DIETARY AND HERBAL SUPPLEMENTS
Also termed nutraceuticals or herbal remedies, many people use supplements to treat their anxiety symptoms. If you do, it’s important to discuss this with your doctor, particularly if you also take other medications. Remember that these remedies can interact with certain medications to cause serious side effects.
Dietary supplements have been regulated in the United States since 1994 by the Dietary Supplement Health and Education Act, which set forth standards for manufacturers who are responsible for the truthfulness of label claims. Although several supplements have been tested and shown to be more effective than placebo, the consumer still faces challenges when deciding whether to take a particular supplement.
Quality control of supplements is also an issue. Most available supplements have not been systematically tested against a placebo treatment. Just because a dietary supplement is natural, it doesn’t necessarily mean it is safe, and health risks can emerge from drug interactions or contaminants. Problems including excess bleeding, pain, insomnia, and even serious drug interactions have been reported with various supplements. For example, ingesting ginkgo biloba along with ibuprophen can slow blood clotting and lead to bruising and bleedings. Also, ginkgo can affect insulin secretion, making it potentially dangerous for diabetics.
Many of the available supplements and herbal remedies used to treat anxiety are described below, but when deciding which one may be right for you, a knowledgeable pharmacist or physician can be very helpful. You might also check reliable online resources, such as the National Center for Complementary and Alternative Medicine (nccam.nih.gov) and the Natural Medicines Comprehensive Database (www.naturaldatabase.com).
A form of sugar or glucose that is naturally present in our diets, inositol is a supplement that influences several anxiety-related brain messengers, including serotonin. Some studies have shown that it is as effective as some SSRI antidepressants in treating panic attacks, and it may help patients with obsessive-compulsive disorder. Side effects are generally minimal but similar to those of SSRIs, including loss of appetite, nausea, diarrhea, and dizziness. It should not be combined with an SSRI, and recommended doses range from twelve to eighteen grams per day.
An herb from the South Pacific that has been used as a social drink and in ceremonial rituals for hundreds of years, kava extracts are thought to influence the GABA brain messenger system to relieve anxiety. Short-term use may improve symptoms of generalized anxiety. However, despite some promising results for the treatment of anxiety symptoms, safety concerns have led to bans of kava in many countries. Although it is available in the United States, the FDA has issued safety warnings about its risks, particularly for liver damage. Alcohol and medicines that affect the liver will increase the risk of liver damage when used with kava.
Amino acids such as lysine and arginine are building blocks for brain messengers or neurotransmitters involved in anxiety symptoms. Several studies have demonstrated antianxiety benefits for a combination of L-lysine and L-arginine. Side effects are generally minimal.
Extracts of these leaves have been used to treat age-related memory loss with varying success. Initial studies of potential benefits for patients with generalized anxiety disorder are encouraging but require follow-up. Potential side effects include an upset stomach and possibly increased bleeding.
This positively charged ion is involved in many body functions that are linked to anxiety symptoms. Several studies have demonstrated magnesium’s possible antianxiety effects for generalized anxiety disorder and other forms of anxiety. It is often combined with various vitamins, so it is unclear whether magnesium alone provides the benefits or if it must be combined with other substances. Magnesium has few, if any, side effects.
Initial studies suggest that cannabinoids, the nonpsychoactive components of marijuana, may reduce anxiety symptoms in patients with PTSD or panic disorder. More research is recommended because of the potential for side effects and abuse.
Some small studies suggest that passionflower may reduce anxiety. One investigation in patients with generalized anxiety disorder showed that benefits of passionflower were equivalent to those of a benzodiazepine antianxiety medicine. However, scientists have been unable to determine the precise passionflower ingredient that provides the benefits, so the consistency of each product varies. Side effects are generally mild and may include dizziness, drowsiness, and confusion.
St. John’s Wort
Extracts from this flowering plant have been used to treat depression, anxiety, and insomnia. Its benefits may stem from action on serotonin, dopamine, and the GABA brain messenger systems. Although investigations in patients with depression are promising, systematic studies in patients with anxiety have not demonstrated benefits. St. John’s wort may cause side effects when taken with several medicines, including anti-inflammatory drugs, antidepressants, statins, and proton pump inhibitors. The available evidence does not support a role for St John’s wort in the treatment of anxiety disorders.
Neuromodulation is a growing area of mental health therapeutics that encompasses several technologies that stimulate or suppress brain nerves in order to reduce mental symptoms. Recently approved by the FDA for certain indications, including depression, some of these brain stimulation methods have minimal side effects compared with medication and tend to show positive results in treatment-resistant cases. These noninvasive approaches—including magnetic stimulation, ultrasound waves, and electrical impulses—are designed to jump-start key neural circuits controlling anxiety in the brain.
