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Cover page of the Journal of Health Sciences


 
 Table of Contents  
REVIEW ARTICLE
Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 231-236

Review of research works done on generalized anxiety disorder at institute for postgraduate teaching and research in Ayurveda, Jamnagar


1 Department of Panchakarma, IPGT and RA, Gujarat Ayurved University, Jamnagar, Gujarat, India
2 Department of Kayachikits, IPGT and RA, Gujarat Ayurved University, Jamnagar, Gujarat, India

Date of Web Publication5-Sep-2017

Correspondence Address:
Divya S Zala
Department of Panchakarma, IPGT and RA, Gujarat Ayurved University, Jamnagar - 361 008, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_115_17

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  Abstract 


Generalized anxiety disorder (GAD) is one of the most common anxiety disorders characterized by persistent worrying, anxiety symptoms, and tension. It is most frequent anxiety disorder in primary care and associated with a significant economic burden owing to decreased work productivity and increased use of health-care services. GAD is a highly disabling illness, often complicated by multiple comorbidities, most commonly depression and other anxiety disorders. Being an alarming disease, it requires effective management. Ayurveda, with its holistic approach, can be helpful in such situation. In this direction, to assess the actual efficacy of different Ayurveda treatment modalities; few works have been carried out at Institute for Postgraduate Teaching and Research in Ayurveda (IPGT and RA), Gujarat Ayurved University, Jamnagar. In the current attempt, it has been planned to review all such works done on GAD. Totally, six studies on GAD were done during 2001–2017 that were compiled and screened. Various ayurvedic treatment modalities such as Nasya Karma, Shirodhara, Medhya Rasayana, yogic practice are found to be significantly effective in GAD.

Keywords: Anxiety disorders, Ayurveda, generalized anxiety disorder


How to cite this article:
Zala DS, Thakar AB, Bhatt NN. Review of research works done on generalized anxiety disorder at institute for postgraduate teaching and research in Ayurveda, Jamnagar. Indian J Health Sci Biomed Res 2017;10:231-6

How to cite this URL:
Zala DS, Thakar AB, Bhatt NN. Review of research works done on generalized anxiety disorder at institute for postgraduate teaching and research in Ayurveda, Jamnagar. Indian J Health Sci Biomed Res [serial online] 2017 [cited 2017 Dec 12];10:231-6. Available from: http://www.ijournalhs.org/text.asp?2017/10/3/231/213991




  Introduction Top


Generalized anxiety disorder (GAD) is characterized by resistant, excessive, and difficult to control worry and other associated symptoms such as fatigue, difficult to concentrate, sleep disturbance, restlessness, and abdominal discomfort. People with symptoms of GAD always tend to expect failure and cannot stop worrying, and this worry is often unrealistic or out of proportion for the situation. Hence, daily life becomes a constant state of worry. It is the most common anxiety disorder in primary care, being present in 22% of primary care patients who complain of anxiety problems.[1] Among the anxiety disorders, GAD has the least mean and median age at onset (early thirties);[2] although substantial numbers of children and adolescents do meet full criteria.[3] Early, GAD onset is associated with greater excessiveness and uncontrollability of worry, as well as a more chronic course with more severe life impairment.[4] Individuals with GAD are at significantly increased risk of impaired social and role functioning, mental health, and overall physical-mental well-being.[5] Clinical trials have shown that anxiolytic drugs alone have limited long-term efficacy.[6] Moreover, they often have adverse side effects including dependency, drowsiness, impaired cognition and memory, and sexual dysfunction. Considering wide magnitude of GAD in Indian subcontinent and absence of promising therapy with safety, suffering population is turning toward certain other systems for safe and effective therapies. There has been few works done on GAD in IPGT and RA, Jamnagar in PG and PhD level and many Ayurveda medicines such as Ashwagandha (Withania somnifera (L.) Dunal), Shakhpushpi (Convolvulus pluricaulis Forsk.), Sarsvata Choorna, and procedure such as Nasya and Shirodhara are found to be beneficial in GAD.


  Materials and Methods Top


Works carried out in different departments of IPGT and RA, Gujarat Ayurved University, Jamnagar at PG PhD levels during 2001–2017 were compiled and screened to revalidate the therapeutic attributes of ayurvedic drugs on GAD.


