Medicinal herbs for the treatment of anxiety: a systematic review and network meta-analysis

Molecular Basis of Anxiety: A Comprehensive Review of 2014-2024 Clinical and Preclinical Studies

Anxiety disorders are among the most common psychiatric conditions that significantly impair one's quality of life and place a significant burden on healthcare systems. Conventional treatments have certain restraints, such as potential side effects and limited efficacy. Τhe underlying pathophysiological mechanisms of anxiety are not fully understood. A comprehensive literature search was performed in MEDLINE and Scopus databases for original English-language articles published between January 2014 and December 2024. Study selection, data extraction, and screening were independently carried out by multiple investigators using predefined criteria. Our review aimed to help better comprehend the molecular basis of anxiety, focusing on the hypothalamic-pituitary-adrenal (HPA) axis, serotonergic signaling, and gamma-aminobutyric acid (GABA) neurotransmission. In addition, we addressed the role of epigenetics and pharmacogenomics in personalized treatment. Although novel anxiety treatments are promising, they are predominantly preclinical and highly heterogeneous, which poses a challenge to achieving reliable therapeutic efficacy. Our findings could potentially contribute to the development of new therapeutic interventions. Further research is warranted, especially in human subjects, with an aim to combine genetic and epigenetic profiles to refine treatment approaches and develop innovative therapeutics.

The role of tele-herbal consultations in workplace wellness

BACKGROUND

 Musculoskeletal disorders are widespread among sedentary office workers, impacting both their physical and mental well-being. There is increasing interest in incorporating herbal interventions as part of a holistic approach to address these challenges, blending traditional and culturally relevant treatments with modern techniques to enhance overall health and wellness.

OBJECTIVE

 This commentary aims to highlight the role of utilizing electronic platforms to provide consultations regarding herbal medicine (or tele-herbal consultations) in managing musculoskeletal disorders and impacting pain relief, changes in psychological well-being, and improvements in workplace productivity among sedentary office workers.

METHODS

 This study discusses the influence of herbal treatments on both physical and psychological dimensions of musculoskeletal disorders, offering insights into holistic healing approaches, based on previously published papers. It also highlights the feasibility and acceptance of tele-herbal consultations.

RESULTS

 The data gathered from previous studies shows that herbal interventions can enhance both subjective physical performance and psychological well-being in office workers. Tele-herbal consultation may be a culturally sensitive solution to provide pain relief and improvements in workplace productivity.

CONCLUSION

 Although the findings of previous studies are encouraging, further research is needed to establish standardized tele-herbal protocols that can effectively relieve pain, boost well-being, and promote a more active, health-conscious lifestyle for office workers. Ultimately, these interventions could lead to improvements in workplace productivity.

Dietary Protocols to Promote and Improve Restful Sleep: A Narrative Review

Humans spend approximately one third of their life asleep but, as counterintuitive as it may sound, sleep is far from being a quiet state of inactivity. Sleep provides the opportunity to perform numerous biological and physiological functions that are essential to health and wellbeing, including memory consolidation, physical recovery, immunoregulation, and emotional processing. Yet, sleep deprivation, chronic sleep restriction, and various types of sleep disorders are all too common in modern society. Failure to meet the recommended 7-9 hours of restful sleep per night is known to increase the risk of several health conditions, reason why regular and adequate sleep should be seen as a priority instead of an unnecessary commodity easily traded as required by the commitments of our busy lives. While both the quantity and the quality of sleep can be largely improved with relatively straightforward practices dictated by good sleep hygiene, emerging research suggests that dietary and supplementation protocols focused on certain foods, nutrients, and biochemical compounds with sleep-promoting properties can act as subsidiary sleep aids in complementing these behavioral changes. The scope of this narrative review is to summarize the available evidence on the potential benefits of selected nutraceuticals in the context of circadian rhythm and sleep disturbances, namely melatonin, magnesium, omega-3 fatty acids, tart cherry juice, kiwifruit, apigenin, valerian root, L-theanine, glycine, ashwagandha, myoinositol, Rhodiola rosea, and phosphatidylserine. A comprehensive recapitulation of the relevant literature is provided, alongside corresponding evidence-based nutritional protocols to promote and improve restful sleep.

Risk factors associated with pain and pain relief in patients with chronic pancreatitis

BACKGROUND

Abdominal pain is one of the most prominent symptoms in patients with chronic pancreatitis (CP) and can manifest intermittently or persistently. The mechanism of pain is not yet clear, and no effective treatment is currently available. This study aimed to explore the risk factors for pain in patients with CP, which may provide new insights for developing effective pain control modalities.

METHODS

This clinical study was based on a single-centre research database that included 570 patients with CP. We compared the differences in baseline data, clinical characteristics, and psychophysiology traits between patients with and without pain. Subsequently, patients will be followed up to assess changes in their risk factors and explore their relationship with pain.

RESULTS

In the final risk factor model, young age (P = .031; odds ratio [OR] = 0.986 [0.973, 0.999]), prolonged disease duration (P < .001; OR = 1.307 [1.127, 1.516]), heavy smoking (P = .014; OR = 1.331 [1.060, 1.617]), alcohol consumption (P = .003; OR = 1.419 [1.127, 1.788]), low body mass index (P < .001; OR = 0.786 [0.703, 0.879]), pancreatic exocrine insufficiency (P = .040; OR = 1.683 [1.024, 2.767]), acute pancreatitis attacks (P = .027; OR = 1.759 [1.067, 2.902]), anxiety, and depression (P = .016; OR = 1.047 [1.009, 1.088]; P = .014; OR = 1.068 [1.013, 1.126]) were associated with CP pain. Reducing tobacco and alcohol intake (P = .001; OR = 2.367 [1.525, 4.637]; P = .024; OR = 2.011 [1.085, 3.199]), increasing the body mass index (P = .005; OR = 1.968 [1.265, 3.805]), and improving anxiety (P = .001; OR = 1.164 [1.081, 1.340]) were identified to be beneficial for pain relief. Compared to the effects on persistent pain, pancreatic enzyme supplementation (P = .004; OR = 1.794 [1.186, 2.502]) had a clear effect on intermittent pain in patients with CP.

