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  • Review Article
  • OPEN ACCESS

Herbal Plants for Mental Disorders in Sri Lanka

  • Ruwini Nishadini Senarathne1,
  • Banukie Nirosha Jayasuriya2 and
  • Shehara Lakchani Abeysinghe Gunawardana1,* 
 Author information  Cite
Future Integrative Medicine   2024;3(3):183-191

doi: 10.14218/FIM.2024.00024

Abstract

A mental disorder, also referred to as a psychiatric disorder or mental illness, is characterized by significant disturbances in an individual’s thinking, emotions, or behavior. In Ayurveda, herbal plants are used as alternative therapies for various ailments, including mental disorders. This review aims to provide a comprehensive overview of herbal medicines used in treating mental disorders in Sri Lanka. It relies on foundational books as primary sources to systematically identify and analyze the therapeutic potential of 24 traditional medicinal plants for treating mental disorders. Each plant was evaluated based on its scientific name, plant parts used, distribution in Sri Lanka, mechanisms of action, and identified phytochemicals. Furthermore, additional research was conducted using keywords such as mental disorders, herbal plants, plant distribution, phytochemicals, side effects, and mechanism of action through scientific databases. The phytochemicals present in these herbal plants possess antioxidant, anti-inflammatory, and neuroprotective properties, contributing to their potential antipsychotic activities. Trigonelline (from Abrus precatorius), bacosides (from Bacopa monnieri), asiaticoside and asiatic acid (from Centella asiatica), quercetin (from Ginkgo biloba), alliin and allicin (from Allium sativum), luteolin-7-O-glucoside (from Eclipta alba), and shogaol (from Zingiber officinale) demonstrate significant potential in modulating neurotransmitter levels, reducing oxidative stress, and alleviating symptoms associated with mental disorders such as depression, anxiety, and neurodegenerative diseases. The suggested therapeutic value of these identified herbal plants and their bioactive phytochemicals indicates the need for preserving and extensively investigating these remedies to establish their clinical effectiveness.

Keywords

Herbal plants, Mental disorders, Ayurveda, Phytochemicals, Sri Lanka, Neuroprotection, Depression, Anxiety disorders

Introduction

A mental disorder, also known as a psychiatric disorder or mental illness, is characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior.1 Genetic, environmental, and psychological factors can cause these disorders, and their symptoms and severity can vary. Millions of people worldwide are affected by mental disorders today, including anxiety disorders, depression, bipolar disorder, post-traumatic stress disorder, schizophrenia, eating disorders, disruptive behavior disorders, and various neurodevelopmental conditions. According to a survey conducted by the Institute of Health Metrics and Evaluation in 2019, approximately 970 million people worldwide, or one in every eight individuals, were living with a mental disorder.2 Anxiety and depressive disorders were found to be the most prevalent, significantly impacting global health.3 This highlights the urgent need for effective interventions and targeted strategies to address and manage mental health issues.

Despite advancements in modern medicine, herbal medicines have maintained their relevance for thousands of years, offering numerous benefits such as easy accessibility, cultural significance, personal preference, and a growing demand for natural and organic products.4 Herbal remedies and medicines are currently in high demand due to their perceived lower incidence of side effects. Additionally, herbal medicine is often used in conjunction with conventional treatments because they are believed to possess synergistic effects, enhancing the therapeutic activity of conventional drugs. Therefore, herbal therapy is commonly sought as an adjunct to conventional treatment for mental disorders.5 This review aimed to provide a comprehensive overview of herbal medicines used in treating mental disorders in Sri Lanka.