  Observations and Results Top


Totally, six research works were studied during this period, clinical studies include administration of drugs in around 336 patients. Grading criteria followed in all studies (except 1 which was conducted in 2017) is shown in [Table 1].
Table 1: Criteria for overall assessment of effect of therapies

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Trial 1 (2001)

In this study, 36 patients were registered and randomly divided into two groups. Of 36 patients, twenty patients were completed the treatment while 16 patients dropped out.[7] The patients of Group A were subjected to Jaladhara for 30 min daily in the morning between 8:30 and 11:00 am for 6 weeks with a gap of 1 week. In Group B, patients were administered 3 g powder of Sankhapuspi[8] Rasayana (It was made from Sankhapuspi Churna processed with 7 Bhavana of Sankhapuspi.) three times a day orally with water for 6 weeks. Effect of therapies on total score of Hamilton Anxiety Rating Scale (HARS) showed that both groups found highly significant (<0.001), but percentage of relief was more in Group B (72.06%) than Group A (67.49%). In Overall effect of therapy, of eight patients of Jaladhara group, only one patient gained marked improvement and remaining seven patients showed moderate improvement. In Group B, of 12 patients five patients gained marked improvement and remaining seven patients were having moderate improvement. Hence, Sankhapuspi Rasayana was better than Jaladhara in providing overall improvement in GAD.[7] The results of overall effect of therapies of this study are placed in [Graph 1].



Trial 2 (2005)

In this trial, 44 patients were registered and randomly grouped into two. Of which forty patients completed the course of treatment whereas four patients were dropped out.[9] In Group A (placebo group), twenty patients were treated with capsule of sugar powder 250 mg thrice a day, while in Group B (n = 20), Kushmandadi Ghrita[10] was given 10 ml twice a day with Anupana of Ushnodaka (warm water) after meal for 4 weeks. In this study, Kushmandadi Ghrita provided highly significant (<0.001) relief, i.e., 71% and placebo group provided significant (<0.05) relief, i.e., 18.75% on HARS. In overall effect of therapies, Group B is much better than Group A. Moreover, no side effect was observed during this study. On the basis of this extensive clinical research and experimental study, it is worth quoting that Kushmandadi Ghrita is found to be a potent anxiolytic drug with no side effect.[9] The results of overall effect of therapies are showed in [Graph 2].



Trial 3 (2011)

Totally, 114 patients (57 in each group) were registered in this study, among them 102 patients (51 in each group) have completed their treatment and remaining 12 patients were discontinued the treatment. Selected patients were randomly divided into two groups, Group A was treated with Sarasvata Choorna 1 g thrice a day with honey and ghee along with the first bolus of the food for 60 days. In Group B, placebo (roasted wheat powder) was given in dose of one gram thrice a day with honey and ghee along with the first bolus of the food for 60 days. Statistically highly significant improvement was observed in total score of HARS in both groups (P< 0.001). In Group A, 51.10% improvement was noticed whereas in Group B 47.67% of improvement was observed. Hence, Sarasvata Choorna provided more relief when compared to placebo.[11] Overall effect of therapies of this trial is mentioned in [Graph 3].



Trial 4 (2011)

Totally, 101 patients were registered for this study, of which 51 patients in Group A and 50 in Group B. Forty-four patients completed the treatment in Group A and 42 patients completed the treatment in Group B. Totally, 86 patients completed the treatment. Selected patients were randomly divided into two groups, Group A was treated with Ashwagandha granules 4 g thrice a day with milk for 60 days while in Group B Patients were treated with placebo (granules made from wheat flour was given a placebo) 4 g thrice a day with milk for 60 days. In both groups, highly significant results found in almost all symptoms such as anxious mood, tension, fear, insomnia, difficulty in concentration and memory, depressed mood, muscular complains, sensory complains, cardiovascular symptoms, respiratory symptoms, gastrointestinal symptoms, genitourinary symptoms, autonomic complains, and in behavior during interview. On the whole despite having insignificant statistical difference in both groups, Group A (Ashwagandha granules) showed a better percentage improvement than Group B (placebo).[12] Overall effect of therapies based on Hamilton's Anxiety Rating Scale is showed in [Graph 4].