CONCLUSION

We identified a multifactorial model of pain risk factors for CP and confirmed that modifying these risk factors could influence patient pain symptoms.

The potential value of traditional Chinese medicine monomers in cerebral ischemia-reperfusion injury: a network meta-analysis based on animal model

BACKGROUND

Cerebral ischemia-reperfusion injury (CIRI) is a complex pathological process, which can further aggravate the damage of ischemic tissues. Traditional Chinese medicine (TCM) monomers, bioactive compounds extracted from Chinese herbal medicines, have been demonstrated to have various protective effects against reperfusion injury. This network meta-analysis (NMA) aimed to investigate the optimal treatment strategy of TCM monomers for CIRI in animal models.

METHODS

Four databases including PubMed, Embase, Web of Science, and Cochrane were searched up to January 06, 2024. First, prospective registration was done at PROSPERO (ID: CRD42024496289), the quality of the included studies was evaluated with SYRCLE's risk of bias tool, and statistical analysis was conducted with Stata Version 18.0 and RStudio.

RESULTS

In total, 26 studies were included, involving 506 animals and 12 TCM monomers. The results of a meta-analysis demonstrated that, compared to the control group, puerarin, paeoniflorin, hydroxysafflor yellow A, sinomenine, and salvianolic acid significantly reduced mNSS scores. Furthermore, ginsenoside, scutellarin, and baicalein significantly reduced Longa scores. In addition, salvianolic acid treatment significantly decreased brain water content. Regarding infarct volume, bilobalide, baicalein and puerarin all demonstrated remarkable effects. The network meta-analysis suggested that paeoniflorin might be the most effective intervention in terms of mNSS score, with a surface under the cumulative ranking curve (SUCRA) value of 92.8%; Scutellarin might be the most effective intervention to reduce Longa score (SUCRA = 87.6%); And salvianolic acid might be the most effective intervention to reduce brain water content (SUCRA = 98.2%); For infarct volume specifically, bilobalide may be the most effective intervention (SUCRA = 95.5%). In our meta-regression, we found that dose and duration of treatment may contribute to heterogeneity among mNSS studies.

CONCLUSION

TCM monomers could provide a favorable neuroprotection on CIRI, with heterogeneous protective effects. Given the small number and the differences in quality of included studies, more high-quality, programmatic animal studies were needed to validate our findings.

CLINICAL TRIAL NUMBER

Not applicable.

Anxiety disorders, PTSD and OCD: systematic review of approved psychiatric medications (2008-2024) and pipeline phase III medications

Objective

This systematic review examines psychiatric medications approved by the FDA for anxiety disorders, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) from 2008 to 2024 and describes the mechanism of action, indications for both labelled and off-label uses, evidence for efficacy, dosing and adverse effects for each medication.

Methods

The methodology involved a literature search of the PubMed database for studies published from 1 January 2008 to 31 December 2024 on FDA-approved psychiatric medications and phase III pipeline medications, using the keywords: "anxiety" OR "PTSD" OR "OCD" AND "psychopharm*" OR "medic*" OR "pharm*". The authors conducted independent assessments of the resulting articles and reached a consensus on eligible studies to include in this systematic review.

Results

Our review revealed that, in the past 16 years, the FDA approved only two medications for anxiety disorders (a delayed-release form of duloxetine for generalized anxiety disorder and an extended-release form of lorazepam) and none for PTSD or OCD. We also identified 14 pipeline medications for anxiety disorders, eight for PTSD and one for OCD, all of which are currently in phase III clinical trials.

Conclusion

Our results showed a paucity of new medications for anxiety disorders and none for PTSD and OCD in the past 16 years. However, phase III psychiatric medications for anxiety disorders, PTSD and OCD seem to show several agents with novel mechanisms of action, various modes of administration, and improved side-effect profiles.

l-theanine: From tea leaf to trending supplement - does the science match the hype for brain health and relaxation?

l-Theanine is a unique non-protein amino acid found abundantly in tea leaves. Interest in its potential use as a dietary supplement has surged recently, especially claims related to promoting relaxation and cognitive enhancement. This review surveys the chemistry, metabolism, and purported biological activities of l-theanine. It is well absorbed from the intestine and can cross the blood-brain barrier. Some studies suggest l-theanine may increase alpha waves in the brain associated with relaxation and selective attention, reduce stress and anxiety, and improve sleep quality, though findings are often inconsistent. Potential neuroprotective and anti-seizure effects have also been reported in animal models. When combined with caffeine, l-theanine may improve cognitive performance, alertness and focus. However, the evidence supporting many health claims remains limited, especially the lack of rigorous human clinical trials. While l-theanine exhibits a good safety profile based on toxicology studies, caution is warranted regarding the purported health benefits, until stronger scientific substantiation emerges. Overall, the mechanisms of action and therapeutic potential of l-theanine require further investigation, given the current interest and increasing popularity of this nutraceutical supplement marketed for brain health and relaxation. In the absence of well-designed and carefully controlled human clinical trials, we would urge caution in the use of l-theanine supplements at pharmacologic doses by the wider population, and believe that the science does not yet match the hype behind this trending supplement for brain health and relaxation.

