It is 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 18% of American adults suffer from anxiety disorders in a given year, making them the top mental health disorders in the United States. The most common type is generalized anxiety disorder (GAD), which is marked by chronic worrying.
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, these drugs frequently cause side effects.
Understandably, a lot of people with anxiety seek alternative treatment options such as herbs and other supplements. 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, MS, a professor in the Department of Professional Counseling at Monmouth University in New Jersey 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, a professor at the State University of New York (SUNY) Upstate Medical University, and director of integrative medicine at SUNY’s Upstate Cancer Center. 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.
Below are 7 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, it can also be quite dangerous, which highlights the need for expert guidance with such supplements. “Over 60 cases of liver toxicity have been reported, some requiring liver transplants,” says Dr. Kapalka, which prompted the FDA to issue a consumer advisory. “Because of this, some countries restrict the sale of this supplement.” In addition, it can also cause yellowing of the skin with prolonged use, and stomach discomfort and headaches may occur.
Also known as Winter Cherry and Indian Ginseng. This is a mainstay of Ayurveda, an ancient system of medicine 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, it led to a score reduction of 44% on the Perceived Stress Scale, while scores decreased by only 5.5% in participants who took a placebo. In other research, 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.
Healthline.com says that it can cause early delivery so pregnant women should avoid it, but there isn’t a link to a study or authority to verify. Also, because the herb is not regulated by the FDA, there have been issues with some ashwagandha products. For example, a study funded by the National Center for Complementary and Integrative Health found that 21 of 193 products had lead, mercury, and/or arsenic levels that were able what’s safe for humans.
This “is a nutrient we get from our diet, but supplementation with capsules or powder has been found to improve anxiety in some studies,” explains Dr. Kapalka. The best food sources of inositol are beans, fruits (especially fresh versus frozen or canned), nuts and grains. 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.”
4. St. John’s Wort
Though this is the most well-established supplement for depression, some evidence suggests that it may also help to relieve anxiety, according to Dr. Kapalka. Upset stomach is the most common adverse effect, and sun sensitivity is another potential side effect, so people taking it should be sure to use sunblock. “Some diets may combine with St. John’s wort to produce cardiac changes, so it is important to monitor heart rate and blood pressure – especially after meals – early in treatment to discover possible sensitivities.” Pregnant women should avoid this herb.
For example, you should avoid foods high in tyramine while taking St. John’s Wort so that you do not risk the chance of a hypertensive events. Such foods include aged meats and cheeses, red wine and overripe avocados.
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. “There are no significant safety concerns regarding short-term use, though there is uncertainty of side effects with long-term use,” he cautions.
For centuries, people have reported that valerian is useful in decreasing anxiety. Though experts aren’t sure exactly how it works, 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 (brand name Xanax) and diazepam (brand name Valium). “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 recent studies, however, lavender oil taken in capsule form was more effective than both placebo and the standard anxiety medication lorazepam (brand name Ativan). “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.
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 is an Atlanta-based journalist, psychotherapist & health coach