Sri Lanka is recognized as one of the world’s biodiversity hotspots, abundant with diverse medicinal plants and traditional healing systems that have long been relied upon for mental and physical well-being. According to the Department of Ayurveda in Sri Lanka, there are over 1,200 plant species with documented medicinal properties, and 174 of these plants (12%) are unique to Sri Lanka.6 Ayurvedic plants and herbs serve as alternative therapies for various diseases, including mental disorders. In Sri Lanka, mental health has become a growing concern due to the increasing number of patients with mental illnesses. In the first quarter of 2017, the following percentages of patients with mental disorders were reported in Sri Lanka: anxiety disorder (4.53%), depression (30.44%), bipolar disorder (5.2%), schizophrenia (7.72%), and disruptive behavior and dissocial disorders (1.73%).7 In traditional Ayurveda, Bacopa monnieri, Centella asiatica, Withania somnifera, Valeriana wallichii, and Aloe barbadensis have been primarily employed for treating mental disorders, particularly anxiety and depression, to reduce stress and mental fatigue. Additionally, Hypericum perforatum, Ginkgo biloba, and Rhodiola rosea have been used to treat bipolar disorder, disruptive behavior, and dissociative disorders. Valeriana wallichii, Curcuma longa, Centella asiatica, and Withania somnifera have also been reportedly used in traditional Ayurveda for treating mental disorders such as schizophrenia.7

No studies have primarily focused on reviewing the herbal plants used for treating mental disorders in Sri Lanka. Comprehensive data on plant species, the parts used, cultural practices, pharmacological action, and methods of incorporation are needed. Furthermore, most herbal plants’ therapeutic potential, central nervous system properties, and safety profile remain largely unknown. The primary objective of this study was to address the existing knowledge gap by reviewing the herbal plants traditionally used in Sri Lanka for treating mental disorders. The specific objectives include evaluating the selected medicinal plants based on their distribution within Sri Lanka, their pharmacological uses and mechanisms of action, and the phytochemicals discovered in these plants to date.

Data collection for the analysis

In this comprehensive review, data were gathered from the Library of the Faculty of Indigenous Medicine, University Colombo at Rajagiriya, Sri Lanka, and the Pallekale Provincial Ayurvedic Hospital in Kandy, Sri Lanka. A variety of books were consulted, including “Medicinal Plants Used in Ceylon” Parts I to V, “Atlas of Ayurvedic Medicinal Plants,” and “Sinhala Waidya Widya.” These texts served as foundational resources for systematically identifying and analyzing the therapeutic potential of 24 traditional medicinal plants for mental disorders. Each selected plant underwent meticulous examination, focusing on its scientific name, mechanisms of action, distribution in Sri Lanka, and discovered phytochemicals. Additionally, further research was conducted using keywords such as mental disorders, herbal plants, plant distribution, phytochemicals, side effects, and mechanism of action. This supplementary investigation utilized research articles published in scientific databases such as PubMed, Google Scholar, and Web of Science spanning from 2001 to 2023 to enhance understanding and insights into the subject matter. The flow chart below visualizes the selection process of sources used to conduct this comprehensive review (Fig. 1).

Flow chart for the selection process of sources.
Fig. 1  Flow chart for the selection process of sources.

Exploring herbal plants as biocompatible therapeutics for mental disorders

A variety of herbal plants have traditionally been utilized in the Sri Lankan Ayurvedic system to treat mental disorders, with a particular focus on managing anxiety and depression (Table 1).8–40 These remedies often combine different plant parts due to the biochemical diversity inherent in each part, whether used individually or in polyherbal blends. For example, leaves from plants such as Abrus precatorius, Asparagus falcatus, Eclipta prostrata, Sesbania grandiflora, and Foeniculum vulgare are combined to prepare mixtures prescribed for mental conditions like ‘Olmada sanni’.41 Different plant parts (leaves, roots, stems, flowers, seeds) typically contain varying concentrations and types of active compounds (phytochemicals), contributing to a wider range of therapeutic effects.41 In Sri Lanka, and herbal plants are predominantly found in dry, wet, and intermediate zones, as well as along coastal areas. While there’s been considerable research into the pharmacological mechanisms of herbal plants for managing conditions like anxiety and depression, the scientific investigation into their effects on more complex mental health disorders, such as schizophrenia, anorexia, and obsessive-compulsive disorder (OCD), is less extensive. Some herbal plants exhibit multiple antipsychotic activities, including Ginkgo biloba, Zingiber officinale, Glycyrrhiza glabra, Curcuma longa, and Centella asiatica.