Coptisine improves LPS-induced anxiety-like behaviors by regulating the Warburg effect in microglia via PKM2

Neuroinflammation mediated by microglia is considered the primary cause and pathological process of anxiety. Abnormal glycolysis of microglia is observed during microglia activation. However, whether regulating the Warburg effect in microglia can effectively intervene anxiety and its potential mechanisms have not been elucidated. This study focused on coptisine (Cop), a natural alkaloid that regulates the glycolysis and function of microglia affecting anxiety. The effects of Cop on anxiety-like behaviors, hippocampal synaptic function, and excessive activation of microglia were assessed in lipopolysaccharide (LPS) induced mouse models of anxiety. Microglia expressing mutant pyruvate kinase isoform M2 (PKM2) were used to further investigate the molecular mechanism by which Cop regulates the phenotype of microglia. neuroinflammatory is emerging Further research revealed that Cop attaches to the amino acid residue phenylalanine 26 of PKM2, shifting the dynamic equilibrium of PKM2 towards tetramers, and enhancing its pyruvate kinase activity. This interaction prevented LPS-induced Warburg effect and inactivated PKM2/hypoxia-inducible factor-1α (HIF-1α) pathway in microglia. In conclusion, Cop attenuates anxiety by regulating the Warburg effect in microglia. Our work revealed the role of PKM2/(HIF-1α) pathway in anxiety for the first time. Importantly, the molecular mechanism by which Cop ameliorates anxiety-like behaviors is through modulation of the dimeric/tetrameric form of PKM2, indicating the usefulness of PKM2 as a key potential target for the treatment of anxiety.

Fluoxetine attenuates the anxiolytic effects of the probiotic VSL#3 in a stress-vulnerable genetic line of aves in the chick social-separation stress test, a dual screening assay

Anxiety disorders represent one of the most common and debilitating illnesses worldwide. However, the development of novel therapeutics for anxiety disorders has lagged compared to other mental illnesses. A growing body of research suggests the gut microbiota plays a role in the etiopathology of anxiety disorders and may, therefore, serve as a novel target for their treatment through the use of probiotics. The use of dietary supplements like probiotics is increasing and their interaction with pharmacotherapies is not well understood. Utilizing the chick social-separation stress test, the primary aim of this study was to evaluate the commercially-available multi-strain probiotic found in VSL#3 for potential anxiolytic-like and/or antidepressant-like effects in the stress-vulnerable Black Australorp genetic line. A secondary aim was to evaluate the interaction between probiotics and the SSRI fluoxetine. Animals were treated with either saline, probiotics, fluoxetine, or probiotics + fluoxetine for 8 days prior to exposure to a 90-min isolation stressor that produces both a panic-like (i.e., anxiety-like) state followed by a state of behavioral despair (i.e., depression-like). The 8-day probiotic regimen produced anxiolytic-like effects but did not attenuate behavioral despair. Fluoxetine failed to significantly alter behavior in either of the two phases. Moreover, the combination of fluoxetine with probiotics attenuated the anxiolytic-like effects of probiotics. The fluoxetine + probiotics combination had no effect on behavioral despair. The results of the current study align with other preclinical studies and some clinical trials suggesting probiotics may offer beneficial effects on anxiety. Investigations examining the anxiolytic-like mechanism of probiotics are needed before any conclusions can be made. Additionally, as the use of probiotics becomes more popular, research on the interactions between probiotic-microbiota and psychotropic medications is necessary.

Mechanism of action of the Banxia-Xiakucao herb pair in sleep deprivation: New comprehensive evidence from network pharmacology, transcriptomics and molecular biology experiments

ETHNOPHARMACOLOGICAL RELEVANCE

Chinese herb pairs are the most basic and compressed examples of Chinese herbal combinations and can be used to effectively explain the fundamental concepts of traditional Chinese medicine prescriptions. These pairings have gained significant interest due to their subtle therapeutic benefits, minimal side effects, and efficacy in treating complicated chronic conditions. The Banxia-Xiakucao Chinese herb pair (BXHP) consists of Pinellia ternata (Thunb.) Breit. (Banxia) and Prunella vulgaris L. (Xiakucao). This formula was documented in The Medical Classic of the Yellow Emperor approximately 2000 years ago，and clinical research has demonstrated that BXHP effectively treats insomnia.

AIM OF THE STUDY

This study aimed to evaluate the efficacy and therapeutic mechanism of the BXHP through a comprehensive strategy involving network pharmacology, molecular docking, transcriptomics, and molecular biology experimental validation.

MATERIALS AND METHODS

The composition of BXHP was characterized using the UPLC-Q-TOF-MS. The active compounds were screened to find drug-likeness compounds by analyzing the ADME data. To predict the molecular mechanism of BXHP in sleep deprivation (SD) by network pharmacology and molecular docking. We established a rat model of SD and the in vivo efficacy of BXHP was verified through the pentobarbital sodium righting reflex test, behavioral assays, enzyme-linked immunosorbent assay, transmission electron microscopy, HE staining, and Nissl staining, and the underlying molecular mechanism of BXHP in SD was revealed through transcriptomic and bioinformatic analyses in conjunction with quantitative real-time PCR, Western blot, and immunofluorescence staining.

RESULTS

In the present study, we showed for the first time that BXHP reduced sleep latency, prolongs sleep duration, and improves anxiety; lowered serum CORT, IL6, TNF-α and MDA levels; decreased hypothalamic Glu levels; and elevated hypothalamic GABA and 5-HT levels in SD rats. We found 16 active compounds that acted on 583 targets, 145 of which are related to SD. By modularly dissecting the PPI network, we discovered three critical targets, Akt1, CREB1, and PRKACA, all of which play important roles in the effects of BXHP on SD. Molecular docking resulted in the identification of 16 active compounds that strongly bind to key targets. The results of GO and KEGG enrichment analyses of network pharmacology and transcriptomics focused on both the regulation of circadian rhythm and the cAMP signaling pathway, which strongly demonstrated that BXHP affects SD via the cAMP-PKA-CREB-Circadian rhythm pathway. Molecular biology experiments verified this hypothesis. Following BXHP administration, PKA and CREB phosphorylation levels were elevated in SD rats, the cAMP-PKA-CREB signaling pathway was activated, the expression levels of the biological clock genes CLOCK, p-BMAL1/BMAL1, and PER3 were increased, and the rhythmicity of the biological clock was improved.

