Anxiety

Anxiety is a mood disorder characterized by a feeling of vague, unspecified harm, apprehension or distress, often about the future, without an apparent cause.  Psychiatrists often distinguish between anxiety, which can be thought of as a reaction to an ambiguous or imagined danger, and fear, which is a response to a real threat.

The following are suggested therapies that may treat anxiety:

Kava Kava:

Rationale:

Kava kava has been clearly proven to alleviate anxiety.  In one well-designed, long-term study it was concluded that kava kava is an effective alternative to tricyclic antidepressants and benzodiazepines for the treatment of anxiety with none of the tolerance and side effects problems that are associated with these classes of pharmaceutical drugs.

Dosage:

Capsules/tablets:  300 - 700 mg per day (for kava kava tablets/capsules that have been standardized to contain 30% kava lactones - this would provide 90 - 210 mg of kava lactones per day).

Fluid extract/tincture:  7.5 ml per day (for kava kava liquid that is concentrated to a ratio of 1:5).

Magnesium:

Rationale:

Anxiety patients are often deficient in magnesium and supplemental magnesium alleviates some cases of anxiety.

Dosage:

200 - 500 mg per day.

Potassium:

Rationale:

People with high levels of anxiety are often found to have abnormally low potassium levels.

Dosage:

500 mg per day.

Selenium:

Rationale:

Anxiety can occur as a result of selenium deficiency and supplemental selenium reduces anxiety in patients with low selenium levels.

In one double-blind study, 50 subjects received either a placebo or supplemental selenium.  Selenium intake was associated with a general elevation of mood and in particular, a decrease in anxiety.  The lower the original level of dietary intake of selenium the more reports of decreased anxiety following five weeks of selenium therapy.

Dosage:

200 - 400 mcg per day.

Gamma Oryzanol:

Rationale:

Gamma oryzanol has been found (in animal studies) to exert mild anti-anxiety effects.

Dosage:

300 mg per day.

Folic Acid:

Rationale:

Folic acid (especially when administered concurrently with vitamin B12) alleviates anxiety.

Dosage:

800 - 2,000 mcg (0.8 - 2 mg) per day.

Tyrosine:

Rationale:

Many anxiety patients experience significant relief using supplemental tyrosine.  The underlying mechanism for this effect may be due to the role of tyrosine as a precursor for the production of L-dopa.

Dosage:

2,000 - 4,000 mg per day.

Alternatives:

Phenylalanine “works” via a similar mechanism to tyrosine.

Phenylalanine:

Rationale:

Many anxiety patients experience significant relief using supplemental phenylalanine.  The underlying mechanism for this effect may be due to the role of phenylalanine as a precursor for the production of L-dopa.

Dosage:

2,000 - 4,000 mg per day.

Alternatives:

Tyrosine “works” via a similar mechanism to phenylalanine.

Inositol:

Rationale:

Inositol alleviates anxiety by enhancing the effects of a calming neurotransmitter named GABA. 

Dosage:

4,000 mg per day.

5-HTP:

Rationale:

5-HTP (a more potent form of the amino acid, tryptophan) functions as a precursor for the calming neurotransmitter, serotonin.

Several clinical studies have shown 5-HTP to be effective in the treatment of anxiety disorders.

Dosage:

200 – 900 mg per day.

Vitamin B1:

Rationale:

Vitamin B1 alleviates many cases of anxiety by activating an enzyme that inhibits the conversion of pyruvic acid to lactic acid.  High levels of lactic acid is an underlying cause of anxiety.  In one human study, 100% of anxiety patients responded well (either complete remission or improved mood) to vitamin B1 supplementation.

Dosage:

100 - 500 mg per day.

Vitamin B3:

Rationale:

The niacinamide form of vitamin B3 has been demonstrated to alleviate anxiety by enhancing the ability of the “calming” neurotransmitter GABA to bind to receptors in the brain.  It appears that vitamin B3 is an effective natural alternative to benzodiazepines such as valium for the treatment of anxiety.

Dosage:

1,000 - 6,000 mg per day.

Vitamin B6:

Rationale:

A clinical study has concluded that vitamin B6 is as effective for the treatment of anxiety when it is administered alone as when it is used in conjunction with tryptophan or when used in conjunction with mega doses of other vitamins.  Vitamin B6 alone was more effective for the treatment of anxiety than tryptophan alone.

