Anxiety disorders such as generalized anxiety disorder (GAD), agoraphobia, and panic disorder are among the most common forms of mental illness in the United States. While Western medicine has made the use of antidepressants central to the treatment of such issues, many people find this form of care lacking. They may turn to complementary and alternative medicine (CAM), and especially herbal remedies, to supplement or even replace existing treatments.
Safety Problems
The safety and effectiveness of herbal treatments for anxiety disorders remains unproven, which makes their use with other drugs potentially risky. It also underscores the importance of clinicians in educating their patients about the potential effects of such untested “cocktails.”
Herbal remedies have undergone clinical trials; but with placebo response rates as high as 50 percent, the limitations of small sample sizes and other methodologies make them uncertain. (Large-scale studies have been scarce and inconclusive.) Complicating the issue is that many herbal remedies culled from Chinese, Tibetan, Ayurveda, or other non-Western cultures, are often small components of larger treatment strategies, making their use as singular forms of treatment in Western societies problematic1.
Herbal Remedies at Work
Why and how herbal remedies help reduce anxiety is only partially understood, but available evidence suggests the involvement of gamma aminobutyric acid (GABA), a neurotransmitter made in the brain, with different plant species and their derivatives. Kava is known to reduce anxiety in patients with elevated symptoms. Valerian root has much stronger sedative and anxiolytic, or anxiety-reducing, qualities, but can be especially risky if taken with alcohol or other sedating drugs.
Passionflower has milder anxiolytic effects than either kava or valerian, and it is often marketed in combination with other herbs. St. John’s Wort has long been a popular antidepressant and anxiolytic remedy in the United States and in Europe. Chamomile is perhaps the most widely used and well-known herbal remedy, having been used for thousands of years in the treatment of anxiety, as well as being an effective anti-inflammatory and anti-hyperglycemic agent1, counteracting the accumulation of excess blood sugar.
Some Success Stories
A recent study gauged the effectiveness of chamomile in staving off anxiety in individuals recovering from GAD. It indicates that long-term chamomile therapy was safe and significantly reduced moderate-to-severe symptoms, which lead to greater psychological well-being relative to participants who had taken a placebo. Moreover, long-term intake of 1500 mg of chamomile extract appeared to be safe, with potentially desirable weight and blood pressure profiles compared to the placebo. However, while chamomile use was associated with general life improvements in those struggling with GAD, it did not significantly reduce the rate of relapse between chamomile and placebo users2.
Two recent randomized controlled trials utilizing saffron and its main active derivative crocin in the treatment of anxiety and depression likewise demonstrated the superiority of this herbal remedy to a placebo. In the first one, participants received either a 50-mg saffron capsule or a placebo for 12 weeks; the saffron group demonstrated significant effect in comparison to the placebo group3. In the second trial, the effects of crocin tablets (20 mg per day for one month) in pre- and post-treatment periods as an adjunct to selective serotonin reuptake inhibitor (SSRI) medications showed that this combination led to a significantly greater decrease in depressive symptoms when compared to SSRI treatment alone4.
In another study, extract from the leaves of Melissa officinalis, or lemon balm, significantly reduced anxiety levels as well as the frequency of benign heart palpitations in those suffering from the condition after only two weeks (in comparison to a placebo group); there was no indication of any serious side effects5. And one trial centered on vitamin C supplements taken by a group of high school students indicates that those who took adequate doses did better in handling stress and anxiety than those taking a placebo7.
One clinical trial, however, points to the failure of a specific herbal remedy to alleviate GAD symptoms. Gamisoyo-san, a traditional Korean formula was tested as an individual extract mixture as well as a multi-compound extract. It failed to show improvement in GAD anxiety levels, although it did effectively reduce symptoms associated with depressive and obsessive-compulsive disorders6.
Take With Caution
According to psychiatrist Dr. Alexander Bystritsky of UCLA, clinicians should warn their patients about the safety of herbal remedies and help them weigh the effectiveness and risks of taking them in combination with pharmacologic treatments.
Possible interference may occur with traditional first-line treatments for anxiety disorders8. When selective serotonin reuptake inhibitors (SSRIs) are taken for anxiety or depression, St. John’s Wort may induce lethargy and serotonin syndrome, or an accumulation of serotonin that may lead to confusion, restlessness, rapid heart rate, high blood pressure, and other symptoms9. Kava and valerian root can increase the sedative effect of benzodiazepines10. Also, herbal remedies could potentially interfere with the treatment effects of cognitive behavioral therapy (CBT)8.
