As mentioned in our article Dealing with Anxiety and Stress, there are 2 reasons that the medical community is turning more and more away from prescription pharmaceutical remedies (drugs) and becoming more inclined to recommend natural, non-prescription remedies for stress and anxiety:
- Many prescription drugs for treating stress and anxiety require, over time, ever-larger doses to achieve the same amount of relief until the recommended maximum dose is reached, which may mean that the drug is no longer working to reduce stress and anxiety; and
- Some prescription drugs are difficult for the patient to stop taking without adverse withdrawal symptoms. In other words, these drugs run the risk of addiction.
Chamomile (Spanish: Manzanilla)
A study examining the effects of oral chamomile on patients with anxiety exhibited a considerable reduction in standard anxiety scores with no significant side effects.
Among the mildest and most common natural relaxation supplements, chamomile tea is a natural, soothing agent that may be consumed with other supplements. Many people enjoy a cup of chamomile tea while winding down with a good book or other bedtime activity.
Persons who are taking blood thinning medications such as warfarin or heparin should consult with the prescriber before using chamomile.1
Ashwagandha (Withania somnifera)
This is a traditional Ayurvedic medicinal herb that long been prescribed for its rejuvenating effects and used as a stress relief supplement.
Clinical studies suggest that ashwagandha can reduce anxiety and stress. One randomized, double-blind study of 75 middle-aged adults with moderate to severe anxiety found that anxiety was dramatically reduced, and fatigue, motivation, and concentration significantly improved, in those who received 300 mg of ashwagandha root extract (standardized to 1.5% withanolides) twice per day (a total daily dose of 600 mg ashwagandha extract containing 9 mg of withanolides), plus a daily multivitamin for 12 weeks (Cooley, PLOS One 2009). A second group of patients in the study who, instead, received a weekly psychotherapy sessions and a placebo,had a smaller reduction in anxiety. Another small study among people with generalized anxiety disorder, panic disorder, and anxiety mixed with depression, found that those who took ashwagandha extract (two to six 250 mg tablets per day, for a total daily dose of 500 to 3,000 mg) for 6 weeks had significant improvement compared to those taking a placebo (Andrade, Indian J Psychiatry 2000).2
Valerian by itself has not fared so well in treating anxiety as it has in promoting better sleep.
However, one study compared the effect of a combination of valerian and St John’s wort (SJW) to diazepam (Valium) in patients with anxiety. After two weeks of randomized treatment, the combined valerian and SJW group reported superior relief of anxiety symptoms. It has also been shown to be effective in a combination of valerian with lemon balm.
In a double-blind, placebo-controlled study, 36 people with generalized anxiety disorder were given either only valerian extract , only Valium, or a placebo for a period of 4 weeks. The study failed to find statistically significant differences between the groups.1
Lemon balm (Melissa officinalis)
One report indicated that a single dose of lemon balm improved memory function and subjective calmness of healthy volunteers (Kennedy et al., 2002, 2004); the same group also did a study with a combination of lemon balm and valerian (Kennedy et al., 2006). The combination group showed an improvement in laboratory test-induced anxiety. Muller and Klement (2006) examined the combined effect of lemon balm and valerian with 918 children less than 12 years of age who were suffering from restlessness and sleep problems. These subjects also reported improved symptoms and no significant side effects.1
Passionflower (Passiflora incarnata)
Passionflower is considered to be a mildly effective treatment for anxiety and insomnia, less potent than kava and valerian, but nonetheless useful. Like lemon balm, chamomile, and valerian, passionflower is also used for nervous stomach.
A study of 36 individuals with anxiety tested passionflower as compared to the standard prescription drug oxazepam (Serax). Oxazepam worked more quickly, but by the end of the 4-week trial, both treatments proved equally effective. Furthermore, passionflower showed a comparative advantage in terms of side-effects: use of oxazepam was associated with more job-related problems (such as, daytime drowsiness). And, in a placebo-controlled trial involving 60 surgical patients, passionflower significantly reduced anxiety up to 90 minutes prior to surgery.
The recommended dosage of passionflower is 1 cup 3 times daily of a tea made by steeping 1 teaspoon of dried leaves for 10 to 15 minutes.1
Skullcap (Scutellaria lateriflora)
One double-blind, placebo-controlled clinical trial conducted on healthy volunteers suggested that skullcap products have clinical benefits as anxiolytics with no overt evidence of toxicity or side effects (Wolfson and Hoffmann, 2003).
