Introduction
As the British-born American poet W. H. Auden pointed out in the early
twentieth century, modern humans live in an age of anxiety. Most
have a certain level of chronic anxiety because modern life is jagged, fast-paced,
and divorced from the natural rhythms that tend to create a harmonious inner life.
For some, this existential unease goes further and becomes a psychological
disorder.
Typical symptoms of anxiety disorder include feelings of tension, irritability,
worry, frustration, turmoil, and hopelessness, along with insomnia,
restless sleep, grinding of teeth, jaw pain, an inability to sit still, and an
incapacity to cope. Physical sensations frequently arise too and include a
characteristic feeling of being unable to take a full, satisfying breath; dry
mouth; rapid heartbeat; heart palpitations; a lump in the throat;
tightness in the chest; and cramping in the bowels.
Anxiety can also give rise to panic attacks. These may be so severe
that they are mistaken for heart attacks. The heart pounds and
palpitates, the chest feels tight and painful, and the whole body tenses with
unreasonable fear. Such attacks can be triggered by anxiety-provoking situations,
but they may also arise suddenly and seemingly without cause, perhaps even
awakening a person from his or her sleep. A person who tends to have panic attacks
more so than generalized anxiety is said to have panic
disorder.
The medical treatment of anxiety involves antianxiety
drugs in the benzodiazepine family, the unique drug BuSpar
(buspirone), and antidepressants. Panic attacks are generally more difficult
to treat than other forms of anxiety.
Proposed Natural Treatments
There are no natural treatments for anxiety that have been shown to be safe and effective. However, some treatments have shown promise for generalized anxiety disorder and related conditions. No natural treatment is likely to be effective for panic disorder.
Valerian. The herb valerian is best known as a remedy for insomnia. However, because many drugs useful for insomnia also reduce anxiety, valerian has been proposed as an anxiety treatment.
In a double-blind, placebo-controlled study, thirty-six people with generalized
anxiety disorder were given either valerian extract, valium, or
placebo for four weeks. The study failed to find statistically significant
differences among the groups, presumably because of its small size. However, a
careful analysis of the results hints that valerian was helpful.
In addition, a preliminary double-blind study found that valerian may produce
calming effects in stressful situations. Again, though, this study was too small
to provide definitive results. Another study evaluated the anxiety-relieving
effects of a combination containing valerian and lemon balm taken in various
doses; some benefits were seen with doses of 600 milligrams (mg) or 1,200 mg three
times daily, but the highest dose (1,800 mg three times daily) actually appeared
to increase anxiety symptoms during stressful situations. Furthermore, people
taking the herbal treatment at any dose showed slightly decreased cognitive
function compared with those given placebo.
Kava. Until 2002, the herb kava was widely used in Europe as a medical treatment for anxiety, based on the evidence of a substantial body of double-blind, placebo-controlled studies. However, because of concerns involving its potential effects on the liver, it was withdrawn from the market in many countries.
Other herbs and supplements. A large (264-participant) three-month, double-blind, placebo-controlled study tested the possible antianxiety benefits of a combination therapy containing the mineral magnesium (150 mg twice daily), the herb hawthorn (150 mg twice daily of a standardized extract), and the seldom-studied herb Eschscholtzia californica (California poppy, 40 mg twice daily). Study participants all had generalized anxiety disorder of mild-to-moderate intensity. The results indicated that the combination treatment was more effective than placebo. No significant side effects were seen. This particular combination therapy is used in France.
A double-blind, placebo-controlled trial of eighty healthy male volunteers found that twenty-eight days of treatment with a multivitamin-multimineral supplement (containing calcium, magnesium, and zinc) significantly reduced anxiety and the sensation of stress.
The supplement 5-hydroxytryptophan (5-HTP) is best known as a proposed
treatment for depression. An eight-week, double-blind, placebo-controlled
study compared 5-HTP and the drug clomipramine in forty-five persons with anxiety
disorder. The results indicated that 5-HTP was effective but clomipramine was more
effective.
