You don’t have to reach for medication to find relief from anxiety. Find out what natural remedies relieve anxiety and can help you, without the side effects of drugs. It’s human nature to feel anxious at certain times, like on the first day of a new job or while giving a public speech. For many people, however, those jitters don’t pass once the high-stress situation is over. If that’s true for you, you’re in good company: An estimated 19% of American adults suffer from anxiety disorders in a given year, making them the top mental health disorders in the United States. Common anxiety disorders include generalized anxiety disorder (GAD), which is marked by chronic worrying, panic disorder, or sudden attacks of panic, and phobia-related disorders, intense fear that is out of proportion to the object or situation that triggered the fear. (See MedShadow’s Anxiety Disorder Fast Facts)
The typical treatments for anxiety are medication and a type of psychotherapy called cognitive behavioral therapy (CBT). Unfortunately, only a third of individuals with these disorders receive treatment, and even when they do, it often does not work. CBT is helpful for more than 60% of people, while medication is only effective in 50% of cases. Worse, drugs frequently cause side effects and some can be risky for older people. A study, published in JAMA Psychiatry found that in 2008, 11% of women aged 65 to 80 were taking benzodiazepines. These drugs should be avoided in the elderly because have been linked to an increased risk of both falls and dementia and, according to the American Geriatrics Society. (See MedShadow’s Different side effects on seniors – who knew? and Nasty Side Effects of Psychiatric Medications)
Understandably, a lot of people with anxiety seek alternative treatment options such as herbs and other supplements. A study of over 1,000 anxiety patients, published in the journal Psychosomatics, found that 43% of the patients interviewed used a variety of complementary and alternative (CAM) treatments. Of CAM users, 21% used supplements or herbal medicine, most frequently chamomile, valerian root, St. John’s wort, lavender and kava.
While these seem to do the trick for some, they can result in serious side effects just as pharmaceutical drugs can. We talked to experts to learn about common natural approaches to anxiety relief and potential side effects to beware of.
“First of all, let’s be clear that nutritional and herbal supplements in general have very little research” supporting them, according to George M. Kapalka, PhD, clinical psychologist in Brick, N.J. and author of the book Nutritional and Herbal Therapies for Children and Adolescents: A Handbook for Mental Health Clinicians.
Kapalka also doesn’t know of any that have been tested in pregnant women, and very few studies have been done in this area with children or older adults, so there is a lack of information about how these groups may be affected.
“It would be important to discuss the use of these compounds with a healthcare provider,” says Kaushal B. Nanavati, MD, an assistant professor of family medicine and medical director of integrative therapy at SUNY Upstate Medical University in Syracuse, NY. Because of varying dosage needs for different people, as well as the risk of side effects, these treatments should not be used without professional guidance, like from a certified herbalist or a physician with special training in herbal medicine.
“It is also a mistake to mix supplements with any medications, as supplements may affect liver metabolism of various medications, including common ones like birth control pills, over-the-counter pain medications and cold remedies, making those more or less effective,” Dr. Kapalka adds.
Results of a study published in the British Journal of Clinical Pharmacology agree that herbal medicines may cause serious complications when combined with prescription drugs. The researchers reviewed published case reports of adverse reactions due to herb-drug interactions in patients taking herbs and prescribed medications. The researchers looked at 49 case reports and two observational studies with 15 cases of adverse drug reactions.
All of the patients who were diagnosed with serious heart conditions, cancer and kidney transplants were prescribed either warfarin, alkylating agents or cyclosporine. After thoroughly analyzing the data, researchers discovered that patients who took herbal medicines containing sage, flaxseed, St. John’s wort, cranberry, goji juice, green tea and chamomilla in combination with warfarin and/or statins to treat heart complications experienced serious side effects that stemmed from the herbal drug interaction.
Below are seven herbs that may help lessen anxiety if used under the care of a professional.
While a number of studies have found this herb to be an effective anxiety buster, a pooled analysis of several trials of kava for generalized anxiety disorder concluded that kava had no effect, and in fact placebos seemed to work better for generalized anxiety disorder. Kava can also be quite dangerous, which highlights the need for expert guidance with such supplements. “Up to 100 cases of liver toxicity have been reported, some requiring liver transplants,” says Dr. Kapalka, which prompted the Food and Drug Administration (FDA) to issue a consumer advisory. “Because of this, some countries restrict the sale of this supplement.” In addition, it can also cause heart problems and yellowing of the skin with prolonged use, and stomach discomfort and headaches may occur.
