Eliana Rodrigues - Etnofarmacologia Parte1

Ethnopharmacological
contributions to
psychiatry

Eliana Rodrigues
Centre for Ethnobotanical and Ethnopharmacological
Studies
Universidade Federal de So Paulo - Diadema
Xochipilli
ETHNOPHARMACOLOGY
RESCUES THE TRADITIONAL
MEDICINE OF SEVERAL
CULTURES

fieldwork!!!!

..utilyzing the following methods
ethnography, botany, zoology...

Interv|ews
(shamans, healer man,, prayer-maker, mldwlves,
babalorlx, medlum, pal-de-sanLo...)

Collecung planLs, anlmals, fungl, mlnerals....
Ethnopharmacological versus random plant selection methods for the evalua-
tion of the antimycobacterial activity
Danilo R. Oliveira et al.
Rev. Bras. Farmacogn. Braz. J. Pharmacogn. 21(5): Sep./Oct. 2011
801
ethanolic extract, this result becomes very promising for
the identication of bioactive substances. Aspidosperma
rigidum and Aspidosperma excelsum, known as
carapanaba, are rich in indole alkaloids (Vieira et al. 2010)
and antimycobacterial activity has already been recently
demonstrated for several substances of this class (Copp,
2003; Okunade et al., 2004), as well as for other species of
the Apocynaceae family (Case et al., 2006; Gautam et al.,
2007; Ramos et al., 2008; Mohamad et al., 2011).
Some species such as Allium cepa, Anacardium
occidentale, Cynnamomum zeylanicum, Jatropha
curcas, Psidium guajava and Zingiber ofcinale in
Malaysian (Mohamad et al., 2011), besides Chenopodium
ambrosioides, Ruta graveolens, Ocimum americanum,
Allium sativum and Mangifera indica in ndia (Gautam
et al., 2007) are also indicated as a possible source of
new antimycobacterial agents, and in South Africa, Ruta
graveolens has also highlighted its potential (McGaw et
al., 2008).
It is expected that the traditional knowledge
about medicinal plants indicates the presence of
biologically active substances. The collection of plants
for biological testing from its traditional use can be a
great advantage, or a shortcut, increasing the chances of
discovering new drugs (Elisabetsky & Shanley, 1994;
Soejarto, 1996). Table 3 shows the enormous potential
of the ethnopharmacological approach found in several
studies, compared with the randomized.
Table 3. Comparison between Ethnopharmacological and
Random approaches in the search for different biological
activities.
Biological Activities
RANDOM
(%)
ETHNO
(%)
References
Antineoplastic 6 25
Elisabetsky &
Shanley, 1994
Antihypertensive 31 44
Adsersen &
Adsersen, 1997
Antihelmintic 9.8 29.3 Bourdy et al., 2008
Icthyotoxicity 9.6 38.6 Bourdy et al., 2008
Toxic/venoms 10.5 52.2 Bourdy et al., 2008
Anti-HIV 8.5 71.4 Slish et al., 1999
Antimicrobial 22 37
Boily & van
Puyvelde, 1986
Antiplasmodial 0.7 18
Carvalho & Krettli,
1991
Acetylcholinesterase
inhibition
8 42.3
Oliveira et al.,
2011a

