Depression and Its Phytopharmacotherapy-A Narrative Review.

Depression is a mental health disorder that develops as a result of complex psycho-neuro-immuno-endocrinological disturbances. This disease presents with mood disturbances, persistent sadness, loss of interest and impaired cognition, which causes distress to the patient and significantly affects the ability to function and have a satisfying family, social and professional life. Depression requires comprehensive management, including pharmacological treatment. Because pharmacotherapy of depression is a long-term process associated with the risk of numerous adverse drug effects, much attention is paid to alternative therapy methods, including phytopharmacotherapy, especially in treating mild or moderate depression. Preclinical studies and previous clinical studies confirm the antidepressant activity of active compounds in plants, such as St. John's wort, saffron crocus, lemon balm and lavender, or less known in European ethnopharmacology, roseroot, ginkgo, Korean ginseng, borage, brahmi, mimosa tree and magnolia bark. The active compounds in these plants exert antidepressive effects in similar mechanisms to those found in synthetic antidepressants. The description of phytopharmacodynamics includes inhibiting monoamine reuptake and monoamine oxidase activity and complex, agonistic or antagonistic effects on multiple central nervous system (CNS) receptors. Moreover, it is noteworthy that the anti-inflammatory effect is also important to the antidepressant activity of the plants mentioned above in light of the hypothesis that immunological disorders of the CNS are a significant pathogenetic factor of depression. This narrative review results from a traditional, non-systematic literature review. It briefly discusses the pathophysiology, symptomatology and treatment of depression, with a particular focus on the role of phytopharmacology in its treatment. It provides the mechanisms of action revealed in experimental studies of active ingredients isolated from herbal antidepressants and presents the results of selected clinical studies confirming their antidepressant effectiveness.

Optimization of lidocaine application in tumescent local anesthesia.

Tumescent local anesthesia is based upon the infusion of large volumes of neutralized anesthetic solutions, mainly lidocaine, at very low concentrations. This results in the paralysis of sensory nerve endings and minute nerve twigs, leading to a reduction in pain. The aim of this study was to assess the safety of lidocaine application in tumescent local anesthesia on different regions of patient's bodies. Measures of safety included the analysis of lidocaine concentrations and its pharmacokinetic parameters. In total, 48 patients were infused with tumescent anesthesia in the hypogastrium, buttocks and thighs, axillae, breasts, trunk, and face and neck areas. Lidocaine was infused in doses ranging from 5.2-40 mg/kg b.w., and in concentrations of 0.05% (hypogastrium, buttocks, thighs) or 0.1-0.15% (axillae, breasts, trunk, face, neck), using a total amount of 300-3200 mg. As the peak lidocaine concentration did not exceed 5 microg/ml (commonly known as the toxic threshold), the results of our study indicate that the doses used (not exceeding 40 mg/kg b.w.) are completely safe for patients undergoing tumescent anesthesia in different body areas. The observation of statistically significant correlations between both the dose and the total amount of lidocaine administered and its peak plasma concentration, together with the lack of correlations between the dose and the amount and the time taken to reach peak concentration, allows the safety of each anesthetic dose to be predicted. An analysis of the heterogeneous dynamics of lidocaine plasma concentration changes in tumescent anesthesia in different body areas indicates that both the rates and the degrees of absorption and elimination depend on the area of infiltration; this is in turn related to the vascularization of any given area. The study of lidocaine concentration and pharmacokinetic parameters also showed that there may potentially be a higher risk of a large anesthetic concentration developing within a short period of time during anesthesia of the upper parts of the body. During tumescent anesthesia, significantly higher plasma concentrations of lidocaine were observed in the face and neck than in the hypogastrium, buttocks and thighs, axillae, breast and trunk 0.5 to 4 h after its infusion. This indicates the need for carefully conducted patient observations immediately after infiltration into the aforementioned areas.