Anxiety - Helpful Herbs

Written in collaboration with Tal Friedman, ND(c), Abrar Negahban, ND(c), Angelica Kada, ND(c), Liam Latouche ND(c), Katarina Vaculik, ND(c), Maria Wong, ND(c)
 

Introduction to Anxiety

Anxiety is extremely common. Practically everyone experiences symptoms of anxiety, but the majority of the time, they are short-lived and do not cause problems.^[1] Anxiety can be a beneficial part of our existence when experienced in the short term. An example would be when it alerts us to imminent danger. This was especially useful in the past, when we would face life-threatening obstacles. However, at times it can take over a person’s life and interrupt daily activities, as well as sleep, diet, and lifestyle, to the point that we just may not even want to go out and socialize with others.^[2] There are many forms of anxiety disorders including, but not limited to, panic disorder, obsessive compulsive disorder, and various phobias. Each of these anxiety disorders is distinct, but they all share the same hallmark features. The most common symptoms of anxiety which all anxiety disorders share are irrational and excessive fear, apprehensive and tense feelings, and difficulty managing daily tasks.^[1] These symptoms of anxiety can range from being relatively mild to severe enough to be mistaken for a heart attack. Some people can experience heart palpitations, shortness of breath, chest tightness, and other quite intense physical symptoms when they experience anxiety.^[2] The formal term for anxiety is “generalized anxiety disorder”.

Anxiety can also have some severe health risks aside from the symptoms listed above. Lately, research has shown that anxiety can be harmful to the heart. A recent paper showed that high anxiety levels were associated with an increased risk for stroke, independent of other risk factors including depression. Those who had the highest amount of anxiety were 33% more likely to have a stroke than those with the lowest amount of anxiety.^[3] The proper assessment and treatment of anxiety can significantly improve overall quality of life for many people, and may also contribute to improving overall cardiovascular health. An anxiety disorder doesn’t need to stand in the way of a happy, productive life. To that end, this article will discuss selected herbal remedies that can help improve anxiety. We will discuss the herbs gingko, Rhodiola, St. John’s wort, and valerian. Although herbal remedies are safe in general, it is always important to remember that side effects are possible. We will highlight the most common and important side effects to keep in mind. If you are interested in pursuing any of these herbs for yourself, make sure that you speak with your health-care provider first, to ensure these herbs are appropriate for you.

The Herbs Ginkgo and Rhodiola

Ginkgo is a tree approximately 30 m tall, with fan shaped leaves that turn a magnificent golden yellow in the fall. The ginkgo tree, although rare in the wild, is widely cultivated in urban centers because of its resilient nature, and there is likely a ginkgo tree somewhere in your neighborhood. The leaf of the ginkgo tree is popularly known for its use in traditional medicine to enhance cognition and memory, as it improves circulation to the brain.^[4] Preliminary research also shows this medicinal plant is useful in the treatment of generalized anxiety disorder. It influences several chemical messengers or neurotransmitters involved in mood, including dopamine and serotonin. Placebocontrolled clinical trials demonstrate that ginkgo extract significantly reduces symptoms of anxiety in those who have been clinically diagnosed, and it can also improve mood.^[5] These studies also demonstrate that gingko has a generally good safety profile, although it is advised not to be taken with anticoagulant and antiplatelet medications. Further research has shown that in a very small proportion of the population, gingko can cause headache, nausea, and stomach upset.^[6] However, the beneficial effects of gingko highly outweigh the possible risks.

Rhodiola is a plant with medicinal properties that, for many years, has been used by Aboriginal people. The traditional use of this plant was for mental conditions, predominantly to alleviate symptoms of anxiety.^[7] More recently, studies have been conducted to further explore the plant’s properties in patients suffering with generalized anxiety. One study concluded that Rhodiola has antianxiety effects and can have a significant impact on people’s mental status. Rhodiola is already known to benefit memory and male sexual dysfunction, but besides these properties, the herb can be used to protect against stressful situations and can help the body adapt to new obstacles. For this reason, Rhodiola is often called an adaptogen or an adaptogenic herb. Studies have shown that after being treated with Rhodiola for a period of time, people report lower levels of anxiety, as measured by clinical questionnaires. During the studies, side effects were observed and were only mild to moderate in intensity, and the most common were dizziness and dry mouth.^[8] Overall, Rhodiola is a safe and effective herbal medicine that can be used to alleviate stress and reduce anxiety. It can be provided as a capsule containing dried herb inside, or as a tincture, which is an alcohol-based extract of the herb.