In this study, the best results for
antimycobacterial activity were also obtained with the
ethnopharmacological approach - 50% ETHNO x 16,7%
RANDOM (Table 2), however, because of the limited
number of the samples, it was not found signicant
difference (p>0,05) between these approaches by the
use of the Chi square and Fisher exact tests. Dipteryx
odorata is the species with the highest salience index
and showed a good antimycobaterial activity (MIC 12.5
!g/mL). This result points out a preference towards
the ethnopharmacological information. In recent work
published by our group (Oliveira et al., 2011a), the
ethnodirected approach using the salience index and
the major use agreement also improved the probability
of nding activity species for acetylcholinesterase
inhibition. In contrast, the study of Case et al. (2006)
that used the informant consensus model (informant
agreement ratio) to select plants used in traditional
medicine for persistent respiratory symptoms among the
Manus (Papua New Guinea), was inaccurate in predicting
antimycobacterial activity plants. However, these authors
related that Due to the complexity of the human body, it
cannot be assumed that in vitro bioassay results translate
to human systems, for either a positive or negative result.
Consequently, the species identied in the survey may
be benecial in the treatment of TB for many reasons
apart from direct antimycobacterial activity, e.g., they
may provide symptomatic relief from cough or have
immunostimulatory effects. It must also be noted that
the in vitro test may not be predictive of activity in vivo.
With innite resources, samples could be submitted to
other relevant assays such as immune-modulating assays
to better understand and assess the biological activity of
traditional medicine (Case et al., 2006). Oliveira et al.
(2011a,b) discuss that some plants could have an adaptogen
effect that contribute to quilombola health by an unspecic
way. Some plants have the role of panacea, being used to
cure all ills.
In the quilombola communities of Oriximin
TB is often called the weakening. So, the ETHNO's
good results can be even more signicant considering
that the therapeutic practices among the quilombolas
from Oriximin are complex. The use of fortifying agents,
depuratives, vomitory agents, purgatives, bitter remedies,
as well as curing infectious diseases, weakness, and
memory loss, play an important role in the processes of
curing diseases and/or health recovery, acting as order to
restore overall health (Oliveira et al., 2011a,b). Similar data
were surveyed by Rodrigues & Carlini (2004; 2006) in the
Sesmaria quilombola community in the State of Mato-
Grosso, in a transition area between Cerrado and Pantanal
biomes, where certain species are characteristic for their
versatility, or nonspecic therapy, is also employed for
rejuvenation, to energize, to muscle building and to fortify
the brain. Another study at the Par State also showed a
substantial number of general cure alls or panaceas,
fortiers, tonics, nerve tonics and aphrodisiacs, as a reex
of the caboclo culture (Branch & Silva, 1983; Berg, 1984;
Amoroso & Gly, 1988).
A broad literature review about the 43 cited
ethnospecies, used against TB and TB-related diseases and
Ethnopharmacological versus random plant selection methods for the evalua-
tion of the antimycobacterial activity
Danilo R. Oliveira et al.
Rev. Bras. Farmacogn. Braz. J. Pharmacogn. 21(5): Sep./Oct. 2011
801
ethanolic extract, this result becomes very promising for
the identication of bioactive substances. Aspidosperma
rigidum and Aspidosperma excelsum, known as
carapanaba, are rich in indole alkaloids (Vieira et al. 2010)
and antimycobacterial activity has already been recently
demonstrated for several substances of this class (Copp,
2003; Okunade et al., 2004), as well as for other species of
the Apocynaceae family (Case et al., 2006; Gautam et al.,
2007; Ramos et al., 2008; Mohamad et al., 2011).
Some species such as Allium cepa, Anacardium
occidentale, Cynnamomum zeylanicum, Jatropha
curcas, Psidium guajava and Zingiber ofcinale in
Malaysian (Mohamad et al., 2011), besides Chenopodium
ambrosioides, Ruta graveolens, Ocimum americanum,
Allium sativum and Mangifera indica in ndia (Gautam
et al., 2007) are also indicated as a possible source of
new antimycobacterial agents, and in South Africa, Ruta
graveolens has also highlighted its potential (McGaw et
al., 2008).
It is expected that the traditional knowledge
about medicinal plants indicates the presence of
biologically active substances. The collection of plants
for biological testing from its traditional use can be a
great advantage, or a shortcut, increasing the chances of
discovering new drugs (Elisabetsky & Shanley, 1994;
Soejarto, 1996). Table 3 shows the enormous potential
of the ethnopharmacological approach found in several
studies, compared with the randomized.
Table 3. Comparison between Ethnopharmacological and
Random approaches in the search for different biological
activities.
Biological Activities
RANDOM
(%)
ETHNO
(%)
References
Antineoplastic 6 25
Elisabetsky &
Shanley, 1994
Antihypertensive 31 44
Adsersen &
Adsersen, 1997
Antihelmintic 9.8 29.3 Bourdy et al., 2008
Icthyotoxicity 9.6 38.6 Bourdy et al., 2008
Toxic/venoms 10.5 52.2 Bourdy et al., 2008
Anti-HIV 8.5 71.4 Slish et al., 1999
Antimicrobial 22 37
Boily & van
Puyvelde, 1986
Antiplasmodial 0.7 18
Carvalho & Krettli,
1991
Acetylcholinesterase
inhibition
8 42.3
Oliveira et al.,
2011a

