Bitkisel Tedavilerin Psikofarmakolojide Kullanımı
Özet
Bu metin, bitkisel tedavilerin psikofarmakolojideki tarihsel kökenlerini, modern tıp ve alternatif tıp içerisindeki konumlandırmalarını ve psikiyatrik rahatsızlıklarda kullanım alanlarını kanıta dayalı tıp temelinde ele almaktadır. İlgili çalışmada Hypericum Perforatum (Sarı Kantaron), Ginkgo Biloba, Kava Kava, Valeriana Officinalis (Kediotu), Passiflora Incarnata (Çarkıfelek Otu), Melissa Officinalis (Melisa), Curcuma Longa (Zerdeçal), Humulus Lupulus (Şerbetçi Otu), Matricaria Recutita (Mayıs Papatyası), Panax Ginseng, Skullcap ve Gotu Kola gibi bitkilerin aktif bileşenleri, etki mekanizmaları, anksiyete, depresyon ve uyku bozuklukları üzerindeki klinik etkinlikleri ile yan etki profilleri detaylandırılmaktadır. Yapılan araştırmalar, bazı bitkilerin hafif-orta düzey depresyon ve anksiyete belirtilerini azaltmada sentetik ilaçlara benzer etkinlik gösterdiğini ortaya koyarken, bazılarında ise standardizasyon eksikliği nedeniyle çelişkili sonuçlar elde edildiğini göstermektedir. Bitkisel ürünlerin eczane dışı kanallardan kolayca temin edilebilmesi, taşıdıkları ciddi toksisite riskleri, hepatotoksik etkiler ve özellikle Sitokrom P-450 enzim sistemi üzerindeki inhibisyon/indüksiyon süreçlerine bağlı gelişen tehlikeli ilaç etkileşimleri nedeniyle hekimler tarafından dikkatle sorgulanmalıdır. Sonuç olarak, bu ajanların psikiyatrik tedavilerde güvenli ve alternatif bir seçenek olarak kullanılabilmesi adına yasal ruhsatlandırma süreçlerinin sıkılaştırılması ve klinik takibin profesyonel düzeyde yapılması gerektiği vurgulanmaktadır.
This text examines the historical origins of herbal treatments in psychopharmacology, their positioning within modern and alternative medicine, and their usage in psychiatric disorders based on evidence-based medicine. The study details the active components, mechanisms of action, clinical efficacies on anxiety, depression, and sleep disturbances, and side effect profiles of plants such as Hypericum Perforatum (St. John's Wort), Ginkgo Biloba, Kava Kava, Valeriana Officinalis (Valerian), Passiflora Incarnata (Passionflower), Melissa Officinalis (Lemon Balm), Curcuma Longa (Turmeric), Humulus Lupulus (Hops), Matricaria Recutita (Chamomile), Panax Ginseng, Skullcap, and Gotu Kola. Research indicates that while some herbs show similar efficacy to synthetic drugs in reducing mild-to-moderate depression and anxiety symptoms, others yield contradictory results due to a lack of standardization. Since herbal products are easily accessible outside pharmacies, they must be questioned carefully by physicians owing to their serious toxicity risks, hepatotoxic effects, and dangerous drug interactions developing particularly from the inhibition or induction of the Cytochrome P-450 enzyme system. Consequently, it is emphasized that licensing studies should be tightened and clinical monitoring should be performed professionally for these agents to be utilized as safe, alternative options in psychiatric treatments.
Referanslar
Çelik S, Konkan R, Erkmen H ve ark. Bitkisel ilaçlar ve psikiyatride kullanımı. Düşünen Adam. 2007;20(4):186-95.
Gökkaya İ, Renda G. Vakalar Perspektifinde Bitkisel Ürünler ve Hepatotoksisite. Literatür Eczacılık Bilimleri Dergisi. 2021;10(2):133-52.
Erdem S, Eren PA. Tedavi amacıyla kullanılan bitkiler ve bitkisel ürünlerin yan etkileri. Türk Hijyen ve Deneysel Biyoloji Dergisi. 2009;66(3):133-41.
