1. No category

No. 34 February 2010
Herbs & Nutrients for the Treatment of Anxiety & Insomnia
Magnolia & Zizyphus
Lemon Balm
Magnolia officinalis bark is used in traditional Chinese
Leaf or aerial parts of Lemon Balm (Melissa officinalis)
are used in western traditional medicine for sleep
disorders of nervous origin, neurasthenia and dyspepsia
associated with anxiety or depression.8,9 Weiss described
the main indications as a nervous heart, a nervous
stomach and difficulties in going to sleep.10 It was highly
regarded by Paracelsus, who believed it would
"completely revivify a man", and would be of great use
in "all complaints supposed to proceed from a disordered
state of the nervous system".11
medicine (TCM) for abdominal pain and distention,
dyspepsia and asthma.1 Magnolia bark has been an
important component of formulations in traditional
Japanese medicine (Kampo) for the treatment of
psychological and neurological conditions, including
anxiety, insomnia and depression. In this case it is
Magnolia obovata bark that is used, although both
species are used in TCM.2
Zizyphus spinosa seed is used in TCM to quieten the
spirit, for dream-disturbed sleep, insomnia, irritability,
palpitations with anxiety and spontaneous or night
sweats.3,4
Suanzaorentang is a TCM formula containing mainly
Zizyphus spinosa seed. It has been investigated in
controlled trials. One study of patients with anxiety
found that it significantly improved mood, decreased
sympathetic nervous system symptoms and improved
performance.5 Another study of patients with sleep
disorders found a significant improvement in sleep
quality and well-being without side effects.6
Clinical Study: Magnolia & Zizyphus
A blend of Magnolia officinalis bark and Zizyphus spinosa
seed was evaluated in an open study in the United
States, which involved 295 volunteers with mild to
moderate sleep difficulties.7 The daily dosage
corresponded to Magnolia officinalis bark (1.2 g) and
Zizyphus spinosa seed (1.3 g), taken one hour before
going to bed, every night for at least 2 weeks. The
volunteers were assessed by questionnaire at baseline
and after treatment. Of the 145 participants that
returned one questionnaire,
• 86.9% found the herbal treatment to be relaxing,
• 82.8% rated it as assisting in a restful sleep,
• 82.8% rated it as effective in reducing fatigue.
In the group of volunteers that returned two or more
questionnaires (treatment was extended to average of
4.2 months in total) the scores were higher. Overall, the
herbal treatment was well tolerated: 18 participants
(6%) reported mild complaints; the most common (in 8
individuals) was feeling groggy the next morning.
Clinical Studies
Three placebo-controlled clinical studies investigated the
acute administration (single doses) of Lemon Balm in
healthy volunteers. Increased calmness was
observed.12-14 In one study, the most notable effects
were observed at a dosage of 1.6 g of dried leaf.12
In a double-blind trial, 30 patients with anxiety and
sleep difficulties were randomised to receive Lemon
Balm extract or placebo for a period of 15 days. The daily
dosage corresponded to 3.9 g of Lemon Balm leaf.
Compared to placebo, patients treated with Lemon Balm
extract experienced:15
• 49% less anxiety,
• 72% fewer anxiety-associated symptoms (12
symptoms measured including emotional instability,
mental confusion, asthenia, difficulty with food),
• 39% less insomnia.
Lavender Oil
The flower and essential oil of the flower of Lavender
(Lavandula angustifolia (L. officinalis)) have been used
traditionally, in oral doses, in France for a range of
conditions including irritability, physical and mental
debility, melancholia, anxiety, nervous crises, insomnia,
sluggish digestion and spasm. The essential oil, when
taken internally, is given in a dose of 2 to 5 drops, 2 to 3
times a day.16 The Commission E advises Lavender flower
and its essential oil for restlessness, insomnia and
abdominal complaints. For these indications, Lavender
oil is prescribed in a daily dose of 1–4 drops, about
20-80 mg.9 Lavender oil was administered in an aqueous
solution of honey or alcohol, or on a sugar cube.9,16
© Copyright 2010 MediHerb. Not for Public Distribution. For Education of Health Care Professionals Only.
1
Clinical Trials
A 4-week randomised, double-blind trial found a
combination of imipramine (a tricyclic antidepressant)
and Lavender tincture was more effective than
imipramine alone for the treatment of mild to moderate
depression. The combination produced a better and
earlier improvement. The administered dosage of
Lavender 1:5 tincture was 60 drops per day.17 The
essential oil is an important component of Lavender
flower tincture. Based on this dose, 12 to 18 mg of
Lavender oil per day is adequate.
Oral administration of essential oil of the flower of
Lavandula angustifolia was as effective as lorazepam
(0.5 mg/day, a benzodiazepine) in adults with
generalised anxiety disorder. Seventy-seven patients
were randomised and received treatment for 6 weeks.
