Also indexed as: Nervousness, Panic Attacks
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.
What are the symptoms of anxiety?
Physical symptoms of anxiety include fatigue,
insomnia, stomach problems, sweating, racing heart, rapid breathing, shortness of breath,
and irritability.
Medical treatments
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 counseling 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
Nutritional supplements 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 sulfate 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.
St. John’s wort has been reported in one
double-blind study to reduce anxiety.10
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.11 There are also animal studies that suggest a benefit from chamomile for
anxiety,12 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 preeminent botanical remedy for anxiety was
kava, an herb from the South Pacific. It has been extensively studied for this
purpose.13 One 100 mg capsule standardized to 70% kava-lactones is given three
times per day in many studies. Preliminary14 and double-blind trials15
16 have validated the effectiveness of kava for people with anxiety, including menopausal women.17 A previous study found kava
to be just as effective as benzodiazepines over the
course of six weeks.18 The latest research shows that use of kava for up to six
months is safe and effective compared with placebo.19 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.20
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful
Reducing exposure to stressful situations can help decrease anxiety. In some cases, meditation, counseling, or group therapy can greatly
facilitate this process.21
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.22 However, a trial of
acupuncture treatment for anxiety associated with quitting smoking did not provide any
evidence of benefit.23 A double-blind study of acupuncture for the treatment of
anxiety associated with dental procedures reported that acupuncture and placebo were equally
effective.24 Acupuncture remains unproven in the treatment of people with
anxiety.
A form of counseling known as Cognitive-Behavioral Therapy (CBT) has been shown to be
superior to placebo for managing the symptoms of panic disorder.25 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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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. 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].
11. 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.
12. 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.
13. Pittler MH, Ernst E. Efficacy of kava extract for treating anxiety:
Systematic review and meta-analysis. J Clin Psychopharmacol 2000;20:84–9.
14. Neto JT. Efficacy and tolerability of kava extract WS1490 in anxiety
states: multicentre Brazilian study. Rev Bras Med 1999;56:280–4.
15. 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.
16. 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.
17. Warnecke G. Psychosomatic dysfunctions in the female climacteric.
Clinical effectiveness and tolerance of kava extract WS 1490. Fortscher Med
1991;119–22 [in German].
18. Woelk H, Kapoula S, Lehrl S, et al. Treatment of patients suffering
from anxiety—double-blind study: Kava special extract versus benzodiazepines. Z
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19. 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.
20. Almeida JC, Grimsley EW. Coma from the health food store: Interaction
between kava and alprazolam. Arch Intern Med 1996;125:940–1.
21. 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.
22. Lo CW, Chung QY. The sedative effect of acupuncture. Am J Chin
Med 1979;7:253–8.
23. Lamontagne Y, Annable L. Acupuncture and anxiety. Can J
Psych 1979;24:584–5.
24. 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.
25. 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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not necessarily occur in all individuals. For many of the conditions discussed, treatment with
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before making any changes in prescribed medications. Information expires March 2005.
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