Möller HJ, Volz HP, Seifritz E, Schläfke S, Bartova L, Kasper S. Baseline symptom severity and efficacy of Silexan in patients with anxiety disorders: A symptom-based, patient-level analysis of randomized, placebo-controlled trials. Eur Psychiatry 2024; 67:e23. [PMID: 38425206 DOI: 10.1192/j.eurpsy.2024.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
The influence of baseline severity on the efficacy of Silexan, a proprietary essential oil from Lavandula angustifolia, in anxiety disorders has not been investigated in a pooled dataset. We report on an individual patient data analysis of all five double-blind, randomized, placebo-controlled trials with Silexan in anxiety disorders. Eligible participants received Silexan 80 mg/d or placebo for 10 weeks. Analyses were based on the Hamilton Anxiety Rating Scale (HAMA), its psychic and somatic anxiety subscores, and the Clinical Global Impressions (CGI) scale. To correlate baseline severity with outcome, patients were segregated into mild, moderate, and severe cases. Altogether 1,172 patients (Silexan, n = 587; placebo, n = 585) were analyzed. For the HAMA total score, we found a significant association between the score at baseline and the treatment effect of Silexan versus placebo at week 10 (p < 0.001). HAMA items from the somatic domain scored lower at baseline and showed less improvement than items from the psychic domain, particularly in patients with mild or moderate baseline symptoms. For CGI item 2 (global improvement), significant efficacy favoring Silexan were observed in mild, moderate, and severe baseline symptom severity. Although significant improvements were found for all subsets, the more severe the initial symptoms, the greater the treatment effects documented by the HAMA. Overall this analysis confirms that Silexan is an effective treatment option in early or mild stages of anxiety disorder. Given its favorable safety profile, Silexan can thus fill a therapeutic gap in the treatment of (subsyndromal) anxiety disorders.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Switzerland
| | | | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
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Dold M, Bartova L, Volz HP, Seifritz E, Möller HJ, Schläfke S, Kasper S. Efficacy of Silexan in patients with anxiety disorders: a meta-analysis of randomized, placebo-controlled trials. Eur Arch Psychiatry Clin Neurosci 2023; 273:1615-1628. [PMID: 36717399 PMCID: PMC10465640 DOI: 10.1007/s00406-022-01547-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/19/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION We report on a meta-analysis of Silexan, a proprietary active substance produced from Lavandula angustifolia, in subthreshold anxiety, mixed anxiety and depressive disorder (MADD), and generalized anxiety disorder (GAD). METHODS The present analyses are based on all currently completed 5 double-blind, randomized, placebo-controlled trials investigating Silexan in adult out-patients who received Silexan 1 × 80 mg/day or placebo for ten weeks according to random assignment (n = 1213). Efficacy was assessed based on the Hamilton Anxiety Rating Scale (HAMA), several anxiety self-rating scales, the Clinical Global Impression (CGI) scale, and the Short Form-36 (SF-36) health status questionnaire. RESULTS After ten weeks' treatment, Silexan was significantly superior to placebo in reducing the HAMA total score (including the psychic and somatic anxiety sub-scores) and self-rated anxiety. Based on a ≥ 50% HAMA total score reduction, the responder rate ratio was 1.34 favoring Silexan, and the rate ratio of subjects much or very much improved according to the CGI was 1.51. Silexan was also significantly superior in improving the physical and mental health summary scores of the SF-36. There were no significant between-group differences concerning the occurrence of adverse events (AEs), serious AEs, and premature withdrawal due to AEs. CONCLUSIONS This meta-analysis demonstrates that Silexan exerts significant anxiolytic effects in subthreshold anxiety, GAD and MADD that were consistently reflected in investigator ratings and patient-reported outcomes, including improvement of health-related life-quality, while showing favorable tolerability and safety.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Balthasar-Neumann-Platz 1, 97440, Werneck, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Sandra Schläfke
- Dr. Willmar Schwabe GmbH & Co. KG, Willmar-Schwabe-Straße 4, 76227, Karlsruhe, Germany
| | - Siegfried Kasper
- Center of Brain Research, Medical University of Vienna, Spitalgasse 4, 1090, Vienna, Austria.
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Salm S, Rutz J, van den Akker M, Blaheta RA, Bachmeier BE. Current state of research on the clinical benefits of herbal medicines for non-life-threatening ailments. Front Pharmacol 2023; 14:1234701. [PMID: 37841934 PMCID: PMC10569491 DOI: 10.3389/fphar.2023.1234701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
Herbal medicines are becoming increasingly popular among patients because they are well tolerated and do not exert severe side effects. Nevertheless, they receive little consideration in therapeutic settings. The present article reviews the current state of research on the clinical benefits of herbal medicines on five indication groups, psychosomatic disorders, gynecological complaints, gastrointestinal disorders, urinary and upper respiratory tract infections. The study search was based on the database PubMed and concentrated on herbal medicines legally approved in Europe. After applying defined inclusion and exclusion criteria, 141 articles were selected: 59 for psychosomatic disorders (100% randomized controlled trials; RCTs), 20 for gynecological complaints (56% RCTs), 19 for gastrointestinal disorders (68% RCTs), 16 for urinary tract infections (UTI, 63% RCTs) and 24 for upper respiratory tract infections (URTI) (79% RCTs). For the majority of the studies, therapeutic benefits were evaluated by patient reported outcome measures (PROs). For psychosomatic disorders, gynecological complaints and URTI more than 80% of the study outcomes were positive, whereas the clinical benefit of herbal medicines for the treatment of UTI and gastrointestinal disorders was lower with 55%. The critical appraisal of the articles shows that there is a lack of high-quality studies and, with regard to gastrointestinal disorders, the clinical benefits of herbal medicines as a stand-alone form of therapy are unclear. According to the current state of knowledge, scientific evidence has still to be improved to allow integration of herbal medicines into guidelines and standard treatment regimens for the indications reviewed here. In addition to clinical data, real world data and outcome measures can add significant value to pave the way for herbal medicines into future therapeutic applications.
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Affiliation(s)
- Sandra Salm
- Institute of Pharmaceutical Biology, Goethe University, Frankfurt, Germany
- Institute of General Practice, Goethe University, Frankfurt, Germany
| | - Jochen Rutz
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Marjan van den Akker
- Institute of General Practice, Goethe University, Frankfurt, Germany
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven, Leuven, Belgium
| | - Roman A. Blaheta
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
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Cho K, Kim M. Effects of aromatherapy on depression: A meta-analysis of randomized controlled trials. Gen Hosp Psychiatry 2023; 84:215-225. [PMID: 37619300 DOI: 10.1016/j.genhosppsych.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/02/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Non-pharmacological interventions, such as aromatherapy, have been utilized for treating depression. This systematic review and meta-analysis aimed to investigate the effects of aromatherapy on depressive symptoms. METHOD The databases of PubMed, MEDLINE, CINAHL, EMBASE, Web of Science, and the Cochrane Library were searched from May 5, 2023, to May 20, 2023. Only randomized controlled trials that implemented aromatherapy in adults aged ≥18 years were included. The standardized mean difference (SMD) was calculated, and subgroup analysis, meta-ANOVA, and meta-regression were performed for the moderator variables. RESULTS Thirty-two clinical trials (27 studies) were included in the final analysis. Aromatherapy demonstrated a moderate effect size for reducing depressive symptoms (SMD = -0.56, 95% CI: -0.69 to -0.43). Inhalation was the most effective method of delivery and blended essential oils were more effective than lavender or other single essential oils. Aromatherapy demonstrated a moderate effect size for reducing depressive symptoms among menopausal women, patients with heart disease (coronary artery disease or acute coronary syndrome), and psychological illnesses. However, it demonstrated no effect on postpartum or pregnant women. Mean age was a significant moderator variable. CONCLUSIONS Reliable evidence is present for the application of aromatherapy to reduce depressive symptoms, and it can be utilized effectively to decrease depressive symptoms.
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Affiliation(s)
- Kyeonga Cho
- Doctoral course student, 1 Gangwondaehakgil, Chuncheon-Si, Gangwon-Do 24341, Republic of Korea
| | - Myoungsuk Kim
- Associate professor, College of Nursing, Kangwon National University, Republic of Korea.
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7
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Kasper S, Eckert A, Möller HJ, Volz HP, Seifritz E. Psychiatric manifestations of post-COVID-19 syndrome: the potential benefit of Silexan. Int J Psychiatry Clin Pract 2023; 27:285-291. [PMID: 37021969 DOI: 10.1080/13651501.2023.2187308] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/10/2023] [Accepted: 03/01/2023] [Indexed: 04/07/2023]
Abstract
Objective: Psychiatric symptoms are common and bothersome in individuals with post-COVID-19 syndrome. Because they are often mixed and subthreshold, established treatment regimens cannot be applied. There is an urgent need to identify therapeutics for affected patients. Silexan, a proprietary essential oil from Lavandula angustifolia, has demonstrated efficacy against anxiety, comorbid symptoms, and subthreshold and mixed syndromes. The aim of the current narrative review is to examine the therapeutic potential of Silexan for psychiatric manifestations in patients with post-COVID-19 syndrome.Methods: We reviewed clinical evidence regarding the efficacy of Silexan and first clinical experience in patients with psychiatric symptoms attributable to the post-COVID-19 syndrome. Furthermore, we discussed potential modes of action based on nonclinical data.Results: Silexan has demonstrated therapeutic efficacy for the treatment of generalised anxiety disorder; subsyndromal anxiety disorders; comorbid depressive, somatic, and sleep disturbance symptoms; and mixed anxiety and depression. Emerging clinical experience also suggests the effectiveness and tolerability of Silexan for patients with post-COVID-19 syndrome. This can be explained by the fact that the therapeutic profile of Silexan overlaps with the spectrum of psychiatric symptoms in such patients.Conclusion: Preliminary findings indicate a promising potential of Silexan for the treatment of psychiatric manifestations in patients with post-COVID-19 syndrome.Key pointsAnxiety and mixed neuropsychiatric manifestations are commonly observed in patients with post-COVID-19 syndrome.Silexan has anxiolytic properties and can alleviate comorbid depressive, somatic, and sleep impairment symptoms.Silexan exhibits several biological mechanisms, such as neurotrophic and anti-inflammatory properties, which have the potential to positively impact post-COVID-19 disease.Silexan has a favourable safety profile and high acceptance among patients.Emerging data suggest that Silexan can alleviate neuropsychiatric symptoms in patients with post-COVID-19 syndrome.Silexan should be considered as a therapeutic in patients with psychiatric manifestations of post-COVID-19 syndrome.
