Journal of Traditional Medicine & Clinical Naturopathy
Open Access

Generalized Anxiety Disorder; Ayurveda; Brahmi vati; Manasmitra vataka

Introduction

Generalized Anxiety Disorder (GAD) may be a one of the foremost common and disabling anxiety disorder. Predominant side effects are abundance stress, restlessness, decreased concentration, irritation, and insomnia and muscle pressure [1]. Major presentation of GAD is the excess, steady stress about day-to-day activities and minor events. Contribution of Disability adjusted life years (DALYs) due to anxiety clutters among mental disorders in 2017 was 19% in India. It shows with different comorbidities including depression, insomnia, substance abuse, anxiety clutters, personality disarranges and incessant medical illness such as hypertension and diabetes. Comorbidities contribute to the destitute treatment results. As a rule 60% have comorbidities with Major Depressive Disorder and other anxiety disorders. Comorbidity diagnosis is related with more social and occupational disturbance [2]. GAD is related with more prominent dependence on open help, impaired work efficiency, disturbed social connections and low ratings of satisfaction in life and includes a gross affect. GAD patients (27%) suffered loss of 4.6 work days because of disability within the previous month and with comorbid depression, 59% of patients lost 8 work days.

As GAD patients present with physical side effects leading to significant use and burden on health care administrations. Pathophysiology of GAD is contributed by various natural variables like genetics, neurobiological and psychological factors. Mental derangements are cognitive conduct, information procession, influence and psychodynamic components. Psychosocial components like development, environment also pays a role. Neurobiological components include decreased Gamma-aminobutyric acid (GABA) and serotonin levels, expanded concentration of noradrenergics, derangements in neural circuitry and endocrine system. Treatment seeking among GAD patients is low i.e. only 40% [3-5]. Management of GAD is through various pharmacological agents. They incorporate serotonin reuptake inhibitors (SSRI), serotonin noradrenaline reuptake inhibitors (SNRI), benzodiazepines, azapirones and pregabalin. A meta-analysis reported that the drug treatment in GAD has low to direct impact size.

Inspite of advances in administration of GAD, full or fractional abatement in long term (5 yr or more) is assessed in as it were 38– 41% of the cases. Few of the limitations of to begin with line routine medications are destitute adequacy, need of reaction in numerous patients, 2–4 weeks delay in onset of side effect help, slow reaction, need of full remission and nearness of leftover symptoms and risk of relapse [6]. SSRI and SNRI have various adverse impacts including nausea, gastrointestinal issues, sexual dysfunction, headache, sweating, weight gain and blood pressure changes. Abrupt discontinuation of these can lead to suspension or withdrawal side effects. All these limitations are empowering the patients to explore for possible therapies in complimentary and elective systems of pharmaceutical. Uneasiness is one of the strongest indicators for the use of elective system of medicines. Only 40% of GAD patients seek treatment, according to [7]. GAD can be treated with a variety of medications. Pregabalin, benzodiazepines, azapirones, and serotonin reuptake inhibitors (SSRIs) are a few examples of these medications. According to a meta-analysis, the drug therapy for GAD has a moderate to small effect size. In anxiety disorders, SSRIs are considered the first-line pharmacotherapy.

In Ayurveda, mental health and psychiatric management have been extensively discussed. Chittodwega is regarded as one of the psychiatric disorders in Ayurveda. It is caused by impairment in the Manasika dosha, which includes Rajas and Tamas. In terms of etiopathology and manifestations, Chittodwega is comparable to GAD. Kava (Piper methysticum), one of the most studied complementary and alternative therapies, has been shown to be effective in treating GAD [8]. A meta-analysis found that complementary and alternative therapies like kava-kava and homeopathy had a smaller effect size than placebo, indicating that they were inferior to placebo. It was outlawed in the UK due to numerous reports of hepatotoxicity and has limited use. Manasmitra vataka, an Ayurvedic medication, has been linked to GAD and comorbid social phobia in a study.