In spite of these concerns, in recent years kava has become popular in the United States with the opening of kava bars and kava cafes. According to Brent Bauer, MD, professor of medicine and director of the complementary and integrative medicine program at the Mayo Clinic in Rochester, Minn., a few small trials showed kava could be helpful for individuals struggling with anxiety. Bauer says he discourages patients with liver disorders from using kava. “Others might be able to use it safely for short periods of time but if someone plans to use it for more than a few weeks, I do ask them to have their liver function evaluated with a blood test just to be safe.” For other patients, Bauer says, “as with any herb, if it is strong enough to be of benefit, it is strong enough to be a risk,” and recommends consulting with your primary care physician before using kava.
Also known as winter cherry and Indian ginseng. This is a mainstay of Ayurvedic medicine, an ancient system that originated in India and has gained popularity around the world. A scientific review by Dr. Nanavati and colleagues showed ashwagandha to be effective in treating anxiety. In one study, for example, researchers used the perceived stress scale (PSS), a commonly used questionnaire on the level of stress people feel in their lives, to assess changes in stress levels before and after treatment with ashwagandha capsules or placebo capsules. Those taking ashwagandha experienced a PSS score reduction of 44%, while scores decreased by only 5.5% in participants who took a placebo. In other research, after eight weeks of treatment, individuals treated with ashwagandha had a 56.5% decrease in anxiety scores, compared to a 30.5% decline in those treated with psychotherapy. Dr. Nanavati says the herb affects pathways in the brain that influence mood.
The Natural Medicines Comprehensive Database rates ashwagandha as likely unsafe during pregnancy, noting evidence that it might cause miscarriage. And since its risks during breastfeeding are unknown, it is best to avoid it.
Also, because this and other herbs are not regulated by the FDA, there have been quality issues with many ayurvedic products. For example, a study funded by the National Center for Complementary and Integrative Health (NCCIH) found that 21% of 193 products tested contained lead, mercury, and/or arsenic levels that were higher than what’s considered safe for humans. Among the products containing metals, 95% were sold by U.S. websites.
Inositol is sometimes referred to as vitamin B8. The body makes inositol on its own, and we also get it from foods such as fruits, beans, nuts and grains. There is some evidence that supplementation with capsules or powder may improve anxiety, explains Dr. Kapalka.
A small study published in The American Journal of Psychiatry found that patients with panic disorder who took 12 grams of inositol every day for a month had fewer and less severe panic attacks and less severe agoraphobia (intense fear and anxiety of being outside or in places difficult to escape, such as crowds) compared to patients taking a placebo. In another small study also in The American Journal of Psychiatry, researchers gave 18 grams of inositol per day to patients with obsessive-compulsive disorder (OCD), for whom medications did not work well enough or caused unacceptable side effects. After six weeks, improvements in patients taking inositol were equal to improvements seen with the antidepressants Prozac (fluoxetine) and fluvoxamine, and significantly greater than placebos.
Side effects may include gastrointestinal distress and gassiness, though these are generally only temporary. Inositol should not be used by women who are pregnant or may become pregnant in the near future. “It is also possible that – like antidepressants – it may increase suicidal thoughts in those with some suicidal tendencies,” says Kapalka.
4. St. John’s Wort
Though this is the most well-established supplement for depression, study results for its effectiveness have been inconsistent. In a trial funded by the National Institutes of Health researchers compared St. John’s wort to a placebo for treating moderate major depression and found no differences in outcomes between the two. Some evidence suggests that it may help to relieve anxiety, according to Dr. Kapalka, but studies specifically testing its effect on anxiety are limited. A study in the journal Phytomedicine determined that St. John’s wort may improve anxiety if taken in combination with the herb valerian.
Side effects can include anxiety, dry mouth, dizziness, gastrointestinal symptoms, fatigue, headache, or sexual dysfunction. St. John’s wort may also cause increased sensitivity to sunlight, so people taking it should be sure to use sunblock.
“Some diets may combine with St. John’s wort to produce cardiac changes, says Kapalka, “so it is important to monitor heart rate and blood pressure – especially after meals – early in treatment to discover possible sensitivities.” For example, you should avoid foods high in tyramine while taking St. John’s Wort so that you do not risk the chance of hypertensive [high blood pressure] events. Such foods include aged meats and cheeses, red wine and overripe avocados.
St. John’s wort is known to interfere with a number of medications. For example, it makes birth control pills less effective, which has led to unintended pregnancy. It can also interfere with antiviral medications, antidepressants and certain antiseizure medications.