Dişli M, Yeşilada E. Türkiye ‘de Bitkisel Tıbbi Ürünler (Türkiye’de Bitkisel Ürünlerin Standardizasyonu, Üretimi Ve Tağşiş). Journal of Biotechnology Strategic Health Research. 2019;3:13-21.
Ersoy E, Özkan EE. Geçmişten Günümüze Hypericum perforatum (Sarı Kantaron) ve Depresyon Tedavisi-Neler Biliyoruz? J Lit Pharm Sci. 2020;9(2):137-48
Ernst E. Herbal remedies for depression and anxiety. Advances in Psychiatric Treatment. 2007;13(4):312-6.
Linde K, Berner M, Egger M, et al. St John's wort for depression: meta-analysis of randomised controlled trials. The British Journal of Psychiatry. 2005;186(2):99-107.
Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane database of Systematic reviews. 2008(4).
Bladt S, Wagner H. Inhibition of MAO by fractions and constituents of hypericum extract. J Geriatr Psychiatry Neurol. 1994;7 Suppl 1(1):57-9.
Kasper S, Caraci F, Forti B,et al. Efficacy and tolerability of Hypericum extract for the treatment of mild to moderate depression. Eur Neuropsychopharmacol. 2010;20(11):747-65.
Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database Syst Rev. 2008(4):CD000448.
Rahimi R, Nikfar S, Abdollahi M. Efficacy and tolerability of Hypericum perforatum in major depressive disorder in comparison with selective serotonin reuptake inhibitors: a meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33(1):118-27.
Ng QX, Venkatanarayanan N, Ho CYX. Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis. Journal of affective disorders. 2017;210:211-21.
Szegedi A, Kohnen R, Dienel A, et al. Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John's wort): randomised controlled double blind non-inferiority trial versus paroxetine. BMJ. 2005;330(7490):503.
Rezvani AH, Overstreet DH, Perfumi M, et al. Plant derivatives in the treatment of alcohol dependency. Pharmacol Biochem Behav. 2003;75(3):593-606.
Meltzer-Brody SE. St. John's Wort: clinical status in psychiatry. CNS Spectr. 2001;6(10):835-40.
Müller T, Mannel M, Murck H, et al. Treatment of somatoform disorders with St. John's wort: a randomized, double-blind and placebo-controlled trial. Psychosomatic Medicine. 2004;66(4):538-47.
Kobak KA, Taylor LV, Warner G, et al. St. John's wort versus placebo in social phobia: results from a placebo-controlled pilot study. J Clin Psychopharmacol. 2005;25(1):51-8.
Karamustafalıoğlu O. Temel ve Klinik Psikiyatri. 1 ed: Güneş Tıp Kitabevleri; 2018.
Lawvere S, Mahoney MC. St. John's wort. Am Fam Physician. 2005;72(11):2249-54.
Hohmann N, Wolf EM, Rigault P, et al. Ginkgo biloba’s footprint of dynamic Pleistocene history dates back only 390,000 years ago. BMC genomics. 2018;19(1):1-16.
AYBASTIER Ö. Farklı formlardaki ginkgo biloba’nın antioksidan özelliklerinin belirlenmesi. Avrupa Bilim ve Teknoloji Dergisi. 2020(18):206-12.
İşeri PK, Efendi H. Demanslı Hastaya Klinik Yaklaşım ve Tedavi. Sürekli Tıp Eğitimi Dergisi. 2003;12(12):458-60.
Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev. 2009(1):CD003120.
Uluoğlu C, Güney HZ. Demanslı Yaşlı Hastalar Üzerinde Yapılan İlaç Araştırmaları. Türk Geriatri Dergisi. 2010;13(3):61-9.
Tan MS, Yu JT, Tan CC, et al. Efficacy and adverse effects of ginkgo biloba for cognitive impairment and dementia: a systematic review and meta-analysis. J Alzheimers Dis. 2014;43(2):589-603.
