NANA KHACHAPURIDZE Professor, Tbilisi State Medical University, Department of Pediatric Neurology
TREATMENT OF PSYCHOVEGETATIVE
DISORDERS WITH VAMELAN
The tensioned lifestyle, time deficiency, overload of the information leads to health problems. One of the most widespread displays of such influence is so-called psychovegetative disorders.
According to various authors the prevalence of psychovegetative disorders is 10-20% in the population. Most frequent symptoms incorporated under this disorder are anxiety, tension, sleep disturbances, irritability and inadequate emotional reactions. Paroxysmal psychovegetative manifestations in the form of phobias and panic attacks are also frequent. Clinical researches revealed that patients with permanent or paroxysmal psychovegetative disorders have higher cholesterol level in the blood and there is higher risk of hypertension, myocardial infarction and stroke development among such patients.
The comparative study showed that suicide rate among the patients with psychovegetative disorders is 20 %, while the rate is 6% in the patients with other disorders. Suicidal tendency is especially expressed in patients with episodic panic attacks and longstanding psychovegetative disorders with superimposed depression.
The adequate treatment of these disorders has not only medical, but also the social importance, because there is higher incidence of alcoholic and benzodiazepines abuse among such patients. 24, 3% of patients with psychovegetative disorders frequently use alcohol and 8,7 % are alcohol dependent. 26% of these patients abuse benzodiazepines and 17% other narcotic drugs.
The exact causative factor of psychovegetative disorders is not known. The role of personal characteristics is great. Disorder of adrenergic regulation is under discussion. Locus ceruleus as one of supersegmentary structures of vegetative nervous system plays an important role in the regulation of the behaviour and vegetative functions.
Clinical research revealed that anxiety disorders is caused by sympathetic hyperactivity.
Neurotransmitter disturbances in the different parts of the central nervous system play the main role in the development of psychovegetative disorder. The anxiety disorders are caused from the dysfunction of the limbic system. Reticular formation with its connections with vegetative nervous system has the regulatory function. It is worth to mention that peripheral vegetative system not only displays the symptoms of the disorders, but also plays the main role in their development. In the beginning of the disorder anxiety is developed and expressed on the periphery of the nervous system and the central nervous system mechanisms are involved only in longstanding disease.
Based on the specific pathogenesis of the disorder, the main medications for its treatment are benzodiazepine derivatives. This treatment method is far not the ideal choice, because of its side effects such as drowsiness, decreased attention and concentration, coordination disturbances, which lead to decreased working capacity of the patient and development of drug dependence.
It is remarkable, that various psychotherapeutic methods are used, in particular, rational and cognitive therapy, psychosemantic correction method, biological feedback, etc. However, these methods require qualified psychotherapist and also there is some fair of nervous profile physicians among the population, and at last these methods are not indicated for the treatment of mild forms of the disease. In such not very severe cases it is important to choose medication which has fewer side effects affecting cognitive and psychic functions. Nonchemical herbal preparations belong to this kind of medicines. The choice of the medicine depends on the duration of the disease and the anxiety level. For the short-term, subsyndromal and mild anxiety disorders the herbal preparation Vamelan is recommended.
Vamelan is presented with gelatinous capsules and contains valerian extract 125 mg, balm 25 mg, and dry extract of mint 25 mg.
Conducted placebo controlled clinical trials showed the effectiveness of Vamelan in the treatment of anxiety disorder of the psychovegetative disease.
It is worth to describe mechanisms of action of components of the Vamelan.
Valerian extract has sedative, hypnotic and mild anticonvulsive effects. On the basis of double blind placebo controlled randomized trials it is proved that valerian improves sleep, shortens sleep initiative period and increase total sleep duration. It`s effect on the sleep patterns begins in two weeks after initiation of the treatment.
In double placebo controlled group of the clinical trial which received valerian extract, duration of slow sleep phase was increased and first phase was shortened while the REM sleep was unchanged. Valerian affects sleep patterns only in patients with insomnias; it has no effect on sleep of normal individuals.
Research study proved positive influence of valerian on both psychic and somatic (vegetative) symptoms. Also it is revealed that valerian has no effect on the metabolism of other medications. It has mild anxiolytic effect, is safe and has no side effects. All mentioned makes this medication the best drug to use widely for stress induced psychovegetative reactions, especially in sensitive groups of patients such as adolescent and elderly population.
The basic active substance of an extract of mint peppery is presented by ether oils main components of which are menthol and its stereoisomers (neomenthol, isomenthol, menthon, menthin acetate, menthofuran, cineol and limonen). Mint is used for symptomatic treatment of digestive tract disorders, such as dyspepsia, flatulence, gastritis, enteritis. The alcohol extract of mint peppery possesses spasmolytic action, shows bile drainage stimulating action.
The main active component of balm is ether oils, which contains monoterpenoid aldehyde, flavonoids, derivatives of hydroxibroun acid. Ether oils has spasmolytic effects, lyophilised waterethenol extract have sedative effect. With large doses it has peripheral analgesic effect.
During the conducted clinical trials patients’ clinical neurologic status, vegetative nervous system status, sleep and life quality were evaluated and all data were recorded. The main clinical complaints were anxiety, imitativeness, tension, and phobias. Reactive anxiety lessened after one week of treatment with Vamelan, then imitativeness, breathlessness and psychogenic cardialgia decreased. With the treatment process anxiety was ameliorated and this effect was in connection with the duration of treatment.
Hence Vamelan is effective medication for treatment of phsychvegetative disorders. It decreases reactive and personal anxiety, sleep disturbances, depression. These effects prove anxiolitic and vegetative effects. All mentioned gives basis for usage of Vamelan in the treatment of psychovegetative disorders in the following situations:
- Neurotic disorders with anxiety, asthenia, vegetative dysfunctions and sleep disturbances;
- In the cases where benzodiazepines are contraindicated (younger age, liver or kidney dysfunctions etc.);
- After withdrawal of benzodiazepines;
- For the acute stress disorders.