Anxiety symptoms can be very distressing…worries, fears, or just being stressed-out. One option to get help is to visit your doctor, as treatments for anxiety with psychotropic medications such as selective serotonin reuptake inhibitors/serotonin norepinephrine reuptake inhibitors, benzodiazepines, monoamine oxidase inhibitors, tricyclic antidepressants, buspirone and antihypertensive agents are well studied and effective. However, these psychotropic medications for anxiety can have significant side effects and can be expensive. Additionally, psychiatric treatment with psychotropic medications is still viewed, sadly, with much social stigma. Another option is to visit a counsellor for cognitive behavioral therapy, but not all can access these services nor afford them. Another barrier to psychiatric and psychological services is that medical insurance companies place restrictions and lifetime caps on mental health treatment. With all these barriers, what is an informed consumer to do? Fortunately, natural supplements for anxiety are becoming an increasingly viable option, as research is revealing the effectiveness and safety of these natural (herbal and nutritional) supplements. There are numerous natural supplements that have been studied for anxiety, and these are generally less expensive and have generally less side effects than anxiolytic medications:
In medicine, the gold standard for accessing efficacy of a treatment for an illness is the placebo-controlled randomized controlled trial (RCT). Only two natural supplements have several placebo-controlled RCTs showing effectiveness for anxiety: kava and inositol (Hofmann, 2012). Kava is made from the roots of the plant Piper methysticum and originates from the western Pacific. A recent study revealed that kava was effective for generalized anxiety disorder when compared to placebo (Sarris et al., 2013a). There have been reports of hepatic failure and liver toxicity with taking kava. There also appears to be a drug-supplement interaction, as the combination of APAP and kava may increase risk for liver failure, as kava potentiates APAP-induced hepatic cytotoxicity (Yang and Salminen, 2011). Before taking kava, one should see a physician for an examination, specifically taking a blood test to see if the liver is functioning properly (liver panel) and to follow-up with a physician to obtain a liver panel at each increase in dose and also at regular intervals while on kava. The dosage should not exceed 250mg kavalactones per day (Teschke et al., 2011). One should also avoid APAP in conjuction with kava (Yang and Salminen, 2011). A recent 6 week RCT study showed that kava was safe, with no changes in liver function at doses up to 240 kavalactones (Sarris et al., 2013b). With follow-up from a physician to monitor liver functions, kava is a viable treatment option for anxiety, given the multiple studies showing effectiveness.
As mentioned above, only two natural supplements have multiple RCTs showing effectiveness for anxiety: kava and inositol. Inositol is a carbohydrate which is sweet in taste. Inositol can be found in fruits and lechitins. One study found that inositol was as effective as fluvoxamine for the treatment of panic disorder (Palatnik et al., 2001). Inositol is a natural compound with few side effects, which makes it an attractive alternative to psychotropics which have significant side effects.
Lavender, also known as Lavandula angustifolia, is a flowering plant in the mint family, and is native to the Old World. In a study that was just published, Kasper et al. (2014) studied lavender oil, Silexan, comparing it to placebo and paroxetine in an RCT for generalized anxiety disorder, and found that lavender oil was more effective than placebo for anxiety. In addition, lavender oil had less side effects than paroxetine, and had a side effect profile comparable to the placebo (Kasper et al., 2014). Another study showed that lavender oil was as effective as lorazepam for generalized anxiety disorder, and does not have the sedative or addictive potential of benzodiazepines (Woelk and Schläfke, 2010). Lavender has a few RCTs which are positive for anxiety, and with more positive studies, it may eventually have the type of evidence backing kava and inositol for anxiety treatment.
Passiflora, commonly known as Passionflower, is a flowering plant, and has a pantropical distribution. One study revealed that Passionflower was as effective as oxazepam for generalized anxiety disorder, and that oxazepam caused impairment in job performance (Akhondzadeh et al., 2001). More studies are needed to confirm these findings that Passionflower is as effective as a benzodiazepine for generalized anxiety disorder and that Passionflower does not cause impairment in job performance.
5. L-lysine and L-arginine
L-lysine is an essential amino acid, whereas L-arginine is a conditionally nonessential amino acid. The combination of L-lysine and L-arginine was effective at reducing anxiety symptoms in healthy adults (Smriga et al., 2007), and modified hormonal responses to psychosocial stress in healthy subjects (Jezova et al., 2005). Although these preliminary studies are promising, studies in clinical samples are needed for the combination of L-lysine and L-arginine for anxiety treatment.
Valeriana officinalis, commonly known as Valerian, is a flowering plant native to Europe, Asia, and introduced into North America. One study showed that the extract of the root of Valerian was more effective than placebo for obsessive compulsive disorder, and Valerian only had somnolence as a side effect when compared to placebo (Pakseresht et al., 2011). However, another study comparing Valerian extract, diazepam, and placebo showed no differences, but the investigators surmise the sample size may be too small (Andreatini et al., 2002). More studies are needed for Valerian in anxiety, given the mixed preliminary findings.