Kraft K, Hobbs C. Pocket guide to herbal medicine: Georg Thieme Verlag; 2004.
Öksüz M. Piper methysticum’un Fitokimyasal Bileşenleri ve Farmakolojik Aktivitesi 2021 [Available from: https://www.bezelyedergi.net/post/piper-methysticum-un-fitokimyasal-bile%C5%9Fenleri-ve-farmakolojik-aktivitesi.
Bilia AR, Scalise L, Bergonzi MC, et al. Analysis of kavalactones from Piper methysticum (kava-kava). Journal of Chromatography B. 2004;812(1-2):203-14.
Singh YN, Singh NN. Therapeutic potential of kava in the treatment of anxiety disorders. CNS Drugs. 2002;16(11):731-43.
Jussofie A, Schmiz A, Hiemke C. Kavapyrone enriched extract fromPiper methysticum as modulator of the GABA binding site in different regions of rat brain. Psychopharmacology. 1994;116(4):469-74.
Ligresti A, Villano R, Allarà M, et al. Kavalactones and the endocannabinoid system: the plant-derived yangonin is a novel CB1 receptor ligand. Pharmacological Research. 2012;66(2):163-9.
Pittler MH, Ernst E. Kava extract versus placebo for treating anxiety. Cochrane Database of Systematic Reviews. 2003(1):CD003383 doi: 10.1002/14651858.CD003383
Sarris J, Stough C, Bousman CA, et al. Kava in the treatment of generalized anxiety disorder: a double-blind, randomized, placebo-controlled study. J Clin Psychopharmacol. 2013;33(5):643-8.
Showman AF, Baker JD, Linares C, et al. Contemporary Pacific and Western perspectives onawa (Piper methysticum) toxicology. Fitoterapia. 2015;100:56-67.
Rowe A, Zhang LY, Ramzan I. Toxicokinetics of kava. Adv Pharmacol Sci. 2011;2011:326724.
Karadağli SS. Yaygın olarak kullanılan sedatif etkili tıbbi bitkiler ve ilaç etkileşimleri. FABAD Journal of Pharmaceutical Sciences. 2019;44(3):243-53.
Bacanlı M, Başaran N, Başaran AA. İlaç-bitkisel ilaç kullanımının toksikolojik sonuçları. Turkiye Klinikleri J Pharm Sci. 2012;1(2):83-94.
Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther. 2002;27(6):391-401.
Leathwood PD, Chauffard F, Heck E, et al. Aqueous extract of valerian root (Valeriana officinalis L.) improves sleep quality in man. Pharmacol Biochem Behav. 1982;17(1):65-71.
Fernández-San-Martín MI, Masa-Font R, Palacios-Soler L, et al. Effectiveness of Valerian on insomnia: a meta-analysis of randomized placebo-controlled trials. Sleep medicine. 2010;11(6):505-11.
Aliakbari F, Rafieian M. The effectiveness of Valeriana officinalis on sleep disturbance in patients with chronic heart failure. International Journal of Pharmaceutical Investigation. 2018;8(3):145-50.
Tovar RT, Petzel RM. Herbal toxicity. Disease-a-month. 2009;55(10):592-641.
Elsas SM, Rossi D, Raber J, et al. Passiflora incarnata L.(Passionflower) extracts elicit GABA currents in hippocampal neurons in vitro, and show anxiogenic and anticonvulsant effects in vivo, varying with extraction method. Phytomedicine. 2010;17(12):940-9.
Akhondzadeh S, Naghavi HR, Vazirian M, et al. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther. 2001;26(5):363-7.
Miroddi M, Calapai G, Navarra M, et al. Passiflora incarnata L.: ethnopharmacology, clinical application, safety and evaluation of clinical trials. J Ethnopharmacol. 2013;150(3):791-804.
Cases J, Ibarra A, Feuillere N, et al. Pilot trial of Melissa officinalis L. leaf extract in the treatment of volunteers suffering from mild-to-moderate anxiety disorders and sleep disturbances. Med J Nutrition Metab. 2011;4(3):211-8.