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Affiliation(s)
| | - Anne Eckert
- Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Hans-Jürgen Möller
- Clinic and Policlinic for Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
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8
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Sattayakhom A, Wichit S, Koomhin P. The Effects of Essential Oils on the Nervous System: A Scoping Review. Molecules 2023; 28:molecules28093771. [PMID: 37175176 PMCID: PMC10180368 DOI: 10.3390/molecules28093771] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Essential oils are a mixture of natural aromatic volatile oils extracted from plants. The use of essential oils is ancient, and has prevailed in different cultures around the world, such as those of the Egyptians, Greeks, Persians, and Chinese. Today, essential oils are used in traditional and complimentary medicines, aromatherapy, massage therapies, cosmetics, perfumes and food industries. The screening effect of essential oils has been studied worldwide. They demonstrate a range of biological activities, such as antiparasitic, antifungal, antibacterial, antiviral, antioxidant, anti-inflammatory, anticancer, antiaging, and neuroprotective properties. In this scoping review, we provide a 10-year updated comprehensive assessment of volatile oils and their effects on the nervous system. MEDLINE, Scopus, and Google Scholar were systematically and strategically searched for original studies investigating these effects from 2012 to 2022. Approximately seventy studies were selected as included studies. Among these studies, several outcomes were reported, including antistress, antianxiety, analgesic, cognitive, and autonomic effects. Some essential oils showed developmental benefits, with the potential to induce neurite outgrowth. The neurotransmitter receptor level can also be modified by essential oil application. Physiological and pathophysiological outcome measures were reported. For physiological outcomes, arousal, cognitive performance, circadian eating behavior, emotional modulation, consumer acceptance, preferences, and willingness to buy were investigated. For pathophysiological conditions, pain, depression, anxiety, stress, sleep disorder, mental fatigue, agitated behavior, and quality of life were measured. In conclusion, essential oils showed promising effects on the nervous system, which can be further applied to their use in functional foods, drinks, and alternative therapy.
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Affiliation(s)
- Apsorn Sattayakhom
- School of Allied Health Sciences, Walailak University, Nakhonsithammarat 80160, Thailand
- Center of Excellence in Innovation of Essential Oil and Bioactive Compounds, Walailak University, Nakhonsithammarat 80160, Thailand
| | - Sineewanlaya Wichit
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Phanit Koomhin
- Center of Excellence in Innovation of Essential Oil and Bioactive Compounds, Walailak University, Nakhonsithammarat 80160, Thailand
- School of Medicine, Walailak University, Nakhonsithammarat 80160, Thailand
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Magden ER, Neal Webb S, Lambeth SP, Buchl SJ, Schapiro SJ. The Effects of Oral Lavender Therapy on Wounding in Chimpanzees ( Pan troglodytes). Animals (Basel) 2023; 13:ani13081382. [PMID: 37106945 PMCID: PMC10135126 DOI: 10.3390/ani13081382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/07/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
Lavender administration in humans has been shown to promote calmness without the side effects often observed with benzodiazepines. Studies in both humans and rodents have found that ingestion of oral lavender capsules resulted in significantly decreased anxiety. Additionally, mice developed an anti-conflict effect and humans increased socially inclusive behaviors. Given the safety of oral lavender oil and the observed benefits, we administered daily lavender capsules to six chimpanzees who exhibited conflict-instigating behaviors in an effort to further decrease our already low levels of wounding. We compared the total number of wounds in 25 chimpanzees housed with the six lavender-treated chimpanzees in five different social groups (1) prior to administration of daily oral lavender capsules to (2) total wounds during daily oral lavender capsule treatment. We hypothesized that lavender therapy treatment would reduce overall wounding in the social groups. Surprisingly, overall wounding was higher during the lavender treatment period (p = 0.01), yet the percentage of wounds requiring treatment significantly decreased during the lavender therapy period (36% vs. 21%, p = 0.02).
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Affiliation(s)
- Elizabeth R Magden
- Michale E. Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, 650 Cool Water Dr., Bastrop, TX 78602, USA
| | - Sarah Neal Webb
- Michale E. Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, 650 Cool Water Dr., Bastrop, TX 78602, USA
| | - Susan P Lambeth
- Michale E. Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, 650 Cool Water Dr., Bastrop, TX 78602, USA
| | - Stephanie J Buchl
- Michale E. Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, 650 Cool Water Dr., Bastrop, TX 78602, USA
| | - Steven J Schapiro
- Michale E. Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, 650 Cool Water Dr., Bastrop, TX 78602, USA
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Shamabadi A, Akhondzadeh S. Efficacy and tolerability of Lavandula angustifolia in treating patients with the diagnosis of depression: a systematic review of randomized controlled trials. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2023; 20:81-91. [PMID: 34420270 DOI: 10.1515/jcim-2020-0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
Pharmacotherapy is the conventional treatment for depression, with only half of the patients responding to the first trial of monotherapy with first-line medicines. One way to overcome this resistance is to use complementary and alternative medicine. The antidepressant effects of Lavandula angustifolia, which is commonly called lavender, have been investigated in previous studies. This study aims to provide the first systematic review of lavender in treating patients with depression diagnosis. ISI Web of Science, Scopus, PubMed, Embase, PsycINFO, Google Scholar, and three trial registries were searched until May 2020 to find randomized controlled trials on lavender for depressed patients. The primary outcome was difference between the intervention and control groups in changing depression scores from baseline to endpoint. The included studies were assessed for effect size and methodological quality. Seven clinical trials were identified, in which 852 patients were studied. In six trials, the effectiveness of lavender in treating depression was reported, as being more pronounced adjunct to a typical antidepressant in one study. Significant reported side effects include headaches and eructation. Lavender is beneficial, tolerable, and safe in treating depression. Despite obtaining promising results, they are not enough to recommend prescribing lavender to depressed patients. Further high-quality, large-scale studies for rectifying the shortcomings of existing studies are recommended.
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Affiliation(s)
- Ahmad Shamabadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Wu H, Wang J, Teng T, Yin B, He Y, Jiang Y, Liu X, Yu Y, Li X, Zhou X. Biomarkers of intestinal permeability and blood-brain barrier permeability in adolescents with major depressive disorder. J Affect Disord 2023; 323:659-666. [PMID: 36493942 DOI: 10.1016/j.jad.2022.11.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/28/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The etiology in major depressive disorder (MDD) has not been fully understood. Accumulating evidence suggests an association between altered intestinal and blood-brain barrier (BBB) permeability and psychiatric disorders, while its changes in adolescent MDD populations have been received less attention. In this study, our aim was to explore the differences in plasma levels of intestinal and blood-brain barrier permeability markers in adolescents with MDD compared with healthy controls (HCs). METHODS We enrolled MDD (n = 50), and HCs (n = 40) with the age of 13-18 years old. The plasma level of zonulin, I-FABP, LPS, and claudin-5 were quantified. The Hamilton Depression Scale 17 items (HAMD-17) and Hamilton Anxiety Scale 14 items (HAMA-14) were used for symptom assessments. RESULTS The plasma levels of zonulin, I-FABP, LPS, and claudin-5 in the MDD group were significantly higher than those in the HCs. Plasma I-FABP levels in MDD with moderate to severe anxiety were significantly higher than those in MDD without moderate to severe anxiety and HCs. In addition, these four biomarkers (alone or combined) can be used as diagnostic markers for MDD in adolescents. LIMITATIONS The key limitation of this study is the blood measurements at a single time point with a relatively small sample size. CONCLUSIONS These findings advance our understanding of the pathophysiology of intestinal barrier injury, bacterial translocation, and blood-brain barrier injury involved in adolescents with MDD.
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Affiliation(s)
- Hongyan Wu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Wang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Teng Teng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bangmin Yin
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuqian He
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanliang Jiang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xueer Liu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Yu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Beneficial effects of Silexan on co-occurring depressive symptoms in patients with subthreshold anxiety and anxiety disorders: randomized, placebo-controlled trials revisited. Eur Arch Psychiatry Clin Neurosci 2023; 273:51-63. [PMID: 35262795 PMCID: PMC9958187 DOI: 10.1007/s00406-022-01390-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
Silexan is a proprietary active substance produced from Lavandula angustifolia, with proven anxiolytic efficacy in subthreshold and generalized anxiety disorder as well as in mixed anxiety and depressive disorder with beneficial impact on anxiety-related sleep disturbances. The pharmacological profile and clinical observations suggest that Silexan may also have an antidepressant effect. To investigate the effect of Silexan on co-occurring depressive symptoms, we present a meta-analysis of the five placebo-controlled clinical trials hitherto performed with Silexan in subthreshold anxiety (n = 3) and anxiety disorders (n = 2). Patients of all trials received Silexan 1 × 80 mg/day or placebo for 10 weeks according to random assignment. Assessment of the antidepressant effect was based on item 'depressed mood' from the Hamilton Anxiety Rating Scale (HAMA) administered in all trials and on the total scores of the Montgomery Åsberg Depression Rating Scale (MADRS) or the Hamilton Depression Rating Scale (HAMD) used in three trials. After 10-week treatment, patients receiving Silexan showed significantly more pronounced score reduction for HAMA item 'depressed mood' than those in the placebo group (p = 0.01). Significant superiority of Silexan over placebo could also be shown for mean MADRS or HAMD total score reduction (three studies; p < 0.01). Silexan-treated patients with more severe depressive symptoms at baseline showed more pronounced improvements than those with milder symptoms. Our meta-analysis clearly shows that Silexan has a beneficial effect on co-occurring depressive symptoms in patients with subthreshold anxiety and anxiety disorders and may, hence, lead to important therapeutic implications for depressive disorders.