In this study, the best results for
antimycobacterial activity were also obtained with the
ethnopharmacological approach - 50% ETHNO x 16,7%
RANDOM (Table 2), however, because of the limited
number of the samples, it was not found signicant
difference (p>0,05) between these approaches by the
use of the Chi square and Fisher exact tests. Dipteryx
odorata is the species with the highest salience index
and showed a good antimycobaterial activity (MIC 12.5
!g/mL). This result points out a preference towards
the ethnopharmacological information. In recent work
published by our group (Oliveira et al., 2011a), the
ethnodirected approach using the salience index and
the major use agreement also improved the probability
of nding activity species for acetylcholinesterase
inhibition. In contrast, the study of Case et al. (2006)
that used the informant consensus model (informant
agreement ratio) to select plants used in traditional
medicine for persistent respiratory symptoms among the
Manus (Papua New Guinea), was inaccurate in predicting
antimycobacterial activity plants. However, these authors
related that Due to the complexity of the human body, it
cannot be assumed that in vitro bioassay results translate
to human systems, for either a positive or negative result.
Consequently, the species identied in the survey may
be benecial in the treatment of TB for many reasons
apart from direct antimycobacterial activity, e.g., they
may provide symptomatic relief from cough or have
immunostimulatory effects. It must also be noted that
the in vitro test may not be predictive of activity in vivo.
With innite resources, samples could be submitted to
other relevant assays such as immune-modulating assays
to better understand and assess the biological activity of
traditional medicine (Case et al., 2006). Oliveira et al.
(2011a,b) discuss that some plants could have an adaptogen
effect that contribute to quilombola health by an unspecic
way. Some plants have the role of panacea, being used to
cure all ills.
In the quilombola communities of Oriximin
TB is often called the weakening. So, the ETHNO's
good results can be even more signicant considering
that the therapeutic practices among the quilombolas
from Oriximin are complex. The use of fortifying agents,
depuratives, vomitory agents, purgatives, bitter remedies,
as well as curing infectious diseases, weakness, and
memory loss, play an important role in the processes of
curing diseases and/or health recovery, acting as order to
restore overall health (Oliveira et al., 2011a,b). Similar data
were surveyed by Rodrigues & Carlini (2004; 2006) in the
Sesmaria quilombola community in the State of Mato-
Grosso, in a transition area between Cerrado and Pantanal
biomes, where certain species are characteristic for their
versatility, or nonspecic therapy, is also employed for
rejuvenation, to energize, to muscle building and to fortify
the brain. Another study at the Par State also showed a
substantial number of general cure alls or panaceas,
fortiers, tonics, nerve tonics and aphrodisiacs, as a reex
of the caboclo culture (Branch & Silva, 1983; Berg, 1984;
Amoroso & Gly, 1988).
A broad literature review about the 43 cited
ethnospecies, used against TB and TB-related diseases and
Cllvelra eL al.,
Piper methysticum Forster f.
kava-kava
min 0 5 10 15 20 25 30 35 40 45
mAU
0
10
20
30
40
50
VWD1 A, Wavelength=270 nm (DIAGNOSE\CPO.D)
Ethnopharmacology applications
pharmacological and
phytochemical studies
Ethnopharmacological survey Drug development
Medicine -psychiatry

LLhnopharmacologlcal puzzle

!"#$%#& () *)+#,)-
!.(/0121 01 3451-
!67# 01 *1$41-
!"#(21 *)801-
!91#(,) 01 )$-
!#&4)(2#-
!:;#+$)(2#-
!%);<1=>)01-

!"#$%
"'() $*+,-. ',+()(.,
0#&%5(?0;$) spraln
#%4#?+1 leprosy
4)4#5$) mumps
$#(050;$) hernla
2;%1$ #@2#$(1 furuncle
Loca| term (em|c) un||zed by nanves as to refer to a certa|n d|sease
Translations in psychiatric disorders

Abaip (Krah Indians)

- individuals with high sensitivity to marijuana hospitalization (schizophrenia?)
- Whites diseases - although they have a repertoire of plants
Most of the psychoacnve p|ants wh|ch be|ong to trad|nona| med|c|ne resu|ted |n drugs un||zed to combat
anx|ety, depress|on, A|zhe|mer d|sease... (CNS d|sturbances)

Psycholeptic
decrease
activity of the mind
Psychoanaleptic
increase
Psycodysleptic
disturb the
"Normal" activity of the mind
| | | |
| | | | | | |
psychoactive substances
Delay et al., (1959), Chaloult (1971), apud Carlini, (1999)
hypnoucs
anupsychoucs
anxlolyucs
sumulanLs
AnudepressanLs
lncremenL memory
nooLroplc
anudependency
psychoLherapy
Several eLhnopharmacologycal surveys have been developed among SouLh and CenLral Amerlcan lndlgenous
culLures concernlng Lhe use of planLs ln rlLuals, malnly Lhe psychoacuve ones durlng shamanlsm

SchulLes, 1973, 1979, 1990, SchulLes and 8aauf, 1990, 8enneu, 1992, SchulLes and Pofmann, 1993,
Coelho, 1976,
ulaz, 1977,
MeLzner, 1998
uobklln, 1989, uobklln and Wlnkelman, 1989,
Shepard, 1998
Carcla-Campayo & Alda, 2003
ue SmeL, 1983, ue SmeL & 8lvler, 1983
Cur sLudles

8odrlgues & Carllnl, 2004, 2003, 2006a, 2006b,
8odrlgues eL al., 2006, 2008a, 2008b, 2013,
Clorgem eL al., 2007, 2011,
Carcla eL al., 2010
CLsuka eL al, 2010,
Soares eL al., 2010, 2013,
Scalco eL al., 2010, Scalco & 8odrlgues, 2012
AnLonlo eL al., 2010, 2013
SanLos eL al., 2012
A blbllographlcal search carrled ouL on
Lhe Medllne and LlLACS daLabases ln
2004 revealed LhaL none of Lhese 23
specles had been sLudled from Lhe
pharmacologlcal or phyLochemlcal polnL
of vlew, desplLe Lhelr undenlable
Lherapeuuc poLenual.