Table 1

Herbal plants used in Sri Lankan Ayurveda to treat mental disorders

Plant namePart of the plantDistribution of Sri LankaAyurveda usePharmacology action/MOADiscovered phytochemicals
Abrus precatoriusRoots, leaves, and seedsWet zone (throughout plains)DepressionNot known yetAbrine, trigonelline, abrol, abrasine, precasine and precool, and amino acids.8
Acacia arabicaBark, leaves, flower, gum, rootsAlong the coastAnxietyThe potent antioxidant activity of the plant controls the oxidative stress markers in brain tissues.9Tannins, terpenoids, alkaloids, saponins, glycosides, polysaccharides, and anthraquinone.10
Allium sativumBulbDry and intermediate zonesAnxiety and depressionTreatment with a dose of 0.5 g/kg attenuated malondialdehyde levels and enhanced superoxide dismutase and glutathione peroxidase activities in the brain. Alleviates anxiety and depression related behaviors in diabetic rats possibly by attenuation of brain oxidative stress.11Alliin, allicin, ajoenes, vinyldithiins, and flavonoids such as quercetin.12
Azadirachta indicaBarkCommonly found in forest edges of the wet zoneAnxietyProduction of free radicals in the brain is increased in conditions like anxiety and depression, leading to a reduction in glutathione, a tripeptide crucial for maintaining oxidative balance and detoxifying reactive oxygen species in brain cells. The phenolic compounds in this plant have shown antioxidant properties and thereby act as antidepressants and anxiolytics.13Phenol, flavonoids, alkanes, aldehydes, ether.13
Bacopa monnieraEntire plantLow counties of Sri LankaDepression, anxietyReduce stress and anxiety by elevating mood and reducing cortisol levels.14Alkaloids (brahmine, nicotinine, herpestine, bacosides A and B), saponins A, B, and C, triterpenoid saponins, stigmastanol, β-sitosterol.14
Cannabis SativaLeavesDry zone (under strict restriction on cultivation)SchizophreniaNot knownFlavonoids, terpenoids, cannabinoids, alkaloids, glycoproteins and phytosteroids.15
Cassia auriculataEntire plantDry zoneDepressionThe ethanolic seed extract may decrease the release of cortisol or CRF or ACTH from the HPA axis and increase the level of GABA that has an inhibitory effect on HPA axis. Hence increased GABA activity leads to hindrance to the stimulation of the hypothalamus for CRF release. In turn, it decreases the release of ACTH and cortisol from the pituitary and adrenal gland respectively which helps respond to stress.16Flavonoids, tannins, lipids, polyphenols, triterpenoids and steroids.16
Centella asiaticaEntire plantVery common weed growing in waste grassy places from sea level to highest elevation.17Antidepressive, and Anxiolytic effects Bipolar diorder, and OCDInhibition of acetylcholinesterase activity, reduction of phospholipase A2 activity, and protection against ß-amyloid formation.18Asiaticoside and Asiatic acid.18
Cinnamomum zeylanicumBarkCoastal area of Sri LankaDepressionEugenol increased the expression of neurotrophic factors in the hippocampus, leading to brain cell regeneration.19Cinnamaldehyde and Eugenol.19
Curcuma longaRhizomeWet and intermediate zones of Sri LankaDepression, bipolar and OCDReduces the negative effects of swim stress on levels of serotonin, 5-hydroxyindoleacetic acid, noradrenaline, and dopamine in the body. It also decreases the increase in serotonin turnover caused by the stress.20Curcuminoids curcumin, demethoxycurcumin, and bis-demethoxycurcumin.20
Datura metelLeaves and seedsDry zoneSchizophreniaNot knownHyoscyamine, scopolamine and atropine, withanolides, daturanolone, fastusic acid, and some tropane alkaloids.21
Eclipta albaLeavesWet zoneAnxietyNot knownLuteolin, apigenin, diosmetin, buddleoside and luteolin-7-o-glucoside etc.22