Hamilton Anxiety Rating Scale scores decreased from
baseline by 45% in the Lavender oil group and 46% in
the lorazepam group. Other measures of anxiety, worry,
severity of illness and sleep disturbance improved to a
similar extent in both groups. Serious adverse events did
not occur. A causal assessment of adverse events
indicated: 9 of 11 mild to moderate adverse events in
the Lavender oil group were gastrointestinal (nausea,
burping, dyspepsia); and 6 of 7 patients experienced
fatigue in the lorazepam group.18 The preparation is
insufficiently defined but the dosage is likely to be
80 mg/day of Lavender oil.19 In an open trial, the same
preparation and dosage reduced anxiety, restlessness
and depression in patients with neurasthenia and
posttraumatic stress disorder.19,20
Magnesium
Due to its role as a cofactor in more than 300 enzyme
systems, deficiency of magnesium can result in a wide
variety of symptoms, including many of a neurological,
neuromuscular or neuropsychiatric nature. Physically,
these may include lethargy, insomnia, tremors, and
spasms and/or weakness of the muscles. Additional
psychological and emotional symptoms may include
depression, mental confusion, decreased attention span,
hyperirritability or hyperexcitability and varying degrees
of personality change.21-25
Deficiency of magnesium is surprisingly widespread,
with dietary surveys showing that the average daily
consumption of the mineral by Australian adults is
10-20% below the recommended dietary intake
(RDI).21,26
These dietary deficits may be compounded by prolonged
stress and/or sleep deprivation, both of which deplete
magnesium levels (perhaps because excretion is
promoted as a consequence of the increased secretion of
catecholamines such as epinephrine, norepinephrine and
dopamine).24,27 In a vicious cycle, some substances
popularly used to aid stress coping (such as fatty foods,
alcohol, soft drinks and coffee) may exacerbate the
situation by inhibiting the absorption of magnesium or
further enhancing its excretion.24,28,29
Low magnesium levels have been observed in a wide
range of mood and mental health disorders, from
premenstrual syndrome (PMS), seasonal affective
disorder and age-related insomnia and memory decline
through to severe depression and acute
schizophrenia.25,29-32
Even when no underlying pathology is present,
magnesium levels have a significant correlation with
mood and well-being. In research published in 2008,
healthy women without psychiatric disorders who had
low serum magnesium levels were found to have a
significantly greater risk of depressed moods than
women with high serum magnesium.33
In other supplementation studies, taking magnesium has
been shown to improve premenstrual mood swings,
symptoms of depression in older people (specifically
those newly diagnosed with diabetes) and insomnia and
disturbed sleep related to restless leg syndrome.24,34,35
Vitamin B6 is required for magnesium absorption, and
the two nutrients are co-factors in the conversion of
tryptophan to serotonin, which is in turn converted to
melatonin. The metabolic pathway involved may be
inhibited by deficiency of either nutrient, as well as by
stress, increasing age and/or insulin resistance.25,28
Vitamin B6
Vitamin B6 is involved in an enormous number of bodily
functions. After consumption, pyridoxine is metabolised
into the metabolically active form of vitamin B6
pyridoxal 5’-phosphate (P5P, sometimes also referred to
as PLP). P5P is a co-enzyme in nearly 100 enzymatic
reactions.22
In addition to its role in the conversion of tryptophan
(and subsequently to serotonin, melatonin and niacin),
P5P is a co-factor in the synthesis of other
neurotransmitters involved in stress coping, including
gamma-aminobutyric acid (GABA) and dopamine (which
is in turn converted into epinephrine and
norepinephrine).22,28
Vitamin B6 deficiency may consequently have a
significant impact on brain function; low levels of these
neurotransmitters may be linked to the development of
depression and other neuropsychological disorders
including Parkinson’s disease and tardive dyskinesia.36
Levels of vitamin B6 may also influence the ability to
cope with emotional stressors. For example, men with
deficient vitamin B6 levels who have been recently
bereaved show greater levels of depression, fatigue and
confused moods than men who have adequate vitamin
B6. It is hypothesised that this effect may be due to the
negative impact of inadequate vitamin B6 on serotonin
and GABA levels.24,37
© Copyright 2009 MediHerb. Not for Public Distribution. For Education of Health Care Professionals Only.
2
Aside from depression, other nervous system symptoms
of vitamin B6 deficiency may include weakness,
sleeplessness, irritability, confusion and an inability to
concentrate.21-23,25,36
Marginal deficiency of vitamin B6 is very common. In
some studies, 71–100% of subjects have not obtained
the RDI from their diets.24 Older people are considered at
particular risk.36 Dietary shortfall may be exacerbated by
gastric atrophy, alcohol abuse, liver dysfunction and
smoking.22,23,25
Use of the oral contraceptive pill has also been
associated with low vitamin B6 levels, and in the 1970s,
several clinical studies found treatment with vitamin B6
to be an effective treatment for depression that occurred
as an adverse effect of the pill.25
Vitamin B6 is also used to relieve premenstrual
depression and a range of other PMS symptoms, and in
this context may work in part by enhancing cellular
uptake of magnesium.24,25
Synergistic Formulation
These herbs and nutrients would complement each other
in a very potent formulation with anxiolytic, mild
sedative and mood-elevating activity.
Cyracos Product Information. Available online:
http://www.npicenter.com/images/profile/naturex/Cyracos_503078
_Marketing_brochure_03.pdf. Accessed November 2009. 16 Valnet J.