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Medicinal Plants Used for Anxiety, Depression, or Stress Treatment: An Update. Molecules 2022; 27:molecules27186021. [PMID: 36144755 PMCID: PMC9500625 DOI: 10.3390/molecules27186021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Depression, anxiety, stress, and other mental disorders, which are on the rise worldwide, are indications that pharmacological therapy can have serious adverse effects, which is why many patients prefer to use herbal products to treat these symptoms. Here, we reviewed plants and products derived from them that are commonly used for the above indications, focusing on clinical data and safety profiles. While lavender, hops, maypop, lemon balm, and valerian have consistently been shown in clinical trials to relieve mild forms of neurological disorders, particularly depression, anxiety, and stress, currently available data do not fully support the use of peppermint for anxiety disorders and depression. Recent studies support the use of saffron for depression; however, its toxicological profile raises safety concerns. St. John’s wort is effective in alleviating mild to moderate depression; however, careful use is necessary particularly due to possible interactions with other drugs. In conclusion, more studies are needed to validate the mechanism of action so that these plants can be used successfully and safely to alleviate or eliminate various mental disorders.
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Seifritz E, Kasper S, Möller HJ, Volz HP, Müller WE, Eckert A, Hatzinger M. Effect of anxiolytic drug silexan on sleep - a narrative review. World J Biol Psychiatry 2022; 23:493-500. [PMID: 36259937 DOI: 10.1080/15622975.2021.2013092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Silexan is an orally administered, proprietary essential oil from Lavandula angustifolia with significant anxiolytic and sleep improving properties. Here we present a narrative review that provides an overview of the available evidence of the effects of silexan on sleep. METHODS We start with a summary of the pharmacological background and continue with presenting sleep-related results from controlled clinical trials with silexan. Then we report on a meta-analysis of item 'insomnia' from the Hamilton Anxiety Scale, which includes data from all randomised, placebo-controlled clinical trials with silexan in which the scale was administered. Finally, we summarise the results of a mediation analysis that was performed to elucidate the pathway of the effect of silexan on sleep. RESULTS In randomised, placebo-controlled trials in patients suffering from anxiety disorders silexan had a significant anxiolytic effect and improved sleep along with recovery from anxiety. Mediation analysis demonstrates that more than 98% of the effect of silexan on sleep was mediated by its anxiolytic effect while the direct effect on sleep was marginal. CONCLUSIONS Silexan improves sleep as a result of its anxiolytic effect.
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Affiliation(s)
- Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Center of Brain Research, Medical University of Vienna, Vienna, Austria
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Walter E Müller
- Department of Pharmacology Biocenter, Goethe University, Frankfurt, Germany
| | - Anne Eckert
- Transfaculty Research Platform MCN & Psychiatric University Hospital Basel, University of Basel, Switzerland
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15
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Zhang W, Yan Y, Wu Y, Yang H, Zhu P, Yan F, Zhao R, Tian P, Wang T, Fan Q, Su Z. Medicinal herbs for the treatment of anxiety: a systematic review and network meta-analysis. Pharmacol Res 2022; 179:106204. [DOI: 10.1016/j.phrs.2022.106204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 12/22/2022]
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Kim M, Nam ES, Lee Y, Kang HJ. Effects of Lavender on Anxiety, Depression, and Physiological Parameters: Systematic Review and Meta-Analysis. Asian Nurs Res (Korean Soc Nurs Sci) 2021; 15:279-290. [PMID: 34775136 DOI: 10.1016/j.anr.2021.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 09/17/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The recent evidence suggested substantial anxiolytic efficacy of lavender. The aim of this study was to examine the efficacy of lavender for anxiety, depression, and physiological parameters and to elucidate the differential effects of lavender on anxiety and depression by study characteristics. METHODS A systematic review and meta-analysis was performed following the PRISMA guidelines. We searched PubMed, Embase, Cochrane Library, Web of Science, and Cumulative Index of Nursing and Allied Health Literature databases for randomized controlled trials investigating the efficacy of lavender on anxiety, depression, or physiological parameters in humans. We assessed the risk of bias within studies with the revised Cochrane risk of bias tool for randomized trials. We used random effect model to estimate the average effect and computed bias-corrected standardized mean difference as effect size metric, Hedges' ĝ for all outcomes. RESULTS Lavender was superior to placebo or no treatment in reducing anxiety (Hedges' ĝ = -0.72, 95% confidence interval [CI] -0.90 to -0.55, p value <.001), depression (Hedges' ĝ = -0.43, 95% CI, -0.59 to -0.27, p value <.001), and systolic blood pressure (Hedges' ĝ = -0.23, 95% CI, -0.41to -0.05, p value = .01). The moderator analysis by meta-regression indicated that route of administration accounted 6.5% (p value = .187) for the heterogeneity in anxiolytic effects, sessions of treatment accounted 13.2% (p value = .055), and participants' health state accounted 8.9% (p value = .131) for the variance in anxiolytic effects. CONCLUSION Lavender aromatherapy showed substantial effect in reducing anxiety and depression, and sessions of administration increased the anxiolytic effects. The effects on physiological parameters showed small with inconsistent significances and randomized controlled trials on the effect of lavender on depression were scarce. Future trials on depression and physiological parameters are recommended, and increasing the sessions of administration is recommended.
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Affiliation(s)
- Myoungsuk Kim
- Department of Nursing, College of Nursing, Kangwon National University, Chuncheon, Republic of Korea.
| | - Eun Sook Nam
- Department of Nursing, College of Nursing, Kangwon National University, Chuncheon, Republic of Korea.
| | - Yongmi Lee
- Department of Nursing, College of Nursing, Kangwon National University, Chuncheon, Republic of Korea.
| | - Hyun-Ju Kang
- Department of Nursing, College of Nursing, Kangwon National University, Chuncheon, Republic of Korea.
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von Känel R, Kasper S, Bondolfi G, Holsboer-Trachsler E, Hättenschwiler J, Hatzinger M, Imboden C, Heitlinger E, Seifritz E. Therapeutic effects of Silexan on somatic symptoms and physical health in patients with anxiety disorders: A meta-analysis. Brain Behav 2021; 11:e01997. [PMID: 33638614 PMCID: PMC8035468 DOI: 10.1002/brb3.1997] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 12/22/2022] Open
Abstract
A meta-analysis was performed to examine therapeutic effects of Silexan on somatic symptoms, including insomnia/fatigue, and physical health in patients with anxiety disorders. Five randomized, placebo-controlled trials were included in this analysis: The efficacy of Silexan (80 mg/day) was investigated in patients with subthreshold anxiety disorders (three trials) and in patients with generalized anxiety disorder (two trials). Silexan was superior to placebo in terms of the mean change from baseline in the Hamilton Anxiety Rating Scale (HAMA) subscore somatic anxiety at week 10 with a standardized mean difference of -0.31 [95% Cl: -0.52 to -0.10, p = .004]. Treatment effects of silexan on somatic anxiety were independent of gender and age. Statistically significant differences were also shown for single HAMA items somatic muscular, cardiovascular, respiratory, and genitourinary symptoms, indicating clinical relevance with small to medium effects of Silexan. Similar clinically meaningful effects of Silexan on SF-36 physical health, including reduced bodily pain and improved general health, and on insomnia complaints and fatigue, were demonstrated. In this meta-analysis including all placebo-controlled clinical trials in patients with anxiety disorders to date, statistically significant and clinically meaningful advantages of Silexan over placebo treatment were found in improving somatic symptoms and physical health.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Guido Bondolfi
- Department of Psychiatry, University Medical Centre, University of Geneva, Geneva, Switzerland
| | | | | | - Martin Hatzinger
- Psychiatric Services Solothurn and University of Basel, Solothurn, Switzerland
| | | | | | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Möller HJ, Volz HP, Seifritz E, Müller H, Kenntner-Mabiala R, Kaussner Y, Schoch S, Kasper S. Silexan does not affect driving performance after single and multiple dose applications: Results from a double-blind, placebo and reference-controlled study in healthy volunteers. J Psychiatr Res 2021; 136:543-551. [PMID: 33221027 DOI: 10.1016/j.jpsychires.2020.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 01/04/2023]
Abstract
Anxiolytic drugs often have sedative effects that impair the ability to drive. Our double-blind, randomized crossover trial investigated the effect of Silexan, a non-sedating, anxiolytic herbal medicinal product, on driving performance in healthy volunteers. Part 1 aimed at demonstrating equivalence between 80 mg/d Silexan and placebo. Part 2 was performed to demonstrate superiority of 160 and 320 mg Silexan over 1 mg lorazepam and included a placebo arm for assay sensitivity. Driving performance was assessed in a validated, alcohol-calibrated simulator test. The primary outcome was the standard deviation of the lane position (SDLP). Secondary outcomes included driving errors and sleepiness. Fifty and 25 subjects were randomized in Parts 1 and 2, respectively. In Part 1, Silexan 80 mg was confirmed to be equivalent to placebo after single administration (equivalence range: δ = ±2 cm). The 95% confidence interval (CI) for the SDLP marginal mean value difference Silexan-placebo for single administration was -1.43; +1.38 and thus similar to the 95% CI of -1.45; +0.79 cm for 7 days' multiple dosing. In Part 2, 95% CIs for SDLP marginal mean value differences to lorazepam were -8.58; -5.42 cm for Silexan 160 mg and -8.65; -5.45 cm for 320 mg (p < 0.001). Confirmatory results were supported by secondary outcomes, where results for Silexan were comparable to placebo and more favorable than for lorazepam. The study demonstrates that single doses of up to 320 mg Silexan and multiple doses of 80 mg/d have no adverse effect on driving performance.
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Affiliation(s)
- Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nußbaumstraße 7, 80336 Munich, Germany.
