Adaptogenic Effects of Ginseng on Stress-related Disorders
Stress has adverse health effects. For example, chronic stress can lead to depression or anxiety. Ginseng (Panax ssp., Araliaceae) root is an adaptogen that is used “to cope with day-to-day and/or workplace stress.” The constituent ginsenosides of ginseng have been shown to have a wide range of biological activities, including anti-inflammatory, antioxidant, and neuroprotective properties. The purpose of this narrative review is to describe how ginseng modulates the biochemical and physiological changes associated with stress and how it can be used as a potential treatment for stress-related disorders such as anxiety and depression.
The HPA regulates secretion of the hormones cortisol and estrogen. Cortisol release is associated with stress, and prolonged cortisol secretion causes immunosuppression and alters metabolism. The effects of estrogen decrease the risk of cardiovascular disease, stroke, and osteoporosis. Other diseases associated stress and hormonal imbalance are type 2 diabetes mellitus, rheumatoid arthritis, erectile dysfunction, and allergic asthma. Ginseng may have therapeutic benefits for all of the aforementioned conditions.
This report provides a top-line summary of the effects of ginseng in vivo and in vitro. The key points are as follows.
Depression and anxiety: In animal models of depression and anxiety, ginseng was equally effective as the antidepressant fluoxetine. Depression is associated with neuronal damage, increased levels of the proinflammatory cytokine interleukin-6 (IL-6), and memory loss. Ginseng is neuroprotective, inhibits IL-6, and enhances memory in elderly patients.
Cardiovascular disease (CVD): Ginseng may help prevent CVD by acting as an antioxidant, improving vasomotor function, and preventing blood clots. In vivo, ginseng decreased levels of reactive oxygen species in myocardial tissue and improved blood circulation.
Stroke: Ginseng suppressed oxidative stress-induced ischemia and the production of pro-inflammatory cytokines, and decreased neuronal necrosis.
Osteoporosis: In vitro, ginseng upregulated estrogen receptor expression in various types of tissue, promoted osteogenesis in bone marrow cells, inhibited receptor activation of nuclear factor kappa-B ligand, nuclear factor kappa-light-chain-enhancer of activated B cells, c-Jun N-terminal kinases, c-Fos, nuclear factor of activated T cells cytoplasmic 1 (NFATc1), tumor necrosis factor alpha (TNF-α), and IL-6. Further research is needed to determine the mechanism by which ginseng regulates osteoclast differentiation and bone resorption.
Rheumatoid arthritis (RA): RA is an inflammatory autoimmune disorder. Ginseng may help prevent RA by inhibiting TNF-α, the major pro-inflammatory cytokine.
Erectile Dysfunction (ED): In vivo studies suggest that ginseng may have a beneficial effect in the treatment of ED with no adverse events.
Type 2 Diabetes Mellitus (T2DM): The authors state that ginseng regulates glucose and lipid metabolism and supplies energy to the body to regulate fat cells. T2DM is associated with stress; accordingly, ginseng is more effective in patients with T2DM rather than type 1 diabetes. [Note: the authors do not say anything more about the research.]
Allergic asthma: Ginseng may help alleviate allergic asthma by activating the mitogen-activated protein kinase (MAPK) pathway, thereby functioning as an anti-inflammatory agent, and inhibiting the cluster of differentiation 40 (CD40) signaling that activates antigen-presenting T cells. The authors state that ginseng is effective for the treatment of allergic asthma caused by problems with the Th2-predominant T cell response.
In summary, the authors postulate that stress-induced anxiety and depression can promote inflammatory responses and that increased levels of inflammatory cytokines and oxidative stress lead to disorders such CVD, stroke, osteoporosis, RA, ED, and allergic asthma. There is experimental evidence that ginseng ameliorates some of the negative effects of stress. Although clinical evidence is lacking, the authors assert that ginseng may suppress the chronic inflammation caused by stress-induced anxiety and depression. The authors conclude that a better understanding of the mechanism of action of ginseng will help facilitate the development of treatments for numerous psychological and physical diseases.
This report is limited by the design. It is a narrative review rather than a systematic review. The authors do not describe any specific study details and many of the statements are not supported by scientific references. The authors declare no conflicts of interest. The study was funded by the National Research Foundation and by a grant from the Korean Society of Ginseng funded by the Korean Ginseng Corporation.
Lee S, Rhee D-K. Effects of ginseng on stress-related depression, anxiety, and the hypothalamic-pituitary-adrenal axis. J Ginseng Res. 2017;41:589-594. doi: 10.1016/j.jgr.2017.01.010.