nanve c|ass|hcanons - Ch|na
1radluonal Chlnese Medlclne dlsungulshes 4 caLegorles of herb LhaL work
prlmarlly on Lhe mlnd:

'subsLances LhaL seule and calm Lhe splrlL',
'subsLances LhaL nourlsh Lhe hearL and calm Lhe splrlL',
'subsLances LhaL exungulsh wlnd and sLop Lremors' and
'subsLances LhaL open Lhe orlces'
WalLer, C. & 8ey, !.M. AusLrallan and new Zealand !ournal of sychlaLry 1999, 33:482-489

1he key Lo menLal healLh - balance of A$)()B C#D)& and ED)&

6 LasLes found ln herbs LhaL may aecL Lhls balance:
sweeL, sour, salLy, pungenL, bluer and asLrlngenL

bluer herbs lncrease A$)()B
pungenL herbs lncrease C#D)& and
sweeL herbs lncrease ED)&F
nanve c|ass|hcanons - Ayurveda
1here are 3 blologlcal humors, each of
whlch has a counLerparL ln Lhe mlnd.
")2)
A5G)
H)4>)
A$)()
C#D)&
ED)&

Psycholeptic Psychoanaleptic
Psycodysleptic
| | |
| | | |
past
Poppy
pagal-ka-dawa

Present
Kava kava
Passion flower
Valerian
Lemon Balm
Lemongrass

Future (our studies)
Caprankohir-h
Pjejapac
Canuaru resin
Erva-molar-macho
past
et eser
Coca