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Balthasar-Neumann-Platz 1, 97440 Werneck, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland
| | - Heiko Müller
- Dr. Willmar Schwabe GmbH & Co. KG, Willmar-Schwabe-Straße 4, 76227 Karlsruhe, Germany
| | - Ramona Kenntner-Mabiala
- Würzburg Institute for Traffic Sciences (WIVW), Robert-Bosch-Straße 4, 97209 Veitshöchheim, Germany
| | - Yvonne Kaussner
- Würzburg Institute for Traffic Sciences (WIVW), Robert-Bosch-Straße 4, 97209 Veitshöchheim, Germany; Department for General Practice, Julius-Maximilians-Universität Wurzburg, Josef-Schneider-Straße 2 / Haus D7, 97080 Wurzburg, Germany
| | - Stefanie Schoch
- Würzburg Institute for Traffic Sciences (WIVW), Robert-Bosch-Straße 4, 97209 Veitshöchheim, Germany
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Wang M, Zhao J, Ali Z, Avonto C, Khan IA. A novel approach for lavender essential oil authentication and quality assessment. J Pharm Biomed Anal 2021; 199:114050. [PMID: 33831738 DOI: 10.1016/j.jpba.2021.114050] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 11/29/2022]
Abstract
Currently, the quality of lavender (Lavandula angustifolia Mill.) essential oil (LEO) is defined and regulated based on standards and methods established by regulatory authorities. Unfortunately, these existing standards and methods are not sufficient for LEO quality evaluation due to the complexity of LEO and adulteration encouraged by a burgeoning market. This study provides an efficient and reliable method for LEO quality assessment and adulteration detection. After a comprehensive investigation, involving a large set of LEO samples (n = 72) analyzed by multiple techniques (GC/MS, GC/Q-ToF, NMR, and chemometric analysis), a new approach named Q-Index was proposed. Fourteen marker compounds, along with trans-furano-linalool oxide acetate (an indicator of synthetic compound adulteration in LEO), were identified. These marker compounds played significant roles in discriminating the adulterated samples from the authentic LEOs. Calculation of the Q-Index value using the identified marker compounds permitted the detection of fraudulent samples. As demonstrated, all the authentic LEOs exhibited high Q-Index values (>100), whereas the adulterated or poor-quality samples displayed low Q-Index values (<100). The NMR-based chemometric analysis, which served as an independent and complementary approach to the GC/MS and Q-Index methods, was applied in order to assess the validity of the Q-Index method. Overall, the results obtained from different methods were in good agreement. Moreover, compared to the NMR method, the Q-Index approach possessed greater sensitivity in detecting LEO adulteration associated with the addition of synthetic compounds. Results of this study demonstrated that the Q-Index method could be successfully applied for LEO quality assessment and adulteration detection. This approach may have a significant potential to improve quality control for the LEO industry.
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Affiliation(s)
- Mei Wang
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, 38677, USA; Natural Products Utilization Research Unit, Agricultural Research Service, U.S. Department of Agriculture, University, MS, 38677, USA
| | - Jianping Zhao
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, 38677, USA
| | - Zulfiqar Ali
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, 38677, USA
| | - Cristina Avonto
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, 38677, USA
| | - Ikhlas A Khan
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, 38677, USA; Division of Pharmacognosy, Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS, 38677, USA.
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20
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Firoozeei TS, Feizi A, Rezaeizadeh H, Zargaran A, Roohafza HR, Karimi M. The antidepressant effects of lavender (Lavandula angustifolia Mill.): A systematic review and meta-analysis of randomized controlled clinical trials. Complement Ther Med 2021; 59:102679. [PMID: 33549687 DOI: 10.1016/j.ctim.2021.102679] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 01/03/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND AIMS Antidepressant drugs are accompanied with high rate of adverse effects. Lavender is one of the most common herbal drugs mentioned in Traditional Persian literature with potential efficacy on mental disorders and less serious side effects. Thus, the aim of this study was to determine the efficacy of lavender on depression severity by preforming a systematic review and meta-analysis. METHODS Databases including PubMed, Scopus, Cochrane library, Embase and Web of science were searched for relevant articles till December 2020. Quality of studies were evaluated by Jadad scale and the Cochrane collaboration tool. Depression as endpoint measure or as a subscale of any valid assessment tool was subjected to quantitative data analyses. Both fixed and random effects meta-analysis were conducted for data synthesis. RESULTS Out of 342 screened studies, 17 articles were included in the meta-analysis. Results showed significant efficacy of lavender in decreasing depression scores compared to the control group (pooled Standardized Mean Difference (SMD)= -0.66, 95 % CI: -0.85 to -0.46;P < 0.001, I2 = 68.2 %;). Subgroup analysis proved that the effect of lavender was marginally more pronounced in participants with diagnosed depression (pooled SMD= -0.62, 95 % CI: -1.26 to 0.01, P = 0.055; I2 = 88.1 %) while its effect was statistically significant in patients having other diseases with concomitant depressive symptoms (pooled SMD= -0.65, 95 % CI: -1.84 to -0.46, P < 0.001; I2 = 52.1 %), and the oral route (pooled SMD= -0.56, 95 % CI: -1.07 to -0.05, P = 0.032; I2 = 85.2 %;) was the most effective route of administration. CONCLUSIONS This systematic review and meta-analysis concluded that lavender has significant antidepressant effects. However, due to some limitations, further large clinical trials are recommended with more homogeneous populations and rigorous designs.
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Affiliation(s)
- Toktam Sadat Firoozeei
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, 1668753961, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, 8174673461, Iran
| | - Hossein Rezaeizadeh
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, 1668753961, Iran
| | - Arman Zargaran
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, 1668753961, Iran
| | - Hamid Reza Roohafza
- Mental Health Department, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, 8158388994, Iran
| | - Mehrdad Karimi
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, 1668753961, Iran.
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Trkulja V, Barić H. Current Research on Complementary and Alternative Medicine (CAM) in the Treatment of Major Depressive Disorder: An Evidence-Based Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1305:375-427. [PMID: 33834410 DOI: 10.1007/978-981-33-6044-0_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Complementary and alternative medicine (CAM) encompasses a wide range of different non-mainstream therapies that have been increasingly used for treatment or adjunctive treatment of various ailments with mood disorders and "depressive difficulties" being two of the commonly CAM (self-)medicated conditions. We focus specifically on clinically diagnosed (in line with the standard criteria) depressive disorders, primarily major depressive disorder (MDD), and overview evidence of efficacy/safety of a range of CAM modalities addressing exclusively randomized controlled trials (RCTs) and systematic reviews/meta-analyses of RCTs. The list of addressed CAM interventions is not exhaustive: due to space limitation, addressed are interventions with at least a few conducted RCTs in the specific clinical conditions. We try to provide numerical and meaningful data as much as it is possible and to (a) indicate situations in which the reported data/estimates might have been "too enthusiastic" and (b) warn about heterogeneity of results that, together with other possible limitations (various biases and imprecision), results in uncertainty about the effects.
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Affiliation(s)
- Vladimir Trkulja
- Department of Pharmacology, Zagreb University School of Medicine, Zagreb, Croatia.
| | - Hrvoje Barić
- Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
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Seifritz E, Möller HJ, Volz HP, Müller WE, Hopyan T, Wacker A, Schläfke S, Kasper S. No Abuse Potential of Silexan in Healthy Recreational Drug Users: A Randomized Controlled Trial. Int J Neuropsychopharmacol 2020; 24:171-180. [PMID: 33300578 PMCID: PMC7968617 DOI: 10.1093/ijnp/pyaa064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/14/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Silexan is a lavender essential oil with established anxiolytic and calming efficacy. Here we asked whether there is a potential for abuse in human patients. METHODS We carried out a phase I abuse liability single-center, double-blind, 5-way crossover study in healthy users of recreational central nervous system depressants. They received single oral doses of 80 mg (therapeutic dose) and 640 mg Silexan, 2 mg and 4 mg lorazepam (active control) and placebo in randomized order, with 4- to 14-day washout periods between treatments. Pharmacodynamic measures included validated visual analogue scales assessing positive, negative, and sedative drug effects and balance of effects; a short form of the Addiction Research Center Inventory; and a drug similarity assessment. The primary outcome measure was the individual maximum value on the drug liking visual analogue scale during 24 hours post-dose. RESULTS Forty participants were randomized and 34 were evaluable for pharmacodynamic outcomes. In intraindividual head-to-head comparisons of the drug liking visual analogue scale maximum value, both doses of Silexan were rated similar to placebo whereas differences were observed between Silexan and lorazepam and between placebo and lorazepam (P < .001). These data were supported by all secondary measures of positive drug effects and of balance of effects. Differences between placebo and both doses of Silexan were always negligible in magnitude. Moreover, Silexan showed no sedative effects and was not perceived to be similar to commonly used drugs that participants had used in the past. CONCLUSIONS Silexan did not exhibit any abuse potential in a standard abuse potential detection screen study and is unlikely to be recreationally abused.
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Affiliation(s)
- Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Switzerland
- Correspondence: Prof. Dr. Erich Seifritz, MD, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Lenggstrasse 31 / PO-Box 1931, 8032 Zürich, Switzerland, ()
| | - Hans-Jürgen Möller
- Clinic and Policlinic for Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Walter E Müller
- Department of Pharmacology, Biocenter Goethe-University, Frankfurt, Germany
| | - Talar Hopyan
- Scientific Affairs-Neuropsychology | Early Phase; Syneos Health, Toronto, Canada
| | - Anna Wacker
- Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | | | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
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Friedland K, Silani G, Schuwald A, Stockburger C, Koch E, Nöldner M, Müller WE. Neurotrophic Properties of Silexan, an Essential Oil from the Flowers of Lavender-Preclinical Evidence for Antidepressant-Like Properties. PHARMACOPSYCHIATRY 2020; 54:37-46. [PMID: 33254260 DOI: 10.1055/a-1293-8585] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Silexan, a special essential oil from flowering tops of lavandula angustifolia, is used to treat subsyndromal anxiety disorders. In a recent clinical trial, Silexan also showed antidepressant effects in patients suffering from mixed anxiety-depression (ICD-10 F41.2). Since preclinical data explaining antidepressant properties of Silexan are missing, we decided to investigate if Silexan also shows antidepressant-like effects in vitro as well as in vivo models. METHODS We used the forced swimming test (FST) in rats as a simple behavioral test indicative of antidepressant activity in vivo. As environmental events and other risk factors contribute to depression through converging molecular and cellular mechanisms that disrupt neuronal function and morphology-resulting in dysfunction of the circuitry that is essential for mood regulation and cognitive function-we investigated the neurotrophic properties of Silexan in neuronal cell lines and primary hippocampal neurons. RESULTS The antidepressant activity of Silexan (30 mg/kg BW) in the FST was comparable to the tricyclic antidepressant imipramine (20 mg/kg BW) after 9-day treatment. Silexan triggered neurite outgrowth and synaptogenesis in 2 different neuronal cell models and led to a significant increase in synaptogenesis in primary hippocampal neurons. Silexan led to a significant phosphorylation of protein kinase A and subsequent CREB phosphorylation. CONCLUSION Taken together, Silexan demonstrates antidepressant-like effects in cellular as well as animal models for antidepressant activity. Therefore, our data provides preclinical evidence for the clinical antidepressant effects of Silexan in patients with mixed depression and anxiety.