Foeniculum vulgareAerial parts and seedsOnly under cultivationDepression, anxiety symptoms in postmenopausal womenCauses protective effects against stress and stress-related conditions by increasing the total neurotransmitter content and its antioxidant properties.23Trans anethole, fenchone, estragol, p-anisaldehyde, among others.23
Ginkgo bilobaLeavesNot widely spread/ Usually imported for use.Depression, acute mania, bipolar disorder, and acute or chronic schizophreniaThe antioxidant and anti-inflammatory properties contribute to reestablishing the brain homeostasis in persons with mental illnesses.24Di-trans-poly-cis-octadecaprenol, Quercetin (c), kaempferol (d), isorhamnetin (e), rutin, luteolin, delphidenon, myricetin, benzoic acid derivatives (ginkgolic acid), N-containing acids, sciadopitysin, ginkgetin, isoginkgetin, amentoflavone, bilobetin, and 5′-methoxybilobeti.25
Glycyrrhiza glabraRootDry zoneDepression, anxietyGlycyrrhizin acts as an inhibitor of 11β-hydroxysteroid-dehydrogenase type-2, which is responsible for converting cortisol to cortisone and antagonist of toll-like receptor 4.26Glycyrrhizin, glycyrrhetic acid, isoliquiritin, isoflavones, among others.27
Hamidesmus indicusLeavesWestern, central, and southern areas of Sri LankaAnxietyThe leaf extract showed facilitation of cholinergic transmission and inhibition of dopaminergic transmission.28Flavonoids, phenols, glycosides28.
Hibiscus tiliaceusFlowerVery common in low countiesPostpartum depressionPhytosterols potentially help manage or prevent postpartum depression by establishing a balance between pregnancy-related hormone levels.29Stigmasterol, stigmastadienol, and stigmastadienon.29
Passiflora incarnateAerial parts of the flowerMainly in the south coastAnxiety and Bipolar disorderAlkaloids and phenolic compounds of the flower are reportedly responsible for its anti-anxiety and sedative activity and it is mediated via its affinity to GABA - A and GABA - B receptors, and the effect on GABA uptake.30Flavonoids (apigenin, luteolin, quercetin, kaempferol); Indole alkaloids (harman, harmine, harmalol, and harmaline); Cyanogenic glycoside (yanocardin).30
Piper methysticumRootOften found in dry zoneGeneralized anxiety disorder, bipolar disorder, and schizophrenia.Modulation of GABA receptors via blockage of voltage-gated sodium ion channels, leading to a reduction in excitatory neurotransmitter release.31Lipophilic kavalactones.32
Piper retrofractumLeavesOften found in dry zoneSchizophreniaNot knownRetrofractamide A, retrofractamide B, piperine, methyl piperate, dihydropiperlonguminine and piperoside.32
Rhodiola roseaRootCostal/mountain rangesfatigue and cognitive dullnessAct as an agonist for serotonin and dopamine, due to its ability to inhibit enzyme monoamine oxidase.33Flavonoids, glycosides, phenolic compounds, and organic acids.34
Sesbania grandifloraLeavesOnly under cultivationDepression, anxietyThe triterpene exhibits a wide spectrum of anticonvulsant profile and anxiolytic activity which also affects the action of GABA and serotonin, thus responding to bodily stress.35Alkaloids, flavonoids, glycosides, triterpenoids, and saponins, among others.35
Vetiveria zizanioidesRootDry zone in Sri LankaAnxietyEnhances the cholinergic transmission in the brain by increasing the onset of sodium nitrite, which further could support the nootropic activity.36Phenolic compounds, flavonoids, sterols, saponins, tannins, glycosides, and carbohydrates.37
Zingiber officinaleRhizomeDry and wet zonesAnorexia, depressionIt is a potent stimulator of pancreatic amylase and intestinal lipase activity, decreases intestinal transit time, and increases the appetite.38 MAO-A enzyme catalyzes the deamination of the neurotransmitters (chiefly dopamine, serotonin, and noradrenaline) in the antidepressant activity of Zingiber officinale extract.39Shogaol, gingerol, trans-1,8-cineole-3,6-dihydroxy-3-O-β-d-glucopyranoside, and trans-1,8-cineole-3,6-dihydroxy-3-O-β-d-glucopyranoside, gingerenone-A, and paradols.40