Trial 5 (2015)

Totally, 36 patients were registered in Group A, among them 34 patients had completed the treatment and two patients discontinued. In Group B, 31 patients were registered among them 30 patients had completed the treatment and one patient discontinued.[13] The selected patients were randomly divided into two groups. Group A, patients were treated with relaxation therapy/yogic techniques, i.e., Shithilikarana Vyayama (3–5 min), Surya Namaskara (3 rounds), Nadi Shuddhi Pranayama (9 rounds), Brahmari Pranayama (3 rounds), Aum chanting (9 times), Pancha Kosha meditation and Yoga Nidra (10 min) in morning time for duration of 30 min. In Group B, patients were treated with Parasika Yavani[14] (Hyoscymus niger Linn) capsule (250 mg) at night after meal with water for 28 days. In both Groups, highly significant (<0.001) results were observed in almost all symptoms such as excessive worry, difficulty in controlling worry, restlessness, irritability, insomnia, fatigue, muscle tension, concentration problem, anticipation of worst, fears, crying spells, breathlessness, loneliness, unsatisfactory sleep, night mares, and loss of interest, palpitations and in headache. Results on sweating and chills and flushes were significant (<0.05) in both groups. Overall effect of therapies showed that in both groups A and B no patients got cured completely. Marked improvement in Group A and in Group B was absent. Moderate improvement observed in 18 patients of Group A and 14 patients of Group B, mild improvement observed in 16 patients of Group A and 15 patients of Group B. The effect of therapy was unchanged in one patient of Group B. The above results indicate that the relaxation technique has an upper hand in treating GAD. The results of Group B, i.e., Parasika Yavani withdrawn after a stipulated time fail to give the desired result.[13] Overall effect of therapy is mentioned in [Graph 5].



Trial 6 (2017)

Totally, 32 patients were registered in the this study, of which 16 patients in Group A and 16 in Group B. Thirty patients completed the treatment, 15 patients from each group.[15] The selected patients were randomly divided into two groups. In Group A, classical Nasya karma followed by oral administration of Sarasvata Choorna.[16] was given. Nasya Karma was given by Panchagavya Ghrita.[17] eight Bindu (4 ml) in each nostril for 7 days followed by a gap of 7 days, likewise 4 regimens were given. Sarsvata Choorna was given 2 g thrice a day with honey and ghee after food for 60 days. There was statistically highly significant improvement observed in total score of HARS in both groups (P< 0.001). In Group A, improvement was observed by 69.69% whereas in Group B 41.01% of improvement observed. On comparison Group A was better than Group B. Hence, it can be concluded that, the therapies used in Group A, i.e., Panchagavya Ghrita Nasya along with Sarsvata Choorna is more effective in the management of GAD.[15] Overall effect of therapy based on Hamilton Anxiety Rating A scale is mentioned in [Graph 6].



Commonly found observations

People of middle-age group are more prone to GAD. The prevalence of GAD was highest in midlife in the primary care attenders aged 35–60.[1] GAD is twice as common among women as among men.[18] It is reported that GAD is found somewhat more frequently in women than men.[18] GAD is also associated with poor marriage stability. People belonged to nuclear families are more susceptible to GAD, an article published in Times of India reveals that when a study was conducted on 450 students by the BMC-run Sion Hospital around 97.1% children with anxiety disorder belonged to nuclear families.[19] Patients of GAD were habituated to take Rajasika dominant food. Rajasika and Tamasika food may act as a predisposing factor in manifestation of a psychiatric disorder. Maximum numbers of patients in all these study were having Vata-Pitta Prakriti and Avar Satva. Avara Sattva people are more prone to mental disorders.[20]


