Valerian – not only to calm down

The anti-anxiety effect of valerian is known since ancient times. Studies nowadays confirm this effect and show further potentials for PMS and hot flashes.

Valerian is one of the most famous medicinal plants and the sedative medicinal plant par excellence. Further, it is also known for its anxiety-relieving effect. As valerian drops, valerian tincture is sold in any pharmacy. Valerian, with botanical name Valeriana officinalis L., is a species of the honeysuckle family (Fig. 1) . In the genus Valeriana, besides the species V. officinalis, V. jatamansi also has some medicinal importance.

Valerian is native to much of Europe and ranges from Spain to Siberia and in Asia to Korea, China and Japan. The herbaceous plant can grow up to two meters high and grows in the sun or partial shade in almost any soil.

Medicinally used are the root (radix) and underground growing parts of the stem (rhizome), which get the characteristic odor from isovaleric acid, an ingredient found in these components. This is perceived by most people as very unpleasant. Other constituents of Valeriana officinalis include valerenic acid, essential oil, iridoids (valepotriates), sesquiterpenes, fatty acids, flavonoids, and alkaloids. One of these alkaloids, actinidine, is an attractant for cats.

Primary insomnia

The best known and proven effect of valerian is the treatment of primary insomnia. This application was already known in ancient times. The ancient Greeks used valerian as a sleep aid [1]. The efficacy of Valeriana officinalis has been proven with various clinical studies [2–7], which have shown various sleep parameters such as.

• Total sleep time
• Fall asleep latency
• nocturnal awakening
• Sleep quality

considered. Valerian is characterized by excellent safety. Occasional side effects involve the digestive system or hypersensitivity. In such a case, valerian can not be used. In the study by Ziegler et al. [6], valerian proved to be as effective as the benzodiazepine oxazepam [6]. Since valerian has no dependence potential, it proves to be a valid alternative to benzodiazepines – with their known, relatively large dependence potential – for the treatment of sleep disorders. Further, unlike benzodiazepines, the use of valerian does not reduce driving ability [7].

As a dose of valerian monopreparations 400-600 mg of valerian extract is used. However, many commercial preparations are combinations of valerian and other sedative medicinal plants, such as hops.

Unknown mechanism of action

Despite many studies, the mechanism of action has not yet been elucidated. It is not known which components of valerian extract are responsible for the sleep-inducing effect. Earlier views that the valepotriates were the actual active ingredients of Valeriana officinalis did not hold. Thus, valerian proves to be a typical representative of those medicinal plants whose effect cannot be attributed to individual ingredients, but only to the total extract. Recent studies show that Valeriana officinalis, like several other medicinal plants, interacts with and inhibits gamma-amino-butyric acid (GABA) [8].

An interesting approach is formed by a pharmacological study by Brattström in 2007 [9]. In it, the scientist examines a combination of valerian and hops and concludes that valerian has an adenosine-like effect and promotes readiness to fall asleep. Hops, on the other hand, help patients who are out of circadian rhythm to regain it.

Anxiety

GABA-modulating medicinal plants have anxiety-relieving potential. This also includes Valeriana officinalis. A study by Savage et al. [8] confirms this effectiveness. If a patient complains of insomnia, and upon questioning it becomes clear that this is a very anxious person, or the patient has been anxious lately because of worry, then valerian may be the remedy of choice.

Anti-epileptic effect

A 2017 pharmacological study reported an anti-epileptic effect, but not from Valeriana officinalis, but from Valeriana jatamansi [10], which grows at altitudes of 1500-3600 meters in Asian countries such as Afghanistan and China. The study was conducted using mice to determine the efficacy of valepotriates against experimentally induced epilepsy. Efficacy was confirmed and explained by the authors as possibly involving GABA regulation and reduction of neuronal apoptosis.