ACTH, adrenocorticotropic hormone; CRF, corticotropin releasing factor; GABA, gamma-aminobutyric acid; HPA, hypothalamic-pituitary-adrenal; MOA, mechanism of action; MAO-A, monoamine oxidase; OCD, obsessive-compulsive disorder.

Mechanisms of phytochemicals and their impact on mental disorders

According to the literature, the mechanism of action of herbal plants has demonstrated effectiveness against mental disorders due to the antioxidant activity of phytochemicals and their potential impact on cellular metabolism.42 Phytochemicals in medicinal plants have been found to regulate neurotransmitter synthesis and distribution or modulate immunological functions.43 For instance, the antidepressant activity of herbal compounds is associated with their ability to counteract diverse stressors, normalize monoamine receptors, and enhance monoamine neurotransmitter levels in specific cortex regions.44 The statement from Fajemiroye et al.45 highlights that several polyphenols found in herbal plants, including curcumin, ferulic acid, proanthocyanidin, quercetin, and resveratrol, are noted for their strong anti-inflammatory and antioxidant properties. These properties are important because they contribute to the polyphenols’ effectiveness in addressing neuropathic conditions. These properties are effective in treating mental stress and mood disorders. Figure 2 represents some of the phytochemicals used in the treatment of mental disorders.

Discovered phytochemicals from herbal plants used to treat mental disorders.
Fig. 2  Discovered phytochemicals from herbal plants used to treat mental disorders.

Abrine and trigonelline are natural alkaloids found in the seeds of Abrus precatorius. Trigonelline has been studied for its antioxidant properties, which may aid in combating chronic diseases by reducing oxidative stress.46 It has also shown promise in improving cognitive function and alleviating mental disorders such as depression. Research suggests trigonelline may have neuroprotective effects, potentially preventing neurodegenerative disorders like Alzheimer’s disease.47 In contrast, abrine is toxic and serves as a defense mechanism for the plant. Due to its toxicity, abrine is not utilized for medicinal purposes.46 Alliin and allicin, found in garlic (Allium sativum), have demonstrated antioxidant, anti-inflammatory, and neuroprotective activities, which are claimed to exhibit potential antipsychotic effects. However, more research is needed to fully understand the mechanisms involved.47 Bacoside-A and B are primarily found in the leaves of Bacopa monnieri, with Bacoside-A being more pharmacologically active than Bacoside-B.48 Some studies suggest that bacosides may modulate neurotransmitter levels in brain, which are involved in mood and behavior regulation. Additionally, bacosides have been found to exhibit antioxidant and anti-inflammatory effects, which could help mitigate oxidative stress and inflammation in brain. These processes are implicated in certain mental disorders, including anxiety and depression.49