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Affiliation(s)
- Kristina Friedland
- Pharmacology and Toxicology, Institute for Pharmacy and Biomedical Sciences, Johannes Gutenberg-University Mainz, Germany
| | - Giacomo Silani
- Department of Pharmacology, Biocenter, Goethe-University Frankfurt, Germany
| | - Anita Schuwald
- Department of Pharmacology, Biocenter, Goethe-University Frankfurt, Germany
| | - Carola Stockburger
- Department of Pharmacology, Biocenter, Goethe-University Frankfurt, Germany
| | - Egon Koch
- Preclinical Research, Dr. Willmar Schwabe Pharmaceuticals, Karlsruhe, Germany
| | - Michael Nöldner
- Preclinical Research, Dr. Willmar Schwabe Pharmaceuticals, Karlsruhe, Germany
| | - Walter E Müller
- Department of Pharmacology, Biocenter, Goethe-University Frankfurt, Germany
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Müller WE, Sillani G, Schuwald A, Friedland K. Pharmacological basis of the anxiolytic and antidepressant properties of Silexan®, an essential oil from the flowers of lavender. Neurochem Int 2020; 143:104899. [PMID: 33181239 DOI: 10.1016/j.neuint.2020.104899] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023]
Abstract
Silexan®, a proprietary essential oil manufactured by steam distillation from Lavandula angustifolia flowers showed pronounced anxiolytic effects in patients with subthreshold anxiety disorders and was also efficacious in patients with Generalized Anxiety disorder (GAD). Moreover, evidences for antidepressant-like properties of Silexan® have been observed in anxious patients suffering from comorbid depressive symptoms and in patients with mixed anxiety-depression disorder (ICD-10 F41.2). In accordance with the clinical data Silexan® is active in several behavioral models in rodents at rather low concentrations indicating potent anxiolytic and antidepressive properties. As possible mechanism of action a moderate inhibition of voltage dependent calcium channels (VDCC) has been found showing some similarities to the anxiolytic drug pregabalin. However, while pregabalin mainly inhibits P/Q-type channels by binding to a modulatory subunit, Silexan® moderately inhibits mainly T-type and N-type channels and to some extent P/Q-type channels. Unlike pregabalin Silexan® is free of hypnotic or sedative side effects and seems to be devoid of any abuse potential. With respect to its specific antidepressant like properties Silexan® improves several aspects of neuroplasticity which seems to be the common final pathway of all antidepressant drugs. As a potential mechanism of its effects on neuroplasticity an activation of the transcription factor CREB via activation of intracellular signaling kinases like PKA and MAPK has been found. Since the concentrations of Silexan® needed to inhibit VDCC function and to improve neuroplasticity are quite similar, the effects of Silexan® on PKA or MAPK could constitute a common intracellular signaling cascade leading to VDCC modulation as well as CREB activation and improved neuroplasticity.
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Affiliation(s)
- Walter E Müller
- Department of Pharmacology, Biocenter, Goethe-University Frankfurt, Germany.
| | - Giacomo Sillani
- Department of Pharmacology, Biocenter, Goethe-University Frankfurt, Germany
| | - Anita Schuwald
- Department of Pharmacology, Biocenter, Goethe-University Frankfurt, Germany
| | - Kristina Friedland
- Pharmacology and Toxicology, Institute for Pharmaceutical and Biomedical Sciences, Johannes Gutenberg-University Mainz, Germany
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Lavender and dodder combined herbal syrup versus citalopram in major depressive disorder with anxious distress: A double-blind randomized trial. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2020; 18:409-415. [PMID: 32739466 DOI: 10.1016/j.joim.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/15/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) accompanied by anxious distress is a chronic and disabling disorder. Its conventional drug therapies often have low patient compliance due to drug-related side effects. In Persian medicine, lavender-dodder syrup is one formula often recommended for such disorders. OBJECTIVE This study compares the effects of lavender-dodder syrup to the standard drug, citalopram, for treating MDD with anxious distress. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION This six-week, double-blind, randomized, clinical trial was carried out in a psychiatric outpatient clinic. During the six-week intervention period, patients in citalopram group received citalopram tablets 20 mg/d plus 5 mL placebo syrup every 12 h; patients in group B received placebo tablets once daily plus 5 mL of lavender-dodder herbal syrup every 12 h. MAIN OUTCOME MEASURES Primary outcome measures, depression and anxiety, were evaluated using the Hamilton Depression/Anxiety Rating Scales, and were scored at the beginning of the study and at weeks three and six. Secondary outcome measures including response to treatment and remission rates were also compared between the two groups. RESULTS Fifty-six participants with MDD and anxious distress were randomly assigned to two groups. Mean depression scores significantly decreased in citalopram and herbal groups at weeks three and six (time effect: P < 0.001), although the observed changes were not significantly different between the groups (intervention effect: P = 0.61). Mean anxiety scores were not significantly different between the two groups at week three (P = 0.75). However, at the end of week six, the observed decrease was significantly higher in the herbal syrup group than the citalopram group (intervention effect: P = 0.007). CONCLUSION The herbal syrup is an effective and tolerable supplement for treating MDD with anxious distress. TRIAL REGISTRATION NUMBER IRCT2016102430459N1 on Iranian Registry of Clinical Trials.
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Araj-Khodaei M, Noorbala AA, Yarani R, Emadi F, Emaratkar E, Faghihzadeh S, Parsian Z, Alijaniha F, Kamalinejad M, Naseri M. A double-blind, randomized pilot study for comparison of Melissa officinalis L. and Lavandula angustifolia Mill. with Fluoxetine for the treatment of depression. BMC Complement Med Ther 2020; 20:207. [PMID: 32620104 PMCID: PMC7333290 DOI: 10.1186/s12906-020-03003-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Depression has rapidly progressed worldwide, and the need for an efficient treatment with low side effect has risen. Melissa officinalis L and Lavandula angustifolia Mill have been traditionally used in Asia for the treatment of depression. Many textbooks of traditional Persian medicine refer to these herbs for the treatment of depression while there are no adequate clinical trials to support this claim. The present study aimed to evaluate the efficacy of M. officinalis and L. angustifolia compared to fluoxetine for the treatment of mild to moderate depression in an 8-week randomized, double-blind clinical trial. Methods Forty-five adult outpatients who met the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) for major depression, were randomly assigned to 3 groups to daily receive either M. officinalis (2 g) or L. angustifolia (2 g) or fluoxetine (20 mg) and were assessed in weeks 0, 2, 4 and 8 by the Hamilton Rating Scale for Depression (HAM-D) including 17 items. Results Our study showed that M. officinalis and L. angustifolia effect similar to fluoxetine in mild to moderate depression. (F = 0.131, df = 2,42, p = 0.877). Conclusion Due to some restrictions in this study including absence of placebo group, large-scale trials are needed to investigate the anti-depressant effect of these two herbs with more details. Trial registration IRCT2014061718126N1. Registration date: 2015-06-04-“Retrospectively registered”.
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Affiliation(s)
- Mostafa Araj-Khodaei
- Department of Traditional Medicine, School of Medicine, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran.,Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Persian Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Ali Noorbala
- Psychosomatic Medicine Research center, Psychosomatic Ward, Imam Khomeini Hospital, Tehran University of Medical Sciences, End of Keshavarz Blv, Tehran, Iran
| | - Reza Yarani
- Department of Pediatrics E, Copenhagen Diabetes Research Center (CPH-DIRECT), Herlev University Hospital, Herlev, 2730, Copenhagen, Denmark.,Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Emadi
- Department of Traditional Medicine, School of Medicine, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran.,Traditional Medicine Clinical Trial Research Center, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran
| | - Elham Emaratkar
- Department of Traditional Medicine, School of Medicine, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran
| | - Soghrat Faghihzadeh
- Department of Biostatistic and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Mahdavi St., Karmandan Town, Zanjan, Iran
| | - Zahra Parsian
- Emergency Medicine Research Team, Daneshgah St. Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Alijaniha
- Traditional Medicine Clinical Trial Research Center, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran
| | - Mohammad Kamalinejad
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Naseri
- Department of Traditional Medicine, School of Medicine, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran. .,Traditional Medicine Clinical Trial Research Center, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran.
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Sayed AM, Morsy S, Tawfik GM, Naveed S, Minh-Duc NT, Hieu TH, Ali ZA, Shinkar A, Doheim MF, Hashan MR, Huy NT. The best route of administration of lavender for anxiety: a systematic review and network meta-analysis. Gen Hosp Psychiatry 2020; 64:33-40. [PMID: 32088511 DOI: 10.1016/j.genhosppsych.2020.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 01/17/2020] [Accepted: 02/03/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is preliminary evidence for lavender as an anxiolytic agent through various routes of administration. Our goal is to elucidate the best route of administration for lavender as a treatment for anxiety. METHODS Thirteen electronic search engines were systematically scanned for relevant publications. The relevant articles were included after the title and abstract screening followed by the full-text screening. This study included randomized control trials reporting lavender for the treatment of anxiety. The protocol was registered in PROSPERO (CRD42017076711). Frequentist network meta-analysis and Bayesian meta-regression were conducted to report the best treatment modality and the effect of covariates on the effectiveness as an anxiolytic. Treatment arms were ordered according P-scores, where higher P-score indicates better treatment choice. RESULTS Forty studies were eligible for qualitative analysis, and 32 were included in quantitative analysis. Lavender aromatherapy was the best approach for the treatment of anxiety among other lavender modalities at the first week recording [Standardized Mean Difference (SMD) = -0.57, 95% CI (-1.14-0.01), P-score = 0.72], in addition to achieve at the first time points [SMD = -0, 95% CI (-0.97 ̶ -0.16), P-score = 0.69], compared to placebo; however, lavender massage along with foot bath were found to be the most efficacious for anxiety treatment at the study endpoint [SMD = -1.10, 95% CI = (-7.41 ̶ 5.21), P-score = 0.65]. Furthermore, network meta-regression revealed that the duration of therapy influenced treatment, suggesting Silexan (oral lavender) 80 mg (first rank probability = .116) as the favorable option for anxiety in long-term treatment. CONCLUSIONS Lavender aromatherapy is, clinically, superior in short-duration, while Silexan (oral lavender) 80 mg is preferable for long-term treatment of anxiety.