Dosage:

25 - 250 mg per day.

Vitamin B12:

Rationale:

Vitamin B12 (especially when it is used concurrently with folic acid) alleviates some cases of anxiety.

Dosage:

1,000 - 2,000 mcg (1 -2 mg) per day.

Magnolia:

Rationale:

Magnolia contains two polyphenols (named honokiol and magnolol) that have shown potent anti-anxiety effects.  Part of magnolia’s anti-anxiety effect occurs from it lowering cortisol hormone levels.

Dosage:

600 mg per day.

Brahmi:

Rationale:

In a recent human study, 35 anxiety patients were treated with brahmi for four weeks.  At the end of the study they were clinically assessed for their anxiety levels and were found to have an average 20% reduction in the severity of their anxiety.

Dosage:

180 - 300 mg per day (using Brahmi capsules/tablets standardized to contain 20% of the active ingredients, bacosides).

Gotu Kola:

Rationale:

Indian studies have confirmed the ability of gotu kola to alleviate some cases of anxiety.  One study found the anti-anxiety effects of gotu kola to be equivalent in effectiveness to diazepam (valium).

Dosage:

The usual dosage of crude, dried, non standardized gotu Kola leaf is 2,000 - 6,000 mg per day.

The usual dosage of 1:5 tincture of gotu Kola is 10 - 20 ml per day.

The standard dosage of gotu Kola capsules/tablets standardized to contain 10% of the active ingredient, triterpenic acids, is 600 - 1,200 mg per day.

Valerian:

Rationale:

Valerian contains compounds (named valerenic acid and valepotriates) that activate sedating GABA receptors in the brain.  This helps to alleviate anxiety.

Dosage:

300 - 400 mg per day.

Theanine:

Rationale:

Theanine (a rare amino acid present in tea) increases the generation of calming alpha brain waves.

A clinical study found that theanine (50 - 200 mg once per week for two months) increased alpha brain-waves generation within 40 minutes in both highly anxious and non-anxious women aged 18-22.  This is consistent with an anti-anxiety effect.

Dosage:

50 – 200 mg per day.

Saint John’s Wort:

Rationale:

Saint John’s Wort is an effective therapy for anxiety in patients who experience anxiety in conjunction with depression.

One double blind, placebo-controlled, study of 105 people with poor mood demonstrated that those subjects receiving Saint John’s Wort experienced significant improvement in anxiety symptoms.

Dosage:

The therapeutic dosage of Saint John’s Wort concentrated capsules/tablets standardized to contain 0.3% hypericin is 900 mg per day (taken as three x 300 mg doses).  This would provide a total of 2.7 mg of hypericin.

Passion Flower:

Rationale:

Passionflower contains alkaloids named harmala alkaloids that alleviate anxiety by sedating the central nervous system.

In a clinical study, passionflower was found to be just as effective as oxazepam (a standard pharmaceutical treatment) for the treatment of anxiety.

Dosage:

1,500 - 3,000 mg per day (using passion flower capsules/tablets).

2 - 4 ml per day (using passion flower fluid extract or tincture).

Ginkgo biloba

Rationale:

Several animal studies have shown that Ginkgo biloba exerts anti-anxiety effects and is as effective as valium for reducing anxiety.

Dosage:

120 mg per day (of a 50:1 Ginkgo biloba product standardized to contain 24% Ginkgo flavonglycosides and 6.5% terpenes) for younger people or 240 mg per day for elderly people with cognitive impairment.

Chamomile:

Rationale:

Chamomile contains a constituent named apigenin that has been found to bind to the same receptors in the brain as valium.  The resulting activation of these receptors helps to alleviate anxiety.

Dosage:

2,000 - 3,000 mg per day (using chamomile capsules/tablets).

2 - 3 ml per day (using chamomile 1:1 fluid extract).

10 - 15 ml per day (using chamomile 1:5 tincture).

Hops:

Rationale:

Hops contain a type of alcohol named dimethylvinylcarbinol that alleviates anxiety by sedating the central nervous system.

Dosage:

1,500 - 3,000 mg per day (using hops capsules/tablets).

3 - 6 ml per day (using 1:2 hops tincture).