CONCLUSIONS

The active compounds in BXHP can activate the cAMP-PKA-CREB-Circadian rhythm pathway, improve the rhythmicity of the biological clock, promote sleep and ameliorate anxiety, which suggests that BXHP improves SD through a multicomponent, multitarget, multipathway mechanism. This study is important for the development of herbal medicines and clinical therapies for improving sleep deprivation.

Perceived Changes in Anxiety Symptom Burden During Treatment with Bryophyllum pinnatum: A Prospective, Single-Arm Study

BACKGROUND/OBJECTIVES

Bryophyllum spp. preparations are widely used in Anthroposophic Medicine, most often for mental and behavioral disorders, including anxiety. Studies in animals revealed various anxiolytic and neurosedative effects for Bryophyllum pinnatum. We set out to investigate the effectiveness of Bryophyllum 50% chewable tablets, a product registered without indication by means of notification in Switzerland, in the treatment of anxiety symptoms in psychiatric and psychosomatic patients.

METHODS

A total of 99 patients with anxiety symptoms were recruited from the waiting list for an inpatient stay at the hospital "Klinik Arlesheim", Department of Psychiatry and Psychosomatics; of these, 54 completed the study and returned fully completed questionnaires. Patients were treated with Bryophyllum 50% chewable tablets (350 mg tablets, made from leaf press juice, 3 × 2 per day; Weleda AG Arlesheim, Switzerland) and filled out questionnaires at baseline and after two and three weeks of tablet intake. The primary endpoint of the study was the change in anxiety symptoms measured with the Beck Anxiety Inventory (BAI).

RESULTS

A clinically relevant decrease in BAI score from baseline (27.4 ± 12.0) to after two (22.4 ± 12.1; p < 0.001) and three (20.6 ± 12.9; p < 0.001) weeks of treatment was observed. Additional improvements were observed in the secondary endpoints (including in depression, sleep quality, and stress); tolerability and compliance were very good.

CONCLUSIONS

The results suggest that Bryophyllum 50% chewable tablets have beneficial effects on anxiety-related symptoms. Since the study design does not allow us to conclude causality between treatment and observed improvements, a randomized clinical trial is urgently needed.

Evaluating deep learning techniques for identifying tongue features in subthreshold depression: a prospective observational study

Objective

This study aims to evaluate the potential of using tongue image features as non-invasive biomarkers for diagnosing subthreshold depression and to assess the correlation between these features and acupuncture treatment outcomes using advanced deep learning models.

Methods

We employed five advanced deep learning models-DenseNet169, MobileNetV3Small, SEResNet101, SqueezeNet, and VGG19_bn-to analyze tongue image features in individuals with subthreshold depression. These models were assessed based on accuracy, precision, recall, and F1 score. Additionally, we investigated the relationship between the best-performing model's predictions and the success of acupuncture treatment using Pearson's correlation coefficient.

Results

Among the models, SEResNet101 emerged as the most effective, achieving an impressive 98.5% accuracy and an F1 score of 0.97. A significant positive correlation was found between its predictions and the alleviation of depressive symptoms following acupuncture (Pearson's correlation coefficient = 0.72, p<0.001).

Conclusion

The findings suggest that the SEResNet101 model is highly accurate and reliable for identifying tongue image features in subthreshold depression. It also appears promising for assessing the impact of acupuncture treatment. This study contributes novel insights and approaches to the auxiliary diagnosis and treatment evaluation of subthreshold depression.

Effects of proof-of-concept training on reducing work stress and anxiety of junior medical staff: a randomized controlled trial proof-of-concept

BACKGROUND

Psychological stress and anxiety have seriously affected the ability of new clinicians to adapt and coordinate their clinical work. Traditional pre-job training is often not very good at assisting new recruits to regulate their emotional problems.

METHODS

This study is a randomized controlled study. A total of 435 newly recruited clinicians participated in the study. 428 clinicians were randomized into a control group (n = 214) and an intervention group (n = 214). The control group conducted regular pre-job training. Doctors of the intervention group attend a themed course every two weeks on the basis of regular induction training. Their physiological status was evaluated by Perceived Stress Scale (PPS-10), Generalized Anxiety Scale (GAD-7) and Psychological Resilience Scale (CD-RISC-10) 3 months later. Participants in the intervention group received a training satisfaction questionnaire.

RESULTS

After entering the clinic for 3 months, the PSS-10 and GAD-7 scores of the intervention group were significantly lower than that of the control group. Consistently, the CD-RISC-10 score of new clinicians who received proof-of-concept pre-job training was significantly higher than that of new doctors in the control group.

CONCLUSION

New doctors received the proof-of-concept group experienced alleviation in stress and anxiety.

A scoping review of over-the-counter products for depression, anxiety and insomnia in older people

BACKGROUND

Depression, anxiety, and insomnia are prevalent in older people and are associated with increased risk of mortality, dependency, falls and reduced quality of life. Prior to or whilst seeking treatment, older people often manage these symptoms or conditions using products purchased over the counter (OTC), such as medication or herbal products. This review aims to map the evidence available for OTC medications, herbal medicines and dietary supplements for depression, anxiety and insomnia in older adults.

METHODOLOGY

We carried out a scoping review, including searches of five databases to identify relevant randomised controlled trials (inception-Dec 2022). We took an inclusive approach to products to represent the wide range that may be available online. Trials were summarised according to condition and product.

RESULTS

We included 47 trials and 10 ongoing trial protocols. Most targeted insomnia (n = 25), followed by depression (n = 20), and mixed conditions (n = 2). None evaluated products targeted at anxiety alone. Where reported, most products appeared to be safe for use, but studies rarely included people with multiple comorbidities or taking concomitant medication. Some types of melatonin for insomnia (n = 19) and omega-3 fatty acids for depression (n = 7) had more substantive evidence compared to the other products.

CONCLUSION

There is a substantial gap in evidence for OTC products for anxiety in older people. This should be addressed in future trials. Research should also focus on products that are widely used, and these need to be tested in older populations that are similar to those who would use them in practice.