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Affiliation(s)
- Ahmed M Sayed
- Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt; Online Research Club (www.onlineresearchclub.org), Japan
| | - Sara Morsy
- Online Research Club (www.onlineresearchclub.org), Japan; Medical Biochemistry Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Gehad Mohamed Tawfik
- Online Research Club (www.onlineresearchclub.org), Japan; Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sadiq Naveed
- Online Research Club (www.onlineresearchclub.org), Japan; MD. Assistant Professor of Psychiatry, Kansas University Medical Center, Kansas, USA.
| | - Nguyen Tran Minh-Duc
- Online Research Club (www.onlineresearchclub.org), Japan; University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Truong Hong Hieu
- Online Research Club (www.onlineresearchclub.org), Japan; University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Ziad A Ali
- Online Research Club (www.onlineresearchclub.org), Japan; Faculty of Medicine, Alexandria University, Egypt
| | - Ashraf Shinkar
- Online Research Club (www.onlineresearchclub.org), Japan; Psychiatry Department, Ain-Shams University Hospitals, Cairo, Egypt
| | - Mohamed Fahmy Doheim
- Online Research Club (www.onlineresearchclub.org), Japan; Faculty of Medicine, Alexandria University, Alexandria 21544, Egypt
| | - Mohammad Rashidul Hashan
- Online Research Club (www.onlineresearchclub.org), Japan; Medical Officer, Respiratory and Enteric Infections Department, Infectious Disease Division, International Center for Diarrheal Disease and Research (Icddrb), Dhaka, Bangladesh
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group, Ton Duc Thang University, Ho Chi Minh City 70000, Viet Nam; Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City 70000, Viet Nam.
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Polonini H, Mesquita D, Lanine J, Dijkers E, Gkinis S, Raposo NRB, Brandão MAF, Ferreira ADO. Intranasal use of lavender and fennel decreases salivary cortisol levels and improves quality of sleep: A double-blind randomized clinical trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2019.101015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Trkulja V, Barić H. Current Research on Complementary and Alternative Medicine (CAM) in the Treatment of Anxiety Disorders: An Evidence-Based Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:415-449. [PMID: 32002940 DOI: 10.1007/978-981-32-9705-0_22] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Complementary and alternative medicine (CAM) encompasses a wide range of different nonmainstream therapies that have been increasingly used for treatment or adjunctive treatment of various ailments with anxiety/anxiety disorders being one of the commonly CAM (self)-medicated conditions. Thousands of published papers refer to use of CAM in various psychiatric disorders or in healthy or medically ill patients with mood or anxiety difficulties. In this chapter we focus specifically on clinically diagnosed (in line with the standard criteria) anxiety disorders and overview evidence of efficacy/safety of a range of CAM modalities: biologically based therapies (typically herbal preparations and less so nutraceuticals); manipulative and body-based therapies (acupuncture, aerobic exercise, massage, therapeutic touch, repetitive transcranial magnetic stimulation, balneotherapy, and others); mind-body therapies (yoga, Morita therapy, Tai Chi, reiki, Chinese cognitive therapy, religious and spiritual interventions, relaxation, mediation, and mindfulness-based interventions); and alternative medical systems (Ayurveda, homeopathy). We focus exclusively on randomized controlled trials and attempt to evaluate the existing body of evidence in the same manner that is applied to mainstream treatments.
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Affiliation(s)
- Vladimir Trkulja
- Department of Pharmacology, Zagreb University School of Medicine, Zagreb, Croatia.
| | - Hrvoje Barić
- Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
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Yap WS, Dolzhenko AV, Jalal Z, Hadi MA, Khan TM. Efficacy and safety of lavender essential oil (Silexan) capsules among patients suffering from anxiety disorders: A network meta-analysis. Sci Rep 2019; 9:18042. [PMID: 31792285 PMCID: PMC6889391 DOI: 10.1038/s41598-019-54529-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/13/2019] [Indexed: 12/15/2022] Open
Abstract
A systematic review and network-meta analysis (NMA) were performed to estimate significance of the anxiolytic effect of lavender essential oil taken as silexan capsules versus other comparators (i.e., placebo/paroxetine/lorazepam). The outcome of interest was Hamilton Anxiety Scale (HAMA). Weighted mean differences (WMD) were calculated to estimate the treatment effect at the confidence interval of 95%. League tables were generated using treatment effect, for all pairwise comparisons, where WMD < 0 favors the column-defining treatment. Five studies were identified with a total of 524 participants receiving treatment with silexan 80 mg and 121 participants taking silexan 160 mg. The NMA results indicated that consumption of silexan 160 mg resulted in higher decline of HAMA score [WMD −1.14 (−1.10, 3.39)] in comparison to silexan 80 mg, placebo [−2.20 (−4.64, 0.24)] and paroxetine [−1.24 (−5.34, 2.85)]. The effect of silexan 80 mg was observed to be same as that of paroxetine. Overall, silexan 160 mg was noticed to be a more efficient treatment giving significant decline in HAMA score across other comparators. However, no improvements in HAMA score was observed for the group receiving lorazepam 0.5 mg when compared to silexan 160 mg, silexan 80 mg, paroxetine 20 mg, and placebo.
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Affiliation(s)
- Wuan Shuen Yap
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Anton V Dolzhenko
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor Darul Ehsan, Malaysia.,School of Pharmacy, Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Zahraa Jalal
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, England, UK.
| | - Muhammad Abdul Hadi
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, England, UK
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor Darul Ehsan, Malaysia. .,The Institute of Pharmaceutical Sciences (IPS), University of Veterinary & Animal Sciences (UVAS), Outfall road, Lahore, Pakistan.
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Donelli D, Antonelli M, Bellinazzi C, Gensini GF, Firenzuoli F. Effects of lavender on anxiety: A systematic review and meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 65:153099. [PMID: 31655395 DOI: 10.1016/j.phymed.2019.153099] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Anxiety is one of the uprising psychiatric disorders of the last decades and lavender administration has been traditionally suggested as a possible treatment. The objective of this review is to assess the efficacy of lavender, in any form and way of administration, on anxiety and anxiety-related conditions. METHODS The PRISMA guidelines were followed. Retrieved data were qualitatively and quantitatively synthesized. Randomized Controlled Trials (RCTs) and Non-Randomized Studies (NRSs) which investigated the efficacy of lavender, in any form and way of administration, on patients with anxiety, involved in anxiety-inducing settings or undergoing anxiety-inducing activities, compared to any type of control, without language restrictions, were identified through electronic database searches. Medline via PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Google Scholar were systematically searched. All databases were screened up to November 2018. Risk of bias was assessed with the Cochrane risk-of-bias tool and the following domains were considered: randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases. RESULTS 65 RCTs (7993 participants) and 25 NRSs (1200 participants) were included in the qualitative synthesis and 37 RCTs (3964 participants) were included in the quantitative synthesis. Overall, the qualitative synthesis indicated that 54 RCTs and 17 NRSs reported at least a significant result in favor of lavender use for anxiety. The quantitative synthesis showed that lavender inhalation can significantly reduce anxiety levels measured with any validated scale (Hedges' g = -0.73 [95% CI -1.00 to -0.46], p < 0.00001, 1682 participants), as well as state anxiety (Spielberger's state-trait anxiety inventory (STAI)-State mean difference = -5.99 [95% CI -9.39 to -2.59], p < 0.001, 901 participants) and trait anxiety (STAI-Trait mean difference = -8.14 [95% CI -14.44 to -1.84], p < 0.05, 196 participants). Lavender inhalation did not show a significant effect in reducing systolic blood pressure as a physiological parameter of anxiety. A significant effect in diminishing anxiety levels was also found in favor of the use of oral Silexan® 80 mg/die for at least 6 weeks (Hamilton Anxiety Scale mean difference = -2.90 [95% CI -4.86 to -0.95], p = 0.004, 1173 participants; Zung Self-rating Anxiety Scale mean difference = -2.62 [95% CI -4.84 to -0.39], p < 0.05, 451 participants) or of the administration of massage with lavender oil (Hedges' g = -0.66 [95% CI -0.97 to -0.35], p < 0.0001, 448 participants). DISCUSSION The most important limitation of this review is the low average quality of available studies on the topic. The majority of included RCTs were characterized by a high overall risk of bias. Another limitation regards the heterogeneity of study designs, especially with regard to non-oral ways of administration. Overall, oral administration of lavender essential oil proves to be effective in the treatment of anxiety, whereas for inhalation there is only an indication of an effect of reasonable size, due to the heterogeneity of available studies. Lavender essential oil administered through massage appears effective, but available studies are not sufficient to determine whether the benefit is due to a specific effect of lavender. Further high-quality RCTs with more homogeneous study designs are needed to confirm these findings. Available information outlines a safe profile for lavender-based interventions, although more attention should be paid to the collection and reporting of safety data in future studies. Considering these findings, since treatments with lavender essential oil generally seem safe, and, in the case of inhalation, also simple and inexpensive, they are a therapeutic option which may be considered in some clinical contexts. OTHER The present systematic review was not funded and was registered in PROSPERO under the following number: CRD42019130126.
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Affiliation(s)
- Davide Donelli
- Terme di Monticelli, Monticelli Terme, 43022 Parma, Italy; Research and Innovation Center in Phytotherapy and Integrated Medicine, CERFIT, Referring Center for Phytotherapy of Tuscany Region, Careggi University Hospital, 50139 Florence, Italy; Servizio di Consulenza in Medicina Integrativa e Complementare, 42123 Reggio Emilia, Italy.