Based on its apparent ability to promote sleep, melatonin has
been tried as a treatment for reducing anxiety. However, while four studies
performed by Saudi researchers reported benefits, other researchers have been
unable to confirm these results.
A four-week double-blind study of thirty-six persons with anxiety (specifically, generalized anxiety disorder) compared the herb passionflower to the standard drug oxazepam. Oxazepam worked more quickly, but by the end of the four-week trial, both treatments proved equally effective. Furthermore, passionflower showed a comparative advantage in terms of side effects: The use of oxazepam was associated with more impairment of job performance. Also, in a placebo-controlled trial involving sixty persons undergoing surgery, passionflower significantly reduced anxiety up to ninety minutes before surgery. The only other supporting evidence for passionflower comes from animal studies.
Several small double-blind studies by a single research group have found preliminary evidence that the oral use of lemon balm (Melissa officinalis) may reduce anxiety levels. Like other antianxiety agents, it may also impair mental function to some degree. A combination of lemon balm and valerian has also been tested, with generally positive results.
One study found that one week of oral treatment with lysine (2.64 grams per day) and arginine (2.64 grams per day) could reduce general levels of anxiety. A double-blind, placebo-controlled trial of forty persons found that gotu kola reduced the “startle” response to sudden loud noises. This suggests, but does not prove, that gotu kola may be helpful for anxiety.
A small, double-blind, placebo-controlled, crossover study found that the use of the herb European skullcap reduced general anxiety levels. The herb Galphimia glauca is traditionally used as a “nerve tonic” by Mexican herbalists. One substantial double-blind study purportedly found that a standardized galphimia extract is as effective as the standard medication lorazepam. However, because this study failed to use a placebo group, these results mean little.
Two preliminary studies that evaluated linden flower for potential sedative or antianxiety effects returned contradictory results. Another study found weak evidence that sage might reduce anxiety.
Other herbs or supplements that are frequently recommended for anxiety attacks include Chinese skullcap, flaxseed oil, chamomile, gamma oryzanol, hops, selenium, and suma, as well as inositol for panic disorder. However, there is no reliable supporting evidence to indicate that they work.
The substance gamma-aminobutyric acid (GABA) is a naturally occurring neurotransmitter that is used within the brain to reduce the activity of certain nerve systems, including those related to anxiety. For this reason, GABA supplements are sometimes recommended for treatment of anxiety-related conditions. However, there are no studies supporting the use of GABA supplements for anxiety. In fact, it appears that, when taken orally, GABA cannot pass the blood-brain barrier and, therefore, does not even enter the brain.
Alternative therapies. Various alternative therapies have shown
some promise for the treatment of anxiety. These therapies include
acupuncture (for generalized anxiety and for situational
anxiety), aromatherapy (either alone or with massage),
biofeedback, and music therapy (for terminally ill
persons). However, the supporting evidence to indicate that these treatments work
remains weak.
There is a fair amount of evidence in support of relaxation therapies and massage (either alone or with aromatherapy) to treat the symptoms of anxiety, at least in the short term. In a 2008 review of twenty-seven studies, for example, researchers concluded that relaxation therapies (including Jacobson’s progressive relaxation, autogenic training, applied relaxation, and meditation) were effective against anxiety. (However, not all of the studies were randomized, controlled trials.) In a randomized trial involving sixty-eight persons with generalized anxiety disorder, ten sessions of therapeutic massage, thermotherapy (the application of heat), and relaxation were all found to be beneficial at reducing anxiety, though none was superior to the others. Finally, three studies failed to find that Bach flower remedies are helpful for situational anxiety.
Herbs and Supplements to Use Only with Caution
Various herbs and supplements may interact adversely with drugs used to treat anxiety, so persons should be cautious when considering the use of herbs and supplements.
Homeopathic Remedies
A double-blind, placebo-controlled study of forty-four people with generalized anxiety disorder found that the use of constitutional, or classical, homeopathy did not significantly improve symptoms.
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