Materials and Methods

Patients who have lakshanas of Unmad (psychiatric disorders that go hand in hand); taking psychotropic medications four weeks before the study; alcohol and other drugs of abuse severe depression (BDI greater than 17); other health issues, such as diabetes and hypertension; The study did not include women who were pregnant or breastfeeding. The patients were split 1:1 between the control and intervention groups. PI was in charge of creating and sealing the sequence [8]. Opaque envelopes were sealed to conceal allocations. The study used random numbers that were generated by computers. The allocation was not visible to any of the researchers. Researchers were not involved in the randomization, distribution, or administration of the study articles. The investigators, outcome assessors, and all participants were blind. Unblinding took place after the data were analyzed. One of the researchers counted the number of unused capsules every 15 days to measure adhesion. The investigators evaluated outcome variables at each assessment time point. A previous study [10] served as the basis for the size of the sample. The study's primary outcome was used to determine the sample size. All out Example was 56, 28 in each arm with 5% alpha mistake and 80% power.

Brahmi vati's ingredients were obtained from legitimate distributors. All raw materials were authenticated in an approved Ayurveda, Siddha, and Unani (ASU) drug testing laboratory at the Central Research Facility (CRF) KLE BMK Ayurveda Mahavidyalaya, Ministry of AYUSH, and Government of India. Each raw material and finished product underwent qualitative analysis in accordance with API (Ayurvedic Pharmacopeia of India) guidelines [9]. The raw drugs were analyzed qualitatively in terms of ash, extractive values, and loss upon drying. Subjective examination of completed item was as far as debris values and misfortune on drying. In the GMP-approved KLE Ayurveda Pharmacy, Belgaum, standard procedures were followed when filling capsules with Brahmi vati powder. The free tablet form of Manasmitra Vataka was obtained from PAKRUTI Pharmacy in Karwar, India, and the standard procedures for capsule filling were followed at the GMP-approved KLE Ayurveda Pharmacy in Belgaum, Karnataka, India. Length of intercession was 45 days with circle back to each fifteenth day during treatment.

Discussion

The review showed that adequacy of Brahmi vati and Manasmitra vataka were tantamount in the administration of Stray. Depression, worry, and anxiety were all reduced by the drugs. Quality of life, disease severity, night-time sleep, daytime drowsiness, and global improvement and efficacy all improved. Since both the liver function tests and the serum creatinine levels were within the normal ranges prior to and following the intervention, neither drug caused any adverse drug reactions or events. Additionally, both drugs had adequate safety margins.

Brahmi vati and Manasamitra vataka had similar effects on primary, secondary, and other outcome variables. Both Manasamitra and Brahmi vati had similar effects on HARS, the primary outcome variable. Within-group comparisons showed that both interventions resulted in a significant and comparable reduction in HARS. Secondary outcome variables like GAD7, BDI, ESS, PSQI, WHOQOL-BREF, CGI-S, CGI-GI, and CGI-EI all experienced similar effects. Concern, depression, daytime sleepiness, sleep profile, quality of life, disease severity, global improvement, and efficacy index were all significantly and similarly improved by both interventions. DBP and other outcome variables only improved with the Brahmi vati intervention. From the prehypertensive state to the normal range, DBP decreased. From the prehypertensive stage on, both groups' SBP fell within normal limits [10]. Brahmi vati interventions improved liver function tests like albumin and albumin globulin ratio, but both pre- and post-values were within the normal range. Using drugs like selective serotonin reuptake inhibitors as a control would have strengthened the study. Multicentric designs and a larger sample size are required for this study. Mediations conveyed for a more drawn out period would have been valuable. Electrophysiological tests like autonomic function tests and biological tests with serum cortisol may have provided better insights into the drug's action.

Conclusion

This study demonstrated that the GAD treatment efficacy of Brahmi vati and Manasamitra vataka was comparable. Serum creatinine levels, a liver function test, and the absence of any adverse drug reactions all suggested that both medications were safe. Brahmi vati improves quality of life, lowers blood pressure in the prehypertensive stages, and reduces the severity of disease. It also has an anxiolytic, antidepressant, and sleep-promoting effect. To gain a better understanding of the drug, additional research on Brahmi vati is required. B. vati can be a part of a comprehensive GAD treatment plan.

Conflict of Interest

The authors declared that there is no conflict of intrest

Acknowledgement

None

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