present
Ginkgo
Brahmi
Guarana
St Johns wort

N-de-cachorro
Pr-j
Raiz-de-bugre
past
Peyote
San Pedro
Iboga

Present
Ayahuasca

Removing the devil
Antidote to opium
HERBAL MEDICINES FOR PSYCHIATRIC DISORDERS 703
Copyright 2007 John Wiley & Sons, Ltd. Phytother. Res. 21, 703716 (2007)
DOI: 10.1002/ptr
Copyright 2007 John Wiley & Sons, Ltd.
PHYTOTHERAPY RESEARCH
Phytother. Res. 21, 703716 (2007)
Published online 11 June 2007 in Wiley InterScience
(www.interscience.wiley.com) DOI: 10.1002/ptr.2187
REVIEW ARTICLE
Herbal Medicines in the Treatment of
Psychiatric Disorders: A Systematic Review
Jerome Sarris
School of Medicine, Department of Psychiatry, University of Queensland, Brisbane, Australia
This paper reports a critical review of 27 herbal medicines and formulas in treating a broad range of psychiatric
disorders (in addition to anxiety and depression), including obsessive-compulsive, seasonal affective, bipolar
depressive, psychotic, phobic and somatoform disorders. Ovid Medline, Pubmed and the Cochrane Library
were searched for pharmacological and clinical evidence of herbal medicines with psychotropic activity. A
forward search of later citations was also conducted. Whilst substantial high-quality evidence exists for the use
of kava and St Johns wort in the treatment of anxiety and depression respectively, currently there is insufcient
robust clinical evidence for the use of many other herbal medicines in psychiatric disorders. Phytotherapies
which potentially have signicant use in psychiatry, and urgently require more research are Rhodiola rosea
(roseroot) and Crocus sativus (saffron) for depression; Passiora incarnata (passionower), Scutellaria
lateriora (scullcap) and Zizyphus jujuba (sour date) for anxiety disorders; and Piper methysticum (kava) for
phobic, panic and obsessive-compulsive disorders. While depression and anxiety are commonly researched,
the efcacy of herbal medicines in other mental disorders requires attention. The review addresses current
issues in herbal psychotherapy: herbal safety, future areas of application, the relationship of herbal medicine
with pharmaceuticals and the potential prescriptive integration of phytomedicines with synthetic psycho-
tropic medicines. Particular attention is given to clinical and safety issues with St Johns wort and kava.
Copyright 2007 John Wiley & Sons, Ltd.
Keywords: herbal medicine; psychiatry; complementary medicine; medicinal plants; mood disorders; psychiatric disorders.
Received 11 March 2007
Revised 23 March 2007
Accepted 28 March 2007
* Correspondence to: Jerome Sarris, School of Medicine, Department of
Psychiatry, University of Queensland, Brisbane, Australia.
E-mail: Jerome.S@student.uq.edu.au
INTRODUCTION
The role of herbal medicine (HM) in the treatment
of various psychological disorders has become well
established over the past decade, with phytotherapeutic
preparations such as St Johns wort (SJW) and kava
possessing respectable clinical evidence. Whilst there
have been several recent literature reviews on HM and
psychiatric disorders (primarily depression or anxiety;
Beaubrun and Gray, 2000; Ernst, 2006; Larzelere and
Wiseman, 2002; Wong et al., 1998), to date no com-
prehensive review of clinically trialled psychoactive HMs
across a broad range of psychiatric conditions has been
reported. A systematic literature search was conducted
to identify relevant trials of HM in the treatment of
major psychiatric disorders (see Table 1 below for the
list of conditions reviewed). Developmental, cognitive/
neurological, sleep, eating and substance-abuse dis-
orders and menstrual dysphoria were excluded from
the review.
METHODS
The electronic databases Ovid Medline, Pubmed and
The Cochrane Library were accessed late 2006early
2007. Ovid Medline was searched using the search term
Herb$ and the subheadings Plants, Medicinal, Drugs,
Chinese Herbal, Plant Extracts, Phytotherapy, Plant
Preparations in combination with the search terms
Depress$, Major Depressive Disorder, Anxiety,
Generalized Anxiety Disorder, Dysthym$, Seasonal
Table 1. Psychiatric conditions reviewed
Disorder
Mood disorders
Major depressive disorder
Dysthymic disorder
Anxious depression
Seasonal affective disorder
Bipolar disorder
Anxiety disorders
Generalized anxiety disorder
Panic disorder
Social phobia
Obsessive-compulsive disorder
Somatoform disorder
Schizophrenic and psychotic disorders
Review article
Plants and the central nervous system
E.A. Carlini
*
Department of Psychobiology, Paulista School of Medicine, Federal University of Sao Paulo, Rua: Botucatu, 862 Ed. Ciencias Biomedicas,
1o andar, CEP 04023-062, Sao Paulo, SP, Brazil
Received 2 November 2002; received in revised form 20 March 2003; accepted 31 March 2003
Abstract
This review article draws the attention to the many species of plants possessing activity on the central nervous system (CNS) In fact, they
cover the whole spectrum of central activity such as psychoanaleptic, psycholeptic and psychodysleptic effects, and several of these plants are
currently used in therapeutics to treat human ailments.
Among the psychoanaleptic (stimulant) plants, those utilized by human beings to reduce body weight [Ephedra spp (Ma Huang),
Paullinia spp (guarana), Catha edulis Forssk (khat)] and plants used to improve general health conditions (plant adaptogens) were
scrutinized.
Many species of hallucinogenic (psychodysleptic) plants are used by humans throughout the world to achieve states of mind distortions;
among those, a few have been used for therapeutic purposes, such as Cannabis sativa L., Tabernanthe iboga Baill and the mixture of
Psychotria viridis Ruiz and Pav and Banisteriopsis caapi (Spruce ex Griseb.) C.V Morton Plants showing central psycholeptic activities,
such as analgesic or anxiolytic actions (Passiflora incarnata L., Valeriana spp and Piper methysticum G Forst.), were also analysed.
Finally, the use of crude or semipurified extracts of such plants instead of the active substances seemingly responsible for their therapeutic
effect is discussed.
D 2003 Published by Elsevier Science Inc.
Keywords: Medicinal plants; Plant adaptogens; Khat; Ephedra spp.; CNS plants; Guarana; Ayahuasca; Iboga; Passiflora; Valeriana; Kava-kava
1. Introduction
Mind-altering drugs, especially plants, have always fas-
cinated human beings Surrounded by mystic superstitions,
magic thoughts and religious rituals, they have always
occupied mans attention Among the plants used by humans,
those able to alter the conscience and the sensorium have
drawn special consideration In fact, due to their astonishing
effects, the psychodysleptic drugs (according to the Delay
and Deniker, 1961, nomenclature), also called hallucin-
ogenic drugs, have occupied much of the researchers time,
directed most of their thoughts and efforts towards attempts
to understand their mechanism of action, and, hence, to un-
derstand human behavior, thoughts, humor, sensations, etc.
However, the challenge of trying to unravel the mecha-
nisms of action on mood, humor, cognition, sensorium, etc.,
led to an inconvenience: to ignore, or to face as low priority,
the fact that plants could also have beneficial properties to
treat mental disease and some psychic ailments Further-
more, as most of the plants were first used by the so-called
primitive cultures, their occasional use by the White occi-
dental culture was relegated to a second plan, being con-
sidered as sorcerers therapeutics In this respect, it is
pertinent to quote a sentence from the first description in
1651 of a Mexican hallucinogenic plant (ololiuqui): A
thousand visions and satanic hallucinations appeared to
them (Hofmann, 1982).
A perverse result of such posture was a neglect of and
probably more, a disdain, for all kinds of therapeutics based
on plants.
Thus, until recently, very little attention was given by the
scientific community to the benefits, as accepted by folk
medicine, of the therapeutic usefulness of plants endowed
with psycholeptic and psychoanaleptic (Delay and Deniker,
1961) properties.
Fortunately, this bad tide has recently turned due to
several reasons, among them the wrong belief that plants,
by originating directly from nature, must be less toxic than
synthetic drugs Another important aspect for this turning
point was the realization by the pharmaceutical industry that
plants, after all, could be a good business as more and more
0091-3057/03/$ see front matter D 2003 Published by Elsevier Science Inc.
doi:10.1016/S0091-3057(03)00112-6
* Tel.: +55-11-5539-0155; fax: +55-11-5084-2793.
E-mail address: carlini@psicobio.epm.br (E.A. Carlini).
www.elsevier.com/locate/pharmbiochembeh
Pharmacology, Biochemistry and Behavior 75 (2003) 501512
1here are 4,000 8C, Lhe Sumerlans menuoned lLs use for
sleep and decrease paln, called her [oy planL