Awad R, Muhammad A, Durst T, et al. Bioassay‐guided fractionation of lemon balm (Melissa officinalis L.) using an in vitro measure of GABA transaminase activity. Phytotherapy Research. 2009;23(8):1075-81.
Sarris J, McIntyre E, Camfield DA. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27(4):301-19.
Ulbricht C, Brendler T, Gruenwald J, et al. Lemon balm (Melissa officinalis L.): an evidence-based systematic review by the Natural Standard Research Collaboration. 2005;5(4):71-114.
Aksu Kapucu Ş. Türkiye'de Piyasalarda Bulunan Bazı Curcuma Longa L. Rizom Ve Preparatları Üzerinde Farmakognozik Araştırmalar. Ankara: Hacettepe Üniversitesi 2012.
Erkul C, Özenoğlu A, Reis E. Zerdeçalın Genel Sağlık Üzerine Etkileri. Türkiye Sağlık Bilimleri ve Araştırmaları Dergisi. 2021;4(2):76-87.
Sarıyer ET, Aksu BM. Kurkumin ve Gastrointestinal Sistem Hastalıkları. Journal of Biotechnology Strategic Health Research. 2020;4(3):194-205.
Laveti D, Kumar M, Hemalatha R, et al. Anti-inflammatory treatments for chronic diseases: a review. Inflamm Allergy Drug Targets. 2013;12(5):349-61.
Sanmukhani J, Satodia V, Trivedi J, et al. Efficacy and safety of curcumin in major depressive disorder: a randomized controlled trial. Phytother Res. 2014;28(4):579-85.
Lopresti AL, Maes M, Maker GL, et al. Curcumin for the treatment of major depression: a randomised, double-blind, placebo controlled study. J Affect Disord. 2014;167:368-75.
Daveluy A, Géniaux H, Thibaud L, et al. Probable interaction between an oral vitamin K antagonist and turmeric (Curcuma longa). Therapies. 2014;69(6):519-20.
Bahramsoltani R, Rahimi R, Farzaei MH. Pharmacokinetic interactions of curcuminoids with conventional drugs: A review. J Ethnopharmacol. 2017;209:1-12.
Demir H. Sinir Sistemi Rahatsızlıklarında Kullanılan Tıbbi Çaylar [Yayınlanmamış Yüksek Lisans Tezi]. İstanbul: İstanbul Üniversitesi Sağlık Bilimleri Enstitüsü; 2013.
Abourashed E, Koetter U, Brattström A. In vitro binding experiments with a Valerian, hops and their fixed combination extract (Ze91019) to selected central nervous system receptors. Phytomedicine. 2004;11(7-8):633-8.
Tan U. Mayıs papatyası (Matricaria recutita L.)'nda farklı ekim zamanları ve çeşitlerin agronomik-teknolojik özelliklere etkisi [Yayınlanmamış Yüksek Lisans Tezi]. Aydın: Adnan Menderes Üniversitesi, Fen Bilimleri Enstitüsü; 2016.
Singh O, Khanam Z, Misra N, et al. Chamomile (Matricaria chamomilla L.): An overview. Pharmacogn Rev. 2011;5(9):82-95.
Yozgatlı B, Koşar M. Anksiyete Ve Depresyon Tedavisinde Kullanılan Bitkisel Ürünlerin Araştırılması. Kayseri: Erciyes Üniversitesi Eczacılık Fakültesi; 2011.
Ernst E. The risk–benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Annals of internal medicine. 2002;136(1):42-53.
Guo X, Wang X, Su W, et al. DNA barcodes for discriminating the medicinal plant Scutellaria baicalensis (Lamiaceae) and its adulterants. Biol Pharm Bull. 2011;34(8):1198-203.
Verma R, Gurmaita A. A review on anticarcinogenic activity of “Centella asiatica”. World Journal of Pharmaceutical Research. 2019;6:7.