The Practice of Aromatherapy, translated from the French by Campbell
R and Houston L, edited by Tisserand RB. Saffron Walden, Daniel, 1982.
17
Akhondzadeh S et al. Prog Neuropsychopharmacol Biol Psychiatry
2003; 27: 123 18 Woelk H, Schlafke S. Phytomedicine 2010; 17: 94 19
Dienell A, Noldner M, inventor. Use Of Lavender Oil For The Prophylaxis
And Treatment Of Neurasthenia, Somatization Disorders And Other
Stress-Associated Diseases. United States Patent Application Publication
No. 20080124410. 2008 May 29. 20 Stange R et al. Focus Alternat
Complement Ther 2007; 12(Suppl): 46 21 National Health and Medical
Research Council. Nutrient reference values for Australia and New
Zealand, including recommended dietary intakes. Commonwealth of
Australia, Canberra, 2006. 22 Shils ME et al. Modern nutrition in health
and disease, 9th Edn. Williams and Wilkins, Pennsylvania, 1999. 23
Mahan LK, Escott-Stump S. Krause’s food, nutrition and diet therapy,
10th Edn. WB Saunders, Pennsylvania, 2000. 24 Braun L, Cohen M.
Herbs and natural supplements: an evidence-based guide, 2nd Edn.
Churchill Livingstone Elsevier, Sydney, 2007. 25 Pizzorno JE, Murray MT.
Textbook of natural medicine, 3rd Edn. Churchill Livingstone Elsevier,
Missouri, 2006. 26 McLennan W, Podger A. National nutrition survey:
Nutrient intakes and physical measures, Australia, 1995.
Commonwealth of Australia, Canberra, 1998. 27 Tanabe K et al. Jpn Circ
J 1998; 62: 341 28 Head KA, Kelly GS. Altern Med Rev 2009; 14: 114 29
Johnson S. Med Hypotheses 2001; 56: 163 30 Durlach J et al. Magnes
Res 2002; 15: 263 31 Killalea DW, Maier JAM. Magnes Res 2008; 21: 77
32
Nechifor M. Magnes Res 2008; 21: 97 33 Jung KI et al. Biol Trace Elem
Res 2010; 133: 153 34 Barragán-Rodríguez L et al. Magnes Res 2008;
21: 218 35 Hornyak M et al. Sleep 1998; 21: 501 36 Malouf R, Grimley
Evans J. Cochrane Database Syst Rev 2003, (4): CD004393 37 Baldewicz
T et al. Psychosom Med 1998; 60: 297
Authors: Michelle Morgan, Jayne Tancred
© Copyright 2010 MediHerb.
Indications
•
•
•
•
•
•
Anxiety.
Insomnia, sleeplessness, restlessness.
Nervous tension, stress.
Depression, irritability.
Gastrointestinal upset due to anxiety.
Premenstrual anxiety and moodiness.
Cautions and Contraindications
Magnolia bark should be used with caution in pregnancy.
REFERENCES
1
Chang HM, But PP (eds). Pharmacology and Applications of Chinese
Materia Medica. Vol 2. World Scientific, Singapore, 1987. 2 Maruyama Y,
Kuribara H. CNS Drug Rev 2000; 6: 35 3 Pharmacopoeia Commission of
the People’s Republic of China. Pharmacopoeia of the People’s
Republic of China, English Edn, Volume I. Chemical Industry Press,
Beijing, 1997. 4 Bensky D, Clavey S, Stoger E. Chinese Herbal Medicine:
Materia Medica, 3rd Edn. Eastland Press, Seattle, 2004. 5 Chen HC et al.
Int J Clin Pharmacol Ther Toxicol 1986; 24: 646 6 Chen HC, Hsieh MT.
Clin Ther 1985; 7: 334 7 Unpublished data. A proprietary blend of
Magnolia and Zizyphus extracts assists with sleep: an open-label
assessment. Available online:
www.nextpharmaceuticals.com/stage/pdfs/Seditol_Open2008.pdf.
Accessed November 2009. 8 British Herbal Medicine Association’s
Scientific Committee. British Herbal Pharmacopoeia. BHMA,
Bournemouth, 1983. 9 Blumenthal M et al (eds). The Complete German
Commission E Monographs: Therapeutic Guide to Herbal Medicines.
American Botanical Council, Austin, 1998. 10 Weiss RF. Herbal Medicine,
translated by Meuss AR from the 6th German Edition of Lehrbuch der
Phytotherapie. Gothenburg, AB Arcanum, Sweden, 1988. 11 Grieve M. A
Modern Herbal. First published 1931, reprinted Dover Publications, New
York, 1971. 12 Kennedy DO et al. Neuropsychopharmacology 2003; 28:
1871 13 Kennedy DO et al. Pharmacol Biochem Behav 2002; 72: 953 14
Kennedy DO et al. Psychosom Med 2004; 66: 607 15 Unpublished data.
© Copyright 2009 MediHerb. Not for Public Distribution. For Education of Health Care Professionals Only.
3