Anxiety

Also indexed as: Nervousness, Panic Attacks

Take control of anxiety and get on with life. Some anxiety is normal—but it shouldn’t interfere with your ability to function. According to research or other evidence, the following self-care steps may be helpful:

Address your stress
Reduce stress with meditation, counselling, and other methods

Avoid caffeine
If you are anxious, avoid stimulants such as caffeine

Try valerian and passion flower
Calm the nervous system by taking an herbal combination of valerian (100 to 200 mg) and passion flower (45 to 90 mg) three times a day

Aim for better nutrition with a multivitamin
Taking one a day may help reduce anxiety and feelings of stress

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full anxiety article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About anxiety

Anxiety describes any feeling of worry or dread, usually about events that might potentially happen. Some anxiety about stressful events is normal. However, in some people, anxiety interferes with the ability to function.

Some people who think they are anxious may actually be depressed. Because of all these factors, it is important for people who are anxious to seek expert medical care. Natural therapies can be one part of the approach to helping relieve mild to moderate anxiety.

Product ratings for anxiety

Science Ratings	Nutritional Supplements	Herbs
	Inositol Multivitamin-mineral	Passion flower (in combination with valerian) Valerian (in combination with passion flower)
	Magnesium Vitamin B3 (niacinamide)	American scullcap Bacopa Chamomile Hops Linden Motherwort Oats (oat straw) Pennyroyal St. John’s wort Wood betony
See also: Homoeopathic Remedies for Anxiety
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Physical symptoms of anxiety include fatigue, insomnia, stomach problems, sweating, racing heart, rapid breathing, shortness of breath, and irritability.

Medical options

Prescription drug treatment includes anti-anxiety agents such as lorazepam (Ativan®), alprazolam (Xanax®), and buspirone (Buspar®). Antidepressants, such as fluoxetine (Prozac®), paroxetine (Paxil®), and venlafaxine (Effexor®), are often prescribed to treat generalized anxiety and panic attacks.

Underlying medical conditions, such as excess hormone secretion from the thyroid or adrenal glands, should be treated when present. Psychological counselling often accompanies drug therapy.

Dietary changes that may be helpful

All sources of caffeine should be avoided, including coffee, tea, chocolate, caffeinated sodas, and caffeine-containing medications. People with high levels of anxiety appear to be more susceptible to the actions of caffeine.¹

Vitamins that may be helpful

Inositol has been used to help people with anxiety who have panic attacks. Up to 4 grams three times per day was reported to control such attacks in a double-blind trial.² Inositol (18 grams per day) has also been shown in a double-blind trial to be effective at relieving the symptoms of obsessive-compulsive disorder.³

An isolated double-blind trial found that supplementation with a multivitamin-mineral supplement for four weeks led to significant reductions in anxiety and perceived stress compared to placebo.⁴

Many years ago, magnesium was reported to be relaxing for people with mild anxiety.⁵ Typically, 200 to 300 mg of magnesium are taken two to three times per day. Some doctors recommend soaking in a hot tub containing 1–2 cups of magnesium sulphate crystals (Epsom salts) for 15 to 20 minutes, though support for this approach remains anecdotal.

Niacinamide (a form of Vitamin B3) has been shown in animals to work in the brain in ways similar to drugs such as benzodiazepines (Valium®-type drugs), which are used to treat anxiety.⁶ One study found that niacinamide (not niacin) helped people get through withdrawal from benzodiazepines—a common problem.⁷ A reasonable amount of niacinamide to take for anxiety, according to some doctors, is up to 500 mg four times per day.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Several plants, known as “nervines” (nerve tonics), are used in traditional herbal medicine for people with anxiety, with few reports of toxicity. Most nervines have not been rigorously investigated by scientific means to confirm their efficacy. However, one study found that a combination of the nervines valerian and passion flower reduced symptoms in people suffering from anxiety.⁸ In a double-blind study, 45 drops per day of an extract of passion flower taken for four weeks was as effective as 30 mg per day of oxazepam (Serax®), a medication used for anxiety.⁹

Other nervines include oats (oat straw), hops, passion flower, American scullcap, wood betony, motherwort, pennyroyal, and linden.

