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Geck MS, Lecca D, Marchese G, Casu L, Leonti M. Ethnomedicine and neuropsychopharmacology in Mesoamerica. JOURNAL OF ETHNOPHARMACOLOGY 2021; 278:114243. [PMID: 34129899 DOI: 10.1016/j.jep.2021.114243] [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] [Received: 02/19/2021] [Revised: 04/27/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The burden of disease caused by mental and neurological disorders is increasing globally, to a disproportionate degree in Latin America. In contrast to the many psychoactive plants with a use history in Mesoamerican cultures, the translation to the wider population of knowledge around numerous botanicals used contemporarily by indigenous Mesoamerican societies to treat psychological and neurological disorders did not receive the same attention. MATERIAL AND METHODS We used the previously published Mesoamerican Medicinal Plant Database to extract species and associated botanical drugs used as treatments for illnesses associated with the nervous system by Mesoamerican cultures in Belize, Guatemala, and Mexico. With the critical use of published pharmacological literature, the cross-culturally most salient genera are systematically reviewed. RESULTS From 2188 plant taxa contained in the database 1324 are used as treatments for illnesses associated with the nervous system. The ethnomedical data was critically confronted with the available biomedical literature for the 58 cross-culturally most salient genera. For a considerable proportion of the frequently used taxa, preclinical data are available, mostly validating ethnomedicinal uses. CONCLUSION This quantitative approach facilitates the prioritization of taxa for future pre-clinical, clinical and treatment outcome studies and gives patients, practitioners, and legislators a fundamental framework of evidence, on which to base decisions regarding phytomedicines.
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Affiliation(s)
- Matthias S Geck
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, 09042, Monserrato, CA, Italy; Biovision - Foundation for Ecological Development, Heinrichstrasse 147, 8005, Zurich, Switzerland
| | - Daniele Lecca
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, 09042, Monserrato, CA, Italy
| | - Giorgio Marchese
- Institute of Translational Pharmacology UOS of Cagliari National Research Council of Italy, Pula, Cagliari, Italy
| | - Laura Casu
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Universitaria, 09042, Monserrato, CA, Italy
| | - Marco Leonti
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, 09042, Monserrato, CA, Italy.
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Borrás S, Martínez-Solís I, Ríos JL. Medicinal Plants for Insomnia Related to Anxiety: An Updated Review. PLANTA MEDICA 2021; 87:738-753. [PMID: 34116572 DOI: 10.1055/a-1510-9826] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sleep disorders are common among the general population and can generate health problems such as insomnia and anxiety. In addition to standard drugs and psychological interventions, there are different complementary plant-based therapies used to treat insomnia and anxiety. This review aimed to find and examine the most recent research on the use of herbal medicines for treating anxiety and insomnia as compiled from clinical trials, as well as to assess the safety and efficacy of these medicines and to elucidate their possible mechanisms of action. The process entailed a search of PubMed, Scopus, and the Cochrane Library databases from 2010 to 2020. The search terms included "sleep disorder", "insomnia", "sedative", "hypnotic", "anxiety", "anxiolytic", and "clinical trial", combined with the search terms "herbs" and "medicinal plants", in addition to individual herbal medicines by both their common and scientific names. This updated review, which focuses mainly on clinical trials, includes research on 23 medicinal plants and their combinations. Essential oils and their associations have also been reviewed. The efficacy of medicinal plants depends on treatment duration, types of study subjects, administration route, and treatment method. More clinical trials with an adequate, standardized design are necessary, as are more preclinical studies to continue studying the mechanisms of action. As a result of our work, we can conclude that the 3 plants with the most potential are valerian, passionflower, and ashwagandha, with the combination of valerian with hops and passionflower giving the best results in the clinical tests.