L-theanine is an amino acid found in green tea. In one study, theanine reduced anxiety symptoms more than placebo in healthy subjects (Unno et al., 2013). In another study, L-theanine augmentation of antipsychotic medications for those with psychosis was more effective than placebo augmentation for reduction of anxiety symptoms (Ritsner et al., 2011). As these are only preliminary findings, more studies are needed.
8. Galphimia glauca
Galphimia glauca is a flowering plant, and from the genus that grows in Latin and south America. One study showed that Galphimia glauca was as effective as lorazepam for generalized anxiety disorder, and it was well tolerated and safe (Herrera-Arellano et al., 2012). More studies are needed before recommending Galphimia glauca for anxiety.
Tryptophan is an essential amino acid in the human diet. Tryptophan has a couple of studies showing it is effective for social anxiety disorder (Hudson et al., 2007; Pecknold et al., 1982). However, pharmaceutical-grade tryptophan use declined significantly in 1989 after it was found to be associated with eosinophilia myalgia syndrome (EMS). However, when tryptophan is given as an intact protein (such as deoiled gourd seed), there is no risk of EMS. In addition, when protein-source tryptophan is given with a high glycemic carbohydrate, it is effective for reducing anxiety (Hudson et al., 2007). Clearly, more studies are needed regarding the efficacy and safety of tryptophan for anxiety.
10. Omega 3 fatty acids
Omega 3 fatty acids are polyunsaturated fatty acids and important for normal metabolism. One study showed that omega 3 fatty acids reduced anxiety in healthy subjects (Kiecolt-Glaser et al., 2011). Another study showed thay omega 3 fatty acids was effective at reducing anxiety in a group with a diagnosis of substance abuse (Buydens-Branchey et al., 2006). But another study showed it was not effect for obsessive compulsive disorder (Fux et al., 2004). More studies in clinical samples (subjects with anxiety disorder) are needed.
gamma-Aminobutyric acid (GABA) is an inhibitory neurotransmitter found in the central nervous system. One study showed that GABA may have a physiologic anxiety effect when one is in a phobic situation (Abdou et al., 2006). Clearly, more studies are needed.
12. Ginkgo biloba
Also known as the maidenhair tree, Ginkgo is native to China. Ginkgo showed effectiveness for anxiety when compared to placebo for generalized anxiety disorder and adjustment disorder with anxiety. In addition, it was safe and well tolerated (Woelk et al., 2007). Although Ginkgo and Chamomile are less studied, they have preliminary evidence that they are effective for anxiety (Hofmann, 2012).
Chamomile is the common name, in the family Asteraceae of daisy-like plants. One study revealed chamomile was effective compared to placebo for generalized anxiety disorder (Amsterdam et al., 2009). As mentioned above, more studies are needed to replicate these findings.
Magnesium is a chemical element, an alkaline earth metal. Preliminary studies have revealed a possible role for magnesium in the treatment of anxiety (Hanus et al., 2004; De Souza et al., 2000). More studies are needed before magnesium can be recommended for anxiety treatment.
15. Lemon balm
Melissa officinalis, commonly known as lemon balm, is a herb in the mint family, and native to Europe and the Mediterranean. One study showed that lemon balm combined with Valerian led to anxiolytic effects in healthy subjects when compared to placebo (Kennedy et al., 2006). Studies in clinical samples are needed for further consideration.
Melatonin is a hormone, and the chemical name is N-acetyl-5-methoxytryptamine. Melatonin has a few studies showing it is effective for anxiety (Acil et al., 2004; Khezri and Merate, 2013; Khezri et al., 2013). However, studies in clinical samples are needed.
Scutellaria is a flowering plant commonly known as scullcap and distributed worldwide. One study found that Skullcap had anxiolytic effects in healthy subjects (Wolfson and Hoffmann, 2003). Studies in clinical samples are needed.
St. John’s wort and hops, natural supplements that have been used for anxiety treatment, did not make this list. Currently, St. John’s wort is not recommended for anxiety, given the negative studies (Kobak et al., 2005). No studies for anxiety treatment in human subjects were found for hops.
Summary- Anxiety Natural Supplements
In summary, natural supplements for anxiety are viable treatment options, and generally have less side effects and are generally less expensive than psychotropic medications for anxiety. Kava and inositol have good evidence in peer-reviewed medical and nutritional journals to recommend them for anxiety treatment. However, kava has the potential for liver toxicity, and therefore monitoring from a medical doctor is necessary. Lavender has a few positive RCTs for anxiety, and with more positive studies, it may eventually have the evidence to recommend it for anxiety treatment as well. The rest of the natural supplements that made the list have preliminary evidence that they may be effective for anxiety, but more studies are needed.
There is one anxiety natural supplement formulation which includes the best of the above list- KalmPro. KalmPro was formulated by an MD, a medical doctor, a psychiatrist, who has extensive clinical, research, and teaching experience in the area of anxiety.