St. John’s wort is not well-studied in pregnant women so caution is warranted on its use in pregnancy and breastfeeding. It is known to interfere with absorption of iron, which is an important mineral for pregnant women and their fetus. (See MedShadow’s “It’s a Gamble:” St. John’s Wort, Depression and Drug Interactions)
Many people are aware that melatonin can relieve insomnia, but it could also be effective in quelling anxiety. “Melatonin may have some benefit for preoperative anxiety as well as postoperative anxiety,” Dr. Nanavati stated. A variety of research has reported anxiety-decreasing effects of melatonin in patients undergoing a range of surgical procedures, such as gallbladder surgery, abdominal hysterectomy, cataract surgery, hand surgery and more, as described in a review published in the British Journal of Anaesthesia.
A Cochrane review looked at 12 studies on melatonin compared to placebo or the benzodiazepine midazolam (Versed) for preoperative and postoperative anxiety. Overall, melatonin appeared to reduce preoperative anxiety better than placebo and as well as midazolam. Melatonin’s benefits for reducing anxiety postsurgically were mixed.
In a study published in the Annals of Pharmacotherapy, researchers gave patients either melatonin or the benzodiazepine oxazepam to help manage sleep and anxiety following a heart attack and subsequent heart procedure. Melatonin showed a significant advantage over oxazepam in improving sleep and lowering anxiety levels. The researchers concluded that melatonin could be considered a new alternative to benzodiazepines in this setting.
Some of the mild side effects reported in studies include headache, dizziness, nausea and sleepiness. “There are no significant safety concerns regarding short-term use, though there is uncertainty of side effects with long-term use,” Nanavati cautions.
For centuries, people have reported that valerian is useful as a sedative. Valerian is a common ingredient in sleep aid products, although studies on the herb’s usefulness have been inconclusive and of poor quality.. The few small trials that have been done on valerian for anxiety symptoms did not produce clear indications of effectiveness. In a very small trial published in Phytotherapy Research valerian was compared to diazepam (Valium) or placebo in GAD patients. After four weeks, valerian and diazepam both appeared to provide some benefits in mental agitation and psychological distress. However, the study authors considered the results preliminary, requiring further study to come to any conclusions since the number of people in each group was so small.
Though experts aren’t sure exactly how valerian causes sedation, it may boost levels of a brain chemical called gamma aminobutyric acid (GABA). This is the same chemical that is increased by medications like alprazolam ( Xanax) and diazepam. “If used during the day, drowsiness is very likely, and gastrointestinal upset, headaches and heart dysrhythmias have been reported,” says Dr. Kapalka. There may also be a risk of liver damage, though this outcome is rare and may not actually be related to valerian use. People should avoid alcohol while taking this herb because it also causes sleepiness. Valerian can also interfere with iron absorption.
Some research supports the effectiveness of this herb in various forms for anxiety reduction, but “the data is limited due to poor quality in methodology in a few of the studies,” Dr. Nanavati notes. In a few studies, however, lavender oil taken in capsule form was more effective than both placebo and the standard anxiety medication lorazepam (Ativan).
An analysis published in The Mental Health Clinician reviewed the results of five trials of an oral lavender oil preparation for GAD, mixed anxiety and depression, and other nonspecified anxiety disorders. After six to ten weeks, all the trials showed some improvement in anxiety scores for patients taking lavender.
In one of the studies lavender oil was compared to a placebo or paroxetine (Paxil) for GAD. The group taking lavender showed a greater reduction in anxiety scores than those experienced by patients taking a placebo. Benefits for paroxetine were not significantly different from placebo benefits. Side effects for lavender were lower than paroxetine and about the same as the placebo.
“There are safety concerns with the use of lavender especially when taken as a tea or extract, as this can cause constipation, headache and changes in appetite.” It can also increase drowsiness if used in combination with sedatives. And it should be used with caution in essential oil.
Other possible natural anxiety relievers include tryptophan, theanine, ginger, passionflower and chamomile, Dr. Kapalka mentioned, though, again, research findings are scarce, and their use must be explored with an experienced healthcare provider to ensure proper dosing and to minimize side effects.
Tori Rodriguez, MA, LPC, AHC, is an Atlanta-based journalist, licensed psychotherapist and Ayurvedic health coach, creator of the body-positive wellness company Bettie Page Fitness, and author of two books – The Little Book of Bettie: Taking a Page from the Queen of Pinups and Bettie Page: The Lost Years. She holds a BS in psychology from Georgia State University and an MA in counseling psychology from the Georgia School of Professional Psychology. Tori has also managed a medical practice and was instrumental in developing Georgia’s multi-specialty telemedicine program. Photo courtesy of Brooklyn Brat Images