Bacopa, a traditional herb used in Ayurvedic medicine, has been shown to have anti-anxiety effects in animals.¹⁰ A preliminary study reported that a syrup containing an extract of dried bacopa herb reduced anxiety in people with anxiety neurosis.¹¹ A double-blind trial in healthy adults found that 300 mg per day of a standardised bacopa extract reduced general feelings of anxiety, as assessed by a questionnaire.¹²

St. John’s wort has been reported in one double-blind study to reduce anxiety.¹³

An old folk remedy for anxiety, particularly when it causes insomnia, is chamomile tea. There is evidence from test tube studies that chamomile contains compounds with a calming action.¹⁴ There are also animal studies that suggest a benefit from chamomile for anxiety,¹⁵ but no human studies support this belief. Often one cup of tea is taken three or more times per day.

Warning: Kava should only be taken with medical supervision. Kava is not for sale in certain parts of the world.

Until recently, the pre-eminent botanical remedy for anxiety was kava, a herb from the South Pacific. It has been extensively studied for this purpose.¹⁶ One 100 mg capsule standardised to 70% kava-lactones is given three times per day in many studies. Preliminary¹⁷ and double-blind trials¹⁸ ¹⁹ have validated the effectiveness of kava for people with anxiety, including menopausal women.²⁰ A previous study found kava to be just as effective as benzodiazepines over the course of six weeks.²¹ The latest research shows that use of kava for up to six months is safe and effective compared with placebo.²² Although kava rarely causes side effects at the given amount, it may cause problems for some people if combined for more than a few days with benzodiazepines.²³

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Integrated approaches that may be helpful

Reducing exposure to stressful situations can help decrease anxiety. In some cases, meditation, counselling, or group therapy can greatly facilitate this process.²⁴

Acupuncture has been the subject of limited research as a therapy for anxiety. In an uncontrolled study, eight patients suffering from anxiety were treated with acupuncture three times per week for eight sessions. Six of the eight patients achieved good to moderate improvement.²⁵ However, a trial of acupuncture treatment for anxiety associated with giving up smoking did not provide any evidence of benefit.²⁶ A double-blind study of acupuncture for the treatment of anxiety associated with dental procedures reported that acupuncture and placebo were equally effective.²⁷ Acupuncture remains unproven in the treatment of people with anxiety.

A form of counselling known as Cognitive-Behavioural Therapy (CBT) has been shown to be superior to placebo for managing the symptoms of panic disorder.²⁸ In a controlled trial, six months of CBT produced a response rate of 39.5%, compared to only 13% in the placebo group. When combined with the tricyclic antidepressant drug imipramine (Tofranil®), response rates were even higher (57.1%). For long-term management of panic disorder, imipramine produced a superior quality of response, but CBT had more durability and was better tolerated.

References
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1. Bruce M et al. Anxiogenic effects of caffeine in patients with anxiety disorders. Arch Gen Psychiatry 1992;49:867–9.

2. Benjamin J, Levine J, Fux M, et al. Double-blind, placebo-controlled, crossover trial of inositol treatment for panic disorder. Am J Psychiatry 1995;152:1084–6.

3. Fux M, Levine J, Aviv A, Belmaker RH. Inositol treatment of obsessive-compulsive disorder. Am J Psychiatry 1996;153:1219–21.

4. Carroll D, Ring C, Suter M, Willemsen G. The effects of an oral multivitamin combination with calcium, magnesium, and zinc on psychological well-being in healthy young male volunteers: a double-blind placebo-controlled trial. Psychopharmacology (Berl) 2000;150:220–5.

5. Weston PG et al. Magnesium sulfate as a sedative. Am J Med Sci 1923;165:431–3.

6. Mohler H, Polc P, Cumin R, et al. Niacinamide is a brain constituent with benzodiazepine-like actions. Nature 1979;278:563–5.