Associations between Chronic Medical Conditions and Persistent Dietary Supplement Use: The US Military Dietary Supplement Use Study

This longitudinal study examined associations between chronic medical conditions (CMCs) and persistent dietary supplement (DS) use. On two separate occasions, 1.3 ± 0.2 years apart, military service members (SMs) (n = 5778) completed identical questionnaires concerning their DS use in the past 6 months and their demographic and lifestyle characteristics. Medical conditions were obtained from a medical surveillance system six months before the first questionnaire and during the period between questionnaires. Diagnoses were grouped into 19 major (largely systemic) and 9 specific CMCs. Conditions diagnosed in both periods (CMCs) were examined in relation to DS use reported on both questionnaires (persistent DS use). After adjustment for demographic and lifestyle factors, higher odds of persistent DS use were found in 7 of the 19 major CMCs and 5 of the 9 specific CMCs. SMs with a CMC had 1.25 (95% confidence interval [95%CI] = 1.10-1.41) higher adjusted odds of persistent DS use. The three specific CMCs with the highest adjusted odds of persistent DS use were anxiety (odds ratio [OR] = 2.30, 95%CI = 1.36-3.89), depression (OR = 2.12, 95%CI = 1.20-3.73), and gastroesophageal reflux disease (OR = 2.02, 95%CI = 1.02-4.04). Among DS categories, participants with a CMC had higher adjusted odds of persistent vitamins or mineral use (OR = 1.31, 95% CI = 1.12-1.53). Participants with CMCs had a higher prevalence of persistent DS use, especially individual vitamin and mineral use.

Effectiveness of Psychobiotic Bifidobacterium breve BB05 in Managing Psychosomatic Diarrhea in College Students by Regulating Gut Microbiota: A Randomized, Double-Blind, Placebo-Controlled Trial

Diarrhea of college students (DCS) is a prevalent issue among college students, affecting their daily lives and academic performance. This study aims to explore the potential effect of Bifidobacterium breve BB05 supplements on the DCS. Initially, fifty healthy and fifty diarrheal students were recruited in the observational experiment and allocated into control and diarrhea groups, respectively. Subsequently, one hundred diarrheal students were newly recruited in the intervention experiment and randomly allocated into placebo and probiotic groups, both treated for 2 weeks. Questionnaires (BSS, HAMA-14, and HDRS-17) were performed to assess the students' diarrheal states and mental health at baseline and post-treatment. Fecal samples underwent 16S rRNA sequencing and Enzyme-Linked Immunosorbent Assay to evaluate gut microbiota and fecal metabolite alternations. Results indicated that B. breve BB05 supplementation significantly enriched (p < 0.05) the reduced gut microbial diversity caused by diarrhea. Diarrhea resulted in notable alterations in gut microbiota composition, as exhibited by elevated Collinsella and Streptococcus, alongside substantially decreased Bifidobacterium, Bacteroides, and Prevotella, while B. breve BB05 supplementation partially restored the compromised gut microbiota at both the phylum and genus levels, particularly by increasing Bifidobacterium and Roseburia (p < 0.05). Importantly, questionnaire results suggested that B. breve BB05 administration achieved superior efficacy in relieving diarrhea symptoms and the associated anxiety and depression in college students. An increased fecal concentration of 5-hydroxytryptamine (5-HT) was also observed in the probiotic group, while Acetylcholine (ACH), Epinephrine (EPI), and Noradrenaline/Norepinephrine (NANE) reduced, revealing the potential of B. breve BB05 in alleviating anxiety and depression via modulating the microbiota-gut-brain axis. Furthermore, correlation analysis suggested that the altered microbiota and fecal neurotransmitters were closely associated with the mental symptoms. These results endorse B. breve BB05 intervention as a promising and innovative approach to alleviate both diarrhea and mental health conditions among college students.

Does valerian work for insomnia? An umbrella review of the evidence

Valerian is one of the most used herbal agents (phytotherapeutics) to manage sleep disturbances, in particular, sleep-onset difficulties in young adults. However, the evidence based on primary studies and systematic reviews that supports its use in this domain is weak or inconclusive. In the current study, an umbrella review was performed on the efficacy of valerian for sleep disturbances with a focus on insomnia. As such, only systematic reviews (with or without meta-analysis) were considered for this study. Systematic searches in PubMed, Web of Science, Scopus, Cochrane Database of Systematic Reviews, PROSPERO and CNKI databases retrieved 70 records. Only 8 articles were considered eligible for qualitative analysis. Overall, data suggested that valerian has a good safety profile, however, the results showed no evidence of efficacy for the treatment of insomnia. Moreover, valerian appears to be effective concerning subjective improvement of sleep quality, although its effectiveness has not been demonstrated with quantitative or objective measurements. Despite its widespread use and prescription by general practitioners, psychiatrists and other professionals, valerian does not have empirical support for insomnia. Further studies, in particular high quality randomized controlled trials, are highly recommended since there are scarce studies and the existing ones are quite heterogeneous and with low methodological quality. The implications of our findings for clinical practice are critically discussed.

Effects of Withania somnifera Extract in Chronically Stressed Adults: A Randomized Controlled Trial

BACKGROUND

Stress is a known causative factor in modulating cognitive health, which overall well-being and quality of life are dependent on. Long-term stress has been shown to disrupt the balance of the hypothalamic-pituitary-adrenal (HPA) axis. Adaptogens, such as Withania somnifera (ashwagandha), are commonly used in Ayurvedic medicine for stress relief and ameliorating HPA-axis dysfunction. The aim of this study was to support the role of a root and leaf water-extracted ashwagandha extract (WS) in stress reduction by confirming the lowest clinically validated dose for stress management (125 mg/day) in a dose-dependent clinical study in adults with self-reported high stress.

METHODS

An 8-week, randomized, double-blinded, placebo-controlled study to compare the effects of three different WS extract doses (125, 250 and 500 mg) was performed. A total of 131 adults were enrolled, and 98 were included in the final analysis. Attenuation of chronic stress was measured using the 14-item Perceived Stress Scale (PSS) and biochemical-related stress parameters.