The Herb St. John’s Wort

St. John’s wort, also known as Hypericum, has been used to treat anxiety for over two millennia.^[9] Although it is primarily used to treat mild to moderate depression, it has also been shown to reduce anxiety as a secondary effect. Patients with anxiety have been shown to have lower levels of certain chemical messengers in the brain, which may contribute to feelings of sadness and anxiety. Research has shown that St. John’s wort works by increasing the amounts of these chemical messengers (serotonin, norepinephrine, and dopamine) in the brain.^[4] Increasing these chemical messengers can result in improvements in mood, satisfaction, and overall quality of life. Research also suggests that St. John’s Wort may lower levels of our stress hormone, cortisol, while enhancing the activity of GABA, a naturally occurring tranquilizer in the brain. In fact, European studies have shown that the antianxiety effects of St. John’s wort are comparable to that of medications used to treat anxiety, such as Valium.^[10] In addition, St. John’s wort has fewer side effects, is not addictive, and is also less costly than antianxiety medications. The most common side effect of St. John’s wort is a hypersensitivity to sunlight, so be mindful to use protection when spending time in the sun if planning to take this herb.^[9]

St. John’s wort is widely available in health food stores and many drug stores. To see beneficial effects, find a product that is standardized to 0.3% hypericin, which is the active ingredient, and consider taking the herb with meals to avoid stomach upset. St. John’s wort is used to help patients cope with mild to moderate anxiety. This means that the anxiety level is bothersome at times and can occasionally cause distress, without majorly disrupting life activities or relationships. St. John’s wort can take 4 to 6 weeks to take effect, and is likely not effective in relieving acute panic attacks, obsessive compulsive disorder, or symptoms of posttraumatic stress disorder. This means if you are trying St. John’s wort, make sure to give it an adequate amount of time, otherwise you may not see an effect. It should also be noted that St. John’s wort can interact with many common medications, especially those used to treat mood disorders (e.g. Prozac, Zoloft, Paxil, Celexa).^[9] If you are experiencing any of these symptoms or are on any medications, talk to your health-care practitioner before taking St. John’s wort.

The Herb Valerian

Valerian is most commonly known for its sedative effects. For this reason, it is also the first go-to herb for insomnia, and has also been used to treat depression and mood disorders. Sometimes, valerian is used to help certain individuals wean off anxiety and sleep medications. The root of this herb is used for its medicinal benefits, which can be found in various forms. The herb can be provided in tea form or orally. Valerian extracts can also be found in the form of tablets and tinctures, either alone or in combination with other herbs and nutrients. The active ingredients in valerian are known as sesquiterpenes and valerenic acid, which in particular have been shown to cause sedation in clinical studies.^[11] Valerenic acid also helps with increasing levels of GABA, which as we’ve identified is the chief inhibitory neurotransmitter in the central nervous system. Valerian achieves this effect by inhibiting the enzyme responsible for breaking down GABA in the central nervous system of the body, which in turn leads to calming effects and the lowering of anxiety symptoms.^[12] Valerian usage has been associated with some adverse reactions in clinical studies. These include headache, digestive upset, mental dullness and morning drowsiness.^[13] If you have allergies or are on any medications, please consult with your health-care provider before trying this herb.

Concluding Remarks

Anxiety can be detrimental to many people, even evoking many serious physical symptoms like chest pain. For others, it simply makes life less enjoyable than it could be. Symptoms vary in different individuals in both type and intensity. We have examined a number of common herbs used for treating anxiety. If you are interested in using any of these herbs, it is important to be treated under the care of a qualified health-care practitioner. We have also identified some of the most common side effects, but allergic reactions and other side effects are always a possibility. These herbs may interact with pharmaceutical or over-the-counter medications, and your doctor should be able to let you know which are right for you. Herbs are one facet of treatment, but there are many additional treatment options to consider. Dietary changes, lifestyle modifications, nutritional supplements, and counselling are also important elements that make up a well-rounded treatment plan. Individualized treatment plans are always ideal because they will tailor your specific situation, so always ask your doctor about the options that are available to you.