7. Vescovi PP, et al. Nicotinic acid effectiveness in the treatment of benzodiazepine withdrawal. Curr Ther Res 1987;41:1017.

8. Brown D. Valerian root: Non-addictive alternative for insomnia and anxiety. Quart Rev Nat Med 1994;Fall:221–4 [review].

9. Akhondzadeh S, Naghavi HR, Vazirian M, et al. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther 2001;26:363–7.

10. Bhattacharya SK, Ghosal S. Anxiolytic activity of a standardized extract of Bacopa monniera—an experimental study. Phytomedicine 1998;5:77–82.

11. Singh RH, Singh L. Studies on the anti-anxiety effect of the medyha rasayana drug, Brahmi (Bacopa monniera Wettst.) Part 1. J Res Ayur Siddha 1980;1:133–48.

12. Stough C, Lloyd J, Clarke J, et al. The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology 2001;156:481–4.

13. Witte B, Harrer G, Kaptan T, et al. Treatment of depressive symptoms with a high concentration Hypericum preparation. A multicenter placebo-controlled double-blind study. Fortschr Med 1995;113:404–8 [in German].

14. Viola H, de Stein ML, et al. Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptors-ligand with anxiolytic effects. Planta Med 1995;61:213–6.

15. Yamada K, Miura T, Mimaki Y, Sashida Y. Effect of inhalation of chamomile oil vapour on plasma ACTH level in ovariectomized rats under restriction stress. Biol Pharm Bull 1996;19:1244–6.

16. Pittler MH, Ernst E. Efficacy of kava extract for treating anxiety: Systematic review and meta-analysis. J Clin Psychopharmacol 2000;20:84–9.

17. Neto JT. Efficacy and tolerability of kava extract WS1490 in anxiety states: multicentre Brazilian study. Rev Bras Med 1999;56:280–4.

18. Lehmann EE, Kinzler J, Friedmann J. Efficacy of a special kava extract (Piper methysticum) in patients with states of anxiety, tension and excitedness of non-mental origin. A double-blind placebo-controlled study of four weeks treatment. Phytomedicine 1996;3:113–9.

19. Volz HP, Kieser M. Kava-kava extract WS 1490 versus placebo in anxiety disorders–A randomized placebo-controlled 25-week outpatient trial. Pharmacopsychiatry 1997;30:1–5.

20. Warnecke G. Psychosomatic dysfunctions in the female climacteric. Clinical effectiveness and tolerance of kava extract WS 1490. Fortscher Med 1991;119–22 [in German].

21. Woelk H, Kapoula S, Lehrl S, et al. Treatment of patients suffering from anxiety—double-blind study: Kava special extract versus benzodiazepines. Z Allegemeinmed 1993;69:271–7 [in German].

22. Volz HP, Kieser M. Kava-kava extract WS 1490 vs. placebo in anxiety disorders—A randomized placebo-controlled 25-week outpatient trial. Pharmacopsychiatry 1997;30:1–5.

23. Almeida JC, Grimsley EW. Coma from the health food store: Interaction between kava and alprazolam. Arch Intern Med 1996;125:940–1.

24. Miller JJ, Fletcher K, Kabat-Zinn J, et al. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry 1995;17:192–200.

25. Lo CW, Chung QY. The sedative effect of acupuncture. Am J Chin Med 1979;7:253–8.

26. Lamontagne Y, Annable L. Acupuncture and anxiety. Can J Psych 1979;24:584–5.

27. Taub HA, Mitchell JN, Stuber FE, et al. Analgesia for operative dentistry: a comparison of acupuncture and placebo. Oral Surg Oral Med Oral Pathol 1979;48:205–10.

28. Barlow DH, Gorman JM, Shear MK, Woods SW. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder. A randomized controlled trial. JAMA 2000;283:2529–36.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.