| | - Michele Antonelli
- Terme di Monticelli, Monticelli Terme, 43022 Parma, Italy; Dipartimento di Medicina e Chirurgia, University of Parma, 43125 Parma, Italy; Research and Innovation Center in Phytotherapy and Integrated Medicine, CERFIT, Referring Center for Phytotherapy of Tuscany Region, Careggi University Hospital, 50139 Florence, Italy; Servizio di Consulenza in Medicina Integrativa e Complementare, 42123 Reggio Emilia, Italy
| | - Caterina Bellinazzi
- Dipartimento di Medicina e Chirurgia, University of Parma, 43125 Parma, Italy
| | | | - Fabio Firenzuoli
- Research and Innovation Center in Phytotherapy and Integrated Medicine, CERFIT, Referring Center for Phytotherapy of Tuscany Region, Careggi University Hospital, 50139 Florence, Italy
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Miguel L, Okemy-Andissa N, N’jilo D, Mokondjimobe E, Moukassa D, Longo-Mbenza B, Abena A. Effets de l’huile des fruits de Dacryodes edulis sur les symptômes de l’anxiété et les performances cognitives chez la souris, après administration prolongée. Encephale 2019; 45:397-404. [DOI: 10.1016/j.encep.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/23/2019] [Accepted: 05/06/2019] [Indexed: 11/26/2022]
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Seifritz E, Schläfke S, Holsboer-Trachsler E. Beneficial effects of Silexan on sleep are mediated by its anxiolytic effect. J Psychiatr Res 2019; 115:69-74. [PMID: 31121394 DOI: 10.1016/j.jpsychires.2019.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 12/15/2022]
Abstract
Disturbed sleep is among the most prevalent hyperarousal symptoms in anxiety disorders. Most drugs recommended for anxiety and insomnia have a sedating effect which is related to their beneficial effect on disturbed sleep. Silexan is a proprietary essential oil from Lavandula angustifolia. This drug has significant anxiolytic and sleep improving properties. Interestingly, these effects are not associated with sedation. Here we asked whether the positive effects on sleep are due to primary pharmacodynamic or secondary, disease related effects. We used the data from a double-blind, randomized study in which 212 patients were analyzed for efficacy after ten weeks' treatment with 80 mg/day Silexan or placebo. Anxiety and disturbed sleep were assessed using the Hamilton Anxiety Scale (HAMA) and the Pittsburgh Sleep Quality Index (PSQI), respectively. Regression-based mediation analysis was employed to estimate direct treatment effects and indirect effects mediated by anxiety control separately for each study group. Sobel's test was used to investigate the extent to which the mediator (HAMA change) contributes to the total effect of the independent variable (treatment) on the dependent variable (PSQI change). Compared to placebo, Silexan significantly reduced the total scores of the HAMA (p < 0.001) and of the PSQI (p = 0.002) after ten weeks, with clinically meaningful treatment group differences that were observed already after two and six weeks for HAMA and PSQI, respectively. Silexan had a statistically meaningful indirect effect on sleep (mediated by the effect on anxiety; p < 0.001) but no appreciable direct effect (p = 0.958). The ratio between the indirect and the total effect was determined to be 0.984, i. e., 98.4% of the total effect of Silexan on disturbed sleep were explained by the effect of Silexan on the symptoms of anxiety whereas 1.6% were attributable to a direct effect. The results indicate that Silexan exerts a secondary sleep improving effect almost exclusively through its anxiolytic action rather than by sedation. Findings are consistent with the drug's assumed mechanism of action.
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Affiliation(s)
- Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich Lenggstrasse, 31/PO-Box 1931, 8032, Zürich, Switzerland.
| | - Sandra Schläfke
- Dr. Willmar Schwabe GmbH & Co. KG, Willmar-Schwabe-Straße 4, 76227, Karlsruhe, Germany.
| | - Edith Holsboer-Trachsler
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland.
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Dome P, Tombor L, Lazary J, Gonda X, Rihmer Z. Natural health products, dietary minerals and over-the-counter medications as add-on therapies to antidepressants in the treatment of major depressive disorder: a review. Brain Res Bull 2019; 146:51-78. [DOI: 10.1016/j.brainresbull.2018.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/04/2018] [Accepted: 12/26/2018] [Indexed: 12/23/2022]
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Möller HJ, Volz HP, Dienel A, Schläfke S, Kasper S. Efficacy of Silexan in subthreshold anxiety: meta-analysis of randomised, placebo-controlled trials. Eur Arch Psychiatry Clin Neurosci 2019; 269:183-193. [PMID: 29150713 PMCID: PMC6726711 DOI: 10.1007/s00406-017-0852-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/02/2017] [Indexed: 12/19/2022]
Abstract
Subthreshold psychiatric disorders do not fully meet the diagnostic criteria of syndromal disorders but may be associated with comparable disability. To investigate the anxiolytic effect of Silexan, an active substance from lavender oil for oral administration, in patients with subthreshold anxiety, a meta-analysis that included all published trials with Silexan in this indication was performed. Three randomised, placebo-controlled trials in subthreshold anxiety disorders (anxiety disorder not otherwise specified, restlessness and agitation, mixed anxiety and depressive disorder) were included. Eligible participants with a baseline Hamilton Anxiety Rating Scale (HAMA) total score ≥ 18 points received 1 × 80 mg/day Silexan or placebo for 10 weeks. Outcomes included the HAMA, the Pittsburgh Sleep Quality Index, the Zung Self-rating Anxiety Scale, the Clinical Global Impressions questionnaire and the SF-36 health status inventory. Data were analysed using meta-analysis based on pooled raw data of individual patients (random effects models). A total of 697 patients were assessed for efficacy. Silexan was superior to placebo in reducing the HAMA total score during 10 weeks' treatment [mean value difference, 95% confidence interval: 3.83 (1.28; 6.37) points]. Superiority was comparably pronounced for psychic and somatic anxiety as well as for observer- and self-rated anxiety. Silexan had a beneficial effect on sleep (secondary to the anxiolytic effect) without causing sedation and improved the patients' health-related quality of life. Adverse event incidence in both treatment groups was comparable [risk ratio: 1.06 (0.85; 1.33)]. Silexan has a significant and clinically meaningful anxiolytic effect in subthreshold anxiety. The results cannot be generalised to other lavender oil products.
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Affiliation(s)
- Hans-Jürgen Möller
- 0000 0004 1936 973Xgrid.5252.0Clinic and Polyclinic for Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Angelika Dienel
- 0000 0004 0390 2958grid.476242.1Department of Clinical Research 1, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Sandra Schläfke
- 0000 0004 0390 2958grid.476242.1Department of Biostatistics, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Kasper S, Müller WE, Volz HP, Möller HJ, Koch E, Dienel A. Silexan in anxiety disorders: Clinical data and pharmacological background. World J Biol Psychiatry 2018; 19:412-420. [PMID: 28511598 DOI: 10.1080/15622975.2017.1331046] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Silexan is a lavender oil preparation available in 80-mg capsules. Here we review clinical trials investigating its anxiolytic efficacy, safety and tolerability in humans, as well as preclinical investigations supporting this therapeutic use. METHODS Besides three selected publications reporting preclinical investigations, seven clinical trials are included, of which five had a treatment duration of 6 or 10 weeks. Primary outcome measure was the HAM-A total score reduction, while single items were assessed with regard to effects on concomitant depressive symptoms and on quality of sleep. RESULTS In patients with subthreshold (subsyndromal) anxiety or generalised anxiety disorder (GAD), an anxiolytic effect of Silexan was evident after 2 weeks. HAM-A total score reductions between baseline and end of treatment were significantly superior to placebo in patients with subthreshold anxiety and comparable with those achieved under lorazepam or paroxetine in patients with GAD. In addition, Silexan had beneficial effects on typical concomitant symptoms of anxiety disorders, such as impaired sleep, somatic complaints, co-morbid depression or decreased quality of life. Except for mild gastrointestinal symptoms, Silexan did not induce any adverse effects and did not cause drug interactions, sedation or withdrawal symptoms at daily doses of 80 or 160 mg. CONCLUSIONS Silexan is a safe and effective treatment in anxiety disorders.
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Affiliation(s)
- Siegfried Kasper
- a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | - Walter E Müller
- b Department of Pharmacology Biocenter , Goethe-University , Frankfurt , Germany
| | - Hans-Peter Volz
- c Psychotherapy and Psychosomatic Medicine , Hospital for Psychiatry , Werneck , Germany
| | - Hans-Jürgen Möller
- d Clinic for Psychiatry and Psychotherapy , Ludwig Maximilians University , Munich , Germany
| | - Egon Koch
- e Research and Development Department, Dr. Willmar-Schwabe GmbH & Co. KG , Karlsruhe , Germany
| | - Angelika Dienel
- e Research and Development Department, Dr. Willmar-Schwabe GmbH & Co. KG , Karlsruhe , Germany
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Yeung KS, Hernandez M, Mao JJ, Haviland I, Gubili J. Herbal medicine for depression and anxiety: A systematic review with assessment of potential psycho-oncologic relevance. Phytother Res 2018; 32:865-891. [PMID: 29464801 DOI: 10.1002/ptr.6033] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/08/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022]
Abstract
Anxiety and depression are prevalent among cancer patients, with significant negative impact. Many patients prefer herbs for symptom relief to conventional medications which have limited efficacy/side effects. We identified single-herb medicines that may warrant further study in cancer patients. Our search included PubMed, Allied and Complementary Medicine, Embase, and Cochrane databases, selecting only single-herb randomized controlled trials between 1996 and 2016 in any population for data extraction, excluding herbs with known potential for interactions with cancer treatments. One hundred articles involving 38 botanicals met our criteria. Among herbs most studied (≥6 randomized controlled trials each), lavender, passionflower, and saffron produced benefits comparable to standard anxiolytics and antidepressants. Black cohosh, chamomile, and chasteberry are also promising. Anxiety or depressive symptoms were measured in all studies, but not always as primary endpoints. Overall, 45% of studies reported positive findings with fewer adverse effects compared with conventional medications. Based on available data, black cohosh, chamomile, chasteberry, lavender, passionflower, and saffron appear useful in mitigating anxiety or depression with favorable risk-benefit profiles compared to standard treatments. These may benefit cancer patients by minimizing medication load and accompanying side effects. However, well-designed larger clinical trials are needed before these herbs can be recommended and to further assess their psycho-oncologic relevance.
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Affiliation(s)
- K Simon Yeung
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Marisol Hernandez
- Information Systems/Medical Library, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Ingrid Haviland
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Jyothirmai Gubili
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
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Abstract
Anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, social anxiety disorder, and others) are the most prevalent psychiatric disorders, and are associated with a high burden of illness. Anxiety disorders are often underrecognized and undertreated in primary care. Treatment is indicated when a patient shows marked distress or suffers from complications resulting from the disorder. The treatment recommendations given in this article are based on guidelines, meta-analyses, and systematic reviews of randomized controlled studies. Anxiety disorders should be treated with psychological therapy, pharmacotherapy, or a combination of both. Cognitive behavioral therapy can be regarded as the psychotherapy with the highest level of evidence. First-line drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for routine use. Other treatment options include pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. After remission, medications should be continued for 6 to 12 months. When developing a treatment plan, efficacy, adverse effects, interactions, costs, and the preference of the patient should be considered.