Adapton:

Rationale:

Adapton (an extract from a species of deep-sea fish) is an effective therapy for the treatment of anxiety and is a worthy alternative to pharmaceutical drugs such as Xanax and Valium.

People using adapton for the treatment of anxiety describe its effects as being mild. long-term and subjectively subtle (compared to the powerful but short-term effects of benzodiazepines such as Valium).

Double-blind studies conducted on Californian students who suffered from anxiety found that those students who received adapton experienced a statistically significant decrease in their anxiety scores following one week of adapton use.

Dosage:

The initial dosage of adapton is 800 mg per day (for the first two to three weeks).  This dosage is taken as one single dose in the morning with a small amount of water.

After two to three weeks, the daily dosage is reduced to 400 mg, also taken in the morning, all at once with a small amount of water.

Most people do not notice any improvement in their anxiety symptoms until at least one week after commencing adapton therapy.

Pregnenolone:

Rationale:

A clinical study found that anxiety patients have significantly lower pregnenolone levels.  Supplemental pregnenolone has been reported to be useful for those patients.

Dosage:

10 – 30 mg per day.

Calcium:

Rationale:

Some cases of anxiety occur as a result of calcium deficiency.

Dosage:

1,000 - 2,000 mg (of elemental calcium) per day.

The best forms of supplemental calcium are:

· Calcium citrate malate (which recent studies have demonstrated to be six times more bioavailable compared to calcium citrate).

· Calcium citrate (21% elemental calcium)

· Calcium lactate (12.5% elemental calcium)

· Calcium aspartate (12.5% elemental calcium)

· Calcium orotate (20.6% elemental calcium)

Boron and silicon both help to improve the effectiveness of supplemental calcium for bone health.

DHEA:

Rationale:

DHEA has been shown to reduce anxiety in middle-aged persons who suffer from depression.  In a clinical study, authors described improvements in lack of joy in daily life, lack of motivation, emotional numbness, sadness, inability to cope and worry after depression patients received supplemental DHEA.

Dosage:

25 – 50 mg per day.

The optimal timing for DHEA supplements is first thing in the morning (either before breakfast or with breakfast).

Melatonin:

Rationale:

Many melatonin users report relief from anxiety as a side-benefit.

Dosage:

1 - 3 mg per night.  Do not consume melatonin during the daytime as it is a powerful sedative.

Lifestyle Changes to Assist the Prevention/Treatment of Anxiety

Exercise:

Moderate to intense exercise reduces anxiety (including cases of anxiety caused by excessive consumption of caffeine).  In one study, 18 students who had previously been assessed to be highly anxious participated in four trials (exercise + study, study only, exercise only and control).  Anxiety scores decreased significantly (by 10%) in the exercise only trial.  The authors concluded that twenty minutes of exercise may reduce anxiety to a greater extent than idleness (i.e. periods away from stress).

Alcohol:

Reduction of alcohol consumption helps to alleviate anxiety.  Alcohol’s main metabolic product, acetaldehyde, is a proven cause of anxiety.

Caffeine:

Anxiety can occur as a result of caffeine withdrawal or from excessive consumption of caffeine.

Tobacco:

Anxiety can occur as a result of nicotine withdrawal in former tobacco smokers.

Amalgam Fillings:

Amalgam dental fillings have been implicated as a cause of anxiety due to their mercury component.  Epidemiological evidence indicates that young people with mercury-containing amalgam dental fillings have a greater incidence of anxiety compared to young people with no amalgam dental fillings.

MSG:

MSG (monosodium glutamate) has been implicated as a cause of anxiety.  It causes over-stimulation of the receptors in the brain named N-methyl-D-aspartate (NMDA) receptors.

References

5-HTP

· Kahn, R. S., et al.  L-5-Hydroxytryptophan in the treatment of anxiety disorders.  Journal of Affective Disorders.  8:197-200, 1995.

Adapton

· Dorman, T., et al.  The effectiveness of Garum armoricum (Stabilium) on reducing anxiety in college students.  Journal of Advancement in Medicine.  8(3):193-200, 1995.

Brahmi

· Singh, R. H., et al.  Studies on the anti-anxiety effect of the medyha rasayana drug, Brahmi (Bacopa monniera Wettst). Part 1.  J Res Ayur Siddha.  1:133-148, 1980.