One of the more popular neuromodulation treatments, repetitive transcranial magnetic stimulation (rTMS), uses magnets to activate brain neural circuits. It has been shown to be effective in treating symptoms but is limited in that it cannot reach regions located deep within the brain.
Transcranial direct-current stimulation (tDCS) uses a simple device involving the placement of electrodes on the head to excite or reduce neuronal activity, and recent research points to its promise in treating anxiety. One study demonstrated that tDCS is particularly effective in relieving anxiety symptoms in patients with obsessive-compulsive disorder.
Cranial electrotherapy stimulation (CES) uses a palm-sized device to send small electric currents across the brain and has been used for treating both anxiety and insomnia. One advantage of this approach is that patients can use the device at home, but some recent studies have begun to question the effectiveness of the method.
One promising method known as low-intensity focused ultrasound pulsation (LIFUP) uses ultrasound energy pulses to excite or suppress brain cell activity. The technique provides noninvasive, focused ultrasound energy through the skull and can be used with functional MRI to target specific brain regions implicated in anxiety symptoms.
BIOFEEDBACK AND NEUROFEEDBACK
Biofeedback and neurofeedback train patients to adjust their reactions to anxiety by monitoring their own physiological stress responses. During stress and anxiety states, heart rate increases, hands become cold and clammy, muscles tense, and brain waves measured by electroencephalograms (EEGs) show increases in beta waves. Also, the stressed-out brain shows a shift in activity from the amygdala emotional center under the temples to the frontal lobe’s thinking brain region.
With biofeedback, patients receive visual or auditory input from noninvasive sensors indicating physiological changes during stress and learn how to control their brain’s activity to achieve and maintain a calm and focused state. Neurofeedback is a form of biofeedback that specifically uses EEG sensors to monitor brain wave activity. A sound or visual cue will provide either positive or negative feedback. Although it has been used for a variety of anxiety symptoms and some people have reported benefits, scientific evidence supporting its use is limited.
MASSAGE AND BODYWORK
Massage and other forms of bodywork help a lot of people relax and reduce their symptoms of anxiety. Anyone who has received a good massage knows how nice and relaxing it can feel, but just how it works to relieve mental anxiety is not entirely clear. It is possible that massage alters brain neurotransmitters involved in anxiety symptoms as well as the level of stress hormones in the body. Also, if the treatment relieves pain, any anxiety associated with that pain will likely decline.
Research has shown that moderate pressure massage provides temporary pain relief for people suffering from fibromyalgia or rheumatoid arthritis. In addition to reducing anxiety levels, moderate pressure massage alters brain wave patterns measured by EEGs and reduces levels of the stress hormone cortisol. Studies using functional MRI indicate that moderate pressure massage alters brain activity in the amygdala, hypothalamus, and frontal lobe. These are all brain regions that control and regulate stress and emotion.
Many people endorse the benefits of various types of bodywork therapy including Reiki, Bowen technique, reflexology, aromatherapy, and chiropractic treatment. As yet, systematic studies confirming the specific benefits of these different approaches over placebo treatments have not been confirmed. However, even without such evidence, these approaches have reportedly helped many individuals.
Acupuncture, another form of bodywork imported from the Far East and practiced for thousands of years, has been used to treat medical conditions like nausea and pain. Some scientific research does point to the benefits of acupuncture and acupressure in treating various anxiety symptoms as well as insomnia.
Many other alternative therapies have been recommended to help people remain calm and manage their symptoms of anxiety, ranging from homeopathic treatments to prayer. Scientific evidence supporting these approaches is limited, but they still seem to help some individuals.
I often recommend that anxiety sufferers try one or more of these approaches, especially since they have minimal risk. Systematic studies have shown that laughter or humor therapy can enhance mood and quality of life. Listening to music, pursuing hobbies, and volunteering are just some examples of potentially fun and relaxing activities that can distract us from our feelings of anxiety and help us remain calmer under stress.
Many alternative treatments may help reduce stress and anxiety, and they also work well in conjunction with conventional therapies to relieve symptoms. Keep in mind that if you do pursue an alternative treatment, do not allow it to delay a trial of a conventional therapy that has been shown to alleviate anxiety. Also, if a particular therapy sounds too good to be true, that may very well be the case. Before beginning an alternative approach, you may want to investigate whether any scientific studies have been performed to show that the approach works better than placebo.Image courtesy of Pixabay and some sources from these References