SILEDIN
in Psychiatric Practice
By
K. BHUJANGA RAO, M.D.
Professor & Head of the Department
of Psychiatry
and
M. URMILA DEVI, M.B.B.S.
Tutor in Psychiatry
Guntur Medical College & Government
General Hospital Guntur (A.P.)
INTRODUCTION
Pharmacotherapy has strengthened the hands of
the Psychiatrist and the greater the spectrum of drugs, easier is his task.
Phenothiazine derivatives, butyrophenones, benzodiazepine compounds, monoamine
oxidase (M A 0) inhibitors, imipramine group of drugs, lithium salts and other
drugs are now extensively used in Psychiatric practice. Most of these drugs
have side effects which become more pronounced on long term use; and
unfortunately, a long-term therapy is necessary for any appreciable recovery in
psychiatric conditions. So far, no ideal drug as to efficacy and safety has
been found. Electro Convulsive Therapy (ECT) either alone or in combination
with psychotherapeutic drugs, was greeted with very high hopes when it was
introduced, but the enthusiasm is waning because of the various drawbacks of E C T which
are being known now. With these things
in view, we decided to try an Ayurvedic drug, Siledin(Alarsin),
which is a herbal preparation. Previous studies on Siledin by Dhairyam (1949) and
Vahia et al (1962) showing the efficacy
and high margin of safely was an encouragement to us to
independently assess the usefulness of
this drug in various Psychiatric illnesses.
SILEDIN
Siledinis described as a
herbal tranquillizer, liver corrective and devoid of any side effects. Its
indications are mentioned as: sleeplessness, various psychiatric conditions,
irritability and as a follow-up therapy after discharge from a Psychiatric
clinic or a Hospital, etc.
Each Tablet of Siledin contains:
Chandrika - 210.0
mg
Shankhapushpi - 70.0 mg
Bhringraj - 52.0
mg
Brahmi - 35.0
mg
Kamboji - 17.5
mg
Vacha -
18.0 mg
Jeevanti - 17.5 mg
MATERIAL AND METHOD
The trialwas carried out in 90 patients, with various Psychiatricillnesses, who attended the outpatientdepartment of psychiatry, at Government GeneralHospital, Guntur, Andhra Pradesh, fromJanuary 1976 to
September 1976. The patients
were thoroughly examined after a detailed
interview. Routine investigations to rule
out the possibility of organic factors in these cases were
done as and when necessary.
|
Sr. No |
|
Male |
Female |
Total |
|
1 |
Schizophrenic
Reactions |
15 |
12 |
27 |
|
2 |
Maniac Depression
reactions (Maniac Phase) |
8 |
3 |
11 |
|
3 |
Reactive Depression |
2 |
4 |
6 |
|
4 |
Neurotic Depression |
3 |
7 |
10 |
|
5 |
Anxiety Neurosis |
17 |
13 |
30 |
|
6 |
Obsessional Neurosis |
2 |
4 |
6 |
|
|
|
47 |
43 |
90 |
TABLE – 1
Showing the various diseases taken up for this study
The subjects under study were divided into 4 groups, viz
1. Group I ---- 15 Patients ------ Kept on placebo (Placebo
being yeast tablets)
2. Group II ----- 25 Patients ------ Patients who were treated by other drugs
previously with
poor response and were kept on 'Siledin' with preceding
drug,
free of 4 weeks.
3. Group III ------ 25 Patients ------
Cases kept on Siledin as first drug.
4. Group IV ------- 25 Patients ------ Kept on Siledin + Minor tranquillizers
Groups 2, 3 & 4 kept were on an initial doseof SILEDIN 1 t.i.d. to a
maximum of 4 t.i.d, depending upon the severity of the illness. The accurate
intake of the drug was ensured at the hospital as well as at home with the help
of a reliable relative. Response to the drug is assessed at the end of every
week till 6 weeks.
The results are graded as : -
1. Excellent – Full or over 75% recovery.
2. Good – 50-75%
3. Fair – 25-50%
4. Poor – upto 25% no improvement
It was observed that 15 cases of the 1st Group (kept on
placebo) did not show any remission and they were treated by different lines of
treatment after a fortnight. The response to the drug was noticed in 75 cases
at the end of the 2nd week, reaching a maximum after 4 weeks.
|
Showing results on the
basis of assessment
|
|
|
TABLE - 2
In certain cases it is felt by the
investigator to keep initial dose of the drug 4 t.i.d. for obtaining a quick
response. Thus in a patient from Group "2" with Maniac states, responded
readily with SILEDIN 4 t.i.d. and he continued to be symptom free with a
maintenance dose of 2 tablets at bed time. In
another case in the same group "2" who refused treatment previously due to ECT
Phobia {fear for Electroconclusive Therapy) response was good with a higher
initial dose.
More than 50% at the sample under study showed
considerable improvement as observed elsewhere (Agarwal S.P. 1968, Hakim R.A.
1953). In the present series Anxiety states responded best (92%). Schizophrenic
reactions and Maniac states were the next better responded (72%, 66% respectively).
Out of 12 cases of depressions, (Neurotic and Reactive types.) Neurotic
depressions showed better response. This isolated response of Neurotic
depression alone may be due to Neurotic element or Depressions and not due to
depression phase. Obsessional Neurosis did not respond to the drug. Combination
of E.C.T. (Electro Convulsive Therapy) is purposely avoided in order to assess
the accurate response to this drug SILEDIN. The percentage of response observed
in psychotic states viz., Schizophrenic and Maniac states (70%) is of
considerable significance in the sense that "SILEDIN" does possess certain
anti-psychotic properties. Absence of side effects, in this study concurs with
previous studies (Agrawal S. P. 1968). Addition of other tranquillizers did not
accelerate the efficacy of "SILEDIN"On the other hand drowsiness was a
distressing disadvantage.
SUMMARY
Psychotropic effect of SILEDIN (Alarsin) a
herbal preparation was studied in 90 cases of various Psychiatric illnesses for
a period of 9 months with comparison of placebo (15:75) in the Psychiatric
Department, Government General Hospital, Guntur with encouraging results except
in obsessional Neuroses.
CONCLUSION
I.
"SILEDIN" (Alarsin) an indigenous
herbal preparation appears to be a potent anxiolytic and moderately potent antipsychotic
drug.
II.
Neurotic element in
depressions responded better than other Depressive reactions in this study.
III. It is free from side effects and toxicity.
IV. She drug can be safely administered in the house thus reducing the
problem of hospitalizations.
V.
The remission of symptom is
dose related.
VI. Addition of other Psychotropic drugs did not influence the efficacy of
the drug.
VII. Encouraging results were observed in cases which were refractory to other
methods of treatment.
VIII. It is cheaper and within the reach of a common man.
ACKNOWLEDGEMENT
We wish to thank the Superintendent
Govt. General Hospital, Guntur for permitting to publish the article. We are
grateful to M/s. ALARSIN Pharmaceuticals of Bombay for free and liberal supply of the drug for the study.
REFERENCES
1. Agarwal S.P (1968) – " The General Practitioner as a Psychiatrist"
paper read at the 44th All India Medical Conference, Allahabad,
1968.
2. Bagadia et al (1962) – Preliminary report of an indigenous drug, acorus
calamus in Psychiatric disorders. Indian Journal of Psychiatry, June 1962.
3. Hakim R.A (1953) – Indigenous drugs in treatment of Mental diseases, paper
read at 6th Gujarat & Saurashtra Medical Conference, Baroda.
4. Kale B.S (1961) – Paper read at 14th Annual meeting of the Indian
Psychiatric Society of Ranchi, March 1961.