Calcium

· Thys-Jacobs, S., et al.  Micronutrients and the premenstrual syndrome: the case for calcium.  J Am Coll Nutr.  19(2):220-7, 2000.

Chamomile

· Viola, H., et al.  Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptors-ligand with anxiolytic effects.  Planta Medica.  61(3):213-216, 1995.

DHEA

· Bloch, M., et al.  Dehydroepiandrosterone treatment of midlife dysthymia.  Biol Psychiatry.  45(12):1533-1541, 1999.

Gamma-Oryzanol

· Hiraga, Y., et al.  Effect of the rice bran-derived phytosterol cycloartenol ferulic acid ester on the central nervous system.  Arzneim Forsch.  43:715-721, 1993.

Ginkgo biloba

· Kuribara, H., et al.  An anxiolytic-like effect of Ginkgo biloba extract and its constituent, ginkgolide-a, in mice.  J Nat Prod.  66(10):1333-1337, 2003.

Gotu Kola

· Bradwein, J., et al.  A double blind, placebo-controlled study on the effects of Gotu Kola (Centella asiatica) on acoustic startle response in healthy subjects.  J Clin Psychopharmacol.  20(6):680-684, 2000.

Hops

· Trickey, R.  Women, Hormones & the Menstrual Cycle.  Allen & Unwin, St Leonards, NSW, Australia.  1998:361-362.

Inositol

· Einat, H., et al.  The effects of inositol treatment in animal models of psychiatric disorders.  J Affect Disord.  62(1-2):113-121, 2001.

Kava Kava

· Geier, F. P., et al.  Kava treatment in patients with anxiety.  Phytotherapy Research.  18(4):297-300, 2004.

Magnesium

· Poleszak, E., et al.  Antidepressant- and anxiolytic-like activity of magnesium in mice.  Pharmacol Biochem Behav.  78(1):7-12, 2004.

Magnolia

· Kuribara, H., et al.  The anxiolytic effect of two oriental herbal drugs in Japan attributed to honokiol from magnolia bark.  J Pharm Pharmacol.  52(11):1425-1429, 2000.

Melatonin

· Reiter, Russel J. & Robinson, Jo.  Melatonin.  Bantam Books, New York, USA.  1996:280.

Passion Flower

· Akhondzadeh, S., et al.  Passionflower in the treatment of generalized anxiety: a pilot double blind randomized controlled trial with oxezepam.  J Clin Pharm Ther.  26(5):363-367, 2001.

Phenylalanine

· Erdmann, Robert & Jones, Meirion.  The Amino Revolution.  Century Hutchinson.  London, United Kingdom.  1987:66-67.

Potassium

· McCleane, G. J., et al.  Pre-operative anxiety and serum potassium.  Anaesthesia.  45(7):583-585, 1990.

Pregnenolone

· Semeniuk, T., et al.  Neuroactive steroid levels in patients with generalized anxiety disorder.  J Neuropsychiatry Clin Neurosci.  13(3):396-398, 2001.

Saint John’s Wort

· Kumar, V., et al.  Anxiolytic activity of Indian Hypericum perforatum Linn: an experimental study.  Indian J Exp Biol.  38(1):36-41, 2000.

Selenium

· Benton, D., et al.  The impact of selenium supplementation on mood.  Biological Psychiatry.  29(11):1092-1098, 1991.

Theanine

· Ito, K., et al.  Effects of L-theanine on the release of alpha brain waves in human volunteers.  Nippon Nogeikagaku Kaishi.  72:153-157, 1998.

Tyrosine

· Erdmann, Robert & Jones, Meirion.  The Amino Revolution.  Century Hutchinson.  London, United Kingdom.  1987:66-67.

Valerian

· Andreatini, R., et al.  Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study.  Phytotherapy Research.  16(7):650-654, 2002.

Vitamin B1

· Vayda, William.  Psycho-nutrition:  How to Control your Mood with Foods.  Lothian Publishing Company, Port Melbourne, Australia.  1992:61.

Vitamin B3

· Akhundov, R. A., et al.  [Psychoregulating role of nicotinamide.]  Biull Eksp Biol Med.  115(5):487-491, 1993.

Vitamin B6

· Hoes, M.  L-Tryptophan in depression and strain.  Journal of Orthomolecular Psychiatry.  11(4):231-243, 1982.

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