The result of this study is very interesting because the study was conducted with valepotriates, which are also found in Valeriana officinalis. Since valepotriates are also ingredients of Valeriana officinalis, such efficacy should also be present in this species of valerian, or studies should report this. However, there is little evidence of this. In Iran, however, valerian seems to have a folk medicine tradition for treating epilepsy. A pharmacological study conducted at Rafsanjan University [11] provides evidence of potential efficacy. Therefore, it would be of great interest to investigate a possible anticonvulsant efficacy of Valeriana officinalis with appropriate studies.

Gynecology

Surprisingly, however, there is also evidence of valerian’s effectiveness in gynecological complaints. This concerns premenstrual syndrome PMS and hot flashes caused by menopause. Positive results are provided by two randomized, double-blind, placebo-controlled trials conducted in Iran [12,13]. The team of authors led by Jenabi [12] administered either 530 mg of valerian extract or placebo twice daily for three months to 60 postmenopausal women. The frequency and intensity of hot flashes were determined using the Kuppermann index. The intensity of hot flashes was significantly lower in the verum group than in the placebo group after one month (p=0.048) and two months (p=0.020), respectively. Frequency was also significantly lower in the valerian group than in the comparison group after two months (p=0.033).

In the study by Behboodi-Moghadam et al. [13], 100 female college students suffering from PMS received either 530 mg valerian extract or placebo twice daily for three months. In the verum group, significant improvement was observed in the subjects after three months in terms of mood, behavior, and physical complaints (p<0.001). This difference was not significant in the control group. This shows that valerian can relieve various PMS symptoms.

Summary

The effectiveness of valerian against sleep disorders and anxiety has long been known. The results of studies investigating the efficacy of valerian against PMS and hot flashes caused by menopause are astonishing. For valerian preparations to become established therapy against gynecological complaints, further studies are still necessary. This also applies to a possible anticonvulsant effect of Valeriana officinalis.

Literature:

1. Mills S, Bone K: Principles and practice of phytotherapy. Modern herbal medicine, Edinburgh: Churchill Livingstone, 2000.
2. Balderer G, Borbely A: Effect of valerian on human sleep, Psychopharmacology (Berl) 1985; 87: 406-409.
3. Leathwood P, Chauffard F: Aqueous extract of valerian reduces latency to fall asleep in man, Planta medica 1985; 2: 695-699.
4. Donath F, et al: Critical evaluation of the effect of valerian extract on sleep structure and sleep quality, Pharmacopsychiatry 2000; 33: 47-53.
5. Oxman A, et al: A televised, web-bases randomised trial of an herbal remedy (valerian) for insomnia, plOs One 2007; 2: 1-10.
6. Ziegler G, et al: Efficacy an tolerability of valerian extract Li156 compared with oxazepam in the treatment of non-organic insomnia: a randomized, double-blind, comparative clinical study, Eur J Med Res 2002; 7: 480-486.
7. Thomas K, et al: Effects of valerian on subjective sedation, field sobriety testing and driving simulator performance, Accid Alan Prev 2016; 92: 240-244.
8. Savage K, et al: GABA-modulating phytomedicines for anxiety: A systematic review of preclinical and clinical evidence, Phytother Res. 2018(1); 32: 3-18.
9. Brattström A: Scientific evidence for a fixed extract combination (Ze 91019) from valerian and hops traditionally used as a sleep-inducing aid. Wien Med Wochenschr 2007, 157(13-14), 367-370.
10. Wu A, et al: Anti-epileptic Effects of Valepotriate Isolated from Valeriana jatamansi Jones and Is possible Mechanism, Pharmacogn Mag 2017; 13: 512-516.
11. Rezvani ME, et al: Anticonvulsant effect of aqueous extract of Valeriana officinalis in amygdala-kindled rats: possible involvement of adenosine, J Ethnopharmacol 2010; 127: 313-318.
12. Jenabi E, et al: The Effect of Valerian on the severity and frequency of hot flashes: A triple-blind randomized clinical trial, Women Health 2017; 16: 1-8.
13. Behboodi Moghadam Z, et al: The effect of Valerian root extract on the severity of pre menstrual syndrome symptoms, J Tradit Complement Med 2016; 6: 309-315.

HAUSARZT PRAXIS 2018; 13(3): 5-6