2700 8C and 1430 8C - Mlnoan clvlllzauon (CreLe) -
AnclenL Creece - used ln rellglous ceremonles Lo lnduce
alLered sLaLes of consclousness and as oracles Lo predlcL
Lhe fuLure.

Analgeslc and hypnouc
Goddess Demeter, venerated by the M|noan c|v|||zanon
oppy (A)4)I#$ &1%(5J#$;% L.)
Cplum - laLex exuded from Lhe lmmaLure frulL
nypoana|ges|c - past
/01023403+050 (herb-of-lnsanlLy)
K);I1=L) &#$4#(?() (L.) 8enLham ex. kurz

rooL
lL was used ln lndla for cenLurles for a varleLy of condluons.
1he acuve prlnclple, reserplne, was lnLroduced lnLo
WesLern psychlaLry as an anupsychouc ln Lhe 1930s, very
soon aer chlorpromazlne was synLheslsed. AlLhough
eecuve as an anupsychouc, reporLs of secondary
depresslon lessened lLs popularlLy.
1oday - PyperLenslve !
annpsychonc - past
kava-kava (A54#$ %#2>M&?*;% C. lorsL.)
SouLh aclc
8ooLs

LnLacLogenlc beverage
1akl Mal, 2013
Cokava, 2013
1asLe of kava, 2013
Carllnl, L.A. harmacology, 8lochemlsLry and 8ehavlour, 73:301-312, 2003
Anx|o|ync]hypnoncs - present
ass|on ower (A)&&5N1$) 5(*)$()2) L.)
Amerlcas
leaves
Copyright 2007 John Wiley & Sons, Ltd. Phytother. Res. 21, 703716 (2007)
DOI: 10.1002/ptr
708 J. SARRIS
The exact pharmacodynamic mechanism responsible
for kavas action is still undened, with conicting evi-
dence regarding the modulation of various GABA
receptors (Davies et al., 1992; Jussoe et al., 1994; Yuan
et al., 2002). Other purported pharmacodynamics in-
volve a down-regulation of -adrenergic activity (Singh
and Singh, 2002). Further research is needed to clarify
the exact mechanism of kavas anxiolytic and hypnotic
activity.
Concerns of hepatotoxicity have emerged in recent
years prompting post-marketing, clinical and toxico-
logy studies to be performed to assess the safety of kava.
A 2002 review of kava was conducted to assess kavas
safety prole via literature searches of four electronic
databases, papers reference lists, spontaneous report-
ing schemes of the WHO and national drug safety
bodies and ten manufacturers of kava preparations
(Stevinson et al., 2002). The data from short-term post-
marketing surveillance studies and clinical trials sug-
gest that adverse events are, in general, rare, mild and
reversible. The review stated that although idiosyncratic
health events have occurred, no serious adverse events
were noted except for case reports (not found in the
trials) of hepatotoxicity and theoretical potentiation
of alcohol and benzodiazepines. Seventy-eight cases
of hepatotoxicity have been documented to 2003,
including 11 cases of hepatic failure leading to liver
transplants and four deaths occurring. Many cases
involved the concomitant ingestion of other compounds
with potential hepatotoxicity (e.g. medications and/or
alcohol). There are several possible mechanisms for
kavalactone hepatotoxicity: inhibition of cytochrome
(CYP) P450, reduction in liver glutathione content or
other enzymes needed to metabolize kavalactones
or inhibition of cyclooxygenase enzyme activity (all of
which may be caused by the kavalactones), concomi-
tant drug or alcohol use, or a genetic CYP P450 insuf-
ciency (Anke and Ramzan, 2004; Clouatre, 2004;
Stevinson et al., 2002).
A recent in vivo trial sought to evaluate the potential
heptotoxicity of kava (Sorrentino et al., 2006). Wistar
rats were fed 7.3 or 73 mg/kg body weight of ethanol
kava extract for 3 and 6 months with no change in body
weight, haematological and liver parameters, and macro-
scopic and microscopic histological changes in the
major organs noted. A study of kava use (Av. 118 g/
week, median duration of use = 12 years) in an Arnhem
Land community in the Northern Territory of Australia
(n = 340) was conducted in 2003 to assess any
hepatotoxicity (Clough et al., 2003). In kava users who
were not heavy alcohol users, only those who used kava
within the previous 24 h displayed GGT levels higher
than nonusers, whereas higher ALP levels occurred only
in those who last used kava 12 weeks and 24 h previ-
ously. Liver function changes in users of aqueous kava
extracts at these moderate levels of consumption ap-
pear to be reversible and began to return to baseline
after 12 weeks abstinence from kava. No evidence of