RESULTS

We have shown that aqueous WS extract (roots and leaves) safely reduces mild to moderate chronic stress at doses of 125 mg, 250 mg, and 500 mg/day for 8 weeks.

CONCLUSIONS

Our findings demonstrate the stress-reduction capabilities of this well-characterized aqueous extract of WS (root and leaf) at the low dose of 125 mg/day, in a dose-dependent manner, via the modulation of the HPA axis.

TRIAL REGISTRATION

This study was registered with the Clinical Trials Registry-India (CTRI) with the registration number: CTRI/2019/11/022100.

Effects and safety of Ginkgo biloba on depression: a systematic review and meta-analysis

Background: Because depression is a major factor contributing to the global disease burden, we tried to analyze the effects and safety of Ginkgo biloba (GKB) on patients with depression. Methods: We conducted a literature search for articles published between January 2002 and May 2022 in seven online databases (PubMed, Scopus, Embase, Google Scholar, Web of Sciences, Cochrane Library, and China National Knowledge Infrastructure). A systematic literature review and meta-analysis were performed to compare the effects and safety of GKB on patients with depression, including subjective and objective indicators of depression evaluation. Results: In total, 21 eligible articles with nine indicators among 2074 patients were included. Several outcomes showed a difference, and the GKB group had better results than the control group, including the Hamilton Depression Scale (HAMD), after taking GKB for 4 weeks (MD = -2.86, 95%CI [-4.27, -1.46], p < 0.01), 6 weeks (mean difference (MD) = -3.36, 95%CI [-4.05, -2.67], p < 0.01), and 8 weeks (MD = -4.58, 95% CI [-6.11, -3.05], p < 0.01), modified Barthel index (MBI) (MD = 14.86, 95%CI [12.07, 17.64], p < 0.01), modified Edinburgh-Scandinavian stroke scale (MESSS) (MD = -4.57, 95%CI [-6.34, -2.79], p < 0.01), brain-derived neurotrophic factor (BDNF) (MD = 16.35, 95%CI [7.34, 25.36], p < 0.01), 5-hydroxytryptamine (5-HT) (MD = 4.57, 95%CI [3.08, 6.05], p < 0.01), and clinical efficacy (risk ratio, RR = 1.24, 95%CI [1.17, 1.32], p < 0.01). However, there were no differences in adverse events between GKB and controls. Conclusion: In conclusion, the main finding was that patients treated with GKB had better MBI, MESSS, BDNF, 5-HT, and HAMD values after 4 weeks, 6 weeks, and 8 weeks than the control group. GKB might reduce the risk of depression or depressive symptoms with safe clinical efficacy. Systematic Review Registration: identifier (INPLASY2023100052).

YAP1 Regulates the YAP1/AR/PSA Axis through Autophagy in Castration-Resistant Prostate Cancer and Mediates T-Cell Immune and Inflammatory Cytokine Infiltration

The emergence of castration-resistant prostate cancer (CRPC) following androgen deprivation therapy (ADT) is associated with increased malignancy and limited treatment options. This study aims to investigate potential connections between immune cell infiltration and inflammatory cytokines with the YAP1/AR/PSA axis by exploring their interactions with autophagy. Our research reveals heightened levels of Yes-associated protein 1 (YAP1) expression in CRPC tissues compared with tissues from androgen-dependent prostate cancer (ADPC) and benign prostate hyperplasia (BPH). Additionally, a correlation was observed between YAP1 and PSA expressions in CRPC tissues, suggesting that YAP1 may exert a regulatory influence on PSA expression within CRPC. Enhanced YAP1 expression in C4-2 cells resulted in the upregulation of androgen receptor (AR) nuclear translocation and intracellular prostate-specific antigen (PSA) levels. Conversely, the suppression of YAP1 led to a decrease in PSA expression, suggesting that YAP1 may positively regulate the PSA in castration-resistant prostate cancer (CRPC) by facilitating AR nuclear import. The modulation of the autophagy activity exerts a significant impact on the expression levels of YAP1, the AR, and the PSA. Moreover, recent advancements in immunity and inflammation studies present promising avenues for potential therapies targeting prostate cancer (PC).

Baseline symptom severity and efficacy of Silexan in patients with anxiety disorders: A symptom-based, patient-level analysis of randomized, placebo-controlled trials

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.

Efficacy of Silexan in patients with anxiety disorders: a meta-analysis of randomized, placebo-controlled trials

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.

Efficacy and Anti-Inflammatory Activity of Ashwagandha Sustained-Release Formulation on Depression and Anxiety Induced by Chronic Unpredictable Stress: in vivo and in vitro Studies

Background

Stress is the psychological, physiological, and behavioral response of an individual's body when they perceive a lack of equilibrium between the demands placed upon them and their ability to meet those demands. Adaptogens are herbs that help with stress management, and Ashwagandha is one such safe and effective adaptogen.

Objective

We evaluated the anti-neuroinflammatory potential of Ashwagandha sustained-release formulation (AshwaSR) by estimating the in vitro expression of pro-inflammatory cytokines, and its efficacy on anxiety and depression in an in vivo study.

Methods

Our in vitro study investigated the anti-inflammatory potential of AshwaSR by estimating the expression of tumour necrosis factor [TNF]-α and interleukin [IL]-1β levels in LPS-induced THP-1 human monocytes, and the antioxidant effects by its potential to inhibit the superoxide [SO] generation in PMA-induced HL-60 human monocytic cells. The in vivo study assessed the efficacy of AshwaSR on chronic unpredictable stress (CUS)-induced comorbid anxiety and depression in Sprague Dawley rats. Antidepressant and anxiolytic effects of AshwaSR were evaluated by open field test (OFT), elevated plus maze (EPM), forced swim test (FST), and Morris water maze (MWM) test.