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Affiliation(s)
- Silvia Borrás
- Departament de Farmacologia, Facultat de Farmàcia, Universitat de València, Spain
- Departamento de Farmacia, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Spain
| | - Isabel Martínez-Solís
- Departamento de Farmacia, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Spain
| | - José Luis Ríos
- Departament de Farmacologia, Facultat de Farmàcia, Universitat de València, Spain
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Garakani A, Murrough JW, Freire RC, Thom RP, Larkin K, Buono FD, Iosifescu DV. Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:222-242. [PMID: 34690588 PMCID: PMC8475923 DOI: 10.1176/appi.focus.19203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
(Appeared originally in Frontiers in Psychiatry 2020 Dec 23; 11:595584)
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Garakani A, Murrough JW, Freire RC, Thom RP, Larkin K, Buono FD, Iosifescu DV. Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Front Psychiatry 2020; 11:595584. [PMID: 33424664 PMCID: PMC7786299 DOI: 10.3389/fpsyt.2020.595584] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/13/2020] [Indexed: 12/20/2022] Open
Abstract
Anxiety disorders are the most prevalent psychiatric disorders and a leading cause of disability. While there continues to be expansive research in posttraumatic stress disorder (PTSD), depression and schizophrenia, there is a relative dearth of novel medications under investigation for anxiety disorders. This review's first aim is to summarize current pharmacological treatments (both approved and off-label) for panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and specific phobias (SP), including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), azapirones (e.g., buspirone), mixed antidepressants (e.g., mirtazapine), antipsychotics, antihistamines (e.g., hydroxyzine), alpha- and beta-adrenergic medications (e.g., propranolol, clonidine), and GABAergic medications (benzodiazepines, pregabalin, and gabapentin). Posttraumatic stress disorder and obsessive-compulsive disorder are excluded from this review. Second, we will review novel pharmacotherapeutic agents under investigation for the treatment of anxiety disorders in adults. The pathways and neurotransmitters reviewed include serotonergic agents, glutamate modulators, GABAergic medications, neuropeptides, neurosteroids, alpha- and beta-adrenergic agents, cannabinoids, and natural remedies. The outcome of the review reveals a lack of randomized double-blind placebo- controlled trials for anxiety disorders and few studies comparing novel treatments to existing anxiolytic agents. Although there are some recent randomized controlled trials for novel agents including neuropeptides, glutamatergic agents (such as ketamine and d-cycloserine), and cannabinoids (including cannabidiol) primarily in GAD or SAD, these trials have largely been negative, with only some promise for kava and PH94B (an inhaled neurosteroid). Overall, the progression of current and future psychopharmacology research in anxiety disorders suggests that there needs to be further expansion in research of these novel pathways and larger-scale studies of promising agents with positive results from smaller trials.
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Affiliation(s)
- Amir Garakani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Silver Hill Hospital, New Canaan, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rafael C Freire
- Department of Psychiatry and Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Robyn P Thom
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kaitlyn Larkin
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Frank D Buono
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Dan V Iosifescu
- Clinical Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States.,Department of Psychiatry, New York University School of Medicine, New York, NY, United States
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Sartori SB, Singewald N. Novel pharmacological targets in drug development for the treatment of anxiety and anxiety-related disorders. Pharmacol Ther 2019; 204:107402. [PMID: 31470029 DOI: 10.1016/j.pharmthera.2019.107402] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022]
Abstract
Current medication for anxiety disorders is suboptimal in terms of efficiency and tolerability, highlighting the need for improved drug treatments. In this review an overview of drugs being studied in different phases of clinical trials for their potential in the treatment of fear-, anxiety- and trauma-related disorders is presented. One strategy followed in drug development is refining and improving compounds interacting with existing anxiolytic drug targets, such as serotonergic and prototypical GABAergic benzodiazepines. A more innovative approach involves the search for compounds with novel mechanisms of anxiolytic action using the growing knowledge base concerning the relevant neurocircuitries and neurobiological mechanisms underlying pathological fear and anxiety. The target systems evaluated in clinical trials include glutamate, endocannabinoid and neuropeptide systems, as well as ion channels and targets derived from phytochemicals. Examples of promising novel candidates currently in clinical development for generalised anxiety disorder, social anxiety disorder, panic disorder, obsessive compulsive disorder or post-traumatic stress disorder include ketamine, riluzole, xenon with one common pharmacological action of modulation of glutamatergic neurotransmission, as well as the neurosteroid aloradine. Finally, compounds such as D-cycloserine, MDMA, L-DOPA and cannabinoids have shown efficacy in enhancing fear-extinction learning in humans. They are thus investigated in clinical trials as an augmentative strategy for speeding up and enhancing the long-term effectiveness of exposure-based psychotherapy, which could render chronic anxiolytic drug treatment dispensable for many patients. These efforts are indicative of a rekindled interest and renewed optimism in the anxiety drug discovery field, after decades of relative stagnation.
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Affiliation(s)
- Simone B Sartori
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria
| | - Nicolas Singewald
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria.
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