  Discussion Top


GAD has the key component of the worry, with associated symptoms of restlessness, fatigue impaired concentration, irritability muscle tension and sleep disturbance. There is no precise term for GAD in ayurvedic classics. Various scholars have used terms Chittodvega[21],[22] Vishaad,[23] Attatvabhinivesh,[24],[25],[26] Anavasthita Chita,[23],[27] etc., to explain GAD. According to Ayurveda, the psychic factors are involved in almost all the disease processes along with physical disturbance as both of these are interdependent. In recent years, several synthetic drugs have been introduced for the treatment of anxiety disorders. Although these drugs are having better results, one cannot avoid major side effects such as drug dependence, drug resistance, and sedation. Ayurveda uses various dosage forms and treatment modalities in different disease conditions such as Shodhana and Shamana therapies, which have been found very effective in controlling GAD. In almost all the study, the diagnostic criteria were based on DSM IV.[28] Assessment was done on the basis of HARS.[29]

Medhya Rasayana drugs have been described in the ayurvedic texts for alleviation and prevention of mental disorders. Medhya Rasayanas are frequently used in most of the studies, these drugs enhances the function of Buddhi (intellect), decreases the Raja and Tama Manasa Doshas[21] and provides better functions to Manasa (mind) and Buddhi. All such herbs have been found to possess Nootropic effect besides varying degree of anxiolytic activity. These drugs are commonly prescribed by the ayurvedic practitioners for depression, anxiety, cognitive disorder, etc. Hence, Medhya drugs such as Shankhpushpi (Convolvulus pluricaulis Forsk.),[30] Aswagandha (Withania somnifera (L.) Dunal)[31],[32] Sarasvata Choorna, Kushmandadi Ghrita, Panchagavya Ghrita gave significant result in GAD. In one trial, Medhya Formulation Sarasvata Choorna was used with first bolus of food because in the disorders of Medha involvement, vitiation of Prana Vayu is present and as per charaka the drug to make its effect on Prana Vayu should be given Sagrasa or along with the food.[33] Acharya sushruta has also mentioned consumption of the drug just before meals to ensure better palatability of the drug so that the drug may be able to perform the required action due to ensurance of more bioavailability.[34]

Nasya and Shirodhara are the two Panchakarma treatment modalities that are used in GAD. Comparatively, Nasya is found to be highly significant. Ayurveda advocate use of Nasya in Urdhavjatrugataroga[35](Diseases of supraclavicular region) and in some psycological disorders such as Unmada (insanity), Apsmara (epilepsy), etc. In GAD, functions of mind are disturbed or aggravated, Acharya Bhela has stated that the brain is the seat of mind.[36] Nasa (nose) is mentioned as gateway of Shira (Head).[37] Hence, Nasya is the treatment of choice for this type of disease, by reaching actual site of pathogenesis. Shirodhara is an effective treatment for reducing stress and expanding one's consciousness. The mind, body, and spirit are intimately connected,[38] and Jaladhara by calming the stressful mind, relaxes the entire physiology. Shamana therapy used after Panchakarma procedures provides better results to attenuate signs and symptoms of disease. Hence, study conducted in 2017 in which Group A, i.e., Panchagavya Ghrita Nasya followed by Sarsvata Choorna gave Satisfactory results.

In three studies, placebo also gave good result in some extent; effect of placebo begins with the patient's trust and confidence in physician and extends through, to the optimum neuroendocrine and immunological functioning and healing capacity which may be helpful in alteration of emotions.

AdravyaBhut Chikitsa[39] (nondrug therapy) such as yogic practice was also gave highly significant result in one study. Yoga as a therapy has a palliative and quality of life improving effect. It does also produce positive emotional and psychological effects even in terminal conditions. Yogic procedures may be works by controlling the excessive activity of Vata and by normalizing the Pitta and excess of Kapha. Yogic procedures also help clear the Manas of unwanted thoughts and reduces excessive thinking also makes one sharp and attentive.

All ayurvedic test drugs - single and polyherbals, yogic practice, and Panchakarma procedures such as Nasya and Shirodhara are found to be effective in relieving signs and symptoms of GAD.


  Conclusion Top


The present study disclosed that many ayurvedic treatment modalities are found to be significantly effective in GAD. Nasya Karma followed by Shamana therapy is more effective than Jaldhara. No any adverse effect reported in any of these studies. Slight effect due to placebo drug shows the psychosomatic nature of disease. In nutshell, ayurvedic therapies provide promising results in GAD.

Acknowledgment

Authors duly acknowledge all the scholars, whose works have been screened in the current attempt.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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