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Affiliation(s)
- Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center, Gottingen, Germany
| | - Sophie Michaelis
- Department of Psychiatry and Psychotherapy, University Medical Center, Gottingen, Germany
| | - Dirk Wedekind
- Department of Psychiatry and Psychotherapy, University Medical Center, Gottingen, Germany
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Silexan in generalized anxiety disorder: investigation of the therapeutic dosage range in a pooled data set. Int Clin Psychopharmacol 2017; 32:195-204. [PMID: 28379882 DOI: 10.1097/yic.0000000000000176] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Silexan, a special active substance produced from Lavandula angustifolia, is efficacious in subsyndromal anxiety at a dose of 80 mg/day, but its effective dosage in generalized anxiety disorder (GAD) has yet to be defined. In two double-blind, placebo-controlled trials, daily doses of 10, 40, 80, and 160 mg silexan were administered for 10 weeks. A total of 925 adults with GAD according to Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria and a Hamilton Anxiety Scale (HAMA) total score of at least 18 points were analyzed for efficacy. We assessed the change versus baseline for the HAMA and the Covi Anxiety Scale, the Clinical Global Impressions scale, the Sheehan Disability Scale, and the SF-36 health status questionnaire using analysis of variance and covariance. Silexan 160 mg/day was superior to placebo for all efficacy outcomes investigated, with responder rates exceeding 60% on the basis of HAMA and Clinical Global Impressions criteria. For the 80 mg/day dosage, superiority over placebo could be shown in one trial as well as in the pooled analysis. The risk of adverse events under silexan was similar to placebo for all dosages investigated. In GAD silexan 160 mg/day is efficacious whereas 80 mg/day may represent the lower end of the therapeutic range. Daily doses up to 160 mg were well tolerated.
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Abstract
Anxiety disorders are some of the most common psychiatric disorders, with potentially debilitating consequences on individual function. Existing pharmacotherapies for anxiety disorders are limited by delay to therapeutic effect, dependence, tolerance, withdrawal, and abuse potential. Therefore, safe and evidence-based complementary or alternative therapies may be important allies in the care of patients with anxiety disorders. Essential oils are lipophilic and concentrated botanical extracts that exhibit many properties of drugs, although they are not Food and Drug Administration approved and have limitations characteristic of herbal preparations. Lavender essential oil has an extensive anecdotal history of anxiolytic benefit that has recently been supported by clinical efficacy studies. The 2 primary terpenoid constituents of lavender essential oil, linalool and linalyl acetate, may produce an anxiolytic effect in combination via inhibition of voltage-gated calcium channels, reduction of 5HT1A receptor activity, and increased parasympathetic tone. The objectives of this article are to provide a brief overview of lavender oil in aromatherapy, explore variability in the constituents of lavender oil, summarize its pharmacology and safety profile, as well as describe its body of research that has been conducted for anxiety.
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Affiliation(s)
- Benjamin J Malcolm
- Assistant Professor of Pharmacy Practice & Administration, Western University of Health Sciences, Pomona, California,
| | - Kimberly Tallian
- Psychiatry Pharmacy Specialist, Scripps Mercy Hospital, Hillcrest, California; Adjunct Clinical Professor, University of California at San Diego School of Pharmacy & Keck Graduate Institute School of Pharmacy, San Diego, California
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Rombolà L, Tridico L, Scuteri D, Sakurada T, Sakurada S, Mizoguchi H, Avato P, Corasaniti MT, Bagetta G, Morrone LA. Bergamot Essential Oil Attenuates Anxiety-Like Behaviour in Rats. Molecules 2017; 22:molecules22040614. [PMID: 28398260 PMCID: PMC6154596 DOI: 10.3390/molecules22040614] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/07/2017] [Accepted: 04/09/2017] [Indexed: 11/16/2022] Open
Abstract
Preclinical studies have recently highlighted that bergamot essential oil (BEO) is endowed with remarkable neurobiolological effects. BEO can affect synaptic transmission, modulate electroencephalographic activity and it showed neuroprotective and analgesic properties. The phytocomplex, along with other essential oils, is also widely used in aromatherapy to minimize symptoms of stress-induced anxiety and mild mood disorders. However, only limited preclinical evidences are actually available. This study examined the anxiolytic/sedative-like effects of BEO using an open field task (OFT), an elevated plus-maze task (EPM), and a forced swimming task (FST) in rats. This study further compared behavioural effects of BEO to those of the benzodiazepine diazepam. Analysis of data suggests that BEO induces anxiolytic-like/relaxant effects in animal behavioural tasks not superimposable to those of the DZP. The present observations provide further insight to the pharmacological profile of BEO and support its rational use in aromatherapy.
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Affiliation(s)
- Laura Rombolà
- Department of Pharmacy, Health and Nutritional Sciences, Section of Preclinical and Translational Pharmacology, University of Calabria, 87036 Rende, Italy.
| | - Laura Tridico
- Department of Pharmacy, Health and Nutritional Sciences, Section of Preclinical and Translational Pharmacology, University of Calabria, 87036 Rende, Italy.
| | - Damiana Scuteri
- Department of Pharmacy, Health and Nutritional Sciences, Section of Preclinical and Translational Pharmacology, University of Calabria, 87036 Rende, Italy.
| | - Tsukasa Sakurada
- First Department of Pharmacology, Daiichi College of Pharmaceutical Sciences, 815-8511 Fukuoka, Japan.
| | - Shinobu Sakurada
- Department of Physiology and Anatomy, Tohoku Pharmaceutical University, 981-8558 Sendai, Japan.
| | - Hirokazu Mizoguchi
- Department of Physiology and Anatomy, Tohoku Pharmaceutical University, 981-8558 Sendai, Japan.
| | - Pinarosa Avato
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, IT-70125 Bari, Italy.
| | | | - Giacinto Bagetta
- Department of Pharmacy, Health and Nutritional Sciences, Section of Preclinical and Translational Pharmacology, University of Calabria, 87036 Rende, Italy.
| | - Luigi Antonio Morrone
- Department of Pharmacy, Health and Nutritional Sciences, Section of Preclinical and Translational Pharmacology, University of Calabria, 87036 Rende, Italy.
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Henter ID, de Sousa RT, Gold PW, Brunoni AR, Zarate CA, Machado-Vieira R. Mood Therapeutics: Novel Pharmacological Approaches for Treating Depression. Expert Rev Clin Pharmacol 2017; 10:153-166. [PMID: 27781556 DOI: 10.1080/17512433.2017.1253472] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Real-world effectiveness trials suggest that antidepressant efficacy is limited in many patients with mood disorders, underscoring the urgent need for novel therapeutics to treat these disorders. Areas covered: Here, we review the clinical evidence supporting the use of novel modulators for the treatment of mood disorders, including specific glutamate modulators such as: 1) high-trapping glutamatergic modulators; 2) subunit (NR2B)-specific N-methyl-D-aspartate (NMDA) receptor antagonists; 3) NMDA receptor glycine-site partial agonists; and 4) metabotropic glutamate receptor (mGluR) modulators. We also discuss other promising, non-glutamatergic targets for potential rapid antidepressant effects in mood disorders, including the cholinergic system, the glucocorticoid system, and the inflammation pathway, as well as several additional targets of interest. Clinical evidence is emphasized, and non-pharmacological somatic treatments are not reviewed. In general, this paper only explores agents available in the United States. Expert commentary: Of these novel targets, the most promising - and the ones for whom the most evidence exists - appear to be the ionotropic glutamate receptors. However, moving forward will require us to fully embrace the goal of personalized medicine and will require health professionals to pre-emptively identify potential responders.
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Affiliation(s)
- Ioline D Henter
- a Experimental Therapeutics and Pathophysiology Branch , NIMH-NIH , Bethesda , Maryland , USA
| | - Rafael T de Sousa
- a Experimental Therapeutics and Pathophysiology Branch , NIMH-NIH , Bethesda , Maryland , USA
| | - Philip W Gold
- a Experimental Therapeutics and Pathophysiology Branch , NIMH-NIH , Bethesda , Maryland , USA
| | - Andre R Brunoni
- b Laboratory of Neuroscience, LIM- 27, Institute and Department of Psychiatry , University of São Paulo , São Paulo , Brazil
| | - Carlos A Zarate
- a Experimental Therapeutics and Pathophysiology Branch , NIMH-NIH , Bethesda , Maryland , USA
| | - Rodrigo Machado-Vieira
- a Experimental Therapeutics and Pathophysiology Branch , NIMH-NIH , Bethesda , Maryland , USA
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Möller HJ, Bandelow B, Volz HP, Barnikol UB, Seifritz E, Kasper S. The relevance of 'mixed anxiety and depression' as a diagnostic category in clinical practice. Eur Arch Psychiatry Clin Neurosci 2016; 266:725-736. [PMID: 27002521 PMCID: PMC5097109 DOI: 10.1007/s00406-016-0684-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/17/2016] [Indexed: 01/04/2023]
Abstract
According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe enough to justify a psychiatric diagnosis, but neither of which are clearly predominant. MADD appears to be very common, particularly in primary care, although prevalence estimates vary, often depending on the diagnostic criteria applied. It has been associated with similarly pronounced distress, impairment of daily living skills, and reduced health-related quality of life as fully syndromal depression and anxiety. Although about half of the patients affected remit within a year, non-remitting patients are at a high risk of transition to a fully syndromal psychiatric disorder. The validity and clinical usefulness of MADD as a diagnostic category are under debate. It has not been included in the recently released DSM-5 since the proposed diagnostic criteria turned out to be not sufficiently reliable. Moreover, reviewers have disputed the justification of MADD based on divergent results regarding its prevalence and course, diagnostic stability over time, and nosological inconsistencies between subthreshold and threshold presentations of anxiety and depressive disorders. We review the evidence in favor and against MADD and argue that it should be included into classification systems as a diagnostic category because it may enable patients to gain access to appropriate treatment early. This may help to reduce patients' distress, prevent exacerbation to a more serious psychiatric disorder, and ultimately reduce the societal costs of this very common condition.
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Affiliation(s)
- Hans-Jürgen Möller
- Clinic and Polyclinic for Psychiatry and Psychotherapy, Ludwig Maximilian University, Nußbaumstrasse 7, 80336, Munich, Germany
| | - Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, von-Siebold-Strasse 5, 37075, Göttingen, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Balthasar-Neumann-Platz 1, 97440, Werneck, Germany
| | - Utako Birgit Barnikol
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University Medical Center Cologne, Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Albertus Magnus University of Cologne, Joseph Stelzmann Strasse 20, 50937, Cologne, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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