Results

AshwaSR inhibited TNF-α, IL-1β and superoxide production in a dose-dependent manner in the in vitro study. The in vivo CUS model induced depression-like and anxiety-like behaviour. Treatments with AshwaSR and escitalopram showed improvement in the EPM and MWM models compared to the CUS-group.

Conclusion

In vitro study demonstrated that AshwaSR inhibits expressions of pro-inflammatory cytokines, IL-1β and TNF-α, and superoxide production. Further, the in vivo study confirmed its anxiolytic and stress-relieving effects in the CUS model that confirmed AshwaSR's potential in managing stress and stress-related symptoms.

Association of Drinking Herbal Tea with Activities of Daily Living among Elderly: A Latent Class Analysis

The aim of this study was to explore whether drinking herbal tea and tea would positively benefit activities of daily living (ADL) in the elderly. We used data from the Chinese longitudinal healthy longevity survey (CLHLS) to explore the association. Drinking herbal tea and drinking tea were divided into three groups using latent class analysis (LCA): frequently, occasionally, and rarely. ADL disability was measured by the ADL score. Multivariate COX proportional hazards models with competing risks were used to explore the impact of drinking herbal tea and tea on ADL disability, statistically adjusted for a range of potential confounders. A total of 7441 participants (mean age 81.8 years) were included in this study. The proportions of frequently and occasionally drinking herbal tea were 12.0% and 25.7%, respectively. Additionally, 29.6% and 28.2% of participants reported drinking tea, respectively. Multivariate COX regression showed that compared with rarely drinking, frequently drinking herbal tea could effectively reduce the incidence of ADL disability (HR = 0.85, 95% CI = 0.77-0.93, p = 0.005), whereas tea drinking had a relatively weaker effect (HR = 0.92, 95% CI = 0.83-0.99, p = 0.040). Subgroup analysis found that frequently drinking herbal tea was more protective for males under 80 years old (HR = 0.74 and 0.79, respectively), while frequently drinking tea was somewhat protective for women (HR = 0.92). The results indicate that drinking herbal tea and tea may be associated with a lower incidence of ADL disability. However, the risks associated with using Chinese herb plants still deserve attention.

Genus Equisetum L: Taxonomy, toxicology, phytochemistry and pharmacology

INTRODUCTION

The genus Equisetum (Equisetaceae) is cosmopolitan in distribution, with 41 recognized species. Several species of Equisetum are widely used in treating genitourinary and related diseases, inflammatory and rheumatic problems, hypertension, and wound healing in traditional medicine practices worldwide. This review intends to present information on the traditional uses, phytochemical components, pharmacological activities, and toxicity of Equisetum spp. and to analyze the new insights for further study.

METHODS

Relevant literature has been scanned and collected via various electronic repositories, including PubMed, Science Direct, Google Scholar, Springer Connect, and Science Online, from 1960 to 2022.

RESULTS

Sixteen Equisetum spp. were documented as widely used in traditional medicine practices by different ethnic groups throughout the world. A total of 229 chemical compounds were identified from Equisetum spp. with the major group of constituents being flavonol glycosides and flavonoids. The crude extracts and phytochemicals of Equisetum spp. exhibited significant antioxidant, antimicrobial, anti-inflammatory, antiulcerogenic, antidiabetic, hepatoprotective, and diuretic properties. A wide range of studies have also demonstrated the safety of Equisetum spp.

CONCLUSION

The reported pharmacological properties of Equisetum spp. support its use in traditional medicine, though there are gaps in understanding the traditional usage of these plants for clinical experiments. The documented information revealed that the genus is not only a great herbal remedy but also has several bioactives with the potential to be discovered as novel drugs. Detailed scientific investigation is still needed to fully understand the efficacy of this genus; hence, very few Equisetum spp. were studied in detail for phytochemical and pharmacological investigation. Moreover, its bioactives, structure-activity connection, in vivo activity, and associated mechanism of action ought to be explored further.

Research advances in probiotic fermentation of Chinese herbal medicines

Chinese herbal medicines (CHM) have been used to cure diseases for thousands of years. However, the bioactive ingredients of CHM are complex, and some CHM natural products cannot be directly absorbed by humans and animals. Moreover, the contents of most bioactive ingredients in CHM are low, and some natural products are toxic to humans and animals. Fermentation of CHM could enhance CHM bioactivities and decrease the potential toxicities. The compositions and functions of the microorganisms play essential roles in CHM fermentation, which can affect the fermentation metabolites and pharmaceutical activities of the final fermentation products. During CHM fermentation, probiotics not only increase the contents of bioactive natural products, but also are beneficial for the host gut microbiota and immune system. This review summarizes the advantages of fermentation of CHM using probiotics, fermentation techniques, probiotic strains, and future development for CHM fermentation. Cutting-edge microbiome and synthetic biology tools would harness microbial cell factories to produce large amounts of bioactive natural products derived from CHM with low-cost, which would help speed up modern CHM biomanufacturing.

Alleviating anxiety and taming trauma: Novel pharmacotherapeutics for anxiety disorders and posttraumatic stress disorder

Psychiatric disorders associated with psychological trauma, stress and anxiety are a highly prevalent and increasing cause of morbidity worldwide. Current therapeutic approaches, including medication, are effective in alleviating symptoms of anxiety disorders and posttraumatic stress disorder (PTSD), at least in some individuals, but have unwanted side-effects and do not resolve underlying pathophysiology. After a period of stagnation, there is renewed enthusiasm from public, academic and commercial parties in designing and developing drug treatments for these disorders. Here, we aim to provide a snapshot of the current state of this field that is written for neuropharmacologists, but also practicing clinicians and the interested lay-reader. After introducing currently available drug treatments, we summarize recent/ongoing clinical assessment of novel medicines for anxiety and PTSD, grouped according to primary neurochemical targets and their potential to produce acute and/or enduring therapeutic effects. The evaluation of putative treatments targeting monoamine (including psychedelics), GABA, glutamate, cannabinoid, cholinergic and neuropeptide systems, amongst others, are discussed. We emphasize the importance of designing and clinically assessing new medications based on a firm understanding of the underlying neurobiology stemming from the rapid advances being made in neuroscience. This includes harnessing neuroplasticity to bring about lasting beneficial changes in the brain rather than - as many current medications do - produce a transient attenuation of symptoms, as exemplified by combining psychotropic/cognitive enhancing drugs with psychotherapeutic approaches. We conclude by noting some of the other emerging trends in this promising new phase of drug development.