irreversible liver damage has been found, although the
study indicated that liver function parameters can be
altered in humans with moderate kava use.
Unlike SJW, few human studies and case evaluations
of CYP 450 enzyme interaction have been conducted
and hence potential kavadrug interactions need to be
studied further in-depth (Singh, 2005). One human
pharmacokinetic trial (n = 12) using probe drug cock-
tails of midazolam and caffeine, followed 24 h later
by chlorzoxazone and debrisoquin, determined that
kava caused CYP2E1 inhibition (approximately 40%)
(Gurley et al., 2005). Kavapyrones from kava were found
in an in vitro assay to inhibit CYP3A4 (Unger et al.,
2002). Whole kava extract (normalized to 100 M
total kavalactones) caused concentration-dependent de-
creases in P450 activities, with signicant inhibition of
the activities of CYP1A2 (56% inhibition), 2C9 (92%),
2C19 (86%), 2D6 (73%), 3A4 (78%) and 4A9/11 (65%)
following pre-incubation (Mathews et al., 2002). An
in vitro study evaluating CYP and pregnane X receptor
modulation in rat hepatocytes treated with puried
kavalactones discovered that dihydromethysticin and
desmethoxyyangonin induced CYP3A23 via pregane X
transcription activation (Ma et al., 2004). Regardless
of in vivo animal and in vitro trials assessing CYP
450 and pregnane X modulation, to date no adverse
events have been documented in humans occurring
from kavas potential pharmacokinetic interaction
with pharmaceutical medicines. Potential interaction of
kava with benzodiazepines causing increased sedation
has been posited (Singh, 2005; Stevinson et al., 2002),
however, no clinical evidence currently supports this
hypothesis.
The future of the therapeutic use of kava remains
uncertain, with safety concerns still restricting prescrip-
tion in many countries. The risk-benet ratio is highly
favourable towards kava due to respectable clinical
efcacy and relative low risk of potential liver toxicity
(1 case/1 million monthly doses (Bauer, 2003). As
current synthetic pharmacological treatment involving
benzodiazepines possesses far greater adverse effects
(Rickels and Rynn 2002; Stevinson et al., 2002), kava
still has an important place in the therapeutic pantheon.
The solution appears to involve kava being removed
from OTC use (to be available only via professional
prescription), the use of aqueous root preparations
standardized for kavalactones (at daily doses of <280 mg
kavalactones) and the avoidance of concomitant use
with alcohol or in cases of known hepatic insufciency
or disease.
Passiora incarnata (Passion ower). Passion ower
has been used in traditional medicine in the Americas
to allay restlessness and overcome wakefulness, when
these are the result of exhaustion or the nervous
excitement of debility (Felter and Lloyd, 2006 (1898)).
An in vivo study employing a methanol extract of
passion ower (125 mg/kg, orally) measured anxiolytic
activity on mice, using the elevated plus-maze model.
The results demonstrated an increased number of
entries in open arms (Dhawan et al., 2002). A pilot
RCT using passion ower extract on patients with GAD
(n = 36) showed that the HM was as effective (with
less side effects) as oxazepam (30 mg/day) in reducing
anxiety (Akhondzadeh et al., 2001).
Valeriana spp. (Valerian). The species Valeriana
ofcinalis and edulis have been used in traditional
American and European medicine as a soporic and
to treat various nervous system disorders (Felter and
Lloyd, 2006 (1898)). Although respectable evidence
exists in the area of insomnia, an insufciency of
clinical trials demonstrating benets in treating anxiety
have been conducted, and this is an area of promising
Va|er|an (")=#$5)() spp.)
Amerlcan and Luropean medlclne
rooLs
Iard|m Lntegeno, 2013
nomeopnca e C|a, 2013
Soporlc, and LreaL varlous nervous sysLem
dlsorders.
Lemon 8a|m (6#=5&&) 1O*5()=5& LF)
Amerlcan medlclne - Mlld sedauve and spasmolyuc agenL

leaves
Pomeopuca e Cla, 2013
Sarrls, !. hyLoLherapy 8esearch 21: 703-716, 2007
Wlklmedla Commons, 2013
Lemongrass (PM%+141Q1( *52$)2;& (uC.) SLapf )
8razlllan herbal medlclne - anxlolyuc and hypnoucs
leaves
Pomeopuca e Cla, 2013
Wlklmedla Commons, 2013

