Research - Valerian
Valerian Reduces Cognitive Dysfunction after Coronary Bypass Surgery
by Heather S. Oliff, PhD
Reviewed: Hassani S, Alipour A, Darvishi Khezri H, et al. Can Valeriana officinalis root extract prevent early postoperative cognitive dysfunction after CABG surgery? A randomized, double-blind, placebo-controlled trial. Psychopharmacology (Berl). March 2015;232(5):843-850.
One of the most commonly performed surgeries in the world is coronary artery bypass graft (CABG). A prevalent complication of the surgery is cognitive dysfunction, which occurs in 20-80% of patients. The authors of this article propose that such cognitive dysfunction is the result of brain damage caused by inflammation and other processes such as embolism (i.e., artery obstruction) and cellular debris picked up and reinfused by the cell salvage processing system. Sleep disruption is another risk factor for post-CABG cognitive dysfunction. Traditionally used as a sedative and anxiolytic, valerian (Valeriana officinalis, Caprifoliaceae) root has been shown to inhibit the inflammatory nuclear factor-kappa B (NF-κB) protein complex, stimulate serotonergic and cholinergic receptors, and improve sleep quality. Therefore, the authors hypothesized that valerian may prevent postoperative cognitive dysfunction in patients undergoing CABG surgery. This randomized, double-blind, placebo-controlled study evaluated the prophylactic effect of valerian root on the occurrence of cognitive dysfunction after CABG surgery.
Men and women aged 30-70 years who were undergoing elective CABG with cardiopulmonary bypass surgery participated in this study conducted at the Mazandaran University of Medical Sciences Mazandaran Heart Center in Sari, Iran. Patients were excluded if they required additional concurrent cardiac surgeries such as valve replacement; were undergoing reoperation; had a history of cerebrovascular disease, alcoholism, or known mental illness; used psychotherapeutic drugs in the previous three months, had hepatic failure, severe pulmonary insufficiency, acute renal failure, previous heart surgeries, or heart failure; were deaf, blind, or unable to speak; had sensitivity to valerian; or had a pH < 7.25 or serum base excess of < −6 mmol/L and coagulopathy (i.e., bleeding disorders).
Patients took capsules containing either placebo or 530 mg dried valerian root extract (Goldaru Company; Isfahan, Iran) every 12 hours, starting one day before surgery and continuing for 60 days post-surgery. The concentration and chemical characteristics of the valerian extract were not reported. The placebo capsules were prepared by emptying valerian capsules and refilling them with wheat (Triticum spp., Poaceae) flour to create a placebo with the same color, texture, taste, and odor as the valerian capsules. All patients had routine anesthesia and CABG with cardiopulmonary bypass surgery. The Mini-Mental State Examination (MMSE) was used to assess cognitive function before surgery, 10 days post-surgery, and two months post-surgery. Scores ≥ 25 were classified as normal, while scores of 21-24 were categorized as mild cognitive dysfunction. Of the 76 patients randomly assigned to receive valerian or placebo, seven in the valerian group and eight in the placebo group were lost to follow-up. No other measures (e.g., degree of inflammation) were obtained that could have provided evidence for alternate mechanisms of cognitive dysfunction.
Mean preoperative MMSE scores were within the normal range (~27) for both groups. In the valerian group (n=31), the mean MMSE score decreased slightly when assessed 10 days post-surgery (26.52) but remained within the normal range and returned to normal (27.45) after two months. In comparison, the mean MMSE score in the placebo group (n=30) decreased significantly when evaluated 10 days after surgery (24.0) and increased slightly to 24.83 after two months, indicating continuing mild cognitive dysfunction. There was a significant downward trend (P<0.05) in all MMSE scores in the placebo group, except for the attention and calculation domains. After adjusting for other variables, analysis using the generalized estimating equation indicated that valerian prophylaxis reduced the odds of cognitive dysfunction compared to the placebo group (odds ratio=0.108; 95% confidence interval [CI], 0.022-0.545). It should be noted that the MMSE is greatly affected by education level and is not very sensitive to mild cognitive impairment.
In summary, the valerian group had a significantly lower incidence of cognitive dysfunction and a greater improvement in cognitive function during the eight weeks after CABG surgery compared to the placebo group (as measured by the MMSE). The authors suggest that patients undergoing CABG surgery may also benefit from the reported anticoronaryspastic, antihypertensive, and antibronchospastic properties of valerian.