When taken by itself, the usual dosage of skullcap is approximately 1 to 2 g, 3 times a day. However, skullcap is more often taken in combination with other sedative herbs such as valerian, passionflower, hops, and melissa, also called lemon balm. When using an herbal combination, follow the label instructions for dosage. Skullcap is usually not taken long term.3
in studies with patients with dementia, ginkgo has been found to stabilize mood and alleviate anxiety (Mix and Crews, 2000). One double-blind RCT of ginkgo extract has been conducted on patients with anxiety (Woelk et al., 2007). In that study, gingko was significantly superior to a placebo on all secondary outcome measures. It was safe and well tolerated and may thus be of particular value in elderly patients with anxiety related to cognitive decline.
The standard dosage of ginkgo is 120 mgs daily standardized to contain 24% ginkgo-flavone glycosides. Levels of toxic ginkgolic acid and related alkylphenol constituents should be kept under 5 parts per million.
A company that evaluates nutritional supplements, consumerlab.com, in its review of gingko products, states that gingko is one of the most adulterated products. Therefore, we recommend that you choose one of the gingko biloba products approved by Consumerlab.com as being tested and found to be free of lead and other contaminants.4
Gotu cola (Centella asiatica)
Gotu kola has been used in traditional Ayurvedic medicine to treat anxiety, as has Ashwagandha (above).
In one test (Bradwejn et al., 2000), gotu kola was shown to be effective in reducing stress-related responses. A recent open-label study on patients showed promising results in reducing anxiety (Jana et al., 2010).
The usual dosage of gotu kola is 20 to 60 mg 3 times daily of an extract standardized to contain 40% asiaticoside, 29% to 30% asiatic acid, 29% to 30% madecassic acid, and 1% to 2% madecassoside.5
Golden root (Rhodiola rosea)
Rhodiola is thought to have “adaptogen” qualities, such as modulating the body’s response to stress and fatigue and improving mental function.
One pilot study has investigated its effect in the treatment of anxiety in 10 patients (Bystritsky et al., 2008). Half of the participants in this study had at least a 50% decrease on an anxiety scale, and four of them achieved remission.
Very preliminary studies suggest potential benefit of Rhodiola for treating anxiety. One such study in a small number of young adults with mild anxiety found that those who took a tablet containing 200 mg 30 minutes before breakfast and 30 minutes before lunch (for a total daily dose of 400 mg) for two weeks, reported significantly lower levels of anxiety and improved mood compared to those who did not take the extract.6
St. John’s Wort (Hypericum perforatum)
St. John’s Wort (SJW) is well-known for its effect on depression. It has been also studied for its effect on anxiety disorders. There is inconclusive research on its use to counter anxiety, but it has been shown to be effective against anxiety when used in combination with valerian root. (See the report on valerian root in this article, above.)1
Kava (Piper methysticum)
Kava (Piper methysticum) is a South Pacific psychotropic plant medicine that has anxiolytic (anti-anxiety) activity. In a number of clinical trials, kava has proven effective in reducing anxiety. Kava has been shown to be as effective as such anti-anxiety prescription drugs as oxazepam, bromazepam, buspirone and opipramol. However, usage for several weeks may be necessary before the maximum benefit is realized.
A 5-week, double-blind, placebo-controlled trial studied 40 people who had been taking benzodiazepine drugs (for example, Xanax, Valium, Librium or Ativan) for an average duration of 20 months. Participants were gradually tapered off their medications and switched to kava or placebo. Individuals taking kava showed some improvement in anxiety symptoms. This would appear to indicate that kava can successfully be substituted for benzodiazepine drugs. This trial involved close medical supervision and very gradual tapering of benzodiazepine dosages. Do not discontinue anti-anxiety medications without supervision. Withdrawal symptoms can be life-threatening. 1
It is recommended that an aqueous solution of kava be used. Even though kava has been shown not to have adverse health effects in recent studies, its usage was restricted in Canada and some European countries due to liver toxicity concerns. Mayo Clinic recommends avoiding usage until further safety studies are conducted, especially for persons with liver problems or who are taking medication to treat liver conditions. We recommend that you consult with a health professional before taking kava.1,7
1 Clinical applications of herbal medicines for anxiety and insomnia, Australia and New Zealand Journal of Psychiatry, published June 19, 2014, http://journals.sagepub.com/doi/10.1177/0004867414539198
2 Product Review: Ashwagandha Supplements, https://www.consumerlab.com/reviews/ashwagandha_supplements/ashwagandha/
3 Skullcap, https://www.consumerlab.com/tnp.asp?chunkiid=21869
4 Product Review: Ginkgo (Ginkgo Biloba) Supplements, https://www.consumerlab.com/results/print.asp?reviewid=GinkgoBiloba
5 Gotu kola, https://www.consumerlab.com/tnp.asp?chunkiid=21763
6 Product Review: Rhodiola Rosea Supplements, https://www.consumerlab.com/reviews/rhodiola_supplements/rhodiola/