Regardless of their somewhat outsider status within the scientific community, herbal remedies are a multibillion-dollar industry, fueled by aggressive marketing and industry lobbying. Such supplements often take their place alongside evidence-based medications in pharmacies even though manufacturers do not need approval from the U.S. Food and Drug Administration (FDA) before putting them on the market.
Patients should be discouraged from abandoning evidence-based psychotherapies and medications for anxiety disorders in favor of herbal remedies. In addition, it is important for clinicians to include all remedies and supplements their patients are taking in their medical history to avoid adverse effects caused by herbal remedies1.
Sources
1. Bystritsky, A. (2015). Complementary and alternative treatments for anxiety symptoms and disorders: Herbs and medication. UpToDate, Retrieved from https://www.uptodate.com/contents/topic.do?topicKey=PSYCH/14624#H2255833
2. Mao, J. J., Xie, S. X., Keefe, J. R., Soeller, I., Li, Q. S., & Amsterdam, J. D. (2016). Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. Phytomedicine, 23(14), 1735-1742.
3. Mazidi, M., Shemshian, M., Mousavi, S. H., Norouzy, A., Kermani, T., Moghiman, T., … & Ferns, G. A. (2016). A double-blind, randomized and placebo-controlled trial of Saffron (Crocus sativus L.) in the treatment of anxiety and depression. Journal of Complementary and Integrative Medicine, 13(2), 195-199.
4. Talaei, A., Moghadam, M. H., Tabassi, S. A. S., & Mohajeri, S. A. (2015). Crocin, the main active saffron constituent, as an adjunctive treatment in major depressive disorder: A randomized, double-blind, placebo-controlled, pilot clinical trial. Journal of affective disorders, 174, 51-56.
5. Alijaniha, F., Naseri, M., Afsharypuor, S., Fallahi, F., Noorbala, A., Mosaddegh, M., … & Sadrai, S. (2015). Heart palpitation relief with Melissa officinalis leaf extract: double blind, randomized, placebo controlled trial of efficacy and safety. Journal of ethnopharmacology, 164, 378-384.
6. Park, D. M., Kim, S. H., Park, Y. C., Kang, W. C., Lee, S. R., & Jung, I. C. (2014). The comparative clinical study of efficacy of Gamisoyo-San (Jiaweixiaoyaosan) on generalized anxiety disorder according to differently manufactured preparations: Multicenter, randomized, double blind, placebo controlled trial. Journal of Ethnopharmacology, 158, 11-17.
7. de Oliveira, I. J. L., de Souza, V. V., Motta, V., & Da-Silva, S. L. (2015). Effects of oral vitamin C supplementation on anxiety in students: A double-blind, randomized, placebo-controlled trial. Pakistan Journal of Biological Sciences, 18(1), 11.
8. Bystritsky, A., Hovav, S., Sherbourne, C., Stein, M. B., Rose, R. D., Campbell-Sills, L., … & Roy-Byrne, P. P. (2012). Use of complementary and alternative medicine in a large sample of anxiety patients. Psychosomatics,53(3), 266-272.
9. Borrelli, F., & Izzo, A. A. (2009). Herb–Drug Interactions with St John’s Wort (Hypericum perforatum): an Update on Clinical Observations. The AAPS Journal, 11(4), 710. http://doi.org/10.1208/s12248-009-9146-8
10. Stargrove, M. B., Treasure, J., & McKee, D. L. (2008). Herb, nutrient, and drug interactions: clinical implications and therapeutic strategies. St. Louis, MO: Mosby Elsevier, 2008
Cinzia Cottù Di Roccaforte earned a Doctoral Degree in Clinical Psychology from Alliant International University Los Angeles in 2019. She received a Bachelor of Arts in psychology from UCLA in 2011 and her Master of Arts in clinical psychology with emphasis in Marriage & Family Therapy from Pepperdine University in 2014. Dr. Roccaforte has been working with Dr. Alexander Bystritsky at the UCLA Anxiety Disorders Program. Dr. Roccaforte and Dr. Bystritsky also collaborated writing articles for Anxiety.org.