Asiaticoside and asiatic acid, primarily found in Centella asiatica, have exhibited antidepressant, anxiolytic, antioxidative, and neuroprotective activities. These compounds may regulate mood by influencing neurotransmitter activity and neuroplasticity in brain. Furthermore, they aid in reducing inflammation and oxidative stress in brain. These processes are implicated in various mental disorders, including depression and anxiety.50 Luteolin-7-O-glucoside, a flavonoid primarily found in the leaves of Eclipta alba, has shown antioxidant, neuroprotective, and anti-inflammatory activities, similar to the mechanism of asiaticoside and asiatic acid against mental disorders.51 Quercetin, a flavonoid found in the leaves of Ginkgo biloba, influences the levels of neurotransmitters in the brain, including serotonin, dopamine, and norepinephrine. This regulation of neurotransmitters can impact mood and emotional well-being, potentially leading to mood-stabilizing effects and relief from the symptoms of mental disorders.52 Shogaol, a phenolic ketone found in the rhizome of ginger (Zingiber officinale), has been found to exhibit antioxidant, neuroprotective, and anti-inflammatory activities, as well as stress reduction properties. Shogaol protects brain cells from oxidative damage and promotes relaxation, which may help individuals cope with stressors more effectively.53 However, the mechanisms of herbal plants against mental disorders have not been sufficiently evaluated by scientific methods. More research and findings are needed to fully understand their working principles.

Ayurvedic poly herbal formulations for mental disorders: Benefits and challenges

Moreover, in traditional Ayurvedic prescriptions, treatments often come in the form of poly herbal formulations, contributing to their widespread use and popularity.54 Poly herbal formulations offer distinct advantages not typically found in conventional drugs. They are known for their broad therapeutic range and effectiveness even at low doses, while still being safe at higher doses.55 This characteristic provides a superior risk-to-benefit ratio compared to conventional medications. While herbal plants have been effectively utilized in Ayurvedic practice for treating mental disorders, there are drawbacks alongside their beneficial effects. These include a lack of scientific evaluations, the potential for contamination during storage (such as fungal infection), the presence of metals that are difficult to remove (lead, cadmium, among others), and the possibility that certain plants may induce toxicity in various organs of the body.56

The therapeutic effectiveness of various natural compounds in treating mental disorders is promising, especially given their antioxidant, anti-inflammatory, and neuroprotective properties. Compounds like trigonelline, bacosides, asiaticoside, asiatic acid, and quercetin show significant potential in modulating neurotransmitter levels, reducing oxidative stress, and alleviating symptoms of mental disorders such as depression, anxiety, and neurodegenerative diseases. However, while these compounds offer substantial therapeutic potential, there are notable challenges and limitations. The lack of comprehensive scientific evaluation, risks of contamination, and potential toxicity are significant concerns that need to be addressed through further investigations.

Conclusions

In Sri Lankan Ayurvedic practice, a range of plant species is used for the treatment of mental health disorders. The growing dependence on and purported therapeutic benefits of various herbal plants and their bioactive compounds highlight the necessity for both their preservation and thorough research. To establish their clinical effectiveness, it’s essential to investigate these remedies extensively. Such studies may help in isolating and purifying the bioactive compounds, confirming the safety and tolerability of these products, and supporting the incorporation of herbal plants currently used in Ayurvedic medicine into clinical practice. Despite promising findings, the current review is limited to just 24 herbal plants, necessitating further investigation into a broader range of species. Additionally, more in-depth scientific research is needed to clarify the mechanisms of action of these plants and validate their clinical effectiveness. These efforts could offer potential solutions to the increasing prevalence of mental disorders.

Declarations

Acknowledgement

We extend our gratitude to the Library of the Faculty of Indigenous Medicine at the University of Colombo, Rajagiriya, Sri Lanka, and the Pallekale Provincial Ayurvedic Hospital in Kandy, Sri Lanka for generously providing their resources to facilitate the data collection for this review.

Funding

This research received no specific grant from any funding agency.

Conflict of interest

The authors declare that there are no conflicts of interest in the publication of this manuscript.

Authors’ contributions

Conceptualization (BJ, SG), acquisition of data (RS), analysis and interpretation of data (RS, SG), drafting the manuscript (RS), critical revision of the manuscript (SG, BJ), and study supervision (SG, BJ). All authors have made a significant contribution to this study and have approved the final manuscript.

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  • Future Integrative Medicine
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Herbal Plants for Mental Disorders in Sri Lanka

Ruwini Nishadini Senarathne, Banukie Nirosha Jayasuriya, Shehara Lakchani Abeysinghe Gunawardana
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