Interventions for generalized anxiety disorder

PURPOSE OF REVIEW

To provide an overview of recently published work on anxiety, focusing on generalized anxiety disorder (GAD) and its treatment.

RECENT FINDINGS

Self-reported anxiety symptoms were highly prevalent during the COVID-19 global pandemic in both the general population and in selected groups. There remains divided opinion about whether internet-based cognitive behavioural therapy (CBT) is noninferior to face-to-face CBT for GAD. A systematic review of drug treatment for GAD showed efficacy for selective serotonin reuptake inhibitors (SNRIs), agomelatine, and quetiapine. There may be a place for repetitive transcranial magnetic stimulation in the treatment of GAD. There was some evidence of efficacy for complementary therapies, including physical exercise, yoga, acupuncture, and Withania somnifera (ashwagandha). However, a systematic review of cannabidiol and tetrahydrocannabinol found insufficient evidence of efficacy in anxiety disorders.

SUMMARY

Antidepressants and quetiapine show efficacy in the treatment of GAD. Internet-based psychological interventions have a place in the treatment of GAD when face-to-face treatment is inaccessible. There is increasing evidence for the use of physical exercise in the management of GAD. Some other complementary therapies, including cannabinoids, require further, methodologically sound, research.

TiO2-Nanowired Delivery of Chinese Extract of Ginkgo biloba EGb-761 and Bilobalide BN-52021 Enhanced Neuroprotective Effects of Cerebrolysin Following Spinal Cord Injury at Cold Environment

Military personnel during combat or peacekeeping operations are exposed to extreme climates of hot or cold environments for longer durations. Spinal cord injury is quite common in military personnel following central nervous system (CNS) trauma indicating a possibility of altered pathophysiological responses at different ambient temperatures. Our previous studies show that the pathophysiology of brain injury is exacerbated in animals acclimated to cold (5 °C) or hot (30 °C) environments. In these diverse ambient temperature zones, trauma exacerbated oxidative stress generation inducing greater blood-brain barrier (BBB) permeability and cell damage. Extracts of Ginkgo biloba EGb-761 and BN-52021 treatment reduces brain pathology following heat stress. This effect is further improved following TiO₂ nanowired delivery in heat stress in animal models. Several studies indicate the role of EGb-761 in attenuating spinal cord induced neuronal damages and improved functional deficit. This is quite likely that these effects are further improved following nanowired delivery of EGb-761 and BN-52021 with cerebrolysin-a balanced composition of several neurotrophic factors and peptide fragments in spinal cord trauma. In this review, TiO₂ nanowired delivery of EGb-761 and BN-52021 with nanowired cerebrolysin is examined in a rat model of spinal cord injury at cold environment. Our results show that spinal cord injury aggravates cord pathology in cold-acclimated rats and nanowired delivery of EGb-761 and BN-52021 with cerebrolysin significantly induced superior neuroprotection, not reported earlier.

Complementary and alternative therapies for generalized anxiety disorder: A protocol for systematic review and network meta-analysis

BACKGROUND

Generalized anxiety disorder (GAD) is a prevalent and impairing psychiatric disorder, which is a great threat to people's mental health, and imposes a major burden on individuals, families and society. Complementary and alternative medicine (CAM) therapies is a potential treatment for GAD, however, the selection strategies of different CAM therapies in clinical practice is still unclear, and the purpose of this study is to evaluate the efficacy and acceptability of different CAM interventions using systematic review and network meta-analysis (NMA).

METHODS

Based on the strategy, the authors will retrieve a total of 9 electronic databases by January 2023. After a series of screening, the 2 researchers will use Aggregate Data Drug Information System (ADDIS) and Stata software to analyze the data extracted from randomized controlled trials (RCTs) of CAM therapies for the GAD. Finally, the evidence grade of the results will be evaluated.

RESULTS

This study will provide a reliable evidence for the selection of CAM therapies for GAD.

CONCLUSION

The results of this study will provide references for evaluating the influence of different CAM therapies for GAD, and provide a choice basis for clinical decision-making.

Clinical evidence construction of East Asian herbal medicine for inflammatory pain in rheumatoid arthritis based on integrative data mining approach

BACKGROUND

Rheumatoid arthritis (RA) is a chronic inflammatory disease that leads to a significant social burden. East Asian herbal medicine (EAHM) has long been used to treat RA. Therefore, a systematic study of how EAHM treatments can be developed into new drugs using specific materials is needed.

METHODS

Eleven databases containing literature in English, Korean, Chinese, and Japanese were searched for randomized controlled trials comparing EAHM with conventional medicine (CM). A meta-analysis was performed on the variable data to assess their effects on inflammatory pain. Subsequently, we searched for core materials and combinations of core material-based data mining methods.

RESULTS

A total of 186 trials involving 19,716 patients with RA met the inclusion criteria. According to the meta-analysis, EAHM had a significantly superior effect on continuous pain intensity, tender joint count, and response rate. Patients treated with EAHM had a significantly reduced incidence of adverse events compared with those treated with CM. Based on additional analysis of the EAHM formula data included in this meta-analysis, 21 core materials and five core herbal combinations were identified.

CONCLUSION

EAHM remedies for RA have the adequate potential for use as candidate materials for treating inflammatory pain in RA. The candidate core herbs evaluated in this study act on multiple pathways and are expected to provide pain relief, sustained inflammation suppression, immune regulation, and prevention of joint destruction. It seems worthwhile to conduct follow-up research on drug development using the core materials derived from this review.