60/-0.4*7(-8379 (splne LurLle)
8odrlgues, L and Carllnl, L.A., hyLoLherapy 8esearch: 19, 129-133 (2003)

Anx|o|ync - future

degreeof
reference
degreesof
sensation
hallucinogenic
plants
++++ pjejapac I
+++ pjejapac II
++ cumx
++ iamh
(marijuana)
++ ahkrr III
++ caprnkohirh kohihti
+ caprnkohirh I
+ caprnkohirh II
+ mputrh I
+ mputrh II
+ ahkror I
+ ahkror II
+ tingui
+ ahkr I
+ ahkr II
+ ahkr III
+ carjatxy


Anx|o|ync - future
Fungi Pjejapac - oneirogenic
Anx|o|ync]hypnoncs - future

Canuaru resln

lumlgauon
Resina de diversas espcies de
Protium (Burseraceae)
Frogs secretion
Trachycephalus resinifictrix Goeldi, 1907
8odrlgues eL al., !ournal of LLhnopharmacology 144, . 806-808, 2012.
esLabllsh a correlauon beLween Lhese
syndromes and anxleLy
8ourbonnals-Spear eL al. !L 109: 380-387 (2007)

Anx|o|ync - future
culLural syndromes
!"#$%&'($"%&$)*'
!"#$%& ()*"+,-)#%. "#$%&'( )*+,$'
"-./0%1*%*(
/%&(%. &+% ),$%.0%# &. 0%&
1-+ ./%%2 #).-+#%+.3 ),.-4,)&
5&/06-"$6 %+(&74-/&+74&86- /%0 9-"
./%%2 %&.)%+3 )0 #)4),).6 */--# 2+%.."+%
&,# &/.- 2+-(-:% /-.. -1 .%;"&/ #%.)+%<=
hypnoncs - future
A>M&1&?Q%) I#(#(1&;% 8alf. l.
et eser
Ca|abar bean

hysosugmlne "aceLylchollnesLerase lnhlblLor
Lo lncrease memory ln Alzhelmer's

Increment memory - past
coca (R$M2>$1@M=;% *1*) Lam.)
Leaves
SouLh Amerlcan

Lncyclopedla 8rluanlca klds, 2013
Snmu|ant] anaestes|c]annpsychonc-past
Clnkgo (S5(TQ1 +5=1+) L.)
leaves
Aslan Lradluonal medlclne
Local LcologlsL, 2013
Increment memory - present
8rahm| - U)*14) %1((5#$5 (L.) ennell

Ayurveda - slnce cenLurles as ln Lreaung anxleLy, lnsomnla, and lnsanlLy".

lnlblLory eecL on Lhe enzyme chollnesLerase and anxlolyuc

Coswaml eL al., lnLernauonal !ournal of Collaborauve 8esearch on lnLernal Medlclne & ubllc PealLh 3: 283-293, 2011.
Wlklpedla, 2013
Increment memory ] nootrop|c ] anx|o|ync - present
Guarana
Indians of the Amazon rainforest (Brazil) stimulant

seeds rich in caffeine
Increment memory ] snmu|ant-present
Paullinia cupana Sapindaceae
St Iohn's wort (VM4#$5*;% 4#$J1$)2;% L.)
Whole planL
Lranqulllzer

Luropean- Consldered able Lo drlve away evll splrlLs, was used ln Lhe LreaLmenL of many
menLal lllnesses.

Anndepress|ve-present
V#2#$142#$M& )4>$105&5)*) C. Mach.
(Malplgulaceae) n-de-cachorro

8Cu8lCuLS, L, CA8Llnl, L.A :;<!=!;"#>:< #"%">#6; 18: 748-733, 2004.
"$+,%-!%./0"!
>9%,)& 23'
"4,*51.60%1*%*(
1"$%23
?"+&0%& 23'
"71$+%1*%*(
5 @=06%9 &80 &. &26+-#).)&83
#%2"+&0)(% &,# 0- ),8+%&.%
4%4-+9 &0 06% .&4% 0)4%<

"5*2*&/60+8 %+ %9%3,:8*+
*;;*1,(
5@*"0 )0 .6-"/# *% &(-)#%# *9
.-4%-,% A6- 6&. :)#,%9
2+-*/%4.@<
Increment memory ] nootrop|c - future

Eliana Rodrigues - Etnofarmacologia Parte1

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Eliana Rodrigues - Etnofarmacologia Parte1

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Ethnopharmacological

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