Acknowledged limitations of the study were the use of a single subjective instrument to assess cognitive function (completed only once per day), and the relatively small sample size. The authors conclude that “the use of V. officinalis root extract may prevent early postoperative cognitive dysfunction after on-pump CABG surgery.… However, further robust randomized, blinded studies with large sample sizes are required.…” More specific cognitive tests and additional measures (e.g., of inflammation) should have been used as well.
—Heather S. Oliff, PhD
Source : HerbalGram - American Botanical Council
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Clinical applications of herbal medicines for anxiety and insomnia; targeting patients with bipolar disorder
Objectives: Patients with bipolar disorder frequently continue to experience residual anxiety and insomnia between mood episodes. In real-world practice, patients increasingly self-prescribe alternative medicines.
Methods: We reviewed case reports, open-label, and placebo-controlled trials investigating the use of herbal medicines to treat anxiety and insomnia, and discussed their potential applications for bipolar disorder.
Results: Eleven herbal medicines that have been studied in human subjects are included in this review. Mechanisms of action, efficacy, side effects, and drug-drug interactions are discussed. Based on currently available evidence, valerian seems to be the most promising candidate for insomnia and anxiety in bipolar disorder.
Conclusions: Adjunctive herbal medicines may have the potential to alleviate these symptoms and improve the outcomes of standard treatment, despite limited evidence. Physicians need to have a more in-depth understanding of the evidence of benefits, risks, and drug interactions of alternative treatments.
Source : Australian & New Zealand Journal of Psychiatry
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Herbal triplet in treatment of nervous agitation in children
Inga Trompetter, Bianka Krick, and Gabriele Weiss
Emotional and behavioral problems in children and adolescents are no exception. To what extent a fixed plant extract combination is able to support children suffering from nervous agitation due to agitated depression among others for approximately 2 years has been investigated in a multicenter, prospective observational study (2008) with 115 children between 6 and 12 years. Assessments of the parents showed a distinct improvement in children who had attention problems, showed social withdrawal, and/or were anxious/depressive. Based on the physicians’ assessment, 81.6–93.9 % of the affected children had no or just mild symptoms at the end of observation concerning nine of thirteen evaluated symptoms such as depression, school/examination anxieties, further anxieties, sleeping problems, and different physical problems. Therapeutic success was not influenced by additional medication or therapies. The treatment was well tolerated. The used plant extracts have been gained from St. John’s Wort herb, valerian root, and passionflower herb.
Source : Wien Med Wochenschr.
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Hyperactivity, concentration difficulties and impulsiveness improve during seven weeks’ treatment with valerian root and lemon balm extracts in primary school children
Jürgen Gromballa,Frank Beschornerb, Christian Wantzenc, Ute Paulsend, Martin Burkartd
- a Dombühler Strasse 8, D-90449 Nürnberg, Germany
- b Spenglersruh 1b, D-36381 Schlüchtern, Germany
- c Gartenstraße 10, D-54470 Bernkastel-Kues, Germany
- d Dr. Willmar Schwabe GmbH & Co. KG, Willmar-Schwabe-Str. 4, D-76227 Karlsruhe, Germany
Valerian root and lemon balm extracts have previously shown efficacy and excellent tolerability in children < 12 years suffering from restlessness and insomnia. We now examined whether treatment with a fixed combination of both may also improve concentration, hyperactivity and impulsiveness.
169 primary school children suffering from hyperactivity and concentration difficulties but not meeting ADHS criteria were treated in an observational study by 27 office based pediatricians with a recommended daily dose of 640 mg valerian root extract WS® 1014 and 320 mg lemon balm extract WS® 1303 (Sandrin®), and evaluated by pediatricians and parents using standardized questionnaires at baseline, weeks 2 and 7.
The fraction of children having strong/very strong symptoms of poor ability to focus decreased from 75% to 14%, hyperactivity from 61% to 13%, and impulsiveness from 59% to 22%. Parent rated social behavior, sleep and symptom burden showed highly significant improvements. Only in two children mild transient adverse drug reactions were observed.
In primary school children with restlessness, concentration difficulties and impulsiveness treatment with WS® 1014 and WS® 1303 (Sandrin®) provides a viable option in addition to counseling and